Wednesday, April 09, 2014

When patients need to become medical experts

Doctors are often faced with rare problems which require special expertise. For example , I recently saw a patient who had been diagnosed with very early with uterine cancer . She came to Malpani Infertility Clinic because she wanted to explore her fertility options . She had been referred to us by her oncologist, who knew that she was very keen on having  a baby, and needed a second opinion from an IVF specialist.

She was married only recently, and the cancer diagnosis had come as a shock for her. She wanted to know if there was any way we could salvage her uterus so she could start a family.

The standard approach to this patient would be to advise a hysterectomy . Most doctors would advise the removal of a cancer, to prevent its spread and safeguard the patient's health. He would also do this to save his own reputation, because this would be the standard, textbook advise. 

Very few doctors would try and stretch their boundaries to find a favorable solution for the patient.  The patient was desperate and thus I felt she could try an innovative approach , which might offer her a chance of getting pregnant.

However, before doing this, I explained that she needed to gather information about all her options - both standard, and non-standard. She needed to become an expert on both her disease, as well as all her fertility options. This can be a tall order, but she needed to research all her options, so she could make the decision she felt was right for her.

The best way to do this would be to document all her research, along with the insights from her oncologist and me . This would ensure that she had full freedom in choosing her treatment path and her doctors would not fear a possible lawsuit. Because their opinion and her informed consent on the matter would be clearly documented , they would also be well proctected.

When patients are willing to go the extra mile, they will find doctors who will also be willing to think of "out of the box" solutions for their rare problems.

Unfortunately, few doctors in India take this approach. Most of them prefer being paternalistic – their approach is that patients come to us with their problems because we are the experts ; and it's our job to provide solutions ! They will often provide just one simple solution with a black-and-white approach and then tell the patient - You can either accept this solution if you want to come to me ; and if not, you can find another doctor and go somewhere else. While this is a straightforward approach and something which works well for some doctors , it is not one which I'm comfortable with myself because it doesn't allow the patient to play any role at all in such a complex decision-making process which will affect the rest of her life.

Expert patients need to take extra time and trouble, but the reward will be that they will have peace of mind they did their best !

Do you have an uncommon fertility issue ? I'll be happy to provide a second opinion. Please send me your medical details by filling in the form at so that I can guide you better !

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