Monday, February 20, 2006

An unhappy patient - and an unhappy doctor

I just saw a patient who had a distressing problem. He was a software engineer, and the couple had not been able to consummate the marriage. His problem was premature ejaculation, which was so severe that he would ejaculate before vaginal entry, as a result of which he had not been able to achieve intravaginal ejaculation.
Premature ejaculation is a complex problem to solve, because it is a learned reflex, in which the man cannot control his ejaculation. Psychologic problems always take a long time to resolve, and they wanted a baby quickly, because he was being posted to the UK in one month's time for one year.
He wanted me to perform an artificial insemination to bypass his problem; but I had to explain to him that because Nature was not very efficient at making babies, the pregnancy rate would be only 10% in one month. This was too low for him, and he wanted to explore alternative options.
I explained that it would be far better if they tried to solve their problem for themselves - after all, it was much more fun making a baby in the bedroom than coming to me !
I suggested they buy a book which described treatment options for premature ejaculation, such as the "squeeze technique", so that they could learn to treat themselves. I also told them there were alternative options, such as self-insemination, and we had a detailed description of this on our website at
www.drmalpani.com/selfinsemination.htm.
I felt I was being empathetic, and by trying to empower them to solve their problem for themselves, I was proving the best possible medical care.
For some reason, he was very unhappy with my advise. He expected a quick solution, and resented by suggestions that he do some "homework" and try to become an expert on premature ejaculation, so that he could tackle the problem more efficiently. I was trying to promote his autonomy, rather than making him dependent on medical intervention ( which I felt was uncalled for, since they were young).
We parted on unhappy terms. He felt I was being unhelpful; and I felt that he was too immature to understand that I was trying to look at the "long-term" picture, and just trying to help him to help himself ! I felt my role was that of a teacher, who goads a student into performing better; rather than trying to spoonfeed him so that he can ace the examination. He was focussed on short term results, which meant we ended up talking at cross-purposes.
I guess patients find the doctors they deserve - and that doctors get the patients they deserve. I wish him luck in his quest for a doctor who will pander to his desires - and I hope he will be able to appreciate ( maybe in a few years) that I was just looking after his best interests !

1 comment:

  1. There are other ways of preventing premature ejaculation but having a strong PC muscle is the most important so you should start performing these exercises immediately. Not only will this improve your stamina and sexual performance, it will also allow you to control when you ejaculate so that you can last for hours in bed. http://www.viagrathunder.com

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