Wednesday, April 29, 2009
'Along with driving down costs, I think the other thing it will do is force that transparency of quality data from U.S. providers, and that to me is a huge benefit,' says Wouter Hoeberechts, CEO of California-based WorldMed Assist, which works with employers to coordinate medical travel options for employees.
Before traveling for medical reasons, Americans will likely research and compare costs, outcomes, and quality-related statistics to determine whether the trip is worth it. If more Americans see that the quality of cardiovascular care is just as good as, say India, and they can get the same procedure at a significant cost saving, they will be more likely to go.
If medical tourism grows in popularity, the increased competition could encourage U.S. providers to improve their services and reevaluate costs, as well as make this information readily available to consumers.
Tuesday, April 28, 2009
I guess it's a difference in world-views. My view is influenced by the fact that I learn a lot of stuff from my patients daily, so I find these interactions educational and interesting. Unusual patients give me a lot of food for thought - and material to blog about as well !
Other doctors may view their patients as just so many office visits they have to complete before going back home, and therefore find that patients who ask too many questions a nuisance. I feel sorry for them - they don't know how much they are missing !
I went to two doctors, one is a fertility expert, the other is a gynec and an obstetrician. both have equivalent amount of experience after them, but my question is, when i went to the fertility expert so many problems cropped up, they said u could have a compromised reserve of ovaries, etc.. and fibroids too. but my visit to my family gynec and obstetrician resulted in me coming out with no evident problems, everything was normal and she just prescribed some iron tabs and another tab for some luteal phase. to enhance pregnancy.. we went to the specialist as my husband had to to his semen analysis and we just went in for another consultation to come out super stressed.. what is your opinion Doctor, whom do we believe? a person who says there is no problem, only the sperm count could be low which can be rectified or someone who is saying there are a zillion issues with your body and you need this and that treatments.. i am really zapped and so stressed. can you please let me know?
My heart went out to her ! Is the infertility specialist giving the right advise ? Or just creating more work for himself by "finding problems" ? Or is the gynecologist providing reassurance because he is clueless and does not know any better ?
I guess this a problem patients encounter all the time ! What does a patient who has angina do when the cardiologist advises a stent; while the cardiac surgeon advises bypass surgery ? Whom should he trust ? And why ?
This is one of the reasons Information Therapy can be so valuable ! If you can do your own homework and make sense of your medical reports , you are in a better position to make sense of conflicting advise and make the right decision for yourself !
What she did was also very sensible . She got a third opinion ( online) from an independent
Monday, April 27, 2009
Indian medical associations say their doctors desperately need continuing medical education (CME) to keep them up to date with the latest drugs, equipment and medical practices but legislation to make this a requirement has made little progress.
The Medical Council of India is campaigning for CME to be made compulsory, as it is in the UK and some US states, for the country’s 615 000 registered doctors and has proposed a draft amendment to a law that would standardize medical practice across the country while making sure it is up to date with the latest developments.
If passed into law, mandatory CME for registered doctors in India could set a precedent for other developing countries but some Indian doctors say their medical associations have failed to lobby hard enough for this and lawmakers have been slow to respond.
“There is resistance to change by [health] professionals who lack the opportunity for undergoing good quality CME, and lack incentives as well as motivation for attending CME programmes,” said Dr P.T. Jayawickramarajah, Coordinator at the WHO’s Regional Office for South-East Asia in New Delhi."
It'd be interesting to do a survey to find out how often Indian doctors update themselves - and how efficiently they do so !
Saturday, April 25, 2009
The proposed website, named Healthbook, would allow individuals to store their own health information electronically and share it with doctors, nurses or family members.
University of New South Wales (UNSW) researcher Professor Enrico Coiera said such a system could be in place by next year.
'This is exactly the sort of thing we are very keen to try and build,' he said.
Professor Coiera and his team was currently working on a prototype website that assists people searching for health-related information and sharing it with others.
'We want to use smart search technologies to help everyone get the most relevant health information and make it Australian specific,' he said.
'We also want to use the Facebook model to allow people to share it with each other.'
A Healthbook system would also allow health professionals to track trends such as the progress of outbreaks."
Friday, April 24, 2009
Most Indian doctors are in private practise and do not have access to a medical library. Even the ones who are affiliated to medical colleges are often far too busy to actually visit the library. Medical books are expensive - and very few are willing to spend money on subscribing to medical journals.
Consequently, many doctors find that their medical knowlegebase is woefully inadequate - and this ignorance can prove to be detrimental to their patients. This is especially true in Tier 2 and 3 towns. Most doctors depend upon their medical representative to update them on the newest drugs ; while others will attend medical conferences once a year to try to remain abreast of what's new. Sadly, both these are extremely unreliable means of acquiring medical information for obvious reasons. Medical reps have a hidden agenda - and a lot of the information they provide is suspect or biased. Medical conferences ( which are often sponsored by pharmaceutical companies in India) are also usually just chances to socialise or go on a holiday, rather than to learn.
Most doctors are aware of their launae - and many are privately quite ashamed of the fact that the only medical textbooks they have are the ones they bought in medical college - some of which are over 10 years old and completely out of date !
Leading doctors have recognised the danger this ignorance can pose to Indian patients, and there have been many calls for making CME ( continuing medical education) compulsory for doctors in India.
The ground reality is that doctors are becoming increasingly worried about the fact that some of their patients know much more than they do about even abstruse medical advances - thanks to the internet. Patients have a lot of time at their disposal - and smart patients can find pages and pages of information on the internet about their problem - often leaving their doctor with an inferiority complex !
So what's the poor doctor to do ? We now have an easy solution for them !
Now, for less than Rs 30 per day, doctors in India can subscribe to the world's largest online medical library, at www.mdconsult.com ! They can try out a risk-free 30 day demo– free of charge ! MDConsult allows doctors to remain uptodate by providing online instant access to the FULL-TEXT of over 50 respected medical books and 50 prestigious medical journals which are constantly updated. This is excellent value for money, because it means they will never need to buy another medical book in their life !
MDConsult also allows access to thousands of patient education brochures which can be handed to patients, to ensure they provide truly informed consent !
