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It might seem surprising that as an IVF specialist I get upset with patients . After all, aren’t doctors meant to be compassionate and empathetic ?
Now this doesn't mean that I am cold and insensitive - it just means that I lose my temper when I see how badly they have been treated by other IVF doctors .
Now you might think that's no reason for me to get angry
with the patient – shouldn’t I be getting angry with the doctor ?
Yes, logically that’s true, but getting upset with how badly other doctors treat
patients doesn't really help , because there’s no way I can improve the way
they treat their patients .
My point is that patients should stop treating themselves as helpless victims , who allow unethical doctors to manipulate them.
Part of the problem is that of information asymmetry , because patients don’t know enough to be able to assess the quality of the advice their doctor is giving them. And it’s easy for doctors to take undue advantage of the desperation and ignorance of their patients, and unethical doctors thrive on this.
This is one of the reasons why I so actively and liberally prescribe Information Therapy - so that patients can recognize bad doctors , and not allow themselves to get cheated .
I get angry when educated patients don't use the tons of free resources available online to do their homework , so they can pick and choose which doctors are worth trusting .
I get upset because they are allowing bad doctors to take advantage of them by remaining ignorant .
The problem is patients underestimate their own intelligence ; while others are just plain lazy , and refuse to put in the work required to make sure they are getting the best possible medical care.
Part of the problem is we have been socialized into believing that half knowledge is dangerous, and that patients should leave everything up to the medical expert , who knows far more than they ever will .
This is a patronizing attitude which I don't agree with , because while the doctors may know about technical minutiae , only the patient knows what their personal preferences are !
This is why , in a healthy doctor-patient relationship , there needs to be trust, equality and respect. Patients need to earn their doctor’s respect by doing their homework , so doctors can see they are well-informed . Doctors will think twice before trying to cheat them by making false promises.
Patients have the ability to be able to defend themselves from bad doctors using the many tools available online for free, and it breaks my heart when they refuse to use them
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It's well known that there is lots of stuff we don’t know about IVF. IVF doctors don’t like being ignorant, which is why there is a lot of scientific research going on in order to expand our knowledge-base.
However, our ability to apply this in clinical practice is still fairly limited , and we need to be humble and accept the fact that the areas of medical ignorance in IVF keep on expanding rapidly.
While our desire to reduce the unknowns is well-intended , so we can get more of our patients pregnant , this does not mean that IVF clinics should start doing scientific research .
Not only don’t clinicians have the training or infrastructure to do this properly, it often becomes a distraction for the clinical staff. Often the research is done extremely poor , and the results are unreliable and untrustworthy, because the doctor is often biased . Thus, pharma companies will often pay doctors for enrolling patients for a “clinical trial” which is designed to prove the utility of their latest and most expensive drug, but this is a complete farce. The results are pre-decided, and the data is massaged to suit the funder’s convenience. Most doctors won’t understand the significance of p values even if they came and bit them, but they are happy to play along because they like pretending to be “scientists” – and the financial incentive acts as a sweetener !
The job of the IVF specialist is to get their patients pregnant by applying the latest proven medical research - not actually doing the research . It’s hard to both things at one time ( unless you are in a large academic institute). Randomised controlled clinical trials need a large number of patients to be able to have enough power to test a hypothesis properly, and clinics don’t have these.
It’s unfair on patients when individual IVF clinics start using their patients as guinea pigs . What’s even worse is they add insult to injury by charging them money for doing this , by claiming that they are using “cutting-edge” technology !
Not only are these doctors lying to their patients in order to make more money, it also means that the “ research “ is a sham. Medical Science doesn't advance , because doctors can't learn anything from this kind of anecdotal experience
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Whenever I talk to patients about the medical details and the technical minutia of the IVF treatment cycles - things like their embryo quality and grading; how we select the right treatment protocol for them; and why vitrification works so well – I often find their eyes glaze over , and they appear bored and disinterested .
It seems that patients don't want to become medical experts – they just want to want to find a medical expert whom they can trust , and who they are confident has enough medical knowledge and expertise to be able to get them pregnant .
Now the point of sharing medical knowledge with patients is not to try to make them doctors. We respect their intelligence, and just want to help them understand exactly what we are doing , and why we are doing it , so they understand what's the doctor’s control and what is not .
At the end of the day , a well-informed patient has realistic expectations of IVF treatment , and will also have peace of mind that the doctor has provided them with the best possible medical care available . This way, they know they have done everything humanly possible to maximize their chances of getting pregnant .
This is why it's important that you take an intelligent interest in your treatment .
