Saturday, November 01, 2014

What do IVF patients want ?


IVF patients , like all patients, want good medical care . However, the problem is that they are not sure what good medical care means . IVF technology is often a black box for most patients, and most patients naively believe that one IVF doctor is very similar to another. It's very hard for them to judge who’s better.

It’s easy to check some of the basics.

Is the clinic well-equipped ?
Do they have a full-time embryologist ?
Do they have a high success rate ?
Do they use the latest technology ?
Are they able to customize the treatment for each individual patient’s unique needs ?
Are they affordable ?

Some IVF clinics which are well-equipped create additional problems for the patient because they overtest and overtreat. They use a mindless protocol for all their patients, and end up wasting a lot of valuable time and money in the process. Often the test results are pointless, because they do not change the IVF treatment plan at all.

Along with technical competence , patients also expect compassion and empathy . They want a kind doctor, who can offer them a shoulder to cry on when things go wrong – someone who can listen to them non-judgmentally, and help to relieve them of their emotional burdens .

After all, infertility is not just a medical problem - it has major psychological consequences , both on the personal and social front. Patients need to be comfortable discussing these touchy issues with the doctor , so that they have a trusted sounding board , and can vent their emotional frustration.

It’s important that high-technology IVF care be provided along with high touch empathy, so that patients are delighted with the care which they are getting . This is automatic when patients are treated with respect, and the medical staff focuses on patient satisfaction.

It’s in the IVF doctor’s best interests to understand what patients want , and to deliver this as efficiently and effectively as possible . If doctors learn to keep their patients happy , they will become much happier themselves as well !

Need help in finding the right IVF clinic ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly ?




 

Friday, October 31, 2014

Personalised IVF care at Malpani Infertility Clinic


•    We will try not to make you feel rushed when we meet with you. Yes, we are busy, but when we are seeing you, you are the focus of our attention !
•    We will try to make you feel comfortable , so that you feel free to ask any question you like. We will do our best to clear all your doubts, so that you never feel that any of your questions are stupid
•    We will respect your preferences and allow you to make your own decisions . We will treat you like intelligent adults
•    We know all our patients by their name – we will never make you feel like a number. We do not employ assistants and interact with you directly, so that you are sure you are always in safe hands
•    We will give you a shoulder to cry on, when you need it. We will help you maintain a positive attitude during the hard times.
•    We will never give you false hope and will always tell you the truth . We will always be available  for you
•    We will be open and transparent, so you are in control of your life
•    We will use technology to help you to help yourself
•    We will share information with you to educate you about the IVF process


Thursday, October 30, 2014

IVF success story at Malpani Infertility Clinic


Hi to all the couples who want to graduate into parenthood.
It can be really traumatizing to not conceive naturally and the first question is why us??

I felt equally low and was in denial for quite sometime to accept there is something wrong.
Obviously after sometime we started looking for medical help.

Me and my husband fell under the category of unexplained infertility for my first child.
We went ahead for IUI and I conceived in my very second cycle ( at that time we lived in the USA). I was 31 years old when I delivered my first baby.
Everything looked pretty simple and we had our first baby.
Soon after that we moved back to Mumbai.

As soon as my baby was 2years we started trying for our second baby but to our luck we were once again not able to conceive naturally. ( contrary to everyone saying second baby is always quick)

We consulted Dr Malpani in August 2013 and he suggested we try naturally for a couple of months but if things don't workout to do some blood tests and get back to him.
In Dec I came back to Dr with my reports which indicated low AMH levels.
He straight suggested us to go for IVF.
I was just not ready for it and was again in denial that my first baby is IUI so I should def be able to conceive by the same treatment plan.
He was categorically clear it will not work.
I consulted other doctors and they said u don't need IVF.
I took 3 cycles of IUI but no luck.
I was then suggested to go for laparoscopy, that's when I realized I am being taken for a medical ride.
I went to Dr Malpani and we started our treatment.
I conceived in my second cycle of IVF.
He was clear since this is your second baby we will not transfer more than 2 embryos.

The complete process was stress free. The staff at the clinic is Superb.
There is a positive Aura in this clinic which makes everything so easy.
Dr Aniruddha & Dr Anjali just put you to so much ease that you feel relaxed in your mind, which is so important for conception.
No guilt trips for your weight, food habits etc etc.

I am thankful to both of them and their team from the bottom of my heart.
Their approach to the whole process is extremely professional and extremely compassionate.

God Bless Always!

