Infertile couples who come to me for a consultation often bring fat files overflowing with their medical records. These contain copies of their earlier test results, as well as summaries of the treatment cycles they have already been through. They pull these out, and wait, expecting me to reach out and go through their records and then pronounce my verdict.

That of course, is something I will eventually do; but even before I reach for the file, I ask the patient- “Why do you think you are not getting pregnant? What have you learned from your earlier medical encounters?

Though this is a very basic question, most patients get thrown off-balance by it.  Most think that it’s the doctor’s job to ascertain why they aren’t getting pregnant, and some of them worry about my competence – what kind of doctor is this who is asking my opinion about why I am infertile ? Shouldn’t he be telling me ? Isn’t this what I am paying him to do ? Others feel that the answer to that question be evident from their medical records and that I should study those first !

The Logic

However, this question is a very important one as it gives me the chance to assess what the level of their understanding about their problem is.   The logic behind it is very simple- if you have to teach someone to drive; you start them out on the first gear and then have them transition to higher ones. Similarly, when it comes to patients, I have to start from their current level of understanding and then lead them to where they should be! Some patients are perplexed with my question and I have to prompt them to give me the answer.

Where does the problem lie?

I explain that the question isn’t a very difficult one to answer.  All that it takes to make a baby are eggs, sperm, uterus and tubes. If they aren’t getting pregnant, the problem lies with one of these 4 things or it might be a case of unidentified infertility (in which we haven’t been able to identify the problem). This is a very basic question and if they are unable to answer this, it simply means they will have to be counseled further.

Being In-Sync with the Patient

The answer that the patient gives, helps be judge how medically sophisticated she  is, and I then mould my conversation accordingly. This is a much more efficient and effective approach, and ensures that the patient and I are on the same page.

When I start going through the records, I ask the patient to explain key test results. Though it may seem like it, I’m not really trying to test them; it’s just my way of reassuring them that they’re smart enough to make sense of what seems to be complex medical gobbledygook!  If they hit a hurdle, I clarify and help them make progress. This approach reassures them that I will treat them as an intelligent adult; and that they don’t need to leave everything up to the doctor. This gives patients a lot of confidence that we can work together as a team.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

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

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