Friday, July 24, 2009

Is the doctor a technician or a professional ?

Most doctors think of themselves as being professionals, and most patients will treat them as such. Not only do they expect the doctor to provide technical expertise, they also want their doctor to guide them as to which the best treatment option for them is. This is true for most doctor-patient interactions, when along with providing medical expertise , the doctor also acts as a friend , philosopher and guide.

However for infertility treatment , some patients take a much more proactive role, and use the doctor as a technician. They are very sure about what they want - and they simply use the doctor as a tool to gratify their personal desires. While some doctors are offended when patients make their own decisions for themselves, I find this a perfectly reasonable approach. In fact, for some patients , I find it's better to let them make their own decisions, so that they take ownership and responsibility for both the decision and the outcome. Since the outcome of any treatment is uncertain, taking the treatment they want to gives them peace of mind they did their best !

My job as a doctor is to ensure that this is a well informed decision, so I provide them with the facts and figures they need and explain the pros and cons of the various options. I try to be nonjudgmental and to give them the freedom to choose what is right for themselves. Thus, if I have a 45-year-old woman who wants to do IVF, I will explain to her that her chances of getting pregnant with her own eggs are very slim ; and that the chances of success are much higher if she is willing to use donor eggs. If she understands this and then chooses to go ahead with her own eggs, I am happy to support her decision.

After all this is her life. As a doctor , I can only provide a narrow medical perspective. I appreciate that when making important decisions like this , a lot of other factors come into play – intangibles such as emotions, religious beliefs and finances. These are areas in which the patient is the real expert - and my role is to empower her to make a decision she is comfortable with. Since she cannot do the IVF for herself in her own bedroom , she requires my help as a medical expert - and I am happy to serve as a technician in this role.

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