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Your hospital has a great website with lots of clever graphics, health calculators, videos, and flash presentations ! Your marketing department is very pleased that you now have a Youtube and Twitter channel and a Facebook page. However, if you are using your hospital website as just a branding tool or a digital hospital brochure , you are not getting most bang for your buck !
You need to integrate Information Therapy as part of your medical workflow, so your doctors can provide better medical care to their patients; and your patients can have a hospital experience they can rave about !




By using clever new applications based on the Healthwise Knowledgebase , you can marry Information Therapy with EMRs, patient portals and web 2.0 social media, to improve the care you provide to your patients , to convert them into raving fans !

Let’s consider a patient with arthritis who needs knee replacement surgery. If your website has lots of valuable content on arthritis and its treatment options, it will rank high on google, which means the patient is very likely to come across your website during his search. If the information you provide is reliable; easy to understand; objective and updated, your hospital’s image in the patient’s eyes improves dramatically ! You can then “convert” this online visitor into a real-life patient by encouraging him to get in touch with you !

Similarly, let’s look at the same patient who is being admitted for elective knee replacement surgery. Prior to admission you can send a welcome email , along with a link to your hospital website which has a lot of accurate information on knee replacement surgery, so they know what to expect during their hospital stay. Not only does this help to relieve the anxiety of the patient and his family, they will also be very impressed by your thoughtfulness and patient-centred focus !

This can be automatic and inexpensive - you just need to embed this into your admission process ! It helps your doctors as well and saves them a lot of time , as they do not need to explain the basics once again, since the email has already done this ! You can do this after discharge as well – and this combination of high tech with high touch can be a winning formula ! It also helps to improve your doctor’s efficiency, as these emails reduce phone calls to your doctors , since most routine queries have been proactively answered !

Please email me at malpani@vsnl.com and I'll be happy to provide more information !

We normally do a blood test for HCG 2 weeks after the embryo transfer to find out if the embryos have implanted and if the cycle has been successful or not.

This can be a very long 2 weeks , and many women will start doing pregnancy tests 5 days after the embryo transfer.

The problem is that even if the embryo has implanted and you are pregnant, the embryo produce such small quantities of HCG for the first few days after it implants ( remember that it's just a microscopic ball of about hundreds of cells or so at this time), that it's not possible to detect this HCG in the blood . To be able to detect the HCG in the urine will take even more time, which is why you need to be patient.

Of course, many patients will cheat :) - and this is an email I got from a patient today. A picture is worth a 1000 words, and this image clearly shows how her pregnancy tests have now become strongly positive ( C stands for Control and T stands for Test). The stripe on C means you have done the test properly. Once the stripe on T shows up ( is positive) , this means you are
pregnant !

She's now ready to start her baby album !

Most Indian hospitals have their own websites which clearly means that they understand the importance of having an online digital presence. However, most of them use their website purely as a branding tool which means their sites are just digital brochureware. Inspite of being an IT global powerhouse, Indian medical websites have lagged behind. The biggest tragedy is that with just a little bit of effort, they could become world-class, given the fact that India has an unbeatable combination of medical and IT expertise !

Just compare www.mayoclinic.com with any Indian hospital’s website ! Or look at the Alexa ratings or Google page ranks for Indian hospital websites . They get only about one tenth the traffic which much smaller US hospitals do. While it’s true that the number of internet users in the US is more than in India, this is irrelevant. The internet has become a global playing field, where hospitals are doing their best to attract patients from all over the world ! And it’s not about the cost of the website or the use of clever flash graphics or Web 2.0 tools either. The reason for the poor traffic is much more basic – it’s poor quality content !

Most hospital websites are chockful of information about the hospital , but they have precious little content which is designed for the patient ! Remember that when someone is sick and is looking for medical care, they will not do a search for Fortis Hospital or Care Hospital ! They will google for more information about their disease – and because Indian hospital websites provide precious little information on just a few diseases, they rank very low on a google search !

The solution is simple – hospital websites need to offer a comprehensive library of online information for prospective patients. However, this is a surprisingly challenging and complex task. Most webmasters have no medical expertise and they naively expect the hospital doctors to provide them with the content for the website. However, most doctors are very poor at communicating and are of little help . Generating high quality content for patients can be a very expensive and time consuming exercise – especially when you need to keep it uptodate and error free . Also, hospital management is worried that they may get sued if they provide incorrect information, which is why they often prefer not providing any information at all !
So what do they do ? Some will get their doctors to provide a few pages of content – material which is badly written, full of medical jargon and hard to understand. Others will source free health information - for example, from Wikipedia. However, this is often of patchy quality – and these hospitals get what they pay for ! The other option is to license this information from US and UK publishers– but this can be very expensive !

