Saturday, May 16, 2015

Doctors as Liars and Patients as Fools


I recently did a consultation with a patient who was very upset with the earlier IVF doctor she had been to .  She said the doctor was very pleased with her IVF treatment cycle, and that everything had gone perfectly. He's transferred three Grade A embryos and at the point of transfer he told the patient, 'Your chances are brilliant, and you have a better than ninety percent chance of getting pregnant because your embryos are such good quality.'  After fourteen days, when the Beta HCG came back as negative, the patient was distraught so she went back to the doctor to say, 'You told us we had such a good chance of getting pregnant, and you transferred three excellent embryos and were pretty confident that at least one would stick, but nothing implanted'. The doctor then started singing a completely different tune.  He said, 'Maybe you have a hydrosalpinx and we need to do surgery to clip the tubes', but by that time the patient had lost all confidence in that doctor . Even worse, she’d lost all confidence in all IVF doctors, so she was extremely reluctant to go to another IVF clinic.

I think the doctor is to blame , because he over promised . He made a claim which he knew was obviously not true. No matter how good the embryos look, there is no way anyone can claim they have a ninety percent chance of implanting, he should never have said this.  It's possible he said this in order to make the patient happy, but doctors need to understand that their words have a lot of
clout. Actions have consequences , and overpromising success can come back to haunt the doctor. 

However, it wasn’t just the doctor to blame.  I think patients also need to take some responsibility for doing their research. Maybe I am being a little harsh by calling the patient foolish, but the fact remains that if she had done her homework, she would have understood that there was no way any IVF doctor could talk about a ninety percent success rate .  She would  have realised that this was just hyperbole and, maybe if she’d figured this out, she wouldn’t have been so hopeful, which also means that she wouldn’t have been so depressed, unhappy , resentful and disappointed when the cycle failed.

This is why it’s so important that both doctors and patients are on the same page , and this is where information therapy has such a key role to play, because it keeps everyone honest.  When the doctor knows the patient is well informed , he will not end up overpromising unrealistic success rates. He will respect the patient , because he knows the patient knows the truth and is capable of acknowledging the possibility of failure. Ideally , the doctor should take the time and trouble to educate and inform the patient , so that she has realistic expectations of the IVF treatment.

I think trying to be excessively cheerful or trying to keep the patient happy by saying stuff which may sound like music to the patient’s ears during the IVF treatment can help on a short term basis. However, this also means that on a long term basis , the patient is going to be extremely unhappy and frustrated when the truth finally comes out.  If doctors don't want to be branded as liars, they need to understand that their patients are not fools . If they take the time and trouble to educate and inform them, this is good, both for their patients and for themselves as well.


Looking for an IVF doctor who calls a spade a spade ? 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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