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• About 42% physicians use an electronic health record solution to document their patient care and about 1 in 3 uses an EHR during a patient encounter.
• Overall, 62% of physicians and 81% of patients have a positive perception of documenting patient care electronically.
• Forty-five percent of patients had a "very positive" perception of their physician or clinician documenting patient care with a computer or other electronic device.
• More than 60% of physicians feel the best benefit to using EHR is the access they have to patient records in real time.
• Physicians also believe that the ability to seamlessly share information with other doctors, pharmacies and payers are one among the most important benefits.

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.

" 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 !

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 !

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 ! )

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 !

“What can you possibly learn from your doctor that is not available on the Internet?” We suspect we'll hear such radical sentiments increasingly in the future. Knowledge is said to be power, and some of the past imbalance of power between patient and doctor may be equalized. But information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the Internet will make such expertise and experience more essential. The doctor, in our view, will never be optional."

Actually, there are some things which the internet can teach patients far better than the doctor
can ! Youtube videos ( on how to take your IVF injections for example) can be played and replayed - and websites don't lose their patience with patients ! Also, many doctors are often not very good at teaching because they cannot stop using medical jargon.

Websites and doctors are all tools which a smart patient should have in their medical tool box. The real mark of a wise patient is that she knows which tool to use at which time !

Have you got fed up of waiting for ever and ever at your doctor's clinic ?
Are you upset when your doctor talks down to you or uses jargon ?
Do you resent the fact that it's impossible to make sense of your hospital bill ?
Why can't hospitals be more patient friendly ?
Why can't doctors be more transparent ?

Instead of just complaining, here's an opportunity for you to provide some answers !
Remember , if you are not part of the solution, you are part of the problem !


You are invited to attend the launch of
The Patient Community@HELP
on Thursday,7th April, 2011 at 11.30a.m.

Introduction and launch of The Patient Community@HELP

Dr.Aniruddha Malpani, M.D., IVF Specialist, Founder, HELP and Patient Advocate- "How Patients can Heal a Sick Healthcare System".

Mr.Kanu (Harshad) Kamdar, Member, Parkinson's Disease and Movement Disorder Soc. of India - will speak on "Partnering with the Health Care Team for Graceful Aging".

Dr.Shantanu Nagarkatti, M.D., Surgeon, Professor, Expert in mind body medicine will speak on "Improving Patient Communication - Learn how to talk to your doctor !"

Mr.P.K. Rao, - Founder, JASCAP will speak on "Converting A Personal Tragedy Into A Socially Useful Project".


The first meeting of The Patient Community@HELP will be held on Saturday, 14th May, 2011 and every second Saturday of the month thereafter.

Goal: To provide a platform for patients and doctors to connect, to help improve the doctor-patient relationship

Get Involved ! Whether you are a medical student, a physician, a patient or a caregiver, we need you.

If you are doctor, you can take a workshop ! If you are an expert patient, you can help other patients ! We are inviting registrations to The Patient Community @ HELP. Call us on 022-65952393/94 or send us an email.

Be there and contribute!
For more Information Click here.

I always tell my 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.

It's very easy to smile and to make false promises. Everyone wants to think positive - and if you believe the The Secret, then you also believe that 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 - it's just that you are prepared for the eventuality. This is something we do in daily life all the time - which is why we buy an insurance policy - not because we want to die, but because we need to be prepared for death !

It's much easier to prepare for a negative result before you get the actual beta HCG result. For one, this is just a theoretical exercise, because the hope that the result will be positive is always there. For another, you have time to think about options and Plan B, so you can think rationally and calmly.

If you prepare for a good outcome and get a good outcome, you can pat yourself on your back , send your doctor a box of chocolates, and move on. However, if you prepare for a good outcome and get a negative result, you are likely to find it very difficult to bounce back or think straight for a long time ! It's much harder to deal with a negative outcome when you are not ready for it.

Conversely, if you prepare for a bad outcome and get a bad outcome, at least you know what your next action steps are and you can move on with life. And if you prepare for a bad outcome and get a positive result, then you have twice as much reason to celebrate !

