Wednesday, November 18, 2015

Why are so many IVF doctors so irrational ?

Most IVF doctors take pride in thinking of themselves as being scientific in their approach.  A lot of patients also suffer from the same delusion , and believe that doctors who practice modern medicine  are rational, and will follow scientific principles in order to give them the right treatment.

However, sadly, this is not true. While evidence based medicine has become an extremely popular buzz word, the reality is that most doctors still practice eminence based medicine - based either on what they think they know ( when they rely on their personal experience, especially after they have got a few grey hairs;  ) or on an expert's opinion ( after hearing a talk at a medical conference, or reading an article in a medical journal).

Humans are remarkably easy to fool, and this is as true for doctors as it is for anyone else. This is why pharma companies invest so many billions on influencing and manipulating doctors. They lure key opinion leaders ( KOLs) to give lectures, and because these physicians are wined and dined, they're programmed into delivering the message which the pharma company wants to convey. This is often based on biased company -sponsored "scientific" studies, and the doctors in the audience are then quite happy to do what the "authority" tells them to do , because they don't realize how the KOL has been manipulated. In fact, often the KOL himself doesn't realize how he's being manipulated - so that not only does he take doctors for a ride, he gets taken for a ride as well !

It's much easier to rationalize than to be rational, which is why humans will continue to suffer from cognitive delusions, and doctors are not immune to these.

Doctors are surprisingly innumerate. They don't understand probability, and most cannot calculate numbers well at all. They are confused by statistics, and are happy to take mental shortcuts so they can carry on with their primary job of treating their patients. This is why they rely so much on anecdotal case studies, either based on their personal experience, or based on what they hear from an expert. Sadly, this is full of misleading biases.

A  good example is the wide misuse of what a lot of doctors called empirical therapy. This is treatment based on experience , and they can use this label to justify anything they choose to do to their patients.  Does the expert's advice be applied to that particular patient sitting in front of them? Doctors really don't have the time or the energy to be asking some of these difficult questions, and it's much easier for them to take use heuristics and rules of thumb to manage their patients. Fortunately, because most of the patients they see  have common, run-of-the-mill, bread-and butter problems, they can get away with this approach most of the time.

This is also why most doctors are mentally lazy . They just don't have the luxury of time to be able to think or apply their curiosity and intelligence to every patient they see. They are quite happy to order a battery of tests  in the hope that something abnormal will come up. They can then start "treating" this abnormality, never mind whether this helps the patient or not.

This is much more convenient for them, and this is why most doctors will not take the time and trouble to take a meticulous history or do a thorough clinical examination. They would rather send the patient off on a wild goose chase by ordering test after test, until one comes back as abnormal ! They can then point out to the patient that they have now finally "pinpointed" the problem, and then proceed to "fix" this.

There are too many patients, and it's much easier for them to take shortcuts, and do what everyone else is doing, or do what the " expert " tells them to do , without applying their own mind. The problem gets worse with time, as they get busier, and have even less time to sit back and reflect about their biases and prejudices.  This is why there are so many IVF specialists in India who prescribe antiTB drugs to all their patients, left , right and center !

The simplest way to counter this problem is to listen to their patients - but ironically, many of them will refuse to do so, because they think their patients are "unscientific" and will not be able to teach them anything !

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1 comment:

  1. Anonymous2:38 AM

    This is beautifully written :) I learn a lot from you, Dr.


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