Tuesday, April 21, 2009

Turning patients away

I just saw a couple who wanted IVF treatment. She was 33 and was worried that her biological clock was ticking away. They both had very stressful jobs which involved extensive travelling, so that their marriage was a weekend marriage - and on the weekends they were often too tired to have sex !

She didn't want to wait for nature to take its own course, and wanted me to do an IVF cycle for her, because she did not want to be an " old " mother.

I did my best to discourage her. While it may be in my best financial interests to do IVF for her, I am not sure it's a good idea to convert a pleasurable bedroom activity into a clinical activity. However, she is a very successful businesswoman, who knows her own mind, and is quite sure that this is what she wants.

What should I do ? Should I agree to her request ? From her point of view, her request is quite reasonable, since she does not have the luxury of time to wait and watch - and after all, if the technology is available, why should I refuse to use it for her, just because she does not meet the medical textbook definition of being infertile ? She feels she is making a well-informed decision, and is willing to fund it. Am I being too patronising by refusing to treat her ? Should I respect her autonomy and do what she wants ? How do I decide what is right ?

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  1. Anonymous6:35 AM

    Your dilema is well taken and appreciated. But in this situation I am inclined to side with your patient.

    The women has in her mind, clearly demarcated the line for her self. By her own admission she's a career women, who is fine with technology helping her with her needs. She has made peace with it. Being educated she understands what she's loosing out in the process. It's an educated compromise on her part, if you will.

    From a third party POV, I see the doctor's role on couple of levels. One, he should see if the patient is healthy to undertake this operation. Two he should be willing to guide and consult her through this process, because even though she's technically "not sick", she still needs medical help to fulfill her need. If it was possible without the medical route she would have opted for that. Given her situation she's probably making a choice for her own good.


  2. //. She was 33 //
    since the age is 33, I second your patient's choice

    If the age is 25, I would have gone for your side


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