MDConsult provides convenience and peace of mind for Indian doctors – on their PC, 24/7 - for only
Rs 9995 per year. Remember, this is a tax- deductible expense !
Many doctors have requested a pharmaceutical company through their medical representative to gift them a free subscription . Many companies have done this for their key doctors as a goodwill gesture - a win-win situation for the pharmaceutical company ( who earns goodwill); the doctor ( who then has access to a treasurehouse of reliable medical information on his PC); and the doctor's patients ( who are secure in the knowledge that their doctor is well-informed and updated !).
What to know more ? Please contact HELP at email@example.com.
If you want to subscribe, please send a DD for Rs 9995 only, payable to Health Education Library for People,
Excelsior Business Center, National Insurance Building, Ground Floor, Near Excelsior Cinema, 206, Dr.D.N Road, Mumbai 400 001
Tel. No.: 65952393/ 65952394/22061101,
with a covering letter, and we will email you your username and password in 2 working days !
NB If you are patient and would like to help your doctor to remain well-informed, you might want to consider gifting a subscription to MDConsult to him - it's a great way to say Thank You !
So how do you figure out if your bill has incorrect codes or duplicate charges? Start by asking for an itemized bill with 'miscellaneous' items clearly defined. Some telltale mistakes: charging for three days when you stayed in a hospital overnight, a circumcision for your newborn girl or for drugs you never received."
Thursday, April 23, 2009
* An itemized copy of your bill.
* A copy of your medical chart.
* A copy of your pharmacy ledger. This shows the drugs you were given during your stay.
Compare your chart and ledger to the itemized bill to see if there are any discrepancies. Also, look for charges that are the result of hospital error, such as an X-ray that had to be redone because a technician goofed. You shouldn't have to pay for someone else's mistakes.
Other errors, such as 'upcoding,' are more insidious. Upcoding is a fraud that involves pretending a condition is more serious than it actually was, in order to charge more."
You'll get interactive, personal guidance based on health information from Mayo Clinic experts. Plus, you can easily access and organize your family's health information all in one place."
Self-care is often all you need, because many problems are self limited and do not need medical attention ! How can you make sense of what your body is telling you when you don't feel well ? These tools will help you decide when you can manage your problem for yourself - and when you need to visit your doctor !
Tuesday, April 21, 2009
She didn't want to wait for nature to take its own course, and wanted me to do an IVF cycle for her, because she did not want to be an " old " mother.
I did my best to discourage her. While it may be in my best financial interests to do IVF for her, I am not sure it's a good idea to convert a pleasurable bedroom activity into a clinical activity. However, she is a very successful businesswoman, who knows her own mind, and is quite sure that this is what she wants.
What should I do ? Should I agree to her request ? From her point of view, her request is quite reasonable, since she does not have the luxury of time to wait and watch - and after all, if the technology is available, why should I refuse to use it for her, just because she does not meet the medical textbook definition of being infertile ? She feels she is making a well-informed decision, and is willing to fund it. Am I being too patronising by refusing to treat her ? Should I respect her autonomy and do what she wants ? How do I decide what is right ?
So what is the poor patient supposed to do ?
Firstly, try to be empathetic and look at things from your doctor’s point of view. He has lots of patients to see; a limited amount of time; and will do his best to maximize his efficiency and his income by trying to see as many patients as possible.
The trick is not to get scared and stop asking questions , but to learn how to ask questions and which questions to ask. Don’t worry that your doctor will think your questions are stupid – after all, the only stupid question is the one you don’t ask ! How will you ever learn without asking questions ?
Here are some suggestions you might find helpful.
1. Do your homework . Be prepared.
2. Tried to find answers for your questions yourself by doing a google search
3. Ask focused questions, which relate to your specific problem
Remember that both you and your doctor have the same interests at heart – both of you want you to get better. Work as partners - you are both on the same side !
It’s a good idea to write your questions down. If you can show him that you have tried to answer them for yourself, he will be much happier to answer the ones which have stumped you !
It’s important to not waste your doctor’s time by asking irrelevant questions. These will often end up irritating your doctor, and you will lose his good will. Remember that doctors don’t have answers to all questions. Medicine is an inexact science, and there are still major areas of ignorance. A good doctor will share these with you ! “I don’t know” can be a very good answer sometimes !
Remember that the quality of the answer depends upon the quality of the question. Take time and effort to frame your questions well.
Try to be assertive – but not aggressive. It’s not hard to do this, if you are respectful and ask your doctor for permission to ask questions ! In case you have lots of questions, request him to suggest a book or website where you can get enough background information about your problem.
Ask if you can email your questions. This way, your doctor can answer your questions at his leisure and you can utilize your personal interaction time more constructively.
Learn not to ask poor quality questions . Thus, if you need to know about clinic timings, it’s best to ask the clinic staff, rather than the doctor. Also, please don’t ask questions on behalf of your aunt or friend – focus on your problems, so your doctor can help you solve them !
If , inspite of your best efforts , your doctor is still upset when you ask questions, then this just means that he is not the right doctor for you - or that you are not the right patient for him. Find another
Monday, April 20, 2009
Walk into any doctor's office or hospital around the country and the first thing that you'll be greeted with is a request for information, no matter how many times you've filled out these documents before.
The lack of computer automation in the U.S. health care system is both surprising and appalling, given the amount of money that's being poured into medical research and the rising cost of premiums for health coverage. Insurance companies seem remarkably good at trimming services for patient care, mandating such things as pre-approval for many tests and operations, and limiting the amount of money being paid for various medical procedures. Yet they have done little to put pressure on one of the costliest inefficiencies in the medical system."
Sunday, April 19, 2009
Without making any representations about the relative clinical value of this robotic system versus manual laparoscopic surgery, I am writing to let you know we have decided to buy one for our hospital. Why? Well, in simple terms, because virtually all the academic medical centers and many community hospitals in the Boston area have bought one. Patients who are otherwise loyal to our hospital and our doctors are transferring their surgical treatments to other places. Prospective residents who are trying to decide where to have their surgical training look upon our lack of the robot as a deficit in our education program. Prospective physician recruits feel likewise. And, these factors are now spreading beyond urology into the field of gynecological surgery. So as a matter of good business planning, concern for the quality of our training program, and to continue to attract and retain the best possible doctors, the decision was made for us. So there you have it. It is an illustrative story of the health care system in which we operate."
