Do you really need a surrogate ? – Dr.Malpani

As an IVF specialist, I receive a lot of queries from infertile couples from all over the world. Many of these are older couples who have been infertile for many years; and since they cannot get medical treatment in their own countries ( either because it’s too expensive or because their government does not allow it), they want to come to India for treatment. Many of them think that because they are too old, their best option would be surrogacy; and since they have read many articles about how easy surrogacy is in India, they often email me asking for gestational surrogacy services.

The tragedy is that so many infertile couples are still so poorly informed about surrogacy treatment and who it is useful for. Many couples naively believe that a surrogate is the final answer to all infertility problems; and that surrogacy has a 100 % pregnancy rate ! Sadly, this is just not true !

Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus, or whose uterus is damaged. Older women who are infertile rarely need a surrogate. As they get older, their fertility declines, not because their uterus ages, but because their eggs get old – a condition called the oopause. Since their own uterus is usually completely normal, using a surrogate makes no sense for them at all ! After all, how can replacing a normal uterus (their own) with a surrogate’s uterus improve pregnancy rates just because the surrogate is fertile and has had babies in the past ? These couples would be much better off considering the options of donor eggs or donor embryos.

Unfortunately, they are often so desperate to have a baby, hat they do not bother to learn that as their biological clock ticks away, it’s the ovaries which get depleted of eggs – not their uterus. Since surrogacy is a lucrative treatment option to offer ( it’s the most expensive of all the IVF treatments offered today) , many IVF clinics are happy to offer surrogacy, without bothering to explain to couples why it may not be the right treatment option for them.

It’s exactly the same situation with couples who have failed multiple IVF cycles; or who have had repeated miscarriages. They are emotionally very vulnerable and are willing to clutch at straws. They have low self-esteem, since their bodies have failed them, and are very happy to explore surrogacy. However, research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality eggs), rather than a uterine problem. Even though surrogacy may not be their right treatment option for them, it continues to be overused and misused. This sort of medical abuse it likely to give all IVF clinics a bad reputation.

Common Myths about Pregnancy – Dr.Malpani

Pregnancy is one of the most exciting times in a woman’s life and every pregnancy is truly a miracle. Because women having been having babies for centuries, there are still many myths and old wives tales about pregnancy, which modern obstetrics is just starting to dispel.

Myth 1. Pregnancy care starts after you get pregnant

Most women register with their obstetrician for medical care after they get pregnant. After all, we are all familiar with the adage: ‘Be good to your baby before it is born’. However, in reality, the best time to start taking care of your unborn baby is even before you conceive! Such care is called pre-pregnancy or pre-conception care.

Why is this care so important? Remember, that the foetal organs are actively developing during first 12 weeks of pregnancy (this crucial period is called organogenesis). The embryo is highly susceptible to external insults during this time, so that any damage can lead to crippling birth defects.

The beauty about pre-pregnancy care is that it is so simple: all that is involved is visiting your doctor before you are planning to get pregnant, rather than after you’ve missed your menstrual period! The doctor normally undertakes the following procedures: (1) takes a medical history; (2) carries out a physical examination; and (3) performs some simple laboratory tests. These procedures are inexpensive and easy to conduct and signify examples of preventive medicine at its best!

Pre-pregnancy care also leads to other benefits. For instance, it allows the doctor (duly assisted by you) to identify problems and rectify them. If, on the other hand, these problems were to be spotted only after you became pregnant, detailed testing can become very difficult, because the very presence of the delicate embryo, can impede testing. The harsh reality is that not all problems are preventable, but you can, nevertheless, increase your chances of having a healthy baby by identifying the risks you face and trying to eliminate them, if possible. After all, most doctors go in for a battery of tests before performing major surgery, to make sure that the patient is healthy enough to withstand the stress generated by the operation and the anesthesia. Pregnancy can also stress the body, and it is important to screen the woman for potential problems before she embarks on one of the most important journeys she will ever make!

A simple precaution you can take is to ensure a regular intake of a vitamin called folic acid. Folic acid greatly reduces the chances of your baby being born with birth defects such as spina bifida or anencephaly if taken before you become pregnant and during the first six weeks of pregnancy.