The good news is that HELP, in partnership with Healthwise , the leading provider of patient educational content in the USA, now offers Healthwise content to Indian hospitals who want to improve their websites. This means that Indian hospitals can now get the exact same content which Healthwise provides in the USA - at a fraction of the cost ! Both HELP and Healthwise are non-profit organizations, whose mission it is to promote Information Therapy to help patients to make better decisions !

This means that hospital webmasters can get an instant painless Transfusion of Information Therapy ! This authoritative patient education library called the Healthwise Knowledgebase can be whitelabelled and plugged into your existing website within one week , thanks to our Technology Partners, Plus91.

As a result of including this Healthwise content, we are sure you will see a dramatic jump in your online traffic ! If this translates into even one more additional patient per week , you will recover your investment very quickly ! In fact, we are so sure about this, that we are happy to provide a free trial for one month. You need to pay for an annual license in advance. If your traffic does not improve by at least 50%, we will refund your money back.

What do you have to lose ? Please email me at malpani@vsnl.com and I'll be happy to provide more information !

Many medicines are available over the counter ( OTC) . These are usually safe drugs, which have been used for many years . They are effective for common problems; have few side effects; and do not need a doctor's prescription. However, most medicines are still available only with a doctor's prescription. This is because medicines can be powerful , and while they may be very good at treating certain problems, they may also have undesirable side-effects. Experts need to make a decision regarding the risk-benefit ratio of these drugs, so they can select which drugs are so powerful that they can only be dispensed with a doctor's prescription.

Medicines form an important tool in the medical armamentarium. However, not all illnesses need medicines, and an increasingly important addition to the medical arsenal today is Information Therapy.

It's useful to remember that while Information Therapy can be effective and inexpensive, just like any other therapeutic tool, it can have side effects as well ! This is especially true with online medical information, because a lot of this is unreliable, outdated and plain wrong. Unfortunately, many people do not have the ability or sophistication to differentiate between good quality and poor quality information , and wrong information can actually harm a patient. Thus, patients with blocked tubes may end up wasting thousands of dollars on pursuing ineffective therapies such as Clear Passage ( massage therapy which claims to open blocked tubes) rather than do IVF; while men with low sperm counts end up getting frustrated after spending hundreds
on " herbal medications" which claim to boost low sperm counts but are completely useless !

Not only can unreliable information harm patients, it can also waste a lot of the doctor's
time, because he now has to remove the myths and misconceptions which patients have acquired online from unreliable websites, which are just out to earn a quick buck by peddling cures !

Just like powerful medicines need to be "prescribed" by a doctor, it's a good idea for doctors
( and hospitals and governments) to "prescribe" reliable information. Information Therapy is powerful medicine - and it needs to be promoted, so that patients benefit from it.

The best way to do this is to use reliable patient educational content, designed by non-profits such as Healthwise. You can see how well this works in real life by going to www.informationtherapy.in !

" PwC and India Health Progress (IHP) have released a whitepaper "Healthcare Unwired - Health Insurance and Healthcare Access" which recommends health insurance as one of the prime drivers behind increasing healthcare access in India. The whitepaper is the outcome of a roundtable meeting held on 24 January 2011 on Health Insurance at India Islamic Cultural Centre, Delhi. The conference was attended by various healthcare and health insurance industry leaders as well as policymakers who emphasized the need to bring in new health insurance schemes at different price points."

I was disappointed that the Report did not talk about how health insurance companies can promote health by prescribing Information Therapy ! It makes business sense for health insurance to empower patients with information - and this is a great opportunity to create a win-win for everyone !

The Institute for Health Technology Transformation is a US based organisation that brings together private and public sector leaders to foster the effective use of technology across the healthcare industry.

Their report, "Top Ten Things You Need To Know About Engaging Patients' is a compilation of what key health IT experts from across the U.S. think are the most important things to know about engaging patients in the digital age along with four key recommendations for practical action.

Mostly common sense. Doctors just need to ask a simple question - How would you like your lawyer to communicate with you ? Use the same principles to open as many communication channels with your patients, so it's easy for them to connect with you !

