Monday, May 20, 2013

Bad doctors and worse patients

Patients enjoy complaining about doctors . Favourite complaints include:
how long they make them wait;
how much money they charge;
how many tests they order ;
how little time they spend;
how they never explain anything.

This is particularly true when the medical treatment does not go as planned. This is why when an IVF cycle fails , patients have a lot of complaints about their IVF doctor . No doubt some of these complaints are justified - but not all of them are !

When a patient who has failed an IVF cycle comes to me for a second opinion, the first thing I ask is - you please show me photos of your embryos. The standard response is a blank look, followed by - I didn't even know that you could ask for photos of your embryos ! When I reprimand them for not being better informed , they start getting defensive.“  I am not a doctor, so how am I supposed to know that you can take photos of embryos ! “
“ My doctor never gave me any, so what can I do ? “ When I ask why they did not do their homework before starting the IVF cycle, so they would know how critically important photos of the embryos are, because they document the quality of the IVF treatment , the response is – “ Isn’t that the doctor’s job ?”

Patients think I am criticizing them – and they start justifying their lack of information . When I question them , I'm not trying to be critical ; and I am definitely not trying to badmouth the earlier doctor; or make the patient feel bad about what happened in the past. I am simply trying to galvanise them into being more proactive, so that start to take more responsibility for the quality of care they receive ! Patients simply cannot afford to leave everything up to the doctor – they need to do their homework
proactively , before going for treatment.

During one of these Q and A sessions which I had with a patient recently , she got increasingly upset and frustrated . I went to a doctor because he was highly recommended , and I blindly obeyed everything he told me ! This doctor had a great bedside manner; and she trusted him. If he does not give photos to this patients , what do you expect me as a patient to do about this ? How can I question him ? Won’t he get upset because he thinks I am challenging his competence ? The patient then started blaming the doctor for not providing the photos.

Yes, it's true that any IVF doctor who does not proactively and routinely provide photos of the embryos to his patients is a bad IVF doctor . However, a patient who doesn't insist on photos of her embryos is an even worse patient – and perhaps deserves to get a bad doctor !

It’s fine for patients to make a mistake once – but if the patient keeps on going back to the same doctor and not insisting on photos , I think this reflects badly on the patient . After all, IVF is not a monopoly – there are lots of IVF doctors, and patients can take the time and trouble to find a better IVF doctor.

If you stop to think about it, it’s na├»ve to expect doctors to improve. After all , it's not always in their best interest to share information . While some are transparent and will provide photographs of embryos , many prefer taking advantage of the information asymmetry, so their authority as the “expert” is not challenged !

However, it’s definitely in the patient's best interest to ask for photos – and I am not willing to be charitable and forgive patients who refuse to take the time and effort to be proactive. There is a lot at stake when you are doing an IVF treatment – and it’s your duty and responsibility to be well-informed !
There’s no need to be aggressive , but you need to learn to be assertive.  And if your doctor takes offense, this is a red flag – and you should start searching for a second opinion.

If patients don’t start doing this, this is going to be harmful - not only for patients , but for good IVF doctors as well. If the cycle fails, and the patient learns that key information was not shared with them, she will start losing confidence in all IVF doctors , as a result of which the image of all IVF doctors takes a beating.

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