Myth 2. Modern medical care is essential if you want to have a healthy baby

While modern obstetric care can ensure that pregnancy and childbirth are very safe for both mother and baby, unfortunately, today doctors have ‘medicalized’ pregnancy to such an extent that what is otherwise a normal event has been converted to one which needs rigorous and frequent medical assistance.

Every mother naturally wants a normal baby, and technology can be very useful in reassuring her that all is well. However, it’s easy to misuse technology. One particularly disturbing trend stems from the fact that many obstetricians nowadays overuse medical technology; such overuse can often prove detrimental to both the mother and the baby. Common tests which are misused include: blood tests for TORCH infections; ultrasound scans; and foetal monitoring. Another area of misuse relates to the tests available for screening the baby for a possible birth defect. Many doctors routinely subject their patients to a ‘triple test’ during the pregnancy to screen for birth defects. While this is an easy test (it’s a simple blood test which measures the levels of 3 hormones in the blood) to carry out unfortunately, it has still not been standardized for Indian women. Such a drawback leads to a large number of tests yielding abnormal results, even though the babies are completely normal. An ‘abnormal’ result creates a lot of anxiety – and then the doctor needs to perform a battery of other tests to confirm that the baby is, in fact, normal to reassure the mother. The second tier of tests can be expensive, and risky as well, because some of them can cause the mother to miscarry. Thus, it is not uncommon for a mother to lose a healthy baby because of a test which was not really required in the first place!

Myth 3. More is better

A lot of medical technology during pregnancy is overused and misused.Foetal monitoring to document fetal wellbeing is a good example. While this procedure was initially designed to serve as a tool to monitor the well-being of the foetus and to help reduce the need for medical intervention, today it is often used to justify an LSCS (Caesarean section) in order to forcibly take out a baby ‘in foetal distress’! A much simpler alternative would be to opt for “ kick counts” in which the mother acts as her own fetal monitor, by counting how many times her baby moves. A baby which moves actively is sure to be healthy!

Myth 4. Hospitals are the best places to have a baby

Despite tremendous advances in medical science, it’s a sad fact that the rituals associated with childbirth in hospitals have unfortunately been designed for the doctor’s convenience, rather than the patients’! Harmful practises include: forced induction of labour; routine use of enemas and intravenous drips, foetal monitoring, making the patient lie down (rather than allowing her to walk about) — it’s a long list! Don’t let the hospital/clinic staff patronize you — you need to assert your rights! It’s very useful to draw up a birth plan (which includes things you will allow and those you won’t ) and make sure your doctor agrees with the procedures. The presence of a doula has been proven to be your very helpful for women in labour. Also, should encourage your husband to participate in this adventure as actively as possible !

A significant recent development is that many women in the West are turning back to natural childbirth once again, often either at home or what are known as ‘birthing centres’. In other words, they would like to keep as far away from a hospital as possible! Despite the fact many doctors scare women into believing that the hospital is the safest place to deliver a baby, recent international studies have shown that the home is often much safer and much more congenial for normal births. For example, Holland, where over 60 per cent of births occur at home, under the supervision of midwives, can justifiably boast of having one of the world’s lowest neonatal mortality rates! The midwifery model seeks to remind women that childbirth is a natural process for healthy women and women need to learn (or rather, relearn!) to trust their bodies!

Myth 5. Mothers need anesthesia to cope with the pain of labour and childbirth

Yet another minus point pertains to the application of anaesthesia for pain relief, which has become the norm nowadays. Epiduran analgesia has become a status symbol in most hospitals. We have mindlessly aped this Western ‘advance’, much to the detriment of both the mother and the child. While techniques for pain relief a valuable resource, can be they should be used only when absolutely necessary. Simple techniques such as yoga and meditation can help you manage the pain of labour very effectively.

Myth 6. A caesarean section is safer for the baby than normal vaginal birth

We are witnessing a virtual epidemic of Caesarean sections today. Whereas a CS once used to be the method of last resort to deliver the baby, it has at present, tragically, become the norm in some hospitals, accounting for 50 per cent of all births. The reason, of course, is obvious: a CS is financially much more lucrative to the doctor than a normal delivery. As a senior obstetrician wryly put it: ‘The only indication for a normal delivery today seems to be if a patient delivers before the doctor reaches the hospital!’ The alarming spurt in CS has taken on the dimensions of a major scandal today, which needs to be tackled actively. What steps can you take if you don’t want to end up as another statistic? It would be a prudent idea to find out the rates your doctor charges for a CS and for a normal birth. You can also ask him what proportion of his patients successfully delivers normally. Other patients in the clinic, as well as the hospital nursing staff, can prove to be valuable sources of information, which you should effectively tap to alert you to a “knife-happy” obstetrician, from whom you need to stay away!

