Tuesday, September 09, 2014

Should doctors set boundaries for patients – who should decide ?

In the past , life was much easier for both doctors and patients . Doctors assumed a paternalistic role and patients were happy to defer to them. This allowed the doctor to use his medical expertise to make the decisions for the patient. This was a win-win situation , when everyone was on the same page .

However , times have changed , and patients want more autonomy . They want more say in the medical decision-making process . Good doctors are also happy to incorporate the patient's wishes , preferences and desires . This is especially true during IVF treatment, which is elective , and is being done because the patient chooses to do it.

However, when I ask my patients how many embryos they’d like me to transfer for them, some of them conclude that I am a bad doctor because I don’t know what the right answer is, and need their opinion in order to decide.

I need to explain to them that as a professional, I will ensure that I will not allow them to make a wrong decision. However, when there are options, I will present these to the patient and allow them to decide for themselves.

I will not decide for them, because they need to live with the consequences of their decisions, and I cannot read their mind.

Conceptually, this is like a parent who allows the child to explore and run around freely on the play-ground – but will not allow the child to cross the boundary and play on the road.  They can feel safe that I set the boundaries, to ensure that they will not make a dangerous decision which may end up harming them.

Thus, if a patient wants to transfer 1 blastocyst, or 2, I am happy to let them make the call.  However, if they want me to transfer 3, then I put my foot down, and refuse to do so by explaining to them  that transferring more just increases their risk of having triplets, without improving their chances of getting pregnant.

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