Tuesday, October 28, 2014

Can you afford not to do IVF ?



A common concern  which lots of infertile couples have is whether they can afford to do IVF or not.

Everyone knows that IVF treatment can be expensive  ! IVF doesn't have a 100% pregnancy rate, which means patients may need 2 to 3 cycles before they get pregnant. Trying to budget for this open-ended expense can be a major challenge ! This uncertainty often puts infertile couples off because many are not comfortable taking such a big financial risk when the outcome is uncertain .

However , I think couples need to remember that sometimes they cannot afford not to do IVF ! IVF is the one treatment which maximizes an infertile couple’s chances of getting pregnant . Irrespective of whether they actually achieve a pregnancy or not, attempting an IVF cycle will give them peace of mind that they followed the right process and did whatever was humanly possible to try to have a baby.

If they fail to make the attempt , this is something which they will most probably regret later on. We rarely regret the things we do , but we often regret the things we didn’t !

It’s true that there is a financial and emotional risk in attempting IVF. However, the emotional risk of not attempting it will often leave a lifelong scar . While the money spent on an IVF cycle can always be earned again, the opportunity cost of not doing IVF when you are young is irreplaceable.

The truth is that there is a price to be paid – whether you do IVF, or you don’t. This cost is both financial and emotional. While it’s easy to measure the financial burden, it’s hard to quantify the emotional pain – and as you get older, the pain of never having tried at all can become a huge burden with the passage of time.

As John Greenleaf Whittier eloquently put it — 'Of all sad words of tongue or pen, the saddest are these, 'It might have been.'

When you are 50 and looking back at your life , the last thing you want to be doing is beating up on yourself because you missed a golden opportunity. It can be hard to live with this regret which gets magnified as tie goes on. You may end up kicking yourself what you failed to do whatever was humanly possible in order to maximize your chances of having a baby !

Not sure if IVF is the right choice for you ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly!

Monday, October 27, 2014

Public health and personal health in India


The PM, Narendra Modi, inaugurated the  brand new Sir H N Reliance Foundation Hospital in Mumbai. He said,  When our country is compared to other countries, the health care system in our country shames us,” Modi said. He added, “Instead of focusing on  treatment of patients, the health care system must focus on preventive  care. It takes less to invest in preventive care than in treatment.” -

Sadly, the truth is that opening more hospitals is not going to solve the problem ! We need to focus on empowering patients  with Information Therapy, so that they can help themselves - both to remain healthy; and to get the best medical care, when they fall ill. The ROI on patient education for the Dept of Public Health is enormous, because this has been a completely neglected area so far.

Friday, October 24, 2014

Corporate hospitals versus small nursing homes


In the past, when patients needed hospitalization, their family doctor would refer them to the neighborhood nursing home , which was managed by a specialist who would provide care which was cost effective and affordable . For more serious problems, he would refer patients to a government or municipal hospital. In those days, there were no large corporate hospitals, and the care which patients received was personalized.

Today, however, the  scenario has changed completely. There are lots of five-star super deluxe specialty care hospitals coming up all over the country . These are extremely profitable ventures, and lots of corporate are now pouring money into these. They are marketed and branded very cleverly and because they are large sprawling structures , with the latest medical technology and lab equipment, with large teams of medical specialists manning them 24/7.

This means that today patients are presented with a dilemma if they need hospitalization. Should they go to the spanking brand-new , state of the art hospital, or should they stick with the local nursing home.

The truth is that most common surgeries and medical problems are best treated much more cost-effectively and efficiently in a well-managed, well-equipped small nursing home . Not only are they much cheaper, it’s much easier for the patient to establish a relationship with the doctor. The care is more hands on and personalized, and more convenient as well, because family members and patients
don’t need to travel long distances . It’s also a lot cheaper, because they do not have to pay the overheads for the unnecessary trappings which super specialty hospitals are fitted with.

However, the problem is that nursing homes vary widely in quality. While some are excellent, others can be death traps, because they are so poorly equipped and badly staffed. This is why patients often prefer large hospitals , without understanding the hazards associated with these. While large hospitals look very impressive and imposing, the sad truth that the care they provide can be pathetic – something to which even the doctors who work in the hospital will testify to !