IVF can be an emotional roller coaster ride; and mental preparation gives you some stability to cope with the ups and downs. It's helpful if both partners have different world views, so they can balance each other !

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 !

Dr Vartabedian has an interesting blogpost. " I was thumbing through Seth Godin’s Poke the Box and stumbled on this quote. I couldn’t help but put it in the context of physicians and their obligation to make content:

I hope we can agree that there’s a moral obligation to be honest, to treat people with dignity and respect, and to help those in need.

I wonder if there’s also a moral obligation to start.

I believe there is. I believe that if you’ve got the platform and the ability to make a difference, then this goes beyond “should” and reaches the level of “must.” You must make a difference or you squander the opportunity. Wasting the opportunity both degrades your own ability to contribute and, more urgently, takes something away from the rest of us."

Some old-fashioned doctors still think it's unethical for doctors to have a website. They fell this is like advertising - and not something which medical professionals should do !

It's interesting to see Dr Vartabedian's viewpoint, which I agree with completely ! The word doctor is derived from the word "docere" = to teach; and I feel doctors have an ethical obligation to do so. They need to teach not just the next generation of doctors, but their patients as well. The internet is a very powerful means of teaching and doctors who do not use it to educate their patients are doing a disservice - to themselves, the medical profession; and their patients !

Happy patients are happy with their doctors - while unhappy ones are happy to blame and criticise their doctor. Doctors seem to have become everyone's favourite whipping boys - they are greedy and just want to make lots of money; they do not have time for their patients ; and cannot communicate well.

It's very easy to blame the doctor, but this is hardly helpful ! Patients need to understand that getting good medical care requires they they establish a healthy doctor-patient partnership - and in order to do this, they need to become expert patients !

This has become surprisingly easy to do, thanks to the net. All you need to do is invest some time and energy - and if you do get lost, there are lots of people who can help, including online bulleing boards and forums; and librarians.

The rewards are well worth it - after all, if you are not part of the solution, you are part of the problem ! You cannot change your doctor's behaviour - but you can change yours ! Do not underestimate your intelligence and common sense - you have a lot at stake ! A big plus to doing so is that armed with the information, you'll be able to find a better doctor !

Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

Pharma marketing - what doctors need to know : "Pharma marketing can be classified into two different categories:

1. Push marketing: targeting physicians. Urging them to “push” certain drugs to their patients.
2. Pull marketing: targeting patients. Urging them to “pull” or request certain drugs from their physicians.

The most important approach to marketing taken by many pharmaceutical companies has been push-oriented. All those busy pharma reps swirling around hospital hallways are trying to persuade you to prescribe their drugs to your patients.

Nevertheless, the pull-approach has become more and more prevalent these days. Pharma companies are increasingly targeting the patients themselves.

What makes a good doctor good is the fact that he has good clinical judgment. This is a term which is hard to define, but basically a good doctor is one has seen and treated and learned from lots of patients, each of whom adds to his knowledgebase and clinical wisdom. As the saying goes, "Good judgment comes from experience. Experience comes from bad judgment."

However, the mere passage of time does not provide good judgment . After all, 20 years of being a doctor could simply mean 20 years of doing the wrong thing ! It's important that doctors learn from their experience - and the only way they can do so is by tracking the outcomes of the patients they treat.

Unfortunately, this rarely happens in real life ! Let's take 2 patients whom a family physician treats for abdominal pain. One gets better and moves on with his life. He does not tell the doctor he is better, because who goes to a doctor when they are fine ? The other may get worse and may end up needing an appendectomy. However, he's not likely to go back to the doctor either ( unless he is angry and wants to sue !). This means that both patients who get better and those who don't rarely provide feedback to their doctor in real life.

However, without this feedback, how is the poor doctor going to learn ? He naively assumes all his patients have got better - and he loses track of those who do not improve , because unhappy patients will do their best to find another doctor.

How can doctors practise evidence based medicine ( EBM) without any evidence ? They need feedback from patients, so that can learn whether what they are doing doing is useful or not ?

EMRs can be a great tool in facilitating this kind of patient feedback ! One week after every clinical encounter, the system can automatically send an email to the patient, asking for feedback. This will provide very useful data - for which each doctor can learn about what he did right - and what he messed up.

