Saturday, January 21, 2006

Same diagnosis - different treatments !

One of my patients asked me, " Why would you offer two patients with exactly the same diagnosis completely different treatments ?" She was referring to the fact that both she and her sister were infertile, and had come to me for advise. I had advised her sister to continue trying on her own; while I had advised her to do IVF. Medically, both of them were completely normal - their husbands had good sperm counts; they were ovulating; and their uterus and tubes were normal. They had what we call "unexplained infertility", where we cannot find a diagnosis to explain the infertility. She was perplexed why my advise to her sister and her were so dramatically different.
I had to gently remind her that doctors don't just fix problems or treat a diagnosis - we treat human beings, all of whom are different. For one thing, she was much older than her sister, and since she was already 39, I felt that IVF would be her best treatment option as it would maximise her chances of conceiving quickly. Time was
at a premium for her because of her age - she could not afford to waste it.
Her sister was much younger, and had just started trying, so there was no need for me to be so aggressive for her.
Even if there hadn't been such a difference in their ages, it is true that I do tailor my advise depending upon my patient's particular situation - not just their medical diagnosis. Thus, if a couple lives in Bombay, I am happy to try IUI ( intrauterine insemination) treatments, even though they have a lower pregnancy rates than IVF ( in vitro fertilisation) , because we have the luxury of time. On the other hand, if a could comes to me from Lucknow, then doing IVF is much more cost effective, because it maximises the chances of conceiving quickly.
I also try to request my patients to provide their input when formulating a treatment plan for them. I remind them that I cannot read their mind - and it's their responsibility to help me to come up with a plan which they are happy with !

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