Dr. Ramchandra Dattatraya Lele views on IT in Medical Informatics       

 

Dr. Ramchandra Dattatraya Lele is a medical doctor who has distinguished himself in the fields of medical education, medical research, medical practice and hospital administration, and above all in pioneering the practice of Nuclear Medicine in India. 

 

In 1968, as Professor and Head of the Department of Medicine at the Grant Medical College and Sir JJ Group of Hospitals in Mumbai, he established a shadow - shield type whole body counter in collaboration with the Health Physics Division of the Bhabha Atomic Research Centre (BARC), and showed the clinical utility of this indigenously made equipment for measuring absorption of iron and vitamin B12, and gastrointestinal blood loss and protein loss without the need to collect samples of urine, stools or blood. In 1973, while he was Dean of Grant Medical College and JJ Hospital he was invited to join Jaslok Hospital and Research Centre, Mumbai, as Chief Physician and Chief of Nuclear Medicine. There he created the first full fledged hospital based Nuclear Medicine Department in the country, including radioimmunoassay of 75 ligands of clinical interest.

He pioneered the intravenous use of Technetium-99 m based radio pharmaceuticals in India, so also Nuclear Cardiology in 1978, Nuclear Stethoscope in 1982 and Single Photon Emission Computed Tomography (SPECT) in 1988. Today, Jaslok Hospital has a triple head gamma camera, the only facility in Asia outside Japan.

As a clinician, he has attained the status of a super - consultant, who practices scientific as well as humane and compassionate medicine, emphasising the need to consider the patient as a person. His book "Clinical Science and Clinical Research" (1993) and "Clinical Approach" (Oxford University Press 1997) have been widely acclaimed as worthy companions for the practicing doctor.

He was the first recipient of the "Gifted Teacher Award" instituted by the Association of Physicians of India in 1991. He was awarded Padma Bhushan in 1992 by the President of India and Dhanvantari Award in 1997, at the hands of H.E. The Governor of Maharashtra.

Comcom: Dr Lele, Your specilisation is nuclear medicine? How did you get interested in computers?

Dr Lele: Let me tell you, how I got interested in computers. I am a physician, I have clinical practice of 50 years. My specialisation is in nuclear medicine.  Nuclear medicine was the first "super speciality"  to use computers for data acquisition, data processing, data quantification and data display. In 1978 , if any body wants to import a computer ministry of electronics has to float a global tender . 

Prof MGK Menon was the minister of state. I told him 'Sir, I am a physician. I want this particular computer. I have studied all the other alternatives and this is my choice'. He said 'you are the user. You know what you want? Why should I float a global tender?' Within ten days, I got what I wanted. . I am having this story to tell . Good things do happen without any administrative hustles.  An understanding man like MGK Menon can understand a physicians need and a dedicated computer could be procured.

In the interaction with the computers, you get the feeling that human brain is extremely capable, but the computer can go beyond that. 

 comcom: You found the association called Indian Association of medical informatics? Please let us have more insight into that?

DR Lele: In 1993 we formed an Indian Association of Medical Informatics . We held three conferences till now. There is a body of doctors who interact with computer experts.  We believe that gradually we can educate other medical professionals for using computer for patient care. 

 comcom: Please let us know, how internet has changed your Medical practice?

Dr Lele: Today sitting in my own room I can have access to any 'Expert database' in the world at any time of the day. Information is at my fingertips. Access to knowledge and access to timely intervention is something which is revolutionary. The usage can be from any place. Internet is a great revolution. But what is more important is that, even in a country like India, a patient  from Kolkatta comes to Mumbai, for consultations. He spends his time with me. He brings with him, his ECG, CT and  MRI. Today without leaving his home in Kolkatta, he can transmit all the data, text, visuals, audio etc.  I can listen to his heart murmurs putting a stethoscope on communication equipments and diagnose. Patient need not travel from Kolkatta to Mumbai.  If he is a sick patient, he has to bring an attendant along with him, spending hotel charges for two days, all these  things are eliminated.  He can get on-line advice. This is a major break through. 

 Comcom: What is the global situation, in INTERNET usage ?

Dr Lele: What is more important is that worldwide 42% of the Web page hits are health related. Today I tell other doctors that they should know as much as their patient knows. Because nowadays, most of the patients, before  coming  to doctors, they  browse the internet to learn and understand the problem.  Patients do ask- "Doctor why are you not giving me this treatment? Why are you doing  this test?" 

Because I understand that, I tell doctors, according to the quality control of tender care this is what you should be doing. This is really a good thing. We cannot afford to be ignorant  of changing technologies and cannot afford to take the patients for granted. This is a very healthy development - internet has made the patient more health conscious. 
Comcom: What are the drawbacks in using INTERNET for medical information?

Dr Lele: That apart, the Internet is a tool for information. There are many other uses of computers which we are forgetting. In 1988, I have written articles called 'Use of  computers in nursing and medical education'. The editor sent it to three referees and commented  that this topic has no relevance to India. At that time, It is unthinkable that computers can be used for teaching. So to prevail upon him, I said, "understand the capabilities of computers, they are tireless tutors - computers can support interactive education". 

Unfortunately, we have not understood the potential of computers. Technology is available and is affordable. It is an apathy that about 180 medical colleges in India, so many nursing colleges - the availability of good teachers, is very very low. Let us understand this.  The computer has the capability of being a tireless teacher. It has no fatigue, no personal biases or prejudices. You ask a question first time or million times it has no irritation with the students. I believe personally that one believes in the medical and nursing, but  neglects the tremendous potential of computer as an educative tool. 

There are 3 demonstrative "Expert Systems" in my PC. It can be seen that by putting signs and symptoms as input , one can get differential diagnosis. The system explains, how a specific diagnosis is correct. That way these systems are good 'Educational Tools'.  It is my plea that all the 180 medical colleges in this country, should seriously consider utilising computer as a teaching tool. Public should demand that this should be made as the norms and  standards for the educational institutions. 

Please note -  Eighty thousand people in US die every year because of wrong medication. Equal number die in Europe. So my plea is, this tool of  Information Technology expertise should not be ignored. As make this plea on behalf of  300 thousand medical practitioners of modern medicine, worldwide. 

We are overwhelmed with data. 90% of the drugs that we are prescribing today, are not  learned by us in our medical curriculum. So the chance of making mistake is tremendous. We should resort to building the knowledge base and timely warning when we prescribe a medicine. It is my own conception that with a palm top computer costing less than 100 dollars and with the knowledge base that physicians like me can build  within 6 months a database, with disease and treatment information. When ever  I try prescribing a drug,  the computer can warn me, that a specific drug reacted adversely on earlier occasion.  This will prevent me to do wrong things retrospectively. I will get prospectively.  

Let us make a resolve for a palm top computer with a knowledge base as our topmost priority. Doctors should get income tax exemption. I will assure you that 300 thousand palmtop computers will be sold in no time. Then the general public will see the benefit. The ultimate benefit  to a patient is that, that they can be saved from doctors mistake rather than depend on their good luck or doctors timely remembering things. The computers will warn the doctors and  not allow doctors to make mistakes. I feel that is the  right technology approach.

Comcom: Thank you


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