" In an earlier column, I complained that IT spends a lot of time providing electronic tools for clinicians--electronic health records (EHRs), computerized physician ordering systems (CPOS), etc.--but not enough time developing tools to improve patient education.

I was wrong. Digging deeper into this area has convinced me that there are all sorts of practical technology-based resources to help patients understand their treatment and how to comply with their doctors' advice. Computer-generated questionnaires, medication resolution programs, and sophisticated videos are making a difference in patient care. "

India can be a market leader in this space !

This is a guest post from a very thoughtful patient of mine. I know many IVF patients will be able to identify with her experience . I just wish more doctors would read this as well, so they can provide more support to IVF patients !

When you do ivf as a medical tourist soon you'll find out you have become a traveller between the worlds. Between continents and between medical worlds: "normal" obstetrics and ivf. Unexpectingly it turns out to be much easier finding an ivf doctor in India than finding an obstetric gynecologist in your home town. And once you are lucky enough to get an appointment, you are faced with different treatment concepts: pregnancy in obstetrics and pregnancy in ivf are a world apart it seems.

Unless you are already established with an ob gyn - not so likely; you would not be an ivf patient if you had made it into the normal gyn world - getting an appointment with a gynecologist becomes a real challenge.

After returning from India I called a gyn I had seen once to schedule appointments for the row of betas after the two week wait. She reluctantly ordered one blood test and told me right away that she was not willing to deal with ivf patients in general, much less with ivfers from abroad and that she was not an obstetrician anyway for that matter.

I then contacted other obgyns in my area but they were so fast in telling me that there were no appointments available any time soon that I did not even had the chance to explain the vital importance of the row of betas in ivf and that this was why I needed an appointment much sooner. Since this was my fourth ivf cycle, as a recurrent ivfer I had by now acquired a daunty respect for those fearful beta numbers and their always heart-wrenching doubling time. During the two weeks of wait for the first beta, the tension grows denser and denser and the only thing that can ease your strain, slightly, is a good doubling time. I had to find a beta-willing gyn at any cost.

A certain familiarity with the medical establishment led me to the conclusion that local doctors in private practice might have arbitrary freedom as to wether accept new patients and therefore insisting on small private practice doctors would lead nowhere. I had to find a public structure with more inclusive patience acceptance. I called the medical faculty associates office at a the local university. Among the options at the answering machine : "if you are pregnant ..."That sounded promising.

I pressed the required key and a friendly voice said, he would now check for available appointment dates. I explained right away that I was doing ifv abroad and that I needed two blood tests and a scan done on specific dates. He was listening for a while and after what seemed to me a long stretch of silence he was trying to find out where in his scheduling scheme I could possibly fit in with my outlandish request for a row of betas. "A row of betas ? I don't think the doctor will do that for you". He appeared to want to be helpful, but just could not comprehend my urgency for blood tests. He suggested to do a home test in the meantime.

I did not want to lecture on the difference between qualitative and quantitative bhcg testing for fear this might ruin his sympathetic attitude towards me. I just began to understand myself that timing in ivf was far away from timing in normal obstetrics. The beta frenzy was a thing exquisitely ivf. He was willing to give me an appointment to see a doctor on a day that luckily turned out to be the day my ivf doctor wanted me to have my first scan, in 10 days to come. I gratefully accepted. I had to find another way to find relief from beta hell. There was no way I could wait 10 days without knowing my beta numbers' fate.

When dismissed from Dr. Malpani's clinic, he will ask you to inform him on your beta results. I emailed him that I was not able to obtain blood tests and therefore could not inform him. Within a few minutes he replied sending me a link to a online lab. What a relief. I would have had to pay for the tests privately though. Relief from awful beta-anxiety has no price.

The beta numbers came in, anxiety stayed. Doubts about adequate doubling time and no doctor to talk to. Again I emailed with Dr. Malpani and was reassured.

While my appointment with the obgyn was approaching, I imagined that I would have to go through at least two assistants before I could talk to the doctor. They would both ask me the same questions again ,checking the same checklist. Why was I so hypercritical ? I should be thankful that someone was paying attention to me no matter how formal.
This doctor turned out to have one assistant only and she was indeed simply friendly and asked me where I had my ivf done. "India ? That's pretty far away".
"Only on the map" I replied thinking of how easy it was to get advise from my ivf doctor by email while I hadn't yet seen the local doctor. I was so tense about seeing the doctor and whether he would have me have a scan done, that I made no attempt to explain this apparent contradiction. Whatever her assumption regarding my state of mind that moment , she was surely right.

