Sunday, May 02, 2010

IVF doctors and oneupmanship

There is no question about the fact that IVF is a competitive business. IVF clinics are usually run by doctors in private practise, who do their best to attract lots of patients to maximise their revenue.

This competition can be good for patients because it enforces doctors to keep their prices competitive; and they also need to ensure that their technology is updated, so that they do not fall behind.

However, this can be a mixed blessing. One effective way of getting patients is to get an interview published in the press. This is why many doctors now employ PR agents, to ensure that they get a lot of press coverage. While this has its pros ( it creates a lot of awareness about the newer medical options which are available for treating infertility) , some of the downsides are that health journalists are often not sophisticated enough to differentiate between hype and reality - and they may end up misleading patints by providing inaccurate information supplied by the IVF doctor who wants to promote his clinic as being the best.

Along with competing with other IVF clinics for press coverage, many IVF doctors also play a more subtle game of oneupmanship within the clinic !

When a patient comes to you for a consultation, how do you show her that you are better than all the other IVF doctors ? What makes you their best choice ?

Let's take the case of the patient who has failed one IVF cycle, and is now looking for a second opinion. This patient has already lost confidence in IVF doctors and is now "looking for the best" !

There are many subtle ( and not so subtle) techniques doctors use to influence the way the patient perceives them.

1. Give appointments after many weeks , to show how busy they are !

2. Give the patient an appointment, and then make them wait for ever and ever, in order to see the doctor. ( It's easy to do this if you have poor time management skills, and overbook lots of patients for the same slot ) Patients are very impressed by how busy the doctor is ! As Prof Cialdini's book, Influence showed, social proof is a powerful way of influencing others !

3. Order lots of tests - and the more expensive and esoteric they are, the better ! This long list of tests shows how thorough this doctor is ( in comparison with the earlier doctor, who missed out on doing all these basic tests - another testimony to his incompetence !)

4. Use new ( unproven and untested) tests and treatments ( such as IMSI)

5. Use lots of jargon to confound the patient. Any one who uses so many polysyllabic words must truly be an expert !

6. Criticise the earlier doctor, for not doing a good job ! ( for example, if the doctor did a Day 3 transfer, even if this is standard medial treatment, say they should have done a Day 5 transfer). It's very easy to be wise in hindsight, but you do not improve your standing by pulling someone else down !

The truth is that you can fool some of the people some of the time - and it's especially easy to fool infertile patients , most of whom are very vulnerable and desperate. However, this approach can also often backfire. Badmouthing other doctors can end up hurting all doctors ! You cannot build up a patient's confidence in your medical skills by undermining her confidence in other doctors ! Also, what goes around comes around - and the other doctor will be happy to badmouth you when your failures go to him ! Doctors need to take a more mature approach - if you are good, you are good , and you don't need to be any better than anyone else !

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