The truth is that while patients are awed by the dazzling equipment and technology available in the new hospitals, the truth is that most of them will never need these. The danger is that once this equipment has been bought, the hospital has to justify the expenditure, which means the doctors are often forced to refer patients for unnecessary scans and tests, to generate income for the hospital. Thus, just because the hospital has invested crores of rupees on a robotic surgery device, their surgeons are now forced to use these. While surgeons are happy to play with these new gee-whiz toys, the truth is that they only add to the expense of the operation – without adding any value whatsoever to healing and recovery. It’s the poor patient ( or his health insurer) who is forced to foot the bills. Sadly, patients aren’t even aware that they are being subjected to avoidable procedures and treatments, which only help the hospital’s bottom line – not their care. However, it’s become a very competitive game, and hospitals spends large amounts of money in a one-upmanship game, to try to convince patients why they are better than the others. Patients are not sophisticated enough to be able to separate the wheat from the chaff, and most just accept whatever their doctor tells them as being gospel truth, without knowing that their doctor is pressurized by the hospital management to bring a certain amount of moolah on a regular basis, in order to meet the targets they set.

While patients may feel very safe in  these hospitals , because they have so much equipment , the care they provide is often extremely impersonal . Patients are often treated as numbers , and there is little continuity of care . It’s very hard to get hold of the Doctor when they want to talk to him, as a result of which many patients are extremely dissatisfied with the services these hospitals provide. However, they are so worried that their local nursing home is not adequately equipped to handle complications, in case these arise, that they prefer the sense of security which large hospitals provide. They are willing to pay the additional premium these hospital charge, because of the trust and confidence which they inspire, thanks to their ambience and façade. However, this trust is misplaced , and that a lot of medical care would be much better provided in small nursing homes , provided these are managed properly.

The trick is that you need to choose between a hospital or a nursing home based on what kind of problem you have . The best model is a blended one, where simple surgical and medical problems are handled in small nursing homes , because these are much more cost-effective . Only the more complicated problems needed to be referred to specialty hospitals . This is the way things would work in an ideal world. However, because both specialty hospitals and nursing homes compete for the same set of patients, and  because corporate hospitals have  so much more clout , the nursing homes are gradually being squeezed out of existence. This is bad for all of us, as medical care delivered in these corporate hospitals will continue becoming more expensive as time goes by.

Thursday, October 23, 2014

Please consult with the patient !

Conversation between doctor and patient/consumer.


When we talk about a doctor-patient consultation , we usually refer to the fact that when someone falls ill, they go to a doctor, who then tells them what to do. This is usually perceived as a one-way street,  where the doctor is the one in charge. He takes a history, does an examination, orders tests and makes a diagnosis and provides treatment .

However, a key component of the consultation needs to be the fact that doctors need to consult with the patient as well. Unfortunately , this is something which is often forgotten !

Thanks to advances in medicine, patients today have lots of choices . Each patient is different,   and depending upon their personality, world-view, religion and culture, each will select a different option. There is no single right answer, and doctors are not mind readers. They need to factor  in the patient’s personal preferences, and they can only find out what these are by talking to the patient.

Doctors cannot afford to guess – and they shouldn’t try to impose their choices on the patient either ! They need to be non-directive and non-judgmental, and allow the patient to decide. They need to ask the patient which treatment they would prefer. This is not a sign of weakness on the part of the doctor – it’s actually a sign of strength !

Sometimes patients get confused when the doctor asks them for their opinion . They believe that this means the doctor is confused and doesn’t know what to do , which is why he needs their advice ! In reality, this means that the doctor is a good professional, who is being respectful . He understands that it takes two to tango , and that patients need to provide inputs so that doctor can help them to make a decision which is right for them.

The only way to have a healthy doctor-patient relationship is when both contribute ! This will help the patient gets the best possible medical care . This might seem obvious , but it's amazing how rarely this advise is followed in real life.

The problem is that doctors are often so full of themselves , and have big egos - especially the big specialists in the big towns , who are brand names . They think they have all the answers and are happy to dish these out to everyone who comes to them. After all, when you have a hammer in your hand, all you see are nails !

In fact, this is a setup where problems are much more likely to occur . Specialists have a very limited perspective – and for a cardiologist, every chest pain originates in the heart, because he doesn’t understand anything about the stomach ! As long as everything is fine, patients have been socialized to meekly agreeing with everything the doctor says. They are passively compliant , but when things go wrong ( as they are bound to do in any complex biological system), they become angry and vengeful.

Medical decisions needs to be made on a shared basis, where both doctor and patient provide their inputs ; and take responsibility  for the outcomes. Sadly, many doctor’s still believe that shared decision making means -  Here's my decision, let me share it with you . Doctors need to respect their patients and their choices !

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