Friday, December 07, 2012

Should patients follow their doctor’s advise ?

Patients come to infertility specialists  because we have a lot of technical expertise. We spend many years in medical  school, mastering technical skills and are very good at doing procedures such as egg collections and embryo transfers. However, when patients come to us, along with our technical expertise, they also ask us for our professional opinion. After all , infertility specialists are medical professionals who can counsel patients as what their treatment options are ; and what their best course of action should be.

While many infertile couples expect the doctor to provide them with guidance , not all of them will. Many couples know exactly what they want ; and they want to use the doctor as a technician who can perform assisted reproductive procedures for them in the lab, because they cannot do these for themselves in their own  bedroom . These patients use their doctors as technicians , rather than as professionals.

In one sense , this is an easy group of patients to deal with , because they know their own mind. They don't need much counseling and they merely use the IVF clinic to execute and implement their treatment plan. Many of these are older women with poor ovarian reserve , who are quite sure that they will not consider either egg donation or adoption . They want the doctor to do IVF for them, even though they know their chances are quite poor because of their diminished ovarian reserve.

On the other hand , these can be difficult patients to work with, especially when the doctor does not agree with the plan of action which they propose. Doctors have egos and opinions ; and many expect patients to follow the advice which they give them . When the patient does not follow this advice , some doctors feel threatened and can get quite upset with the patient. Also, doctors are likely to be biased towards advising medical intervention – both because this is what that they’ve been trained to do ; and because it is more profitable for them to do so.

I think the trick is that both the doctor and the patient need to be on the same page . If the patient is looking for a technician , and the doctor is happy to provide only his technical expertise ( even though he may not see eye to eye with the patient), this is a winning combination. Similarly , if the patient wants professional advice and the doctor is happy to provide his counsel which the patient takes into consideration when making a final decision , both are likely to be happy with each other.

However, when the patient is looking for a counselor who will provide them with professional guidance and if the doctor thinks of himself as being a technical expert, both will be unhappy. Similarly, when the patient has made up their mind as to what treatment they want , and if the doctor does not agree with this treatment plan, he may get offended because he thinks of himself as the professional who makes the decisions in his clinic !

Infertile couples have many medical and non-medical options, and I usually advise them to search for additional viewpoints –  try to find someone who will play devil’s advocate, so you can analyse the pros and cons of all your options, rather than  prematurely closing your mind and selecting the first one which appeals to you. Remember that there are no right answers – only an answer which is right for
you ! Even this answer will change, as time goes by and you grow and mature.

However, you need to make your own decisions – after all, this is your life ! Try to find a non-judgmental doctor who will provide non-directive counseling and who will support you, so you have peace of mind you did your best.
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