| A common problem we have
seen is that many infertile patients are very reluctant
to change doctors, even when they are unhappy with their
present doctor. Often this is because they prefer being
passive and refuse to take matters in their own hands
- "better the known devil than the unknown one".
Some feel that their present doctor knows all their medical
details, even though he may not be very competent, and
they do not want to take the time and trouble to explain
their problem all over again to a new doctor. They often
don't even have copies of their medical tests and treatments,
because many doctors refuse to give these to patients,
so as to "hold on" to their patients. Unfortunately,
this passive attitude means that you are depriving yourself
of getting the best medical care, and reducing your chances
of conceiving.
Here are two simple things you
can do to empower yourself.
1. Make sure you keep
notes of everything you have been through. While the
doctor may have your medical records, you can keep a
set of your own. You will find the Dr Malpani Treatment
Cycle Chart very helpful - just keep one for each treatment
cycle, and file them in reverse chronologic order. It's
good idea to summarise your treatment cycles on a single
page of paper, so it's easy for you to review.
2. You can get a free
second opinion from me by filling up the second opinion
form. This form acts as an excellent gauge for how well-informed
you are about your treatment, and your options. If you
cannot understand the terms, or find that you cannot
fill up the form properly, this means you need to do
more homework !
When to Change Doctors
Changing doctors is never easy, because, over
a period of time you do build up a personal relationship
with your doctor. However, you should consider changing
doctors if you feel that :
- The doctor is incompetent (i.e., he has ignored
obvious symptoms, missed a diagnosis, prescribed the
wrong drug, or can't get to the bottom of your problem);
- The doctor does not communicate with you effectively
(i.e., his explanations are not in lay person's language
or no time is given to you to ask questions and bring
up related problems);
- The doctor does not pay attention to your needs
and concerns;
- You have lost confidence in the doctor's skill
and ability.
- You find the doctor is too inconsiderate (i.e.,
he makes you wait a long time for an appointment,
he fails to return your phone calls, he does not provide
clinic time during evening or weekend hours); and
- Your doctor is too expensive.
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Many patients are worried that if they go to a new doctor,
he will insist on repeating all the tests all over again.
While this can be frustrating and expensive, it can be
helpful as well, because it allows the doctor to reassess
your problem with a fresh perspective. Please ask your
doctor to explain why he needs to repeat the tests, and
how this will help in your treatment. If tests have already
been done, but are more than a year old, or if they have
been done from an unreliable lab, you may need to repeat
some of these again.
When you change doctors, ask your old doctor for a
copy of your medical records - remember that your medical
records are your property, and you are entitled to a
copy of them - you may have to assert yourself to get
your rights !
You may find that your new doctor criticises the treatment
your previous doctor provided. Remember that doctors
do have big egos, and they are often intensely competitive
and critical of each other. This can upset you, because
you may start feeling that you were given substandard
medical care. As long as you have a clear understanding
of what was done to you and why, you should ignore this
criticism - don’t let it disturb you. Anyone can
be wise with hindsight – and do remember that
all doctors will try to do their best to help you to
get pregnant!
Many doctors will repeat exactly the same treatment
the previous doctor has administered – often because
they have nothing better to offer! However, remember
that even though you have changed your doctor, you have
remained the same – and the purpose of changing
doctors should be to allow you to progress further with
your treatment.
Get a second opinion - this can never hurt and is always
helpful. If you find two experts saying the same thing
then you know you are on the right track! If, on the
other hand, they disagree, don't get upset - there are
few black and white areas in infertility, and doctors
often have different ways of treating a particular problem.
Ask questions of both of them and then choose the method
which appeals to you - it's finally your decision!
What if you don't understand what the doctor is saying
and are getting confused? This is not your fault. If
you do not understand anything the doctor says - ask
questions! If you still do not understand the fault
is his - he is not explaining in terms which you can
follow. Find another doctor!
Remember that you need to ask questions to get answers
- your doctor cannot read your mind! But also remember
that your doctor does not have all the answers - after
all, medicine is still an imperfect science, and your
doctor is not a fortune-teller. If he does not know
the answer, he should tell you this as well.
How do we do a consultation in our practice? We first
ask the couple why they think they have not been able
to conceive, and how they expect us to be able to help
them. The answers give us a good idea of how much the
couple understands about their problem. It’s often
heartbreaking when we see couples who have been through
3 IVF cycles, and don’t even know how many eggs
they grew or how many embryos were transferred each
time – or even why the IVF was done in the first
place. During a consultation, we first explain, using
models, how babies are made. We then review the medical
records, and explain to the patient what we feel their
medical problem is. We then explain to them what the
treatment options are, and tell them to think about
these and then make up their mind. In our clinic, we
do not charge for a repeat consultation, in order to
encourage patients to ask questions, and to give them
time to make up their own mind. We take pride in the
fact that our patients have a good understanding of
their medical problem, and realistic expectations of
how we can help them!
Remember that the purpose of a consultation is to get
information. If you do your homework before going, you
will be able to make better use of your doctor’s
time, since you can focus on the issues which are important
to you. You then need to go home and process this information,
so you can decide what to do. It’s very difficult
to think straight when you are sitting in front of the
doctor, so it’s usually a good idea to give yourself
enough time to apply your mind and assimilate the information,
before making a decision. There is usually no urgency,
since infertility treatment is never an emergency. Beware
of a doctor who wants you to decide on the spot –
it’s hard to do so under pressure, and you may
end up making a decision in haste, which you may then
repent at leisure.
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