And then she asked me about the due date. The due date ? WTH ? Heavens, I am doing ivf ! I am not in the usual pregnancy business. In ivf the due date is an almost non-existing concept. In ivf you go from hurdle to hurdle, from beta to beta, from scan to scan, day by day, week by week. The relief of one doubling beta lasts the blink of an eye and you start worrying about your next beta two days from now. And once you made it to the ultra sound level and you are lucky enough to see what could be a a gestational sac, a black little hole, you start getting very nervous when your next appointment approaches: will there be a heartbeat ? You will never forget that flimsy flickering filament and life appears to be so fragile and delicate, a friable thread of silk.

"The due date", I said, "I never got that far". A look at her told me that she considered my situation to be too complex. She did not inquire and I was glad I did not have to go over my ivf history. I handed her my discharge papers. Without having a look at them she said the doctor would be here soon and left.

The doctor stepped in, I explained I was doing ivf abroad. I told him my beta numbers and he decided they were too low. The feeling of desperation took over. I had the impression that maybe he was not used to see beta numbers at such an early stage of pregnancy and that was why he considered them too low. But I had not enough energy to find that out. I would ask Dr. Malpani.

By now I have become an established patient with both the pregnancy worlds. Pregnancy symptoms might be the common interface. I learned to navigate myself through the "normal" obgyn world being aware that I am confronted with a somewhat different obstetric culture. There is no "clash of civilization" in obstetrics, no self-fulfilling prophecy of conflict. After all, a pregnancy is a pregnancy, no matter where.

" In Denmark, we’ve developed communication thus far for almost all IT systems in the health sector. We have implemented all prescription and medication information, and all discharge letters and summaries from hospitals. This also includes outpatient notes, injury reports, x-ray reports, lab reports and lab orders. Reimbursements from health insurance have been made electronic, along with referrals to hospitals and private specialists, and referrals to psychologists. All private physicians have electronic health records today so they can communicate and transfer documents electronically, as well.

From the beginning it was a grassroots effort; we thought it was a good idea to exchange information electronically. And now it has become mandatory that you must communicate electronically. There was a state-wide agreement that this was a good idea."

" Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

What has gone wrong with us?"

What people do not realise is that when patients start behaving as consumers, the doctors you deal with will stop behaving as trusted professionals and will start behaving as businessmen who will focus on their bottomline. When you are ill, you need a trusted advisor - and if you do not treat your doctor as a healer, he will not behave as one. What a shame that it's come to this !

" Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."

This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own website, thus helping lots of
other patients !

" Second, anonymous reviews should not be allowed. Not only can anonymous posts be manipulated by someone bearing a grudge, glowing narratives can be planted by a doctor or his staff. Ratings accountability allows doctors to use real patient feedback to constructively improve their practice. Angie’s List, a leading fee-based consumer rating service, sets an example by not allowing anonymous reviews of health professionals."

I agree ! It's very easy for a disgruntled patient to write a complaint about Dr Malpani - and I am sure our friendly competition may even egg on their patients to do so . These kind of complaints can cause a lot of damage and are very hard to fight, because the poster is anonymous - and can say what he likes and get away with it !

" And perhaps more important, doctors who fail to embrace social media risk becoming irrelevant, as more patients flock to the web as a source of health information, rather than endure the inconvenience of a doctor’s office:

Doctors who are not active online risk being marginalized. Facebook and Twitter users, half of whom are under of age of 34, rely on the web for most of their information. As this demographic ages, it’s conceivable that they will consult social media first to answer their health questions."

In the past, senior doctors had an edge over their juniors because of the "grey-beard" syndrome. Times are changing and doctors need to evolve with them ! Patients will usually go online first when they have a health-related problem - and doctors who are not online may soon find that they have become dinosaurs, who can no longer survive !

" Interactive health is about making health knowledge, supportive care, and motivation available to us, anytime and anywhere, so that we can integrate this wisdom into our daily actions to live longer, healthier, happier lives. Welcome to the new era of Interactive Health."

We are very nearly there now ! Everyone will have their PHR in the cloud; doctors and other medical professionals will use their EMRs to upload your medical data to this PHR, so that the medical information is automatically updated and complete. You can share portions of your PHR with others - and your doctor can prescribe Information Therapy to you, tailored to your needs !

When doctors are stumped with a difficult patient, they will often refer the patient to a specialist, in order to help them with the diagnosis and management.