For Heaven's sake , please don't assume that you need to be
a doctor in order to be able to understand all this . There is absolutely no
reason for you to underestimate your intelligence - all you need is curiosity
and patience . IVF treatment is not Rocket Science , and you can figure out the
details. A good doctor will actually
help you understand what is going on – and it’s in both the patient’s and the doctor’s
best interests that you know exactly what's happening , so you are in
control of your life, and don’t have any regrets later on that you left any stone unturned in your quest for a baby
One of IVF’s dirty little secrets is that the amount of stuff we don't know about IVF is far more than what we do know. For example, we are still not able to predict which embryo will implant; or why top quality blastocysts do not implant ; or which eggs will fertilise; or which embryos will develop into blastocysts.
Most IVF doctors are quite happy to conceal this ignorance , and this is why patients overestimate how much we can control during an IVF treatment cycle.
There is tons of stuff we don't know much about – and we conveniently label this as “unexplained”, to hide our cluelessness, because once we put a name on the problem, we feel more in control – even though the name is meaningless, and is virtually a waste-paper basket diagnosis.
Because so much remains unidentifiable , undiagnosed and untreatable , we continue to use empirical therapy extensively in IVF.
Empirical therapy covers many interventions, such as using vitamin D to improve ovarian reserve ; and treating patients with low-dose aspirin after the transfer based on the fact that its anti-platelet activity may improve uterine blood flow.
As long as these “treatments” are low cost and low risk , I am comfortable prescribing them. However, doctors love prescribing the “newest, latest and most expensive” therapy which happens to be the fashion of the month ! There seems to be no limit as to what they will prescribe under the guise of empirical therapy . This includes stuff like IVF intralipids; low molecular weight heparin ( LMWH); intravenous immunoglobulins ; and paternal lymphocyte immunization therapy ( LIT).
The truth is no one knows whether any of these things work or not , even if doctors prescribe them confidently, based on their “extensive personal clinical experience” !
I think that's fine , but in all fairness , doctor should share this uncertainty with their patients, before actually prescribing unproven therapy . The sad reality is doctors will not do this , because they just want patients will behave like dummies who will obey orders mindlessly , and not question the doctors as to whether there is any scientific basis behind what they are advising.
Dumb doctors love dumb patients , and dumb patients deserve dumb doctors !
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Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
When an IVF cycle fails , patients are distraught and heart-broken.
When they ask the doctor for an explanation, the doctors starts concocting all sorts of reasons rather than being honest and say – I don’t know.
Some of them blame “bad eggs or bad sperm” for the IVF failure.
This makes no sense to me – after all, the whole point of doing IVF treatment is to bypass these problems !
What the doctor is effectively doing is subtly blaming the patient for the IVF failure, and this just adds insult to injury.
The doctor should be upfront with the patient , and explain to them at time of the embryo transfer that they cannot predict whether the embryo will implant or not – no one in the world can !
It’s important to provide photos of the embryos to the patient, so the patient can see the doctor is being open, transparent and respectful.
The problem is that most IVF clinics don’t do this, which is why patients lose trust in IVF doctors.
And once the patient has encountered one bad doctor ( and wasted a lot of money on their treatment), they don't trust any other doctor in the future .
This is why you need to ask questions proactively , so that you find a doctor who is happy to share information with you , and who doesn't talk down to you or underestimate your intelligence .
Not only does a good IVF doctor do his best to make sure that are you going to get pregnant in the IVF cycle , he also makes sure that you are well informed as to what is going on.
While it's true that the outcome of the IVF cycle is not in the doctor’s hand, the IVF process definitely is, and the more actively engaged you are in your treatment , the more actively engaged the doctor will be as well
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This COVID19 crisis has been extremely difficult - for patients as well as doctors .
This is specially true for IVF clinics, and most patients aren’t sure whether they can go ahead with their treatment, because of the Lockdown.
They aren’t sure if they should start their treatment, or wait.
Many of them have got fed waiting for the Lockdown to stop, but the Government seems to keep on extending it indefinitely, and they can’t keep on waiting for ever, because their biological clock is ticking on.
Others are waiting to get vaccinated, so they feel protected and can start IVF.
The good news is we have been working through the lockdown, because medical services are essential, and none of our patients has got infected with COVID during the IVF treatment.
The precautions we take help to protect them and keep them safe.
However, the Lockdown has made life harder for our patients, and one of our patients couldn’t come to the clinic to get her HCG injection.
One of our nurses, Pooja, very kindly offered to go to Borivali Railway Station and deliver the HCG injection to her, so her treatment wouldn’t be impacted.
We did her pickup as scheduled, and she is now happily pregnant !
This is the benefit of taking treatment in a boutique IVF clinic, where we treat patients as humans, and not as widgets !
Our focus is on maximizing patient pregnancy rates , not on maximizing revenue !
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
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Watch more such videos and updates, do subscribe to our Youtube Channel
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues . Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Watch more such videos and updates about IVF on our Youtube Channel
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Watch more such videos and updates about IVF on our Youtube Channel
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.
