Avoiding "cookie-cutter" Medicine

Medicine has been called an art and to some extent this is clearly true. Although statistics, protocols and algorithms exist to guide therapy a thoughtful physician must always take into account the particular needs of his patient. I know that this sounds incredibly obvious but the reality is that with the advent of the internet additional voices have been added to the patient-doctor relationship. I stress to my patients that they are unique and although others may voice their opinions as to the best course of action, the final decision should rest between doctor and patient.

Recently I had a patient with a strong history of depression whose insurance required a series of 3 IUI cycles before covering IVF. She had only a single good fallopian tube and as a couple they had no previous pregnancies. The semen analysis was a bit borderline as well. So given the situation I was proposing moving directly into IVF. Looking at the whole picture this seemed an appropriate plan and the couple was motivated. The insurance company was resolute in their requirement of 3 IUI cycles. I spoke with several employees and was finally told by the Medical Director that the requirements were non-negotiable. This is "cookie-cutter" medicine. No personalized care, one size fits all, don't tell me the facts just follow the algorithm medicine. Bleh.

So I followed the rules. 3 stimulated IUI cycles failed. No surprise. However, IVF was successful on the first try and the patient appreciated the effort that we made to "fight City Hall."

As a physician I learned early in my career that if all else fails "Listen to the patient." I view fertility treatment as a joint effort between the couple and the physician. However, as the physician I have the benefit of having treated patients with similar problems and can take the long-view of a treatment plan. This creative approach was instrumental in Dr. DiMattina and myself launching the Natural Cycle IVF program. One size does not fit all. Some patients are best served by a very proactive approach, moving into stimulated IVF as fast as possible, whereas others take a more step-wise tact with increasing complexity of treatments if unsuccessful. Talk with your RE to develop the plan that meets your needs. If you are a Diplomat going on assignment in 8 weeks then your needs are different than the patient with a pathological fear of needles...or multiples....or OHSS....or being pregnant during August in Washington, DC!