I’m an IVF specialist and most patients come to me for a consultation because they want IVF. They have been advised to have IVF treatment, and they will ask me for a second opinion , or come to me as their consultant of choice for their IVF treatment. They expect that I’m going to advise them to do IVF too - after all, doesn't an IVF specialist advice patients to do IVF ? However, when I review their records , I find that some of these patients don’t need IVF at all. Lots of them just need counselling ; or medication to induce ovulation ; or perhaps artificial insemination or IUI.
When I tell them, “I don’t think you need IVF and here are simpler alternative options which are much easier and much less expensive”, some of them are taken aback. They say, “We came to you because you’re an IVF specialist and because we want IVF , and you’re turning around and saying we don’t need IVF and you’re refusing to do it for us”. Some of them actually get upset , but there’s very little I can do about this.
It's much easier for me to just go ahead and pander to their request and do the IVF cycle because that’s what the patient wants. And isn’t the customer always right?
But I really can’t really do this in good conscience because I don’t think it’s fair to do IVF just because the patient thinks they need it. As a professional, I should be convinced that IVF is the best solution for them , before actually advising IVF for them. So, though I know that I do risk losing the patient, who is likely to be unhappy with my advice and go to another IVF doctor, this is something I’m quite comfortable doing. Some patients are mature enough to understand that the very fact that I’m advising them not to do IVF, means I’m looking out for their best interests - that I doing what I think is right for them , rather than just trying to maximise my income.
Mature patients are willing to keep an open mind and they understand that as a conservative doctor, I prefer simpler less expensive options rather than more invasive expensive choices. This requires a lot of counselling and I need to spend a lot of time convincing them why they don't need IVF. I think it’s worth doing this, because I can sleep well at night, knowing I’m doing what’s right for my patients. A good infertility specialist knows how to do IVF; a better doctor knows when to do IVF; and the best specialist knows when not to do IVF !
Of course, if the patient is not happy with my advice, they will walk out of my clinic and go to the next IVF clinic , who perhaps will be happy to do what they want. But this is something which I accept is likely to happen , and I don’t get upset or worried about this. Patients will get the doctors they deserve - and doctors get the patients they deserve !
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