Finally, a hospital CEO who has the courage to admit why hospitals buy what they do. Investing one tenth of this money in a Patient Education Resource Center would have been of much more use to their patients !
Saturday, April 18, 2009
That view is squarely opposed by Aurelia Boyer, the chief information officer for New York-Presbyterian Hospital and a former nurse. She thinks that health care is “paternalistic by nature.” Rather than wait for HIT integration among lumbering health-care giants, she wants to give patients access to their data immediately, in the hope of linking up the disconnected bits of the health system more speedily."
The benefits of giving patients a PHR seem to be obvious to everyone, except for doctors ! If I have complete access to my personal bank account so I can manage my wealth, why shouldn't I also have complete access to my personal health record, so I can manage my health ? I am sure many patients will do a much better job than their doctors are doing for them !
Just as important, it can make that information available to the patients too, empowering them to play a bigger part in managing their own health affairs. This is controversial, and with good reason. Many doctors, and some patients, reckon they lack the knowledge to make informed decisions. But patients actually know a great deal about many diseases, especially chronic ones like diabetes and heart problems with which they often live for many years. The best way to deal with those is for individuals to take more responsibility for their own health and prevent problems before they require costly hospital visits. That means putting electronic health records directly into patients’ hands."
Tuesday, April 14, 2009
A personal health record is an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions and track health histories. It does not replace the legal record of any provider.
The move by Northwest Physicians follows a recent trend of liability carriers promoting online patient-doctor connectivity, with hopes of fostering better communication with patients and improved patient safety."
Money Talks - and hopefully this economic incentive will induce doctors to encourage their patients to use a PHR !
This is a great idea - and will soon become as routine as phone consultations ! It will not replace all face to face visits of course - but will help substitute for many "routine" clinic visits, saving patients and doctors ( and their insurance companies !) a lot of time and money !
Monday, April 13, 2009
Under the pilot program, Serigraph members planning to undergo certain procedures can enjoy access to an extended network of respected hospitals and health care providers in India. By electing to use the international benefit, members can receive care at accredited facilities at lower out-of-pocket costs for common non-emergency procedures that could result in thousands of dollars in total savings. The pilot program includes coverage of certain common non-emergency procedures such as major joint replacement, upper and lower back fusion, and other procedures that have significant cost differences between domestic and international providers."
Sunday, April 12, 2009
Smart card technology can also improve the healthcare insurance process. Currently, eligibility verification and claims processing are too often characterized by redundant information collection, multiple reimbursement forms and lengthy delays. Paper-based manual processes greatly increase the risk of human error which results in significant avoidable costs to insurers, national health agencies, and healthcare providers. Too often, these processes result in significant delays in referral, treatment, and reimbursement for insured patients."
This real-life story is inspiring - and can teach both doctors and patients what motivated patients can achieve, when allowed to do so !
Consider this restatement:
When we put the patient at the center, and make them the point of integration, the entire system becomes simpler, more robust, more scalable, and more useful."
In a way it's sad that something so obvious has to be said at all - but the truth is that all of us need to be reminded that patients need to come first !
Thursday, April 09, 2009
Good doctors know this - and will use lots of tools to help you retain what they tell you !
Often patients begin a medical search hoping to discover a breakthrough medical study or a cure buried on the Internet. But even the best medical searches don’t always give you the answers. Instead, they lead you to doctors who can provide you with even more information.
“It’s probably the most important thing in your cancer care that you believe someone has your best interests at heart,” said Dr. Anna Pavlick, director of the melanoma program at the New York University Cancer Institute. “In an area where there are no right answers, you’re going to get a different opinion with every doctor you see. You’ve got to find a doctor you feel most comfortable with, the one you most trust.”"
‘The NHS commits to offer you easily accessible, reliable and relevant information to enable you to participate fully in your own healthcare decisions and to support you in making choices’.
‘You have a right to make choices about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your individual needs.’"
I wish the Indian government would also make it compulsory for health insurance companies and doctors to prescribe information ! This would be a very cost-effective intervention, which would change the way patients in India are treated !
Good and caring physicians have always tried to supplement their classic medical (pharmacological) prescriptions with sensible advice for living. Recently however, empirical advice has advanced this common practice to a new level of scientifically based advice, or 'behavioral prescriptions.' For example, behavioral prescriptions that I offer my patients include participating in the arts (such as dancing, playing an instrument, or singing), enjoying nature, doing work that is meaningful and gratifying, engaging in responsible sexuality, and encouraging specific stress releasing physiological behaviors such as crying and laughing."
Just like drug therapy ( Rx), good doctors also prescribe behavioural therapy ( Bx) !
Tuesday, April 07, 2009
This is from the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
Abortion: the medical term for miscarriage. The various types include:
* Complete abortion: A miscarriage in which all of the products of conception have been expelled and the cervix is closed.
* Habitual abortion: A miscarriage occurring on two or more separate occasions.
* Incomplete abortion: A miscarriage in which only a portion of the products of conception have been expelled. This usually requires dilatation and curettage.
* Induced abortion: An intentional termination of pregnancy.
* Inevitable abortion: A miscarriage that cannot be halted.
* Missed abortion: A miscarriage in which a dead fetus and other products of conception remain in the uterus for four or more weeks.
* Selective abortion: A term often used to refer to intentional termination of one or more gestational sacs within the uterus, usually in the case of a multiple pregnancy (triplets or more).
* Spontaneous abortion: A miscarriage or the unintended termination of a pregnancy before the twentieth week.
* Therapeutic abortion: An intentional termination of pregnancy for the purpose of preserving the life of the mother.
* Threatened abortion: symptoms such as vaginal bleedings, with or without pain, which may end with a miscarriage or with continuation of a normal pregnancy.
Adhesion: An abnormal attachment of adjacent tissues by bands, scars or masses of fibrous tissue.
Adrenal Glands: Two glands near the kidneys that produce hormones, including some male sex hormones - the adrenal androgens.
Agglutination of Sperm: Sticking together of sperm.
Amenorrhea: The absence of menstruation.