However, while specialists can be very skilled at making the right diagnosis, they are often not very interested in helping the patient to learn to live with his disease. This is not an area which is of much interest to them, and not their core competence either.

However, after the diagnosis has been made, the patient's life still carries on - and he is often unsure where to turn for help.

For example, let's look at a young woman who goes to her family physician with the problem of blurring of vision. The physician dutifully refers her to an ophthalmologist, who then sends her on to a neurologist, who makes the diagnosis of multiple sclerosis. The doctors pat themselves on their backs, for having come to the right diagnosis so efficiently - and the patient is grateful that at least now she knows what her medical problem is. However, she still has to learn how to live with MS, and learning how to cope with a chronic illness is often the hardest part of having MS.

Unfortunately, this is something about which none of her doctors is well-informed ! The neurologist knows a lot about demyelination and how this affects nerve function - but he cannot teach her much about how to come to terms with her illness ; and how to manage her activities of daily living. How does she deal with her fatigue ? with a cranky child ? arm weakness ? her fears that she may become wheel chair bound ?

The best source of this expertise is not going to be a doctor - it's going to be an expert patient - someone who has lived with MS for many years, and is willing to share their heard-earned wisdom and experience.

Good doctors have always done this informally for many years - and it's been proven that support groups are a great way of helping patients to cope with their illness. It's now also possible to have online support groups, where patients can reach out and connect with each other.

Doctors can also learn a lot from expert patients. Thus, while a diabetic specialist knows a lot about the metabolism of insulin and how to program an insulin pump, he may not know much about what you need to do about your diet and activity in real life ( for example, when you have to attend a marriage or go out for a holiday). You may think these are "silly questions" and may not want to bother your doctor with these trifles - but the fact still remains that you need reliable answers !

It's best to learn these pearls of wisdom from other patients. They will be much more
empathetic - and their advise is likely to be much more practical, as it is based on their real-life experience - not on what a text book says ! Also, while it may not always be reliable ( because patients can be poorly informed sometimes), at least you know it will be provided with no vested interest !

While patients in the US are deluged with information, patients in India are usually starved for this. They have to depend upon US websites for information ( much of which is not applicable to Indian conditions and diseases); or upon their doctor ( who is often too busy to educate them !)

One of the major issues is that the importance of educating patients has still not become a pressing issue for doctors. Traditionally, Indian doctors have always been quite paternalistic; and most Indian patients are quite happy to follow the doctor's orders.

While it's true that times are changing, and that the younger generation of doctors is more willing to be open ad to invest time in discussing treatment options with their patients, another limitation has been the acute shortage of patient educational materials designed for India.

Another major issue has been the fact that there are so many regional languages in India - and many Indians are illiterate.

The good news is that this challenge is actually a great opportunity - and clever startups like PEAS India ( in which I am an angel investor) are now developing a library of patient educational DVDs , customised for India !

This may be a terrible confession for a doctor to make, but when I have a medical problem, I'd trust an expert patient rather than a doctor. Let me explain.

I have chronic back pain and this can be quite severe at times. However, I am very reluctant to go to an orthopedic surgeon, because I know pretty much what he is going to say. He's going to do a cursory examination and then ask me do do a MRI scan. The MRI scan will find some bulges in my intervertebral discs - and the radiologist will happily report this as prolapsed intervertebral disk ( slipped disc, in layman's terms). The doctor will be happy he's made the right diagnosis; and will advise bed rest; pain-killers ; and physiotherapy - with the caveat that if it gets worse, he'll be happy to do "minimally invasive surgery" to fix the problem.

This is the standard medical paradigm for managing back pain - and while it's completely reasonable ( and follows medical textbook advise) , it's does not add to the quality of my life. I want to continue playing tennis daily - and want advise on how to manage my back pain without having to stop my tennis ! This is not something most orthopedic surgeons know much about, because they spend more time in the Operating Room than on the tennis court !

I'd much rather talk to a tennis player who has had back pain for many years, and ask him how he's managed it. He is the true expert on my problem and I'd be happy to learn from him. For one, his advise would be much more applicable to my problem - and for another, he has no hidden agenda !

Of course, not every patient is an expert patient. I want someone who's smart, well-read and well-informed - and who has taken the time and trouble to explore his options. ( If he also happens to be a doctor, that's an additional bonus !)

While doctors are good at making the right diagnosis, how to live with the disease ( how to manage what medical textbooks call "activities of daily living" ) is something patients can learn much better from other patients. This is not an area in which doctors are well-informed , because it's not something which interests them !

