Tuesday, October 21, 2014

Why do you think you are not getting pregnant ?

Infertile couples who come to me for a consultation often bring fat files stuffed with their medical records. These contain copies of their earlier test results ; and summaries of the treatment cycles they have already been through. They pull these out , and then wait patiently , expecting me to study their records and then pronounce my verdict.

However, before I touch the file, I ask the patient, Why do you think you are not getting pregnant ? What have you learned from your earlier medical encounters ?

Many patients are puzzled when I ask them this basic question. Isn't it the doctor’s job to find out why they are not getting pregnant ? And isn’t the answer in their medical records ?

This is a very important question , because it allows me to assess how much they understand about their problem.  After all, if you need to teach someone, you have to start from their level of current understanding, and then take them to where they should be !

Some patients look confused, and I need to prompt them. I reassure them that this is an easy question to answer. After all, you only need 4 things to make a baby – eggs, sperm, uterus and tubes; and if they aren’t getting pregnant,  the problem  is either with the eggs; the sperm ; the uterus; the tubes; or we have not been able to identify it ( a condition we label as unexplained infertility).

If they cannot answer this simple question, this means they need a lot more counseling and time. I can judge how medically sophisticated the patient is from their answer, and I tailor my conversation accordingly. This is much more efficient and effective , and ensures that the patient and I are on the same page .

When I start going through the records, I ask the patient to explain key test results.  It’s not as if I am trying to test them  - it’s just to reassure them that they are smart enough to make sense of what seems to be complex medical gobbledygook ! If they get stuck, I clarify and help them to make progress. This approach reassures them that I will treat them as an intelligent adult; and that they don’t need to leave everything up to the doctor . This gives patients a lot of confidence that we can work together as a team.

Need help in making sense of your medical reports ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly!


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