Many doctors will agree that it can be very frustrating to treat an "interesting patient" - and then never find out how the story ends, because the patient never comes back and is "lost to followup" !

Not only will this data help doctors to learn and improve , it can also be very useful as a clinical practice builder , because patients are touched when their doctor reaches out to them proactively. Patients are happy when they learn that the doctor is interested in finding out how they are doing - and happy patients make for happy doctors !

Everyone knows IVF has a limited success rate and that there are no guarantees in medicine. If that's the case, then why do we offer an IVF guaranteed pregnancy program ?

Is this just a marketing gimmick ?

No ! There are lots of benefits to this option, both for our patients and for us.

For one thing, this option bolsters the patient's confidence levels ! Patients who have failed IVF cycles elsewhere have lost confidence in doctors - and in themselves. Before starting the IVF cycle, most clinics promise the moon. However, when the cycle fails, the patient becomes a leper and the doctor becomes inaccessible ! Finding a doctor who is is willing to put his money where his mouth is helps them to rebuild confidence in the medical system !

This option also helps patients to have realistic expectations of the IVF treatment. For many patients, IVF is their last resort. They are fed up and frustrated and do IVF with a lot of hope that this high-tech expensive method with such a high success rate will finally give them the baby they have longed for for such a long time ! When the IVF cycle fails, this is often the last straw which breaks the camel's back, and they are shattered, disheartened and dis-spirited. This is why the drop out rate with IVF treatment is so high - very few patients have the emotional stamina to do more than 2 cycles. It's true that IVF can be an emotional roller coaster ride, but when patients think of IVF in terms of a single cycle "sure shot" technique, they are setting themselves up for unhappiness. Even worse, by not repeating the cycle, they are depriving themselves of their best chance of having a baby !

The guaranteed pregnancy option is very useful as it helps them to reframe their perspective . They look at the treatment more realistically and realise it's not always a 100 meter sprint. The are willing to work with the doctor - and give the technology enough time and opportunity to maximise their chances of success.

It also helps them to regain control of their life. This option helps them to establish a timeline , so they have a clear road map of what they will do ; when they will do it ; and when they will move on to Plan B. Otherwise, when an IVF cycle fails, many patients are paralysed into inactivity - and they do not have the heart or the stomach to try again ! When they make a 4-cycle commitment upfront, they realise they are in it for as long as it takes , which is far more
realistic !

This option also helps them to move on with their life. Even if they do not get a baby at the end of it, at least they have peace of mind they did their best, in a systematic and well-organised fashion, so they do not have any regrets when they are looking back at the age of 50 !

It also helps to reduce disputes between husbands and wives. Men are from Mars and think only with their heads. Women , on the other hand, think with their heads and their hearts, and this just ends up confusing their husbands. This option ensures both are on the same page - and that they will remain there, even if the cycle fails ! This makes it easier for the husband to console his wife if the cycle fails, because they have something positive to look forward to !

Everyone knows that IVF success rates improve with repeated attempts - and the cumulative conception rate in our clinic after 4 cycles is 87% ! I usually tell my patients - I am very sure we will be able to give you a baby - it's just that I don't know when this will happen, as I am not a fortune teller !

This option is very helpful from a medical point of view as well. It allows us us to learn how the patient responds to the treatment, so that we can continually improve and fine-tune the treatment protocol until we achieve success ! After all, every woman is different, and we need to tailor or protocol to her response - a process which can take time ! This option allows us to learn from each cycle, so we can move closer to the desired goal !

Can we offer this option to all patients ? Sadly, no. We restrict it to patients with a good prognosis, allowing us to create a win-win situation.

Does this make any financial sense for us ? In case the 4 cycles fail, where does the money to pay back the patient come from ? Do we lose money ? No, we don't. In what I think is a way of sharing risk amongst patients by pooling them together, the patients who get pregnant ( and " overpay" us) end up subsidising the treatment of those who fail !

Does this make financial sense for the patient ? Yes, definitely ! For one, it protects you against a future price rise, as you can do your 4 cycles any time you want over a 2 year period. Also, there is no additional cost for freezing your embryos and transferring them. This means that if you have frozen embryos, you get a number of additional free "bonus" cycles - at no extra cost to
you !


