Monday, April 18, 2011

Preparing for the worst

I always tell me patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative - and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.

Intelligent patients appreciate my honesty and frankness - they prefer a doctor who will tell them the unvarnished truth. Others who cannot handle the truth will usually move on to another doctor who is willing to promise them the moon - and who is happy to tell them what they want to hear !

It's very easy to smile; be optimistic - and make false promises. Everyone wants to think positive - and if you believe the book The Secret, then positive thoughts attract success !

While I am personally very optimistic by nature, I feel it's not correct for a doctor to overpromise success ! Patients are emotionally very vulnerable and it's easy to take them for a ride - something which many unscrupulous IVF doctors do all the time, by quoting inflated success rates and promising the moon !

When I tell patients to prepare for the worst , this does not mean that I not hopeful or that I am a defeatist. I am not being negative or being a pessimist - I am just trying to be a realist !

Being prepared does not mean that you are expecting a bad outcome or that your negative thoughts will attract failure - it's just that you are preparing for it. This is something you do in daily life all the time , so why shouldn't you do it during your IVF treatment as well ?

It's always easier to mentally prepare when you do not need to !

Let's assume to decide to be positive, optimistic and upbeat and prepare only for a good outcome. If you do get pregnant, you'll be pleased and happy - and life will move on. However, if you do not get pregnant , you will go to pieces. Bouncing back will be much harder - and you'll find coping with the emotional roller coaster ride much more difficult.

However , if your prepare for a bad outcome and get pregnant, you get double the joy ! And even if you do not get pregnant, while your heart will still break, your mind will help you heal faster because you were mentally prepared for this.

It's harder to deal with a negative outcome when you are not ready for it ! IVF is a scary emotional roller coaster ride and mental preparation gives you some stability.

The trick is to find the right balance - to look for the middle path - what Buddha called the golden mean ! It can be helpful if both partners have different world views because they can balance each other !

However, if the husband is optimistic and the wife is pessimistic, and the cycle fails, he may end up blaming her for the failure because " you are always negative" ! Victim blaming is very common when patients adopt a pessimistic approach in order to protect themselves from heartbreak - and this is just adding insult to injury !

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  1. It is such a fine line between being realistic and setting someone up for failure, especially in this industry.

    Perhaps you're being a little harsh in saying 'intelligent' people will all appreciate the 'honesty', because everyone, even intelligent people may feel the burden of being vulnerable.

    I think you are so right to not overpromise, so long as you temper this with a bit of encouragement (perhaps comparing it to the rate of success for normal couples to fall pregnant without IVF, or that the patient is in excellent hands, etc.), because the IVF patient is under enough stress as it is, and regardless of whether or not you know the stats, the reality of not having a successful IVF procedure is bleak, despite knowing the odds - if you didn't believe it would be successful, you wouldn't be Investing the time, emotion and money on the procedure in the first place.

    Great topic for raising some conversation, though!

  2. Yes, you are right - it is a fine line - and thoughtful doctors do their best to keep their balance, because it's cruel to take away a patient's hope. However, false hope can be even more cruel, and it's very difficult for a doctor to judge on the first consultation as to whether the patient needs a dose of a reality check; or a pep talk to boost her spirits.

    I find that most doctors overpromise - and under-deliver. I'd prefer the opposite approach, as it helps patients to have realistic expectations of what we can do for them.


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