Myth 7. It’s not safe to have sex during pregnancy, as this can hurt the baby

This is not true. The baby is safe inside its own private swimming pool in the uterus, and sex will not affect it. In fact, many women find that their libidio increases dramatically during the first few weeks of pregnancy, and it’s safe to have sex if you so desire.

Myth 8. It’s not safe for pregnant women to fly

Modern aircraft cabins are pressurized, which means that it’s safe for women to fly in the first 32 weeks of their pregnancy. After this time, most airlines will not allow you to fly, because they are worried you may go into labour in the plane.

Myth 9. You can tell your baby’s gender by the way you are carrying

How you carry your baby depends upon many variables, including your build; the baby’s size; and whether the baby’s head has entered the pelvis or not. This has nothing to do with the baby’s gender – but you always have a 50% chance of being right !

Tips for a Healthy Pregnancy

The following pointers can prove useful during your pregnancy.
• Learn as much as possible about the wonderful ways in which your body is changing and about how your baby is growing. Talk to your mother, your friends, and other women about pregnancy, labour and birth. Attend pregnancy-related classes, read the relevant books, and watch videos about normal pregnancy and childbirth. You can find a wealth of resources free at HELP – Health Education Library for People, Excelsior Business Center, National Insurance Building, Ground Floor, Near Excelsior Cinema, 206, Dr.D.N Road, Mumbai 400001. Tel. No.:65952393/65952394, http://www.healthlibrary.com.
• Remain active! Continue with the exercise programmes that you were following before you became pregnant, modified, if needed, according to the recommendations of your doctor. If you were not exercising at all before becoming pregnant, consider going in for walking or swimming. Start with short periods of exercise, and gradually increase the amount of time.
• Get plenty of rest. Listen to your body to determine if you need short breaks during the day as well as to determine how many hours of sleep you need at night.
• Talk to your baby and enjoy your growing bond with him. Research now shows that babies can react to the sense of touch as early as ten weeks of pregnancy! A little later, they can react to light, your voice, music, and other sounds.
• Try to minimize the stress in your life by practising stress management techniques such as slow and deep breathing, yoga and relaxing various muscle groups when you feel stressed.
• Plan your baby’s birth. For most women, the process is normal, natural, and healthy. nd healthy.
• Enjoy this special time in your life! Your husband and, your family and friends can help you make the most of this wonderful transition. Have confidence in your body’s ability to grow, nourish, and give birth to this baby just as women have done for centuries.
• During pregnancy, many women are highly motivated to remain as healthy as possible, so that they can give their baby the best start in life. Pregnancy is an excellent opportunity to develop good health habits; you can use these habits to keep yourself healthy for the rest of your life!

Dr.Malpani- Why does the infertile man get such poor quality treatment ?

As an IVF specialist , I have noticed that infertile men often get very poor quality treatment. There are many of reasons for this.

The first is the infertile couple themselves. Having a baby is usually considered to be the woman’s problem , and she is the one who seeks medical attention which means she usually goes to her gynecologist. Many men have a fragile ego, and while some refuse to go for sperm testing , others postpone this, because they are worried they will find that they have a problem. Many men still blissfully resume that if their libido is normal , this automatically means that their fertility is fine , and that they do not need to check their sperm count.

By default, it is usually the gynecologist who then becomes the primary care physician for infertile couples. Unfortunately, most gynecologists are clueless about male infertility. Many have never examined a man in their entire professional career . They usually ask for a semen analysis; and if this is abnormal, they refer the man to a urologist. However , sometimes they do not interpret the semen analysis report properly , and this causes its own set of problems. For example some gynecologists still believe that a count of less than 60 million is abnormal – which means that men with a completely normal semen report are overtreated with medication , wasting valuable time.

