Patients often get upset when I criticize the treatment which they’ve received at their earlier IVF clinic. They can’t understand why there is such a big difference in their doctor’s opinion and mine , because I’m fairly vocal about many unproven , untested treatments such as ERA and PGD , which belong in a research setting, and should not be offered to patients. Many doctors use these experimental treatment left , right and center , and patients get extremely upset when I tell them they are being treated as guinea pigs !
They are not sure whether they can trust me , or whether they should be trusting their doctor . After all, aren’t doctors supposed to be scientists ? Isn’t IVF a science ? Shouldn’t doctors be professionals who do what’s best for their patients ?
I wish this was true , but the reality is that doctors are humans first, and we all have egos . We also have many biases and prejudices , but unfortunately , most doctors are completely unaware of these . The more senior they get, the more likely they are to practice what I call “ eminence-based medicine “, based on their “ extensive clinical experience “ !
Others will blindly follow what they have read in the latest medical journal article ; or copy what their friend ( who is an expert in the US ) told them to do . Others will be influenced by the lectures they hear from KOLs in medical conferences , because they don’t know that these “leading doctors” are paid by pharma and medical device manufacturers” to sell their product !
They blindly continue doing what they think is right , without being willing to keep an open mind , and entertain the possibility that they could be wrong . The reality is that Mother Nature is a bitch , and that there are really no black or white answers in medicine. Most truths are shades of gray , and it’s hard to be sure whether what we are doing is right or wrong . However, we still need to continue practicing medicine and treating our patients , even when we don’t have perfect information.
What differentiates good doctors from bad ones is that we are aware of our biases and prejudices . These are the 3 key tools I use in order to help me cope with this uncertainty.
The first is humility , which means I’m willing to accept the fact that I could be wrong . I am happy to learn more , which is why when someone comes to me with an alternative perspective , I will do a literature search , and talk to experts, people I’m trying to drill down and dig deeper as to whether what they’re saying makes any sense or not . After all, medical science does advance , and what was true in the past may no longer be true in the future . Just because we couldn’t do something 10 years ago doesn’t mean that we will never be able to do it, and we need to keep up with the times. But that does not mean that we uncritically accept the “latest advance” just because it is new ! We need to beware of the “shiny object syndrome” and refuse to play with the latest toys at the expense of our patients !
Secondly, I always try to remain curious . I think of myself as a constant learner , and I learn not only from colleagues and medical textbooks and journals , but also from my patients . I tell them – you are my research assistants, and if you find information which disagrees with what I’m telling you , please share this with me , and I can review it and tell you whether I’m wrong , or if that information is wrong.
The final tool is integrity . It’s critically important that we be honest – honest with our patients , and honest with ourselves . Often this is missing , especially when doctors focus primarily on generating revenue rather than on doing what’s right for their patients . Fortunately for me, at this stage in my life , I can invest in humility, curiosity and integrity , because I don’t have to prove anything to anyone . I’m perfectly comfortable with telling patients that I don’t know when I don’t know stuff.
Much more importantly , I take pride in being open and transparent and giving them reasons as to why I think a particular way . Not only do I do this in my consulting room , but also on our website , where I can share information publicly with other people . If what I say is wrong , then other people can criticize me and help me to correct my mistakes , and make sure that I do what’s right for my patients .
Sophisticated, intelligent patients appreciate this transparency and openness . They have the maturity to understand that doctors don’t have all the answers, and don’t put the doctor on a pedestal. They are willing to do their homework , and want to be treated as an intelligent partner – which is why so many of our patients are doctors themselves !
Most patients in India are quite happy to blindly do whatever the doctor tells them to, and the tragedy is that many doctors are very paternalistic , and will not encourage patient’s questions . Their attitude is – I am the doctor in the room , and if you don’t want to listen to what I have to say , then please leave !
I think this is a very unhealthy approach . I think of myself as a coach and a guide , and I offer non-directive counseling . I remind patients that the outcome of any treatment is always going to be uncertain , and this is why they need to take an intelligent interest, so they understand their options !
If they are well-informed , the process will be a happy and positive one , and they will be at peace with themselves , no matter what the final outcome is . This is the approach we’ve consistently followed over the last 35 years – and will continue doing so.
For direct advice, you can get information to any query related to your IVF treatment from Dr. Malpani’s AI Twin instantly at https://www.drmalpani.com/chat-w-chatbot/index.html