Monday, 21 April 2008

Doctor Knows Best

Now here's a sentence I thought I'd never write: I miss Dr Abrupt. His secretary called on Friday afternoon: Dr Abrupt is away at a conference all this week, but he had asked her to telephone me to let me know that he had received the results of my Day 3 bloodwork, and that everything looked fine. He had passed my file over to his colleague Dr Knows Best, who would be seeing us for our Day 21 appointment.

This morning, we got up bright and early for our appointment at the Great Big Infertility Clinic. After waiting over half an hour, eventually we were called in to see Dr Knows Best. I renewed my acquaintance with the dildo cam, which revealed that I had ovulated from my right ovary this month (so still no confirmation that my left ovary is in fact functioning as it should). After some prompting on my behalf, Dr Knows Best volunteered the information that I had 9 follicles on my right ovary, and 5 on my left ovary. I said I thought that, given my anxieties about diminished ovarian reserve, this was a good sign. 'Not necessarily,' said Dr Knows Best. 'It doesn't matter how many follicles you have, if they don't respond to stimulation.'

After I'd put my knickers back on, we then sat down to discuss my protocol.

Dr Knows Best explained that I would start taking the nafarelin nasal spray on the first day of my next period. The dose would be 3 sniffs per day. At this point I interrupted. Did that mean I was doing a regular dose, rather than a micro dose, flare? 'You've obviously been spending too much time on the internet,' replied Dr Knows Best. 'Why don't you let me worry about what protocol we're doing? All you really need to know is what dose of drugs to take, and when to take it.'

He proceeded on with his explanation. I would start the Menopur injections on day 2 of my period, and would come in for a scan eight days later. I explained that, given my poor response last time round, I didn't feel terribly comfortable about being left to stim for eight days; I would prefer to be more closely monitored on this cycle. Dr Knows Best informed me that the Great Big Infertility Clinic no longer performed scans earlier in the stimulation phase; they did not feel that they were of any use in monitoring patients' response (they also don't appear to check E2 levels either). I was on the maximum dose of Menopur, and after eight days they would know whether I had responded or not. If I hadn't responded, then there really was very little more they could do for me. He then smiled, and asked us whether we had any further questions.

Why are you such a pompous and patronising ass? What the fuck are we doing here? Instead, I asