Wednesday, August 31, 2016

Why don't patients ask their doctors questions ?

I was getting increasingly upset during the consultation with my patient. She had already done four IVF cycles, all of which had failed,  and she didn't have a clue as to what was done during any of the cycles. She didn't know how many follicles she had grown; how many eggs the doctor had retrieved; and how many embryos had been transferred. She didn't have details about her medications, or even a treatment summary.

She was an educated, intelligent patient, and I asked her - Why didn't you ask your doctor these basic questions? Why don't you have a record of your treatment ? Where are the photographs of your embryos?

Her answer was a plaintive - The doctor never gave me anything. They keep all the details in the clinic itself, and claim that this is their policy . They said that you won't understand any of the technical minutiae because you are not a doctor, so why are you asking for any records ? You need to learn to trust us and not doubt us - we are good doctors , and have a high success rate. You won' t understand any of these medical details, so don't waste your time doing searches on the internet. Just go home and relax and pray, and leave all the medical details to us.

I could understand her willingness to do everything the doctor said in her first cycle, because she didn't know any better. But to stick to the same doctor and not ask for any details after 4 failed cycles was carrying things a bit too far. It's good to be a compliant patient, but this doesn't mean that you don't speak up at all.

Her justification was that's it's not a tradition in India to question the doctor .

" We've been taught that the doctor knows best , and he will do whatever is needed.  We shouldn't interfere, because a little knowledge can be dangerous, and we shouldn't be trying to play doctor. Therefore we just blindly did whatever he told us , because that's the best way to get results - to obey the doctor blindly and unquestioningly. In fact, if we ask questions, the doctor gets irritated , and we don't want to upset the doctor because we want to be treated well , and we want him to think of us as being good patients."

It's true that many doctors discourage questions. They want to increase their through-put and prefer patients who do as they are told. They don't like their authority being challenged, and feel threatened by an empowered patient. They can get quite nasty when the patient wants her doubts resolved. For example, some will say - " Who's the doctor in this room - you or me ? If you trust Dr Google, then why don't you go to him for treatment ? "

Patients also underestimate their own intelligence. They feel that medicine is so complex that they won't understand anything in any case, so why ask questions when the answers will go over their head ? They also feel guilty if they take too much of the doctor's time, because they can see how busy he is.

Now, I think it's important that you trust your doctor, but you trust your milkman as well, but that doesn't mean that you don't count the number of milk bottles which he delivers daily !  There's too much at stake when medical treatment is involved . In any process where the outcome is uncertain ( as is true of IVF)  you need to be actively involved. You don't need to implement it yourself, but you do need to understand it well enough , so that you can make sure that the proper process is being followed, and that the doctor is not taking shortcuts.

This is why good doctors will encourage questions, and answer them proactively - for example , by having FAQs on their websites. They treat their patients as intelligent partners , and will invest time, energy and resources to make sure they are well-informed. This is in every one's best interests, because then patients have realistic expectations, and understand what the likely outcomes are going to be, so they can cope better with the uncertainty inherent in any medical treatment.

Need answers to your IVF questions ? Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

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