Monday, April 27, 2015

When IVF Doctors Disagree


Patients think of IVF as being a medical science,  where everything is in black and white . They naively believe that all IVF doctors, irrespective of where they practice, will look at a patient's medical record  and then formulate a treatment plan which will be exactly the same , no matter who the doctor is. 

Unfortunately the fact is that medical practice is not just a science, it's also an art, and a craft . When doctors disagree, this often leaves patients confused and upset , because they are not sure whom to trust , and it's hard to deal with uncertainty . Thus there will be some doctors who will insist on routinely doing a hysteroscopy for all patients before an IVF cycle.  Others feel that this is not required if the vaginal ultrasound scan shows the endometrium is normal. 

This means that if a patient who does an IVF cycle at one clinic and fails, and then goes to another doctor for a second opinion, and this new doctor says - " Your cycle failed because your doctor didn't do a hysteroscopy", the patient is going to feel cheated . She will complain that the earlier doctor was negligent , and that the reason she didn't get pregnant is because the doctor did not bother to do a hysteroscopy. She jumps to the conclusion that her earlier doctor was sloppy , careless and incompetent because he did not test her properly before doing her IVF treatment. She many even feel that he was out to make money by doing IVF, which is why he took a shortcut which resulted in the failure !

This reasoning is flawed.  It is not compulsory to do a hysteroscopy before IVF , and whether or not the doctor had done the hysteroscopy, this was very unlikely to have changed the outcome of the IVF treatment.  However once that seed of doubt has been planted in the patient's mind, she loses confidence in the doctor . The problem is that once she loses confidence in one doctor, she loses confidence in all doctors . She starts treating all of them with suspicion and wonders whether they know what they are doing. 

The fact of the matter is that doctors disagree because each of them has personal preferences , and this quite acceptable. The problem arises when doctors do not explain what they are doing and why they are doing it.  This is not because doctors are trying to hide information from patients - it;s just they are very busy , and because many believe that patients should trust them, and accept whatever advice they give them, without counter-checking .

When there is a discrepancy between what one doctor advises and a second doctor's opinion , this doesn't mean that one is wrong and the other is right.  Patients need to be mature enough to understand tthat there are multiple ways to skin a cat . They need to appreciate that no one doctor has a monopoly on knowledge . If there is a difference of opinion, this is not because one doctor is clueless, or the other is smarter or better informed, but it's simply because that there are no black or white answers in IVF  ! Patients need to do their own homework , so that they can find the treatment path which they are most comfortable with.

Need help in making sense of conflicting advice from different IVF doctors ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !




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