As a senior IVF specialist , I'm often asked to give a second opinion on the IVF treatment which patients have taken another IVF clinic. This is a useful exercise for me , because it teaches me a lot. I can study the treatment protocols which other doctors use; and how they modify these , depending upon the patient's response. I also probe to find out how much the patient has understood about their treatment, because this tells me a lot about good their doctor was. Good doctors take the time and trouble to educate their patients; and if the patient is well-informed, this is a sign that their doctor is a good physician.

Sometimes I'm forced to be critical of the treatment which was provided by the clinic . Providing a second opinion can be a difficult task , because you often have to second-guess what the other doctor did. It's easy to point out flaws , errors and shortcomings with hindsight wisdom . It's easy to be cleverer than the treating doctor because I am looking through a retrospectoscope ! However, I do not like criticizing professional colleagues, and try to be respectful, because I always remind myself that I wasn't there when the actual treatment was being performed, which is why I may not have insight into why the doctor chose to make certain decisions.

Unfortunately , however, many times the quality of documentation leaves a lot to be desired , and it's hard not to be critical. Patients are often poorly informed , and are not aware of exactly how many follicles were seen on the ultrasound scans; how many eggs were retrieved; and what the quality of their embryos was.

Many IVF clinics do not even bother to show patients photographs of their embryos! Under the circumstances , it becomes very difficult to provide an intelligent second opinion . If I had good-quality documentation , with images of the ultrasound scans of the endometrial thickness and texture ; and images of the embryos, I could tell patients with confidence that they had received good quality medical care. However, when even this basic information is lacking from the medical documentation , then I'm forced to come to some unsavory conclusions . After all , poor quality documentation suggests poor quality medical care. In this situation, I sometimes have to say unkind things about the medical care which was given.

This causes the patient a lot of unhappiness , because they are understandably upset and distressed that their doctor was not transparent , forthright and open with them. Now the point of the exercise is not to cast aspersions on the professional abilities of other doctors; or to play a game of medical one-upmanship. Rather than look backwards , patients need to learn from these mistakes , so that they can move forward confidently and get better medical care for their next IVF cycle, by proactively asking their doctor for better documentation !

Providing good-quality documentation is good for the doctor , because a good doctor is proud of the fact that he's provided high quality medical care and produced good-quality embryos . If he can show these to the patient , he knows he's done a good job, even though not every good-quality embryo will become a baby , It's equally important for patients as well , because patients have peace of mind that they've received good quality medical care ; and even if the cycle fails , they are not likely to blame the doctor for providing suboptimal medical care.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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