What happens when the infertile man is referred to the urologist ? While the urologist is a specialist , many of them do not have a special interest in treating the infertile man; and there are very few specialised andrologists ( male infertility specialists). This is why many urologists continue to provide many ineffective tests and treatments for the infertile man. They will often try empiric medical therapy to improve a low sperm count; and because this rarely works, patients get fed up and frustrated. The trigger happy urologists diagnose a varicocele for practically all men referred to them, by doing a color Doppler ultrasound scan. Once they find a varicocele , they are happy to treat it – and when this doesn’t help to improve the patient’s fertility status, they throw up their hands and say – Sorry – there is nothing else we can do ! The other problem with a referral to a urologist is that the care of the infertile couple gets fragmented. Often the gynecologist has no idea what the urologist is doing , and vice versa, which means the couple is not treated as a unit. This often causes them to lose confidence in medical treatment.

Another weak link in the medical system is the fact that many laboratories do not know how to perform a semen analysis properly. Since it is such a cheap test, they often do it badly, resulting in wrong reports – and therefore , the wrong treatment.
Compounding this problem is the underlying fact that the basic sciences understand very little about male infertility. We really still don’t know enough about normal sperm production; and since we cannot pinpoint what the problem in sperm production is in the infertile man , there is very little effective treatment we can offer him. This is why the standard treatment for a man with a low sperm count today is ICSI ( intracytoplasmic sperm injection, www.drmalpani.com/icsi.htm) – a treatment which is conceptually crude, but works amazingly efficiently. We still do not have good tests for analyzing sperm function, so that a lot of our treatment consists of bypassing problems , rather than identifying them and solving them. This is a sad testimony to the fact that the infertile man has been relatively
neglected !

About 15 years ago , it was felt that strict morphology testing using Kruger criteria would help us to identify which infertile men had functionally competent sperm. Unfortunately , we now realize that these criteria are not always reliable. The new generation of sperm function tests are supposed to check for DNA integrity. Unfortunately , these are equally unreliable, even though they are presently very fashionable. This is because while they do generate valuable information in research studies, they are not very good at providing clinically useful information for the individual patient. Thus , while we know in general that infertile men will have higher sperm DNA fragmentation levels than fertile men, there is no number at which we can tell the infertile man whether or not his sperm are capable of fertilizing his wife’s eggs.

This sad truth is that male infertility treatment still leaves a lot to be desired. And this is why , ironically , the most effective treatment for the infertile man it to treat his fertile partner !

Dr.Malpani- Should you treat your doctor as a technician or a professional ?

The answer to this question depends on 2 variables: your personality; and that of your doctor.

If you are well-informed ; have done all your homework; have explored all your options; and are quite certain of what you want from life and your medical treatment, then your best option is to treat your doctor as a technician and get him to do what you want him to do. This is a perfectly reasonable approach; and works well if you a compliant doctor who is willing to listen to your perspective.

However , some doctors can be very authoritarian, and will insist that their patients follow their rigid guidelines. Actually , having well defined medical protocols can provide a lot of structure and security, and is a good idea when tackling complex problems which require multidisciplinary teams , such as bone marrow transplantation.

On the other hand , if you are uncertain or confused; and need guidance and counseling, is best to treat your doctor as a professional. His first task will be to walk you through your treatment options and help you to decide what’s best for yourself. Of course , not all doctors are good at this. Some doctors pride themselves on their technical skills and would much rather treat you as a disease which needs to be fixed , rather than a human being who needs hand-holding. This is especially true in certain specialties such as cardiac surgery , where many doctors would much rather be in the operating room , fixing blocked coronary arteries , rather than talking to their patients.

It’s also perfectly acceptable to use one doctor to provide you with guidance; and the other as a technician , to perform the surgery. This is why certain doctors , who may be technical wizards in the operating room, continue to attract lots of patients , even though they maybe very rude and have a terrible bedside manner. Of course , many doctors don’t like this, because the amount they get reimbursed for providing counseling and showing you the right direction , is much less than they get paid when they are operating in the theater.

In the best of all possible worlds, you will find a doctor who is both a consummate professional and a skilled technician. While these are few and far between, it’s well worth taking the time and effort to find such a gem.

Dr.Malpani-What does a mother go through when her daughter is infertile ?

A Comanche Mother
Image by George Eastman House via Flickr

This is a guest blog entry from the mother of one my patients. It offers great insight into the impact of infertility on other family members !

Q 1 What do you feel when you see your daughter go through IVF ?

