By Sujata Devadas, June 22 2016
“An empowered patient is a better patient. This is especially true in managing chronic illnesses like hypertension, diabetes etc,” says Dr Indira Gouthaman.
This Indian healthcare professional began treating patients in 1990 in Palakkad, a town in the southern-most state of India, Kerala. In 2009, she enrolled for her Masters in Health Science, Diabetology, from Annamalai University, Chidambaram in Tamil Nadu, India. Founded in 1929, this university is one of Asia's largest public residential universities. She also worked part-time at Apollo Health City, Jubilee Hills in Hyderabad. The hospital has a good reputation for medical tourism.
Patients from all over the world including Kenya, Pakistan and
Egypt visited this hospital. “I took a keen interest in explaining their medical condition to admitted patients and raising their awareness of it to a different level.” That is how she began her mission to empower patients.
Step 1: Hyderabad
Dr Indira learned about diabetes self-management education (DSME) during her Masters programme. She chose to do her Masters thesis based on how patients can be helped with knowledge about their medical problem. When Dr Indira went in with the endocrinology team to help diabetic patients at Apollo Health City, she requested patients admitted for surgical or medical reasons for their email addresses.
“Just a handful at first, then over time, I added further email ids,” she says. “Then I began forming and sending an email every week with information pertaining to diabetes."
"After I completed one year of doing this, I sent the recipients of these weekly emails a questionnaire to assess what they knew about diabetes and got an excellent response. I submitted this with my thesis for Masters in Health Science, Diabetology.” Even after completing her Masters, she continued her once-a-week mails to this group.She moved to Abu Dhabi a short while later, joining the National Hospital. In 2011, she accepted the designation of general physician at LLH Hospital, Abu Dhabi.
As she performs her daily duties in healthcare, Dr Indira often faces questions from patients. “One young man asked me ‘why do I sweat when I eat spicy food?’ I could not give him an immediate answer. But I went home and checked. Reading is my hobby. As soon as I found the answer, I sent it to him. Even today, I am his family’s favoured physician.” Dr Indira adds: “Incidents like this made me create one more email group titled ‘An Apple A Day’ in 2012, to answer such interesting questions and disperse the information to many others, so that all of them gain.”
Recipients often forward her emails to friends and relatives, expanding the readership further. “That is perfectly alright.” says Dr Indira. “I am quite convinced that an informed person has a better chance of enjoying a healthier life.”
Abey was a grade 12 student with life threatening severe hypoglycemia admitted at Apollo Health City. Now, he is a doctor.
Do you wish to be included in Dr.Indira's email group? Right at the bottom, fill in the contact form and make this request. Dr.Indira will be duly informed.
Right from the start
Dr Unnikrishnan, currently the Dean of Academics for the Kerala University of Medical Sciences, was Dr Indira’s colleague at the Government Medical College in Thrissur, Kerala. “I was a faculty in Physiology while she was teaching in the Anatomy Department,” says Dr Unnikrishnan. “She was quite a favourite as a teacher. Her classmate and friend Dr Nileena Koshy recounted to me the other day that even while Indu was a medical student, less enthusiastic medicos would borrow her class notes penned in excellent handwriting for xeroxing just before the study holidays.”
Dr Unnikrishnan is himself an excellent teacher, and a guiding light for Dr Indira since the inception of her group emails. “To use e-mail as a medium for patient education is uniquely innovative,” says the Dean. “I requested my friend, Dr Indira, to cover the subject of deficiencies recently. Her messages are personalised and focused. As someone whose hobby is reading literature, I do appreciate the good quality of Indu’s disseminated information. Quite a bit of creative effort goes into the preparation of each issue.”
Fact, not fiction
“It is fact, not fiction. I come across patients who are reluctant to take metformin 1000mg but happy to take glimepiride 1mg because their concept of the dose of a medicine is the number not the pharmacological actions. For them, 1000mg is too strong a dose whereas 1mg is very tiny. This is quite understandable as the patient has no idea of how the medication acts. But when I take time to explain that the 1000mg of metformin has less chance of hypoglycemia than a 1mg of glimepiride with its pharmacological mechanism, they are ready to take the 1000mg happily,” Dr Indira explains.
The first mailing group created in Hyderabad is focussed on diabetes. The weekly ‘Apple A Day’ email group created in Abu Dhabi deals with a wider range of health related issues - mostly answers to patient queries that arise during Dr Indira’s daily medical practice.
“For example, the mails on managing high uric acid, Vitamin D deficiency, cholesterol management, hypothyroidism etc. have been circulated many times. Also, the video on how to do a breast self-examination has been embedded in an email and posted every year in October to further awareness,” says Dr Indira. Both groups taken together, it reaches 700 readers.
The ‘Diabetes made easy for you’ emails usually go out fortnightly. Depending on her time, Dr Indira might even send it out more frequently, and sometimes she might miss a week. “I do the research and ensure the information is scientific, backed by evidence- based practice before sending it out. It comes from my standard medical textbooks or from international healthcare organisations such as AHA, ADA and WHO.”
Dr.Indira on Asianet Radio programme 'Jeevitharekha'
Dr Indira also gives free lectures and holds free camps. A Keralite, she gave a talk in her mother tongue, Malayalam, for a programme titled Jeevitharekha (Lifeline) on Asianet Radio in May. “I speak regularly on diabetes in Jeevitharekha. I take part in camps conducted by LLH Hospital and also by KMCC (Kerala Muslim Cultural Centre), Thrissur.”
People from various nationalities - India, Pakistan, Sri Lanka, the Philippines - attend her lectures. She welcomes everyone interested in learning about his or her own body and wish to keep it healthy and hearty. “I can easily identify a curious mind during a consultation,” says Dr Indira. “Some patients just want a prescription for their ailment.
But others ask many questions about their illness and about the medicines prescribed.”
Confidentiality and medical ethics prevent mentioning specific cases but examples abound of appeals to Dr Indira for medical advice or a second opinion. Their trust is evident when patients stay in touch with her despite moving out of Abu Dhabi. They continue to consult her as a trusted medical care professional. They apologize to her for their frustration but they trust her second opinion.