Ampulla: Theouter half of the fallopian tube, where fertilisation occurs. It opens into the abdominal cavity through the tubal ostium, which is lined by the fimbria.
Androgens: Male sex hormones. Testosterone is one example.
Andrology: The science of diseases peculiar to the male sex, particularly infertility, and sexual dysfunction.
Anomaly: A malformation or abnormality in any part of the body.
Anovulation: Total absence of ovulation. Note: This is not necessarily the same as "amenorrhea." Menses may still occur with anovulation.
Anovulatory Bleeding: The type of menstruation often associated with failure to ovulate. May be scanty and of short duration ; or abnormally heavy and irregular .
Antibody: A protective protein produced in the body that fights or otherwise interacts with a foreign substance in the body.
Artificial Insemination by Donor (AID): The injection of donor semen into a woman's reproductive tract for the purpose of conception.
Artificial Insemination by Husband (AIH): The injection of husband's semen into the wife's reproductive tract for the purpose of conception.
Aspermia: The absence of semen . This is not the same as azoospermia.
Asthenospermia: A condition in which the sperm do not move (swim) at all or move more slowly than normal.
Azoospermia: The absence of sperm in the ejaculate.
Basal Body Temperature (BBT): The temperature of the woman, taken either orally or rectally, upon waking in the morning before any activity. Used to help determine ovulation.
Bicornuate Uterus: A congential malformation of the uterus in which it appears to have two "horns " (cornu).
Capacitation: The process by which sperm are altered ( usually during their passage through the female reproductive tract ) that gives them the capacity to penetrate and fertilize the ovum.
Cervix: The lower section of the uterus which protrudes into the vagina
Child-Free Living: A resolution to infertility in which the couple opts for a life-style without parenting, either temporarily or permanently.
Chlamydia: A sexually transmitted disease that may cause impaired fertility .
Chromosomes: Rod-shaped bodies in a cell's nucleus which carry the genes that convey hereditary characteristics. Made up of DNA.
Cilia: Microscopic hair-like projections from the surface of a cell capable of beating in a coordinated fashion.
Clitoris: The small erectile sex organ of the female, located in front of the vagina and similar to the penis of the male.
Clomiphene Citrate: A synthetic drug used to stimulate the hypothalamus and pituitary gland to increase FSH and LH production. It is usually used to treat ovulatory failure due to hypothalamic pituitary dysfunction.
Coitus: Sexual intercourse.
Conception: The fertilization of a woman's egg by a man's sperm resulting in a new life.
Congenital: A characteristic or defect present at birth. It is acquired during pregnancy but is not necessarily hereditary.
Corpus Luteum: The special gland that forms in the ovary at the site of the released egg. This gland produces the hormone progesterone during the second half of the normal menstrual cycle.
Cryobank: A place where tissues (i.e., sperm, oocytes, embryos) are stored in the frozen state.
Cryopreservation (Freezing): A procedure used to preserve (by freezing) and store embryos or gametes (sperm, oocytes).
Cryptorchidism: Undescended testicles.
Dilatation and Curettage (D & C): Dilatation of the cervix to allow scraping of the uterine lining with an instrument (curette). This is also a means to induce abortion in the first trimester of pregnancy.
Dysgenesis: Faulty formation of any organ.
Dysmenorrhea: Painful menstruation.
Dyspareunia: Painful intercourse for either the woman or the man.
Ectopic Pregnancy: A pregnancy in which the fertilized egg implants anywhere but in the uterine cavity (usually in the fallopian tube, the ovary or the abdominal cavity).
Egg (Oocyte) Donation: Surgical removal of an egg from one woman for transfer into the fallopian tube or uterus of another woman.
Ejaculation: The male orgasm during which approximately two to five milliters of semen (seminal fluid and sperm) are ejected from the penis.
Embryo: The term used to describe the early stages of fetal growth, from conception to the eighth week of pregnancy.
Embryo Transfer: The introduction of an embryo into a woman's uterus after in vitro (or in vivo) fertilization.
Endocrine System: The system of glands including the pituitary, thyroid, adrenals, testicles or ovaries.
Endocrinologist: A doctor who specializes in diseases of the endocrine glands.
Endometrial Biopsy: The extraction of a small sample of tissue from the uterus for examination. Usually done to show evidence of ovulation .
Endometriosis: The presence of endometrial tissue (the normal uterine lining) in abnormal locations such as the tubes, ovaries and peritoneal cavity, often causing painful menstruation and infertility.
Endometrium: The mucous membrane lining the uterus.
Endosalpinx: The tissue lining in the fallopian tube.
Epididymis: An elongated organ in the male lying above and behind the testicles. It contains a highly convoluted canal, four to six meters in length, where, after production, sperm are stored, nourished and ripened for a period of several months.
Erection: The enlarged, rigid state of the penis when sexually aroused.
Estradiol (E2): A hormone released by developing follicles in the ovary. Plasma estradiol levels are used to help determine progressive growth of the follicle during ovulation induction.
Estrogen: Aclass of female hormones, produced mainly by the ovaries from the onset of puberty until menopause which are also responsible for the development of secondary sexual characteristics in women
Fallopian Tubes: A pair of narrow tubes that carry the ovum (egg) from the ovary to the body of the uterus.
Fertilization: The penetration of the egg by the sperm and fusion of genetic materials to result in the development of an embryo.
Fetal Death: The term often used to include both miscarriage and still-birth.
Fetus: The developing baby from the ninth week of pregnancy until the moment of the birth.
Fibroid Tumor (Leiomyoma): A benign tumor of fibrous tissue that may occur in the uterine wall. May be totally without symptoms or may cause abnormal menstrual patterns or infertility.
Fimbriae: The fringed and flaring outer ends of the fallopian tubes which capture the egg after it released from the ovary.
Follicle: The structure in the ovary that has nurtured the ripening egg and from which the egg is released.
Follicle Stimulating Hormone (FSH): A hormone produced in the anterior pituitary that stimulates the ovary to ripen a follicle for ovulation.
Follicular Phase: The first half of the menstrual cycle when follicle development takes place in the ovary.
Frigidity: The inability to become sexually aroused. Not a known cause of infertility.
Gamete: The male or female reproductive cells- the sperm or the ovum (egg).
