Why this blogger is not a doctor substitute

January 25, 2014Carole 2 Comments »

So here’s the thing. I am not an MD and have no desire to be one. Still, I get lots of questions from patients that stray into territory that belongs between the patient and their doctor. For example, should I try lab test/procedure A or B? My answer is usually something like, based on my experience in the lab with A or B, these are the differences between A and B. Ask your doctor for guidance in your specific case. Or here are links to more information about this topic that you can read up on in preparation for your next meeting with your doctor.

I don’t have the complete picture on your case and you are already paying someone who went to medical school and beyond a lot of money to answer your questions. I realize patients are often asking me for either a second opinion, or if they have a doctor who doesn’t  spend time enough time -or any time- answering their questions, a first opinion. (And yes, there are many reimbursement/financial reasons that time between doctor and patients is increasingly shortening- but that’s a problem the doctor’s office manager and practice partners need to solve–and another blog topic altogether. Suffice it to say that some practices do a better job than others in making time for their patients).

I have known fantastic doctors who I would entrust with my life and horrible doctors who I wouldn’t send my worst enemy to because they are dangerous sociopaths. Do you find that surprising? You shouldn’t. Doctors are human beings after all, subject to the same flaws and imperfections as the rest of us.

So when you hire a doctor–and yes, you do HIRE your doctor, whether you realize it or not –s/he is offering services that you are paying for- there are certain expectations you should have.  Here’s my short list:

Doctors should have a good reason for ordering a test or a treatment plan and they should be able to explain it to you. Of course, there are patients who say,” I trust you, Doctor. I don’t need to understand what you are doing or why”, so I understand that patient education is not something that should be forced on all patients. On the other hand, every doctor should offer to explain their medical thinking to patients. If a patient knows WHY something is being ordered for them- they are more likely to be compliant in their part of the treatment.

Doctors  should be able to explain what a test result means and what action they recommend as a result of the test. One caveat of medicine is not to order a test if you don’t know how you will use the result. Or worse, don’t order a test you can’t interpret. So they should be able to explain test results to you. If they can’t, find another doctor.

I have been getting a flood of requests lately to interpret semen analysis results and grade embryology pictures. While I recognize the need for reassurance that patients are looking for- I am not the answer to this problem.  I can send you to links for more information, but I really can’t give you the time, attention and medical insights you deserve and -ARE PAYING FOR- from your doctor.

I started blogging for patients because I thought the medical community was doing a poor job in many cases of educating patients about their options. I saw a lot of medical paternalism and hated it because –as a patient myself from time to time– I didn’t want to be treated like a dummy- especially when I had to live with the consequences of their recommendations. My strategy has been to try to provide leads via the blog to more information so that you can have a better conversation with your doctor but frankly, I am not a substitute for having that conversation with your doctor.

What can you do to get the most effective medical treatment?

Make your needs clear. If you want more information, say so. If your doctor can not do this, it might be time to shop around for another doctor. I get emails much too often from patients who are way deep into their treatment and out of pocket to the tune of thousands of dollars and not getting pregnant and just NOW are asking due diligence questions like:

What kind of pregnancy rates is my doctor delivering to his patients?  The Society for Assisted Reproduction (www.sart.org) collects and compiles information on their website on pregnancy rates from IVF procedures in the US. (The CDC has a similar website with the same data, more or less,  but their website is less user friendly).  I can not emphasize this enough: It is worth looking up the stats for the doctors in your area. There is lots of controversy (and grumbling)  in the IVF community about whether the stats are meaningful (data is two years behind, patients find numbers confusing,  some other doctors cook the books). Still, it’s more data than most patients get for other interventions so you should check it out, just so you understand that the delivery of IVF services is not consistent. Annual reported pregnancy rates  on a per practice basis in the US vary widely from abysmally low rates of less than 10% of patient cycles result in pregnancy per year to over 70% of patient cycles result in  pregnancy. So yeah, picking a better than average clinic should be your goal. If all patients did this and the poor performing clinics go out of business– GOOD!

Demand transparency regarding:

  • What it will cost: You should receive written estimates of all costs to you for proposed treatments in advance of the treatment. For IVF , this would usually include diagnostic tests, ultrasound or hormonal blood test monitoring, cost of medications, cost of IVF lab services, cost of anesthesia, cost of optional services like freezing and storage or eggs, sperm or embryos, and physician fees. If you have insurance, you should get the insurance company to provide you with a written estimate on what they will pay and what you will pay out-of-pocket. For more information about negotiating with your insurance company (or doctor) , go to this website: http://www.fertilitywithinreach.org/communicating-with-your-insurance-provider/
  • Treatment outcomes: Since reported pregnancy rates on the SART or CDC websites are two years old, ask your doctor for more current results to see if they are consistent with what was reported before –and not on a downward trajectory. Also, ask how long a lab has been offering embryo biopsy and genetic testing or egg freezing. These are newer techniques and some practices roll them out without adequate training of staff so first patients get poorer results than those patients who are treated 6 months or a year later. You might also ask how long a lab/practice has been offering blastocyst culture (usually needed for most biopsy cases) or the freezing technique vitrification (quickly becoming the standard of care). If they don’t want to talk about their results with patients like you (your age and your medical issues so it is relevant to you and not the best-case scenario) and give you actual numbers, that’s not a great endorsement.

So PLEASE find doctors  and labs who will be good to and for you. They are out there, but you might have to kick over a few rocks and kick aside a few snakes to find them.

Other Fertility Lab Insider posts on this topic:

http://fertilitylabinsider.com/2013/03/advocating-for-yourself-finding-a-good-ivf-clinic/

http://fertilitylabinsider.com/2013/05/finding-your-best-fit-ivf-program/

http://fertilitylabinsider.com/2010/05/finding-a-good-fertility-doctor-part-one/

http://fertilitylabinsider.com/2010/05/using-cdc-reports-to-find-a-good-fertility-doctor-part-two/

http://fertilitylabinsider.com/2011/12/how-do-you-know-if-your-ivf-clinic-is-good/

http://fertilitylabinsider.com/2011/06/the-changing-doctor-patient-relationship-lessons-from-infertility/

http://fertilitylabinsider.com/2010/05/interview-your-doctor/

 

 

© 2014, Carole. All rights reserved.

2 Responses to this entry

  • It Is What It Is Says:

    Well written and well stated,Carole. This should be required reading for anyone seeking or undergoing infertility treatment.

  • Carole Says:

    Dear It is what it is: Thanks for your kind support. What is the use of having experiences- especially bad ones- if they can’t be shared to help someone else avoid the same trouble?

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