Tuesday, August 30, 2011

How to do a consultation systematically in 3 steps

I was giving an infertile couple a tour of our IVF lab. The husband was a cardiologist and he was marveling over how complex IVF is . He knows I am a big believer in Information Therapy, and he started wondering aloud how I could explain something so intricate, involved and complex as IVF in a 15 min consultation.

I explained that I have a standard three-stage format for doing a consultation. In step number one , I explain normal fertility - how babies are made when everything is working properly. I review normal anatomy and physiology ; the role of the cervical mucus and the fallopian tubes; the concept of the fertile time; when ovulation occurs and how to track this; and the importance of frequent intercourse to maximize normal fertility. This is a review of the basics , just to make sure that patients understand the fundamentals. Sometimes , people think they understand , while they really don't , but they are too embarrassed to ask questions to clarify their doubts. I feel it’s always worthwhile doing this , no matter how sophisticated the patient seems to be !

In step number two , I explain to the patient what is wrong with them , based on her diagnosis – for example, if her tubes are blocked or if she is not producing eggs . If we don't have a diagnosis then step number two consists of explaining what tests are needed to establish the diagnosis.

In step number three , I explain to the patient what we can do to solve the problem . For example, if the tubes are blocked, we can use IVF to bypass the block; or if eggs are not being produced, we can use medicines to induce ovulation.

This is a simple and systematic approach , which ensures I do not forget anything and have covered all the possibilities . The good thing about this model is that it can be applied to any medical problem – whether it's heartburn or backache !

Step 1 : review the basics of how things work normally – the normal anatomy and physiology , when all is well
Step 2: explain to the patient what’s wrong with him ( or what tests you need to do to find out what the problem is)
Step 3: explain how we can fix the problem

This is a helpful model, because it obeys the basic learning principle that we need to move from the known to the unknown when teaching a new concept to patients .

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