Gamete Intra-Fallopian Transfer (GIFT): Procedure in which the sperms and eggs are transferred by laparoscopy into the fallopian tubes where fertilization may then take place.
Genes: Substances that convey hereditary characteristics, consisting primarily of DNA and proteins and occurring at specific points on the chromosomes.
Genetic: Pertaining to hereditary characteristics.
Genetic Abnormality: A disorder arising from an anomaly in the chromosomal structure which may or may not be hereditary.
Genetic Counseling: Advice and information provided, usually by a team of experts, on the detection and risk of recurrence of genetic disorders.
Gestation: The period of fetal development in the uterus from conception to birth, usually considered to be 40 weeks in humans.
Gland: Hormone-producing organ.
GnRH (Gonadotropin Releasing Hormone; LHRH): A hormone released from the hypothalamus that controls the synthesis and release of pituitary hormones FSH and LH.
Gonadotropin: A hormone capable of stimulating the gonads to produce hormones and / or gametes .
Gonads: The glands that make the gametes (the testicles in the male and the ovaries in the female).
Gynecologist: A doctor who specializes in the diseases of the female reproductive system.
Hamster Test (Sperm Penetration Assay), used to determine the ability of a man's sperm to penetrate a hamster egg. Thought to provide evidence of the sperm's fertilising ability.
Hemorrhage: Excessive bleeding.
Hereditary: Transmitted from one's ancestors by way of the genes within the chromosomes of the fertilizing sperm and egg.
Hirsutism: The presence of excessive body and facial hair, especially in women.
Hormone: A chemical, produced by an endocrine gland, which circulates in the blood and has widespread action throughout the body.
Human Chorionic Gonadotropin (HCG): A hormone secreted by the placenta during pregnancy that prolongs the life of the corpus luteum.
Human Menopausal Gonadotropin (HMG): A natural product containing both human FSH and LH. These hormones are extracted from the urine of postmenopausal women.
Hydrocele: A swelling in the scrotum containing fluid.
Hydrosalpinx: A large fluid-filled, club-shaped fallopian tube closed at the fimbriated end . It is a cause of infertility.
Hydrotubation: Lavage or "flushing" of the fallopian tubes with a sterile solution which sometimes contains medication such as antibiotics, enzymes, or steroids.
Hypogonadism: Inadequate gonadal function as manifested by deficiencies in sperm production in males or egg production in females and/or the secretion of gonadal hormones (estrogens and androgens, respectively).
Hypospadias: A malformation of the penis in which the urethral opening is found on the underside rather than at the tip of the penis.
Hypothalamus: A part of the base of the brain that controls the release of hormones from the pituitary.
Hysterosalpingogram: An X-ray study in which a contrast dye is injected into the uterus to show the delineation of the body of the uterus and the patency of the fallopian tubes. Also called a tubogram or uterotubogram.
Idiopathic ( Unknown or Unexplained): The term used when no reason can be found to explain the cause of a medical condition.
Immunological Response: The production of antibodies in the woman or man .
Implantation: The embedding of the fertilized egg in the endometrium of the uterus.
Impotence: The inability of the male to achieve or maintain an erection for intercourse due to physical or emotional problems
Incompetent Cervix: A weakened cervix that is incapable of holding the fetus within the uterus for the full nine months. Can be a cause of late miscarriage .
Infertility: The inability of a couple to achieve a pregnancy after one year of regular unprotected sexual intercourse , or the inability of the woman to carry a pregnancy to live birth.
Interstitial Cells: The cells between the seminiferous tubules of the testicles that produce the male hormone testosterone. Also called Leydig cells.
In Vitro (literally, in glass) Fertilization (IVF): A procedure in which a egg is removed from a ripe follicle and fertilized by a sperm cell outside the human body. Also called "test tube baby" and "test tube fertilization."
In Vivo Fertilization: The fertilization of an egg by a sperm within the woman's body.
Kallman's Syndrome: Hypogonadism with anosmia (loss of the sense of smell). Uncommon cause of male infertility.
Karyotype: A study of the chromosomes of the tissue. Used for genetic studies.
Klinefelter's Syndrome: A congenital abnormality of the male wherein he receives an XXY chromosomal complement instead of XY. These men are infertile.
Labia: Folds of skin on either side of the entrance of the vagina.
Laparoscopy: The direct visualization of the ovaries and the exterior of the fallopian tubes and uterus by means of inserting a surgical telescope through a small incision below the naval.
Laparotomy: Abdominal surgery.
Leydig Cells: See interstitial cells.
LHRH: Luteinizing hormone releasing hormone (see GnRH).
Libido: Sexual desire.
Luteal Phase: The days of the menstrual cycle following ovulation and ending with menses during which progesterone is produced by the corpus luteum
Luteal Phase Defect: A shortened luteal phase or one with inadequate progesterone production.
Luteinized Unruptured Follicle Syndrome (LUF): A condition in which the egg is not released during ovulation; the follicle does not rupture and the egg is trapped.
Luteinizing Hormone (LH): A hormone secreted by the pituitary gland. Secretion of LH increases in the middle of the cycle to induce release of the egg.
Menarche: The onset of menstruation in girls.
Menopause: The cessation of menstruation due to aging or failure of the ovaries. Most commonly occurs between the ages of 40 and 50.
Menotropins (Human Menopausal Gonadotropin or HMG): Injections which containing FSH and LH. They are produced by extraction from the urine of menopausal women.
Menstruation: The shedding of the uterine lining by cyclic bleeding that normally occurs about once a month in the mature female.
Miscarriage: A spontaneous abortion of a fetus up to the age of viability.
Mittelschmerz: German for "middle pain," referring to the pain during ovulation that some women experience.
Morphology of sperm: The study of the shape of sperm cells. This evaluation is part of a semen analysis.
Motility of Sperm: The ability of the sperm to move about.
Mumps Orchitis: Inflammation of the testicle caused by mumps virus. Can lead to sterility if infection with the virus occurs after puberty.
Myomectomy: Surgical removal of a fibroid tumor (myoma) in the uterine muscular wall.
Necrospermia: A condition in which sperm are produced and found in the semen but they are dead. These sperm cannot fertilize eggs.
