Wednesday, June 22, 2016

Red flags when selecting an IVF clinic

All IVF patients know that which clinic they select for doing their IVF treatment can have a big impact on the outcome of their cycle, and this is why they spend a lot of energy and time in shopping around for the right IVF doctor. Unfortunately, a lot of them are not really sophisticated enough to be able to differentiate a good doctor and a bad doctor, and most will end up going to whichever IVF clinic their family doctor sends them to.

In the past, you could trust that your family doctor would send you to a good clinic, but as we all know, this is no longer a reliable method for selecting an IVF clinic , because the medical profession is riddled with corruption. This is why you need to do your own homework and your due diligence before blindly trusting anyone. It's a good idea to check out the IVF clinic your family doctor goes to, but please also check out at least one more.

Here are some red flags you should look out for when you are selecting an IVF clinic.

If you go to a clinic which makes you routinely wait a long time, that's a red flag, which means they don't respect your time and they're not well organized.

If you don't get a chance to talk to the main doctor, that's a cause for concern as well. Lots of clinics make you talk to the junior doctor, who will take a history which the senior doctor glances at, so that you have maybe three or four minutes to talk to the main doctor. This works well if you have routine run-of-the-mill problem, but if you want individualized, specialized, personalized care from the senior doctor, then this is not such a great method.

You should worry if everyone is put through the same battery of tests. This is a " mindless medicine" protocol where one size is made to fit all, because the senior doctor does not want to apply his mind to tailoring the treatment for the individual patient.  This is never a good idea , because every patient is different . If you are asked to do tests, there should be an explanation for what tests are being done; why they're being done ; what the doctor expects to find; and how this will change your treatment options.

You should especially wary when the tests are very expensive;  or when you're forced to go to a particular lab for the tests. Often there is a hidden agenda as to why the doctor is sending you for a particular test.

Some doctors do certain unproven tests for everyone - for example, a hysteroscopy or PCR tests for endometrial TB.  You should also worry if the doctor routinely asks for multiple tests to rule out a particular disease. Thus , some doctors have a bee in their bonnet about genital tuberculosis as a cause for infertility , and some will treat everyone with anti-TB medicines , irrespective of whether the tests are positive or negative ! I don't think this is good quality medical care and these anti-TB medicines can be toxic, have side effects, and make you waste a lot of time and money.

It's a good idea to talk to other patients in the clinic while you are waiting ( and sadly, there will be a lot of waiting in most IVF clinics ). This can be a good opportunity to compare notes, so you can compare your experiences with those of others.

Similarly, if you have a doctor who seems to be too trigger happy , and does a laparoscopy and hysteroscopy for every patient, this can be a red flag as well.

At the end of the day, I'm not asking you to become a doctor when you're evaluating a doctor . However, it's a good idea to do your homework and get a second opinion , so you can ask more intelligent questions and select the right doctor for yourself.

Online reviews about the clinic are useful , and this is something which should be explored as well. There are lots of sites which allow patients to review doctors , and they will give you a good sense of what other patient's experience with this doctor has been. Unfortunately, there are problems with reviews as well , and I'll be discussing this in the next post.

You can also get a good sense of the doctor's philosophy when you visit his website. Does he want to educate you  about infertility, so you know more about your problem , and can make well-informed decisions ? or is the website all about the doctor and is  celebrity patients ? While it can be great when you know that the doctor has lots of success stories, ultimately the focus of the doctor should be on the patient,  and you want a doctor who's empathetic and patient-centric.

You can learn a lot when you finally meet the doctor. Is he in a rush ? Or is he willing to sit down and discuss your concerns ? Does he address them all ? Is he optimistic and hopeful ? Is he willing to share information? Is he willing to empower you?

Money is always an important issue. IVF can be an expensive treatment, and there is no certainty whether the treatment will work or not. While it's true that the most costly clinic is not always the best, you should worry if a clinic charges too little, because it's quite likely that they may be cutting corners in order to reduce their costs. This may turn out to be much more expensive in the long run.

There are lots of unethical practices as regards payment, and you need to be on your guard. If the doctor asks for cash payments; or money under the table; or does not give you a receipt for your payment, then you need to worry. No  honest doctor will do this - and if the doctor is willing to cheat the government, why do you think he won't be willing to cheat you as well ?
Another common problem is that the doctor asks for additional money mid-way during your cycle for additional procedures ( without having discussed this with you when you signed up), when you are not in a position to say no. If this happens, then it's quite likely that you are being taken for a ride. 

Finally, how well does the doctor treat you at the end of your cycle ? Do they provide you with complete documentation proactively and routinely ? Do they provide embryo photos ? Or do they abandon you if your cycle has failed ?

If you feel you have received bad medical care, then please do speak up. You should provide feedback to the doctor, and to the hospital management as well. If you feel that they are ignoring you, then do this in writing. It's also a good idea to post your reviews online. This can help to protect other patients from unethical doctors.

 All this can seem to be a lot of time and trouble and effort. Isn't it just much easier to go to the first one who you pick or the one who's closest to you or the one you've read about in a newspaper article? Yes, it's easier but can often be the wrong decision, which can prove to be expensive.

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