A There are mixed feelings – of high hopes as well as anxiety. On a positive note, I feel good that with the advances in medicine today we have expert guidance in Infertility Treatment which was not available to the previous generation. So, a ray of hope crosses my heart that there is still a chance for my daughter to conceive and achieve her dream.

Anxiety, that my daughter has to take so many injections and medicines. I can see her emotional strains when two IUI cycles failed after all the efforts put in not to mention the financial loss incurred due to her taking leave without pay from her current company to attempt IVF as also the risk that she may not get her job back.

However, the biggest risk – “What if too much of these injections and medicines end up in pregnancy, but with a child suffering from Down’s Syndrome? Better not to have a child than give birth to one who will face difficulties for life.

Q 2 How does your daughter cope? How does she feel about it?

A I can see my daughter struggling to cope with difficulties and there are quite a few – the main being to reduce her weight.

I admire her commitment to have gone through it all. She could have chosen the easy way out and said ‘No’ to Infertility Treatment. After all, she has crossed 40 yrs. and she knows her chances are low. She has sacrificed her job, left her home in Pune to be under Dr. Malpani’s excellent care in Mumbai.
As a mother, I’ve encouraged her to do her Best and leave unto God the Rest.

It is said that some of our principal regrets in life are the opportunities we passed up and the chances we didn’t take.

Q 3 How do I feel about one child having children, one not?

A Each person has his own Destiny – Karma. My daughter got married at 41 yrs, while my son was quite young when he married , so by God’s grace he did not have difficulty vis-à-vis “infertility factor”.

According to me, the be all and end all of marriage is not just re-production. Sure, grand children are a source of delight and posterity is ensured.
However, I’d rather apply the analogy to marriage that “Oftentimes two people working together find easy that which seems un-surmountable to one alone.”

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How your doctor can reduce your fertility – a guide from Dr Malpani

Infertile patients expect that their doctors will provide them with treatment to improve their chances of having a baby. Tragically, some medical procedures can actually end up reducing your fertility !

Here’s a list of the top ten procedures which can actually harm you, rather than help you ! If your doctor advises any of these, please get a second opinion before agreeing !

1. D&C ( dilatation and curettage) . This is a “minor” surgical procedure in which the doctor dilates the mouth of the uterus ( the cervix) and scrapes the uterine lining using a curette
( curettage). This endometrial tissue is then sent for pathological examination. In the past, when doctors had very little to offer to their patients, this used to be the mainstay of the treatment of an infertile couple. In fact, even today, some women will ask the doctor to do a D&C for them because their mother conceived after doing this procedure ! They feel that it helps to “clean the uterus”, thus improving their fertility ! While it is true that some women will get pregnant after a D&C ( sometimes this is just a placebo effect; while sometimes the endometrial inflammation induced by the procedure can improve uterine blood flow and fertility), this is an obsolete procedure which should be used in this day and age only for confirming the diagnosis of endometrial tuberculosis.

2. Metroplasty. This has become quite a fashionable procedure in some parts of India, where the doctor “improves” the shape of the uterine cavity to improve fertility. It can actually create uterine scarring and induce fertility. It’s only in India that doctors use this technique for “treating” infertility. In all other countries, it is reserved for correcting uterine anomalies or removing intrauterine adhesions.

3. Hydrotubation. This is a procedure in which the doctor flushed the uterus and the tubes with fluid ( which often contains a concoction of chemicals such as steroids and antibiotics) to treat infertility. While it can help some women with cornual blocks, for the vast majority this painful treatment ( which is often repeated many times in one month) is a waste of time and money.

4. Empiric treatment for abnormal sperm . This continues to remain a major time-waster for infertile couples. Tragically, most doctors are still unaware of the recently revised criteria of what a normal sperm count is – and will often reflexively treat men with what they think is an “abnormal sperm report”. There are various levels of sophistication to this futile effort. To cloak this with an aura of scientific respectability, high tech labs will now test sperm for DNA fragmentation levels – and doctors are quite happy to “fix” the problems these tests will often pick up. What many patients do not realise that there is very little correlation between these test results and their fertility potential – and that even fertile men have high DNA fragmentation levels ( but are fortunately unaware of this, as they have enough sense not to get their sperm tested in a lab !)

