Friday, September 13, 2013

The expert IVF patient

I saw an interesting patient today. She had been diagnosed with early endometrial adenocarcinoma , and was concerned about her fertility,  which is why her cancer specialist had referred her to me.  She wanted to know what her chances of having her own baby were. This newly married 24-year old woman had been having heavy periods because of her polycystic ovarian disease . She had a diagnostic hysteroscopy done, which showed she had early ( preinvasive) localized cancer.

She wanted to know if it was possible to preserve her uterus , as she wanted to have a baby eventually. Most doctors would advise her to remove her uterus by doing a hysterectomy . This is standard textbook advise, because it allows the doctor to remove the cancer.  It also protects the doctor , because if the doctor doesn’t suggest surgery and if at all the cancer spreads, the patient could sue the doctor for not giving appropriate advice.

My approach is different - I give patients the power to make their own decision. I explained  to her that while I was an IVF specialist , I am not an expert on endometrial cancer ; just like her gynecological oncologist wasn’t an expert in IVF. This over – specialization in medicine meant that she would have to become the expert on her rare problem. She would have to understand the problem, analyze the pros and cons, study her options and discuss her personal preferences with us. We would act as a safety net and not let her make  a wrong decision - but if there were choices, she would have to select which one was best for her.

Patients need to be mature enough to understand that doctors don’t always have all the answers. The outcome for such rare problems isn’t well understood, because we don’t know what their natural history is.  She needed to come to a conclusion based on incomplete information, but should never have any regrets later on about the path she selected. The best  way to implement this is by writing a step by step plan , so there is clarity and everyone is on the same page. Unfortunately, few doctors use this approach; most want to be decision makers , as they’re meant to be the experts who have all the solutions.

Do you have a rare problem and need to learn more about your options ? Please send me your medical details by filling in the form at so that I can guide you better !

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