We do sign a legal binding contract before we start the treatment, so the patient is protected and secure. While the actual medical protocols we use are the same for all patients, whether they use the standard single cycle pay as you go option, or the guaranteed pregnancy option, over the years we have observed that patients who select this guaranteed pregnancy option have a much higher success rate !

Doctors come in all shapes and sizes . This is just as well, as patients come in different flavours as well, and in the best of all worlds, each patient will find the doctor with whom they can work best with.

This is why doctors prescribe all kinds of therapy - medicines; injections; vaccines; acupuncture; supplements; diets; and surgery. However, there are 3 kinds of therapy which all doctors should prescribe routinely, which they often forget to do !

1. Information Therapy. This should be number one ! The word doctor is derived from the word " docere" - which means to teach. Educating patients is critically important, both for the doctor and the patient, so that they both have realistic expectations of what each expects; and what the likely outcome is going to be. There are many tools available for educating patients - and this can be done online; before , during and after the visit; and by assistants as well.

2. Humour Therapy. Humour is one of the most effective coping mechanisms available and a regular dose can help all of us - patients, as well as doctors ! Good doctors try to make the patient feel comfortable and at ease and humour can be a very useful tool in doing so. It's a good idea to prescribe Laughter Therapy ! For example, I tell all my infertile couples to watch the movie, Maybe Baby. This is not an educational film - it's a romantic comedy about an infertile couple trying to have a baby. It stars Mr Bean - and most patients find watching the movie helps them cope better with their infertility !

3. Biblio Therapy. Many patients - especially those with chronic illnesses - feel cut off and isolated from the rest of the world. It's hard for them to find someone who understands what they are going through - and this adds to their unhappiness and stress. Reading books about other patients who have dealt with a similar problem can be very powerful medicine ! It helps them to realise that others have "been there and done that" - and this can inspire them to fight back !

These are common sense measures, so why does a doctor have to "prescribe " these ? For one, when a doctor advises a patient to do something, he is much more likely to do it. Even more importantly, it helps the patient to realise that the doctor is an empathetic human being, who has his best interests at heart - he's not just a technician. And finally, prescribing these will help the doctor to become a better doctor , as he learns to see things from his patient's point of view - and become a better human being !

" My doctor never has time to talk to me or to explain to me what is happening !" This is the commonest complaint patients have about their doctors.

It's true that doctors are busy - and good doctors are in high demand, with enormous patient loads. Their time is precious - and the reality is that they do not have the luxury of sitting down and chatting with you.

However, there's no point in looking for problems - you need to find solutions ! You cannot change the constraints your doctor operates under - but there's a lot you can do to make the most of the limited time you have with him !

What are some useful strategies ?

1. Remember that your doctor is no longer the only dispenser of reliable medical information. This was true 50 years ago, when doctors had a monopoly on access to medical knowledge, which is why your grandparents were forced to turn to a doctor for more information about their health problems. The good news is that you can easily get high quality medical information on the net today. ( This information is likely to be far better than what your doctor can give you. It's often professionally produced ; rich in graphics ; and has no jargon, because it's produced for patients ! Most importantly, you can absorb it at leisure. ) You need to be a well-informed medical consumer and be able to separate the wheat from the chaff, but these are easy skills to master.
Do your homework before going to the doctor - and after wards as well , so you do not need to depend only on your doctor for information. This will also allow you to make better sense of what he is saying - and he does not need to waste time explaining the basics to you, so you can ave a higher-level conversation about your specific issues.

2. When you talk to your doctor, make notes . This will help you make sense of what's happening. It's also a good idea to ask your doctor if you can email him. He may not have much time to spare on a "face to face" conversation - but answering email is something he can do more efficiently when he is not seeing patients. Email is often better, because everything is documented; you can re-read the information until you absorb it; and you can share the information with medical friends and relatives !

3. Make friends with a staff member. Having an "insider" in the clinic can help you understand what's happening. While the doctor maybe a bottleneck, often his assistant or nurse may have more time to lavish on you. They are often a better source of information, because they use less jargon and are less intimidating !