5. Treatment for genital tuberculosis. We are now seeing an “epidemic” of uterine TB in India – especially in north India, where it appears that practically even woman who goes to a gynecologist has TB ! Doctor use dodgy tests called PCR to test the endometrium for the presence of DNA fragments which are supposed to be be specific markers for the tubercle bacilli – without even bothering to determine what the prevalence of this TB PCR positivity is in the fertile population ! Not only do these poor patients end up taking 6 months of toxic and expensive drugs; their husbands will often stop having sex with them ( because they are worried that they will transmit the TB to them); while others are scared that they will give the TB in their uterus to their baby !

6. Treatment for TORCH infections. Women who have been unfortunate enough to have a miscarriage will get routinely ( and mindlessly) tested for the presence of antibodies against the TORCH group of infections. If any of these tests is positive, the doctor then promptly treats this infection with antibiotics ( which are completely useless and uncalled for !). The truth is that pregnancy. You can read about this at http://www.drmalpani.com/torch.htm

7. IUI ( Intrauterine insemination ) for treating couples men with a low sperm count. Since everyone knows that ” you need just one sperm to fertilise an egg”, it seems to make a lot of sense to treat infertile couples who have a low sperm count with IUI . After all, IUI is a simple and inexpensive treatment, which every gynecologist can offer – and patients understand the logic as to why it should help. The truth is that the problem with men with low sperm counts is not just that their sperm count is low – its often that the sperm are functionally incompetent – and no amount of concentrating the good sperm or washing them is going to help !

8. Diagnostic laparoscopy. Once upon a time, a laparoscopy was a major advance in evaluating the infertile woman, because it actually allowed the doctor to visualise the ovaries and fallopian tubes without having to cut open the patient ! Minimally invasive surgery was a major advance then , but now it’s being overused. Many doctors still routinely perform a laparoscopy for all infertile women, which is completely unnecessary surgery, as is does not change the therapeutic options for these patients. The status of the fallopian tubes can as easily be checked with a simple HSG, which is much less expensive ! It’s true that a laparoscopy allows the doctor to also “find” adhesions and endometriosis, but making the diagnosis of this ( or “treating” them ) does not really improve the patient’s fertility at all !

9. Medications for treating endometriosis. Endometriosis is an enigmatic and frustrating disease; and mot doctors will still reflexively “treat ” this with medications, such as GnRH analogs. While these medications are great at suppressing the endometriosis (and will provide dramatic pain relief), this suppression is only temporary – and does not improve the patient’s fertility at all (since they also suppress ovulation at the same time !) Once the meds are stopped, the endo recurs ! Even worse, “treating” the endo with meds just wastes the patient’s time – something which most infertile patients cannot really afford to fritter away !

10. Operative laparoscopy for myomectomy and cystectomy. One problem with today’s high tech diagnostic tools ( such as vaginal ultrasound scans) is that it allows the doctor to “diagnose” small 1 cm size ovarian cysts and fibroids. Now while cysts and fibroids are very common in fertile women as well; and small cysts and fibroids do not affect fertility, once the sonographer has “reported” his “diagnosis”, the patient often panics ! The doctor is happy to point out these abnormalities – and convinces the patients that it is these abnormalities which are the cause of her infertility – and that once these are “treated”, she’ll get a baby quickly ! What’s worse is that it’s easy to do the surgery with a laparoscopy ( which is just “minor surgery”), that patients are quite happy to sign on the dotted line without realising that these are incidental findings of no clinical importance; and that the surgery will not help them. What’s worse, is that this unnecessary surgery can reduce your fertility as normal ovarian tissue is also removed along with the cyst wall, thus reducing your ovarian reserve.

I sometimes think we are seeing an epidemic of overtesting and overtreatment. Doctors seem to like doing tests – and patients like being tested ! Unfortunately, patients are still not sophisticated enough to differentiate between useful tests and useless tests – and the truth is that some tests can actually be harmful !

The hidden danger with a lot of these unnecessary testing is that patients get fed up; lose confidence in doctors; and refuse to pursue more effective treatment options, because they do not trust doctors any more !

The message is simple – if you have a medical problem, remember that Information Therapy is invaluable ! Please get a second opinion if you are unsure and confused. Send me your medical details by filling in the free second opinion form at http://www.drmalpani.com/malpaniform.htm and I’ll be happy to help !