Really smart doctors will refer their newly diagnosed patients to other expert patients , to help them cope better with their illness !

As i have written earlier, the primary job of a doctor it to teach patients. After all, medical care does not just consist of making a diagnosis or prescribing a medicine. Teaching patients about their illness; what they can do to manage it; and what they can do to remain healthy is an integral part of a doctor's job.

However, as important as teaching is learning. Doctors need to learn all the time. Medical science makes dramatic advances all the time, and doctors have to invest time, money and energy in ensuring they knowledge base is updated and current . This is why doctors read medical journals and medical conferences !

However, a very important teaching tool ( which many doctors sometimes overlook) are patients. Patients can be your best teachers - if you give them an opportunity to teach you ! Patients will not teach you just about the medical details of the disease ( though reading medicine about patients you have actually seen is the best way of making sure that the knowledge "sticks" !) .

Patients can teach doctors how to live; and how to cope with adversity ! Expert patients know a lot about their disease, and can teach a doctor a lot about how his patients can learn to live with their disease.

( And if you are lucky, and your patient is an investment consultant, he can also teach you how to invest in shares and stocks ! )

The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD ( preimplantation genetic diagnosis) with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !

Doctors , like all big boys, love to play with new toys - and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive - and are always trying to be one-up on each other. An easy way of being different is to use the newest technology - but the trouble is that never is not always better ( though newer is always more expensive !)

Because these new tools are so expensive , doctors need to use them extensively, to justify the expense - after all, they need to show the bean counters who pay their salaries and bonuses that the new tool is cost effective !

The key question thoughtful patients need to be asking is - Is it really better ? Or is it a solution looking for a problem ?

I think the truth is we really don't know right now ! It's very likely to be useful for some patients - but to expect it to be useful for everyone across the board is hoping for too much ! While it may seem logical to use PGD, unfortunately, biological systems are not always logical ! What seems to make sense in theory often does not

As a doctor in clinical practise , whose major focus is simply to get as many of my patients pregnant as quickly as possible, I am quite conservative and prefer to wait and watch.

I follow Alexander Pope's dictum,
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

Only time will tell how useful PGD-CGH is - but the enormous commercial pressures under which IVF clinics operate - and the constant demand by patients that their doctor use the newest and the latest breakthrough technology they read about in the newspaper means that most IVF clinic will likely end up overusing it !

I always tell me patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative - and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.

Intelligent patients appreciate my honesty and frankness - they prefer a doctor who will tell them the unvarnished truth. Others who cannot handle the truth will usually move on to another doctor who is willing to promise them the moon - and who is happy to tell them what they want to hear !

It's very easy to smile; be optimistic - and make false promises. Everyone wants to think positive - and if you believe the book The Secret, then positive thoughts attract success !

While I am personally very optimistic by nature, I feel it's not correct for a doctor to overpromise success ! Patients are emotionally very vulnerable and it's easy to take them for a ride - something which many unscrupulous IVF doctors do all the time, by quoting inflated success rates and promising the moon !

When I tell patients to prepare for the worst , this does not mean that I not hopeful or that I am a defeatist. I am not being negative or being a pessimist - I am just trying to be a realist !

Being prepared does not mean that you are expecting a bad outcome or that your negative thoughts will attract failure - it's just that you are preparing for it. This is something you do in daily life all the time , so why shouldn't you do it during your IVF treatment as well ?

It's always easier to mentally prepare when you do not need to !

Let's assume to decide to be positive, optimistic and upbeat and prepare only for a good outcome. If you do get pregnant, you'll be pleased and happy - and life will move on. However, if you do not get pregnant , you will go to pieces. Bouncing back will be much harder - and you'll find coping with the emotional roller coaster ride much more difficult.

However , if your prepare for a bad outcome and get pregnant, you get double the joy ! And even if you do not get pregnant, while your heart will still break, your mind will help you heal faster because you were mentally prepared for this.

It's harder to deal with a negative outcome when you are not ready for it ! IVF is a scary emotional roller coaster ride and mental preparation gives you some stability.

The trick is to find the right balance - to look for the middle path - what Buddha called the golden mean ! It can be helpful if both partners have different world views because they can balance each other !

However, if the husband is optimistic and the wife is pessimistic, and the cycle fails, he may end up blaming her for the failure because " you are always negative" ! Victim blaming is very common when patients adopt a pessimistic approach in order to protect themselves from heartbreak - and this is just adding insult to injury !