Saturday, November 26, 2011

Doctor vs Doctor

It's true that doctors often disagree. This means that patients get confused and frustrated, because they don't know what to do ! After all, if experts cannot agree, what's the poor patient to do ?

We need to remember that medicine is not an exact science - it's evolving rapidly, and recent advances can mean that there may be newer ( and better) options to solve a problem.

However, the bigger problems is that doctors have large egos - and are very fond of making up their own mind - and then closing it ! Many doctors will trust only their own "personal judgment" based on their "personal experience" - which means it's hard for them to accept alternatives. Some treat dissent as a personal insult - and will refuse to discuss options - it's "my way" or go away !

This is especially true when infertile couples seek medical help.

Gynec vs Gynec

The point of first contact for most infertile couples is their gynecologists. While most older ones are quite conservative, the young ones are more interventionist, and will often advise a laparoscopy as a preliminary investigation - even though most infertile women do not need one at all !

Gynec vs Gynec Endoscopist

Now that gynecologists have superspecialised, we now have a breed of gynecological endoscopists who will not accept the laparoscopy report of an ordinary gynecologist, and will insist on repeating this again. Even worse, they will make it a point to "diagnose" an abnormality which the earlier doctor missed, thus proving that they are better doctors ! Sadly, most of these "abnormalities" are just red herrings, which are of no clinical importance. This is especially true for those unfortunate infertile women who have endometriosis, for example.

Gynec vs IVF specialist

Most gynecologists are very reluctant to refer their patients to an IVF specialist, because they do not want to "lose" their patient. They will repeat IUI treatment cycles ad nauseum - till the patient gets fed up and frustrated.

While some of these differences are a result of maximising personal income, it's also fair to point out that it's not just pecuniary gains or vested interests which cause these differences in opinion. Many doctors have different world views, just because they see completely different patient populations !

Thus, older gynecologists who also practise obstetrics ( OB) are likely to see lots of older women who have got pregnant in their own bedroom. They are therefore much more likely to allow nature to take its own course and treat all 35 year olds as having normal fertility ! IVF
specialists , on the other hand, usually see only the ones who have problems - which is why they are much more worried about the biological clock , ovarian reserve and time !

We all have our biases - and this is completely natural . We tend to remember our successes and conveniently forget our failures.

IVF specialist vs IVF specialist

In fact, even IVF specialists differ amongst themselves ! Thus, many will remove a small hydrosalpinx prior to IVF; while others will routinely do a hysetroscopic metroplasty to "improve uterine receptivity" and facilitate embryo implantation !

Western medicine vs Alternative Medicine

This is also why IVF doctors have such a poor opinion of alternative medicine . They see lots of infertile women who have done a lot of alternative medicine and failed, which is why they then turn to IVF as their last resort. Because IVF specialists see only the alternative medicine failures, they start believing that alternative medicine is all rubbish and does not work.
Conversely, they have lots of faith in their modern technology - after all, they see embryos which they have created in their labs daily, and this can be quite awe - inspiring !

Alternative medicine doctors, on the other hand, have a completely different perspective ! They see lots of patients, many of whom have unexplained infertility , and who quickly get pregnant after they "treat them". Now whether the pregnancy was a result of the treatment, or inspite of it, is something we'll never be able to find out ! However, like all doctors, they are quick to take the credit for their successes - and their patients are more than happy to give them what they think is their fair due. This is how their reputation and practise grows !

I think the truth lies somewhere in the middle. Everything works, when used intelligently - the secret is to select patients carefully !

So what is the poor patient to do ? There's only one solution - you need to do your own homework, and the more you know, the easier it will be for you to make the decision which is right for you. It will be easier for your doctor as well !

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