At the end of a consultation, I usually ask my patients - So what have you decided ? What would you like to do next ? After all, IVF is an elective treatment; and infertile couples have many choices. These are very personal decisions, which are best made by the couple themselves, rather than the doctor.

Often, many patients will answer - Whatever you say, doctor !

While it may seem very flattering that they are willing to allow me to make the decision for them, this is actually not a good answer , and I am unhappy when I hear this !

I'd much rather have a patient who took the time and trouble to understand their options, so they could make the decision for themselves . The best decision is one you make yourself

I will not let them make the wrong decision - but when there are choices, patients need to use their best judgment and decide for themselves - they cannot leave everything upto God - or upto the doctor !

Many decisions are too important to leave upto anyone else. While a doctor can provide guidance ( for example, about success rates), his opinion should just be one of the variables you consider when making your final decision.

I agree it's much easier to let the doctor decide for you - but this is not in your best interests, or the doctor's ! After all, the outcome of any treatment is always uncertain, and if you do not get pregnant, you may be resentful. Making your own decision gives you peace of mind you did your best ! It also encourages you to seek out information and take a more active role in your treatment - actions which actually improve your chances of getting pregnant !

There is a shortage of doctors. This is true all over the world because of many reasons. Medical training is expensive and arduous, and not many people are capable of surviving the grind. Also, doctor are unevenly distributed, which means that there are too many in large cities, but not enough in the villages. Finally, a lot of the doctor’s time , energy and expertise is wasted in handling problems which do not really need their expert attention. These are problems which can easily be handled by the patient and his family himself.

The standard solution to the chronic shortage of doctors has always been the standard knee-jerk response - train more doctors ! This solution comes in many different flavours - open more colleges; or create a new cadre of barefoot village doctors. However, these are just short-term fixes - and the problem recurs every few years, because doctors create a demand for their own services. This means that churning out more doctors will never help - it will just exacerbate the problem !

The solution is surprisingly simple - empower patients to take better care of their own health !
How can patients figure out when they need to go to the doctor ( and when they can take care of themselves as home ? ) How do they determine which problems they can solve for themselves and which should make them seek medical attention ? Is this headache a migraine ? or a brain tumour ? Is the fever because of a viral URTI ? or is it TB ? How is the poor patient going to figure this out ? Isn’t that what you need a doctor for ?

Right now the standard response for all patient queries is - Ask your doctor ! ( Isn't it ridiculous that most books and websites on fitness and exercise have this disclaimer - Please check with your doctor before starting an exercise program ! ) All we end up doing is making patients more dependent on the doctor and unnecessarily increasing the doctor's workload ! What we need to do is make patients more independent, so they can fend for themselves !

The trick to making patients do all the work is to develop clever tools which will help the patient to make sense of what is happening to them so they can communicate clearly with their doctor. The vast majority of health problems are self-limited and just need reassurance. They can easily be managed by a phone call or an email.

Doctors can learn a lot from retailers. In the past, customers went to the shop and the shopkeeper would have to physically carry the selected objects and then pack them and bill for them. The shopkeeper was the major bottleneck - and had to do all the grunt work. The new supermarkets make the customer do all the work, thus allowing them to service a much larger number of customers - for much less ! It's true that the retailing ecosystem had to change to allow this evolution to occur ( better packaging; better shelf displays; better branding; and more customer education), but this has now become the standard - and the retail industry is doing very well for itself, thank you !

Here's a simple example . A lot of the doctor's time is spent on taking a medical history. Many busy doctors do not have the time to do this themselves, which is why they get an assistant ( who may not be very competent !) to do it for them. We make our patients do this themselves by making them fill a very detailed and complex form ( see a copy at www.drmalpani.com/malpaniform.htm)

This has many advantages. It saves me time. It ensures the history is complete and that I have not overlooked any important information. Even more important, it helps to educate my patients ( because they need to do their homework to be able to fill in the form intelligently !). It also ensures they are better organised, because they need to collate all their medical test results and summarise their history !

Please note that I do not expect patients to make their own diagnosis ! However, patients are the experts on their problem, and helping them to help the doctor will help everyone !