Nidation: The implantation of the fertilized egg in the endometrium of the uterus.
Obstetrician: A doctor who specializes in pregnancy and childbirth.
Oligo-Ovulation: Infrequent ovulation, usually less than six ovulatory cycles per year.
Oligospermia: An abnormally low number of sperm in the ejaculate of the male.
Oocyte: The egg.
Oocyte Retrieval: A surgical procedure to collect the eggs contained within the ovarian follicles.
Orchitis: An inflammation of the testes.
Ovarian Failure: The inability of the ovary to respond to any gonadotropic hormone stimulation, usually due to the absence of oocytes.
Ovaries: The sexual gland of the female which produces the hormones estrogen and progesterone, and in which the ova are developed.
Oviduct: Fallopian tube.
Ovulation: The discharge of a mature egg, usually at about the midpoint of the menstrual cycle.
Ovulation Induction: The use of hormone therapy (clomiphene citrate, HMG,HCG) to stimulate development and release.
Ovum: The egg (reproductive) cell produced in the ovaries each month. (The plural of ovum is ova.)
Pelvic Inflammatory Disease (PID): Inflammatory disease of the pelvis, often caused by infection.
Penis: The male organ of intercourse.
Pituitary: A gland located at the base of the human brain that secretes a number of important hormones related to normal growth and development and fertility.
Polycystic Ovarian Syndrome (PCO): Development of multiple cysts in the ovaries due to arrested follicular growth resulting in an imbalance in the amount of LH and FSH released .
Polyp: A nodule or small growth found frequently on mucous membranes, such as in the cervix or the uterus.
Postcoital Test (Huhner Test ): A diagnostic test for infertility in which vaginal and cervical secretions are obtained following intercourse and then analyzed under a microscope.
Progesterone: A hormone secreted by the corpus luteum of the ovary after ovulation has occurred. Also produced by the placenta during pregnancy.
Prostate: A gland in the male that surrounds the first portion of the urethra near the bladder. It secretes an alkaline liquid that neutralizes acid in the urethra and stimulates motility of the sperm.
Pyospermia: A condition in which the presence of white cells in the semen indicates possible infection.
Retrograde Ejaculation: Discharge of semen backward into the bladder rather than forward through the penis.
Retroverted Uterus: uterus that is bent backward.
Rubin Test: Obsolete test in which a gas such as carbon dioxide is blown into the uterus under pressure to test if the fallopian tubes are open.
Salpingitis: Inflammation of the fallopian tubes.
Salpingolysis: Surgery to clear the fallopian tubes of adhesions.
Salpingoplasty: Surgery to correct blocked fallopian tubes.
Scrotum: The bag of skin and thin muscle that holds the testicles.
Secondary Infertility: The inability to conceive or carry a pregnancy after having successfully conceived and carried one or more pregnancies.
Semen: The sperm and seminal secretions ejaculated during orgasm.
Semen Analysis: The study of a fresh ejaculate under the microscope.
Seminal Vesicle: A pair of pouch-like glands above the prostate in the male that produce a thick, alkaline secretion that is passed in the semen during ejaculation.
Seminiferous Tubules: The long tubes in the testicles in which sperm are formed.
Septum: An abnormality in organ structure present since birth in which a wall is present where one should not exist.
Sperm (Spermatozoa): The male reproductive cell, that has measurable characteristics such as:
Motility: Refers to percent of sperm demonstrating any type of movement.
Count (or Density): Refers to the number of sperm present.
Morphology: Refers to form or shape of the sperm.
Viability: Refers to whether or not the sperm are alive.
Sperm Bank: Place in which sperm ( from donor or from husband) is stored frozen for future use in artificial insemination.
Sperm Washing: A technique that separates the sperm from the seminal fluid.
Spermatogenesis: The production of sperm within the seminiferous tubules.
Spinnbarkheit: The stretchability of cervical mucus.
Split Ejaculate: A method of collecting a semen specimen so that the first half of the ejaculate is caught in one container and the rest in a second container. The first half usually contains the majority of the sperm.
Surrogate mother: A woman who gestates an embryo and then turns over the child to the infertile couple, who may be its genetic parents.
Testicles: The male sexual glands of which there are two. Contained in the scrotum, they produce the male hormone testosterone and produce the male reproductive cells, the sperm.
Testicular Biopsy: Surgical excision of testicular tissue to determine the ability of the testes to produce normal sperm
Testicular Failure: Occurs when the testes fail to produce sperm.
Testosterone: The most potent male sex hormone, produced in the testicles.
Test-Tube Baby: A child born through in vitro fertilization.
Thyroid Gland: A gland located at the front base of the neck which secretes the hormone thyroid which is necessary for normal fertility.
Tuboplasty: Surgical repair of fallopian tubes.
Turner's Syndrome (Ovarian Dysgenesis): A congenital abnormality of the female wherein she receives an XO instead of an XX genetic sex complement. Women with this condition are sterile.
Ultrasound ( Sonography): A imaging technique for visualizing the growth of ovarian follilces during infertility therapy .
Unexplained Fertility: See idiopathic infertility.
Urethra: The tube that carries urine from the bladder to the outside. In men it also carries semen from the prostate to the point of ejaculation during intercourse.
Urologist: A doctor who specializes in diseases of the urinary tract in men and women, and the genital organs in men.
Uterotubogram: See hysterosalpingogram.
Uterus: The hollow, muscular organ in the woman that holds and nourishes the fetus until the time of birth.
Vagina: The birth canal opening in the woman extending from the vulva to the cervix of the uterus.
Vaginismus: A spasm of the muscles around the opening of the vagina, making penetration during sexual intercourse either impossible or very painful.
Varicocele: A varicose vein of the testicles, sometimes a cause of male infertility.
Vas Deferens: A pair of thick-walled tubes about 45cm long in the male that lead from the epididymis to the ejaculatory duct in the prostate.
Vasectomy: Surgery to excise part vas deferens to sterilize a man.
Vasogram: X-ray of the sperm ducts.
Venereal Disease (VD): Any infection pertaining to or transmitted by sexual intercourse. Also known as STD or sexually transmitted disease - most commonly gonorrhea , syphilis and chlamydia.
