Thursday, December 23, 2010

The quality of a doctor's answers depend upon the quality of a patient's questions

Recently I witnessed an infertile couple who had over three heavy files bulging along with medical tests and reviews. They may have visited more than ten infertility experts who tried every single possible examination under the sun to attempt to discover what their issue was. The lady had been examined for antisperm antibodies, NK cells , hostile cervical mucus, tuberculosis, chlamydia, sperm DNA fragmentation… you name it, and she had had the examination done. Every single gynaecologist had repeated test after test, however every result had been normal. They were at their wit’s end. “Why can’t I get pregnant , doctor , if things are all normal ?” was her plaintive cry.

I was surprised about how little she had learned after going to numerous doctors. Rather than understanding from her experience, she was still asking the wrong question ! She expected me to order extra medical tests, or utilize some modern device in order to probe her insides and pinpoint the elusive issue.

I needed to advise her that the quality of the response we get is determined by the standard of the actual question we ask. Nobody cares about issues - folks just worry about solutions. Rather than continue asking “What’s the issue ? Why aren’t I getting pregnant ?”, she need to preferably be asking , “What can I do in order to get pregnant ?”

Ask a better question , therefore you get a far better answer ! It was an entirely new perspective for her, and I had to walk her through this viewpoint. As I told her, it barely mattered what are the reasons for her inability to conceive had been - the only thing which mattered was how all of us can fix the problem.

Everybody knows: GIGO - garbage in, garbage out. In case you continue asking “What’s the problem ?” you will end up throwing away a lot of time, money and energy in trying to discover it. Sadly, several of these diagnostic labels are incorrect, unreliable or simply completely wrong. For instance, a couple of years ago, numerous patients had been identified as having an “inadequate luteal phase” - and perhaps treated for this issue ! We now realize, with hindsight, that there's absolutely no such situation, and we did a significant disservice to our patients by coining this term and doing such a (mis)diagnosis.

This breaks my heart when I notice how much time and money infertile folks have lost in seeking a diagnosis. Is it the endo , doc ? Could I be possessing antisperm antibodies ? These are all the completely wrong concerns, but we see this all the time.

Hence, after a unsuccessful IVF cycle , the first question patients ask is - Why didn’t I get pregnant ? (Interestingly, patients who conceive after IVF (In Vitro Fertilization) never ask - Why did I get pregnant? The truth is that we can't answer either of these questions - and quite often it’s only a matter of chance!

The correct question patients should be asking after a unsuccessful IVF cycle is - What can I do next? Usually, the best solution would be to repeat the IVF (In Vitro Fertilization) cycle. It’s a lot like purchasing a lottery ticket - there’s absolutely no compulsion to do so, but if you don’t buy, you don’t win! And the oftener you purchase, the greater your chances of winning!

That's why, for many infertile patients, it’s better to look ahead instead of to look backwards. The best question is - What’s the next thing? Its best if you make a list of all feasible treatment alternatives - ranging from: stopping treatment and remaining child-free; adopting; repeating the IVF cycle; doing the IVF cycle at a new medical center; or utilizing third party reproduction. After that you can eliminate the alternatives that you will not consider, so that you are then left with the alternatives you are ready to explore. After this you ought to concentrate on each one of these, until you discover one which is best for you.

Usually, if you are using this technique, you might find that the absence of alternatives makes decision making easy , and you can prepare your next step and navigate your path through the infertility maze with much less effort !

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