How exactly to talk to your doctor on the telephone

Do You Remember?......Call
Image by rogilde – roberto la forgia via Flickr

Often you can save yourself a long wait for the doctor at the clinic by getting advice on the telephone. Such a trend is becoming increasingly important today, when time is at a premium and commuting is so arduous, thanks to frequent traffic jams ! You need to learn to make intelligent use of the phone to get appropriate help from the doctor. However, when you’re sick or hurt, it becomes difficult to think clearly and the following routine may help you to help the doctor give you the care you need over the telephone:

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  • Keep a pen and paper ready so that you can write down the relevant instructions.
  • · Make sure all your medical records are at hand, so that you can answer questions about your medical problem intelligently and accurately.
  • Identify yourself properly, giving your full name as well as your diagnosis ( try not to tax your doctor’s memory!).
  • Don’t insist on talking only to the doctor every time you call. For example, if you just need to make an appointment, or merely clarify a doubt, the nursing staff or receptionist may be able to help you. To put it differently: respect your doctor’s time!
  • When you don’t know what you need (for example, you may not be sure how serious the illness is, i.e., if you require a visit to the clinic), tell the staff you’re uncertain and request that you speak to a nurse or the doctor’s assistant over the phone. Don’t be hesitant; if you’re feeling concerned or anxious, let the clinic staff know.
  • Ask if you can take a few minutes of the doctor’s time now, or whether you should call back again – this is common courtesy!
  • Report specific symptoms. For example, rather than just saying, ‘I don’t feel well, or I’ve got the flu,’ which can be interpreted in different ways, be prepared to describe your symptoms precisely; for instance, fever, sore throat, cough, and/or bodyache. Similarly, instead of just saying, ‘my baby has a fever’, specify the exact temperature and the duration of the fever as well as other signs or symptoms.
  • Don’t misuse the phone by trying to wangle a free consultation. Not only is this unfair to the doctor, but also such a consultation is likely to be very unreliable!
  • Ask the doctor what you should do and write down his instructions carefully. Ask the doctor to spell out any word if you are unsure about it.
  • Ask if and when you should call back, or if you should come to the clinic.
  • Ascertain what complications could occur that may require you to hurry to the emergency room.
  • Don’t forget to thank the doctor for talking to you on the telephone!

If you have the doctor’s mobile number or residence number, please treat with respect. This is a privilege he has granted you, so don’t abuse it for routine calls which are better handled by calling the clinic or the secretary.

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It’s a good idea to find out what the clinic policy is about phone calls in advance.

  • When is the best time to call?
  • What is the doctor’s rule for returning calls?
  • Whom should you speak with (e.g., assistant, nurse) if the doctor can’t come to the phone?
  • What is the phone number for making emergency calls or for calls when the office is closed?
  • Whom can you call if your doctor is out of town?

Sometimes, you may have to call a doctor after the clinic has been closed. Remember when you call a doctor after hours, he is trying to help you solve your immediate problem, not provide advice about your entire medical situation. Try to be specific in your complaint; you should know what medications you are currently taking and which of them has proved successful in the past. If you are not happy with the physician’s advice or if you feel you are getting worse, go to the nearest emergency room at once.

Let me give an example of a precise and useful telephone call: ‘I am an asthma patient and have had increasing wheezing today. I am not coughing up any mucus. I am using my albuterol inhaler every three hours but it doesn’t seem to work. Last year when I suffered a similar episode, the doctor gave me prednisone and it worked, but the prescription is a year old. What should I do now?

On the contrary, here is an example of a bad telephone call: ‘I don’t feel good. The doctor treats me for breathing problem. I take three breathing pills, one is green, one is white and one is real, and I ran out of the red one last week. While I have you on the phone, I think I have a fungus on my feet, can you suggest a prescription for something for that as well….’

Making effective use of the telephone can help to save both you and your doctor considerable time, effort and money! Learn to use this instrument wisely and well.

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Personally, I prefer email to talking to patients on the phone for many reasons.

1. Everything is documented

2. There is no scope for confusion or misunderstanding

3. I can refer to the patient’s medical records , to ensure my advise is correct

4. We don’t have to play telephone tag , which means I can answer at my own convenience. This is especially important for overseas patients, because of the timezone differences !

Smart patients need to learn how to communicate with their doctors – and using the phone and email effectively can help them they save the doctor’s time, as well as their own !

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