Viscosity: Thickness of the semen.
Vulva: The external genitalia of the female.
Zygote: An embryo in early development stage.
Zygote Intra-Fallopian Transfer (ZIFT ( ZIFT Video ) ): Transfer of a zygote into a fallopian tube (usually done by laparoscopy)
This is a great " Infertility Lingo Guide" ( to help you make sense of abbreviations on the net) from
2 WW - Two week wait. The time between ovulation, conception attempts, or possibly AF.
ACA - Anti
ADI - Anonymous donor insemination. This is when a couple uses sperm from a donor they do not know.
ADN - Any day now.
AF - Aunt Flo. This refers to a woman's menstrual cycle.
AH - Assisted hatching.
AHI - Artificial insemination from husband.
AHI - At home insemination
AI - Artificial insemination.
AO - Anovulation.
AOA - Anti
ART - Assisted reproductive technology.
AWOL - A woman on Lupron.
BA - Baby asprin.
Baby dust - good wishes for getting pregnant.
BBS - Breasts
BBT - Basal body temperature.
BCP - Birth control pills
BD - Baby dancing. Sex that is hoped to end in a conception.
Beta - Beta hCG test
BF - Breast fed.
BFN - Big fat negative.
BFP - Big fat positive.
BIL - Brother
BM - Bowel movement.
BMS - Baby making sex.
BTDT - Been there done that.
BTW - By the way.
BW - Blood work.
C# - Cycle number.
CB - Cycle buddy.
CBEFM - Clearblue easy fertility monitor.
CCT - Clomid challenge test. A test where clomiphene is used to help predict the health of an egg supply.
CD - Cycle day. The particular day of the ovulatory cycle a woman is in.
CF - Cervical fluid.
CM - Cervical mucus.
CNM - Certified nurse/ midwife.
COW - Curse of womanhood.
CP - Cervical position.
Cryo - Cryopreservation. This is the freezing of embryos for future IVF use.
D&C - Dilation and curettage.
D&E - Dilation and evacuation.
DD - Dear daughter
DE - Donor egg. Eggs that are not those of the woman trying to conceive.
DH - Dear husband.
DI - Donor insemination. The insemination of sperm that is not that of the husband of partner .
DP - Darling partner.
DPC - Days since last Clomid pill was taken.
DPO - Days past ovulation.
DPR - Days post
DPT - Days post transfer.
DS - Dear son.
DW - Dear wife.
Dx - Diagnosis.
E2 - Estradiol. Estrogen that is most important to a woman's reproductive system.
ER - Egg retrieval. This is when mature eggs are removed from a woman's ovary for use in cryopreservation or IVF
EB - Endometrial biopsy.
EDD - Estimated due date.
Endo - Endometriosis.
EPO - Evening primrose oil.
EPT - Early pregnancy test.
ET - Embryo transfer.
EWCM - Eggwhite cervical mucus.
FBIL - Future brother
FET - Frozen embryo transfer. The use of embryos that are from IVF or cryopreservation.
FFIL - Future father
FG - Flower girl.
FH - Future husband.
FHR - Fetal heart rate.
FI - Fiance.
Fil - Father
FM - Forum mail.
FMIL - Future mother
FMU - First morning urine.
FP - Follicular phase.
FSH - Follicle stimulating hormone. It can also be used to refer to a fertility medication that is comprised of a naturally occurring or a synthetic hormone.
FSIL - Future sister
FT3 - Triodothyronine. This is part of a thyroid function work up.
FT4 - Thyroxine. This is part of a thyroid function work up.
FTTA - Fertile thoughts to all.
FUR - False unicorn root.
FV - Fertile vibes.
FW - Future wife.
FWIW - For what it's worth.
GAFIA - Get away from it all.
GD - Gestational diabetes.
GIFT - Gamete intrafallopian transfer. A technique in which eggs and sperm are deposited into fallopian tubes.
GM - Grooms men
GMB - Good morning brides.
GMTA - Great minds think alike.
GNB - Good night brides.
GnRH - Gonadotropin releasing hormone.
GP - General practitioner.
GYN - Gynecologist.
HAGD - Have a great day!
HAND - Have a nice day.
HCG - Human Chorionic Gonadotropin. This is the hormone in a human placenta, and it is what is measured in a pregnancy test.
HMG - Human menopausal gonadotropin.
HPT - Home pregnancy test.
HRT - Hormone replacement therapy.
HSC - Hysteroscopy.
HSG - Hysterosalpingogram. This test determines the tubal patency.
HTH - Hope this helps.
HUTH - Hang up the horns.
Hx - Medical history.
IAC - In any case.
ICBW - I could be wrong.
ICI - Intra
ICSI - Intra
IF - Infertility
IM - Instant message.
IMBO - In my biased opinion .
IME - In my experience.
IMHO - In my honest opinion.
Injects - Referring to an injectable fertility drug.
INPO - In no particular order.
IOW - In other words.
IRL - In real life.
ITI - Intra
IUI - Intrauterine insemination.
IVF - In vitro fertilization.
JIC - Just in case.
JK - Just kidding.
JMHO - Just my honest opinion.
JMO - Just my opinion.
JOTD - Joke of the day.
KDI - Known donor insemination. When a couple knows who their sperm donor is .
KISS - Keep is simple sweetheart
KUP - Keep us posted
KWIM - Know what I mean?
LAP - Laparoscopy.
LH - Luteinizing hormone
LMBO - Laugh my butt off.
LMP - Last menstrual period.
LO - Love olympics.
LOL - Laugh out loud.
LP - Luteal Phase
LPD - Luteal phase defect
LSP - Low sperm count.
LTBM - Living together before marriage.
LUF - Luteinized unruptured follicle syndrome.
MC - miscarriage
MF - Male factor.
MIFT - Micro injection fallopian transfer.
MIL - Mother
MOB - Mother of the bride.
MOG - Mother of the groom.
MOH - Maid of honor.
MS - Morning sickness.
N/A - Not applicable.
NAK - Nursing at keyboard.
Newbie - New to internet.
NFP - Natural family planning.
Niping - Nursing in public.
NMP - Not my problem.
NOYB - None of your business.
NP - No problem.
