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| Why IVF maybe the best way for infertile couples to have a baby | Patients and doctors perceive illness and treatment from completely
different perspectives. Let's look at infertility, for example. Most
doctors look at the world through a biomedical perspective. They want
to diagnose the problem; and then come up with solutions to help the
couple to conceive. This is traditional in medicine, where the first
step is making a diagnosis; after which we create a treatment plan.
Text books will talk in terms of treatments based on correcting an
underlying problem; and will usually offer a sequence of treatment
steps which progress from simple to complex; and less expensive to more
expensive. This is the stepped care approach, which makes a lot of
sense from a societal perspective.
However, the patient's
perspective is completely different. They don't really care as to
whether the reason they can't have a baby is because he has a low sperm
count or she has blocked tubes. All they want is a baby, so they can
move on with their lives.
This often creates a lot of tension
between patients and doctors. From a patient's perspective, rather than
waste time, money and energy on ineffective treatments which have a low
success rate, it makes sense for them to move on directly to the
treatment which gives them the best chances of success - and this is
IVF - the final common pathway, which allows us to bypass all medical
problems !
However, most doctors do not share this point of
view. Many are not very empathetic and do not understand the emotional
pain infertile couples suffer from. They would prefer taking a text
book approach to the problem . Many are tied down by treatment
guidelines published by Gynecology Societies or the government, which
limits the options they can offer to patients.
Also, doctors
often tend to be quite arrogant. They take the approach that they know
what's best for the patient, because they are the experts; and often
will not take the patient's viewpoint into consideration at all.
Let's
look at a 35 year old couple who want a baby. They are very successful;
very well off; and need a baby to complete their life . Traditionally,
doctors would do a workup to find out what the problem is; and then
start treatment to correct this problem. Unfortunately, this sort of
approach can be very time consuming - and not very efficient. Patients
will often get fed up - and they simply do not have the time or energy
to keep on going back to the doctor for repeated followups, all of
which exact an emotional toll. Not only is there the pain of failure;
there is also the opportunity cost; and the waste of time. From a
doctor's view point, this is par for the course, but I feel doctors
need to be more flexible, and to tailor treatments to suit the
patient's perspective.
For this couple, the bottleneck is much
more likely to be the time and energy they can devote to their baby
making project, rather than money. It would make much more sense to
just do IVF for them to maximise their chances of having a baby
quickly. Now I understand that a lot of doctors will feel this is too
aggressive and is overkill. I used to think so myself. However, I now
feel we should let the patient decide, rather than make decisions for
them. If the trade-off is between time and money, many will decide to
go for the most efficient route, even if this is more expensive, as
this may be the most cost effective for them !
Not only are we
saving the couple a lot of time by giving them a baby quickly by IVF;
we are also helping to improve the quality of their parenting, so that
they can spend quality time with their baby when they are young and
have energy - rather than waiting till they turn 40 before moving on to
IVF !
In a fee for service setting, I feel decisions as to which
treatment option to explore are best left to patients, rather than to
doctors. A good doctor will explain all the options to the patients;
the trade-offs involved; and then allow the patient to decide for
themselves !
Unfortunately, especially in the UK, most GPs are
not very empathetic towards infertile couples; and they while away a
lot of the couple's valuable years in ineffective treatments before
referring them to a specialist. This represents hundreds of years of
wasted opportunity and heartburn for thousands of infertile couples,
causing enormous private pain . |
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