Sunday, September 27, 2009

When doctors cannot answer "Why ?"

The commonest question doctors are asked is - Why ?

As an IVF specialist, the questions I get include:

Why is my sperm count low ?
Why did the IVF cycle fail ?
Why am I not getting pregnant even though all my tests are normal ?
Why did I miscarry ?

Not being able to provide a good answer is frustrating - for both doctors and patients.

While we do understand some of the causes, the fact is that most of the time we are clueless as to what the real underlying reason is for an individual patient . Doctors are good at describing what happens - and we can often give these conditions a name. While providing a label can help to reassure patients that we have dealt with problems similar to theirs in the past, the honest truth is that medical technology is often not good at drilling down to find the answer to the Why ?

Some doctors, in order to placate the patient will often order a series of additional tests - some of which are very expensive . The results are often more gobbledygook - but because they are "scientific", they often provide patients with consolation that this new doctor is very "thorough" and well-informed - and he has been able to find a problem which all the earlier ( incompetent) doctors failed to find.

Unfortunately, many of these tests are completely useless, because they do not change the treatment options. In fact, they can often be actually harmful, because the doctor ends up wasting the patient's time and money pursuing and "treating" red herrings.

Unfortunately, most doctors refuse to take a critical look at their practise , and because of their personal biases, continue subjecting their patients to a battery of tests, even though they have not been proven to be helpful. Many patients are happy to toe the line, because they are fed up; frustrated; and are willing to clutch at straws !

Mature patients are willing to accept that life is full of mysteries; and that medicine is often an art, rather than a science. They willingly take the help which the doctor provides , but also understand that medical science has its own limitations. The sooner they come to terms with this, the easier it will be for them to move on with their life.

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