NRN - No reply necessary.
NWR - Not wedding related.
OB - Obstetrician
OB/GYN - Obstetrician/ Gynecologist.
OC - Oral contraceptive.
OD - Ovulatory dysfunction.
OIC - Oh I see.
OOT - Out of town guests.
OP - Original poster.
OPK - Ovulation predictor kit.
OPT - Ovulation predictor test.
OT - Off topic.
OTC - Over the counter.
OTOH - On the other hand.
Ov, Ov'ing - Ovulating or ovulation.
P4 - Progesterone. The test that measure the amount of progesterone in a woman's blood.
PCO - Polycystic ovaries.
PCOD - Polycystic ovary disease.
PCOS - Polycistic ovarian syndrome.
PCP - Primary care physician
PCT - Post coital. When a woman gets a pelvic exam after sexual relations.
PDA - Public display of affection.
PG - Pregnant.
PID - Pelvic inflammatory disease
PMS - Pre
POAS - Pee on a stick.
PPAF - Post pardum Aunt Flo
PPD - Postpartum depression.
PROM - Premature rupture of membranes. When a woman's water breaks prematurely.
PTL - Praise the Lord.
Px - Prognosis.
QOTA - Quote of the afternoon.
QOTD - Quote of the day.
R - FSH
RB - Ring bearer.
RE - Reproductive endocrinologist.
RI - Reproductive immunologist.
RSA - Recurrent spontaneous aborter. Someone who has had more than 2 miscarriages.
Rx - Prescription.
SA - Semen Analysis.
SAHD - Stay
SAHM - Stay
SBT - Sad but true.
SD - Save the Date.
SHG - Sonohysterogram.
SMEP - Sperm meets egg plan.
SNS - Supplemental nursing system.
SO - Significant other.
STD - Sexually transmitted disease.
Stims - Using fertility drugs to stimulate the ovaries to produce eggs.
TCOYF - Taking care of your fertility.
TFIC - Tongue firmly in cheek.
TGFD - Thank God for discharge.
TIA - Thanks in advance.
TMI - Too much information.
Monday, April 06, 2009
So what's the solution ?
Like most modern doctors, I never tell patients what to do. I believe in non-directive counselling, and believe my role is to help them to make the right decision for themselves.
When they need help, I usually tell patients to follow a three-step technique to help them make the right decision for themselves.
Step 1 - Use your brains
Knowledge is power and information therapy is essential medicine. If your doctor won't provide you with the information you need, please use the internet ; or get a second opinion.
Make a list of all your options. Use the McKinsey system, to make a list which is mutually exclusive and complete exhaustive. Please keep an open mind and just list all your choices. Don't be judgmental or make any attempt to censor the list.
The more the homework you do, the better your results. You can also brainstorm to come up with new options too ( What If I had a million dollars ? is a helpful tool to use when you need to think "out of the box").
Step 2. Listen to your heart
What if you had no constraints ? What would you choose ? Which is your first choice ?( Don't worry about the practicality of your choice right now - this will come later). There should be no ifs and buts at this stage. Continue to keep an open mind and don't think about objections at this stage. Remember, that you need to use a combination of logic and emotions to come to the right decision.
Step 3 Work out the logistics
This is the "nitty-gritty" of the treatment. Which doctor should I choose ? When should I start the treatment ? How can I afford the treatment ?
Patients often try to do this first - and then get stuck. If you do steps 1 and 2 ( in that order), the logistics will usually fall into place on their own. Doctors are experts are organising the minutiae of the medical treatment, so let them do this - after all, this is their job. You need to focus on Steps 1 and 2 - something which no one else can do for you !
You will find this framework extremely helpful in making the right medical decision when confronted with choices. Use it sensibly - and be willing to re-visit it as time goes by and you uncover new options ( Step 1); or your heart's desires change ( Step 2).
And what is the role of the doctor ? I feel my role is to be a safety net, in that I can reassure the patient that I will offer my recommendations ( and the reasons for these); and not let them make a wrong choice - but when there are options, I will allow them to decide for themselves, if they want to do so.
Sunday, April 05, 2009
Patients are emotionally vulnerable and they hang onto every word their doctor says. Even a casual statement - or expression - is analysed and interpreted
( misinterpreted ? ) in a hundred different ways.
Since patients now tend to place so much of their faith in tests and technology, many doctors will overtest - and then "find problems" which "need treatment". These are often red herrings of no clinical importance , but once a doctor has implanted a seed of doubt, it's very hard to get rid of this.
For example, I often see patients who have had recurrent miscarriages, who have been told they have a "bulky uterus" on ultrasound scanning. What does this mean ? Nothing at all ! Many fertile women have a large uterus, and this is of no clinical importance. The trouble is that the patient's mind often starts playing games. As it is, they have low self-esteem, because they cannot hold on to their pregnancy. When the doctor seems to have "identified the problem" using sophisticated technology, they are now convinced that their bodies are flawed - and are willing to do anything to correct this problem. Some will happily undergo useless surgery to "correct the bulky uterus" - while others will accept that surrogacy is their best option ! This is how doctors create patients for themselves !
The tragedy is that often when a patient goes to an expert for a second opinion, the expert does additional tests which the earlier doctor did not do. Even though these tests maybe useless, the patient is often impressed by how thorough this new doctor is - and how intelligent he is to have thought of all these additional tests which the earlier doctor was too dumb to prescribe ! If the tests then pick up a problem ( and remember that if you run a sufficient number of tests, you will always find a problem in everyone !) they are thrilled that their new doctor has finally found made the right diagnosis , which the earlier doctor was too incompetent to do! They are quite happy to then accept any treatment which is offered - no matter how expensive or useless it is.
We are now seeing a vicious cycle of over-testing and over-treatment. Unfortunately, with the "free market" system of medical practise, doctors, as rational human beings, are responding intelligently to the (perverse) economic incentives offered to them, so I don't think this is likely to improve. There is no incentive not to test or not to treat when testing or treatment are not needed - and the doctor who does not advise tests and treatment is often thought of as being an old-fashioned fool !
Let the patient beware - more is not always better ! Good doctors are usually conservative and know when masterly inactivity and watchful waiting are the best medical treatment options !