Thursday, July 24, 2008

It's easy to fool patients

As an IVF specialist, I often cringe when I see what other infertility specialists do when they see patients.

Some common sins are:

1. Letting an assistant take the history, so the "expert" only spends a few minutes formulating the treatment plan. This is not a good idea, because taking a history is a great opportunity for the doctor to establish a personal rapport with the patient. Very busy doctors just don't have the time to do this, and they often delegate this key task to an assistant. This often means that patients do not get a chance to establish a relationship with their doctor.
2. The "expert" only see the patient on the first visit, at which time they he is on his best behaviour, because he is trying to convince the patient to come to him for treatment. After the first visit, the patient never gets to see the "specialist" again - and has to make do by talking to nurses and assistants.
3. Overtesting. Many clinics will routinely perform a "laundry list" of tests and investigations for all comers. This is bad medicine, because one size can never fit all. All this overtesting leads to additional problems such as overtreatment for unimportant findings, which are of no clinical importance. Not only are some of these "exotic" tests ( such as immune testing or tests for NK cells ) very expensive, their results are impossible to interpret, because they have never been validated. This type of testing adds to the aura of expertise ( because these are "new and specialised" tests which have never been done before !). Unfortunately, all they end up doing is wasting time, money and energy.
4. Lack of transparency. Many clinics keep all the medical records; and do not share data or information with the patient. Not only is this very disrespectful, it's downright illegal, because patients have a right to their own medical records. Clinics do this in order to be able to "hold on" to their patients.

How can specialists get away with such behaviour ?

The commonest reason is because patients are intimidated and do not dare to ask questions. Because they are desperate, they put all their hopes on the doctor's expertise, and do not want to "rock the boat" by complaining or asking questions ! This leads to a vicious cycle, and because experts can get away with it, they continue doing so ( because this saves them a lot of time and allows them to maximise their throughput and their income).

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