Thursday, April 28, 2005

Doctor , what would you do ?

As an IVF specialist, one of the commonest decisions we need to make is how many embryos to transfer. This remains one of the most difficult decisions, and we allow our patients to decide for themselves. Most patients ask me - "Doctor, what would you do ? " and are quite happy to leave the decision upto me - the medical expert.
However, even after 15 years of practise and having over 1500 IVF babies, this remains the most difficult question to answer.
I usually tell patients, "If the technology was perfect, I would not be asking you this question. If you wanted one baby, I would transfer one embryo; and if you wanted twins, I would transfer two. However, the technology is not perfect, and each embryo has about a 10% chance of becoming a baby. It's stil not possible for us to predict which embryo will become a baby, but we do know that the more the embryos we transfer, the better your chances of conceiving. However, as with other areas in life, there is a price you pay for everything. More is not always better, and there is a risk of having high-order multiples such as triplets and quadruplets if you transfer three or more embryos. It's a trade-off, and you need to weigh the risks and benefits before deciding."
A common response to this is - "Yes, doctor, we understand, but what would you do if you were in our place ? Can't you decide for us - we are confused ! You have so much more experience and expertise in this matter ! What do your other patients do ? Can't we do the same ? "
While it's very tempting for me to decide for my patients ( and very flattering to my ego), I try to resist this strongly. After all, it's my patients who have to live with the consequence of this decision for the rest of their lives, not me, which is why I feel they need to decide for themselves.
I remind them, " The very fact I am allowing you to decide means I need your input. I promise I will never let you make a wrong decision - but when there are options, you need to choose for yourself. If you are not sure, take the path of least regret, so you have peace of mind you tried your best. Every patient is different; everyone has a different perspective, which means given the same set of circumstances, 100 different patients may choose 100 different options. What I would do and what others do is all irrelevant - you need to do what's right for you !" Non-directive counselling means trying not to impose your viewpoint on the patient - after all, even doctors have biases, and we should not allow these to sway our patients.
While most patients appreciate why this is so important, others remain unhappy that the doctor is not helping them to decide.
The moral is simple - The buck stops with you. Learn to become well- informed, and to make your own decisions. It's hard to do so, and it's very tempting to abdicate the responsibility to your doctor, but this is not wise. You have made such hard decisions in your life before as well ( "whom should I marry " being an excellent example), so have faith in your abilities to decide for yourself !

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