Saturday, November 06, 2010

Why are patients so naive ?

I just saw a patient who was at her wit's end. She had done 4 IVF cycles at the same clinic and had failed all of them. She was angry; and was complaining bitterly about how badly the doctor at the IVF clinic had treated her. " She would make us wait for hours - and we only got a chance to talk to her at the first consultation. After this, all the care was provided by her assistants, who refused to allow us to meet Madam ! "

I asked her some basic questions about her medical treatment. " I need more details about your prior IVF cycles . What were the medications which were used for superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo quality ? Do you have photos of your embryos ? What was the endometrial thickness ?
Can you please send me the printed treatment summary from your IVF clinic ? "

She was completely clueless about these basics ! She had no idea about how many eggs were collected each time - or even how many embryos were transferred. All she had from the clinic were some prescription slips - but no medical details at all.

I asked her why she didn't have this and she replied - " The clinic keeps all the medical records for all the patients. They do not give us copies ! The doctor does not tell us anything; and does not answer any of our questions. If we ask the staff or the assistants, they just tell us - Talk to the doctor - but the doctor is never available ! She is too busy seeing new patients ! The doctor did not give us any papers even though I asked for them many times !"

She was feeling very sorry for herself that her doctor has been so unhelpful - but did not think she could have done anything about it. Her attitude was - " This is the way things are done ", so what can I do ? "

I agreed with her that her doctor seemed to have provided very poor quality care ! However, while she was not responsible for her doctor's actions, she was responsible for her own - and the fact that she had not been more assertive and proactive reflected poorly on her !

I can understand her feeling helpless in the first cycle - after all, she had no way of knowing how transparent her doctor would be. But to allow the same poor quality care to continue for 4 cycles meant that she continued to allow her doctor to provide poor quality treatment. She was as responsible for her poor care as her doctor was !

As the old saying goes - " Fool me once - shame on you; fool me twice - shame on me".

In fact, I would be much more critical of her than her doctor. I can understand why her doctor was not willing to talk to her - she was just behaving rationally and optimising her income by seeing more new patients, to improve her clinic turnover. However, why was the patient behaving like a passive victim ? She was paying big bucks for her treatment, and should have been more assertive and articulate ! There was no reason for her to continue going to the same doctor if she was unhappy after the first IVF cycle. There's no shortage of IVF clinics in India - and many doctors treat their patients with respect and provide a high quality service .

Part of the problem is that patients do not respect themselves enough ! Infertile patients are so desperate for a baby, that they just do not use their common sense when dealing with their doctor. They want a doctor who will solve all their problems and provide them with a baby, which is why they want to be able to blindly trust their doctor. They do not dare ask too many question because they are scared this may upset the doctor and rock the boat. They are happy to toe the line and be compliant - and they just do what all the other patients in the clinic are doing, since this seems to be the accepted norm.

Often, many of them do not even know that they have a right to their medical records - or that there is a better and more enlightened way of doing things. They underestimate their ability to understand and take charge of their treatment.

Sadly, it's not just doctors who do this - many other professionals do so as well. I remember my experience with a Senior Counsel who is one of India's leading lawyers. When I went to him for a consultation, he refused to talk to me and spoke only to my advocate. It seemed that it was beneath his dignity to discuss my case with me !

The good news is that I found another lawyer whose approach was refreshingly different ! He dictated the brief in front of me - and this inspired confidence in me that he knew all the facts of my case and the relevant law as well !

I behaved as a responsible consumer - and when I found the first lawyer's attitude unacceptable, I found another lawyer ( even though the first lawyer had much higher brand name recognition !)

I think patients also need to take a similar assertive approach. Not all doctors are the same - and many are proactive, respectful and thoughtful. If your doctor does not treat you with respect, then you should find another doctor. And if you are too scared or lazy to do so, then please do not complain about the care you receive !

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