Tuesday, April 03, 2012

Doctor , do I really need to do a HSG ?

I was doing a consultation for a patient who had failed three IVF cycles in other clinics. In order to maximize her chances of success, I told her we could do a ZIFT for her ; and that in order to confirm that her fallopian tubes were open, I needed her to do a HSG.

She had had a HSG done over three years ago, which was normal, and wanted to know why I wanted her to repeat this. However , reports which are over a year old are suspect , and doctors will often be forced to repeat them , in order to ensure that the results represent the current clinical situation. The patient was understandably quite reluctant to repeat the HSG again. Not only is a HSG quite painful , it's expensive as well , and her logic was that if my tubes were open 3 years ago and I have not had any infection or any problem since then, then why would they be blocked now and why do I need to repeat the test again ?

I could understand her viewpoint , but as a doctor , I'm a medical expert and I can't afford to take any shortcuts in my treatment . We need to follow a certain protocol , and as a good doctor , I can explain the rationale behind my protocol to my patient. Some patients will be happy with this explanation , and will be happy to comply with my suggestion , because they understand the importance of repeating the tests. However, some patients will stick to their guns and will refuse to repeat the tests.

I think that's absolutely fine as well, provided they understand the reasoning behind my advice. It's perfectly okay for patients to take shortcuts , because this is a decision which they making for themselves – and they are ones who will suffer the consequences of whatever decision they choose to make. I am very reluctant to force a patient to do something she doesn’t want to do, provided she understands that she was taking a small risk by choosing to forgo the HSG.

As a doctor it's difficult for me to take shortcuts . Having said that , protocols can be fairly mindless and do not necessarily apply to all patients, which is why I always seek the patient's input and am quite happy to allow them to make the final decision for themselves. If they decide they don't want to do all the recommended tests and procedures, that’s fine by me.

This does not mean that I'm a wishy-washy doctor or that I don't know what to do. It just means that I'm willing to respect the patient's preferences and incorporate them within my treatment plan , because I'm willing to be flexible and understand that there are no hard and fast rules in medicine. All rules can be broken , if that's what the patient wants to do.

Of course, this applies only for intelligent , well-informed patients , who are highly engaged in their own medical care and are capable of making their own decisions for themselves, rather than those who passively depend on the doctor to do everything for them. Fortunately for me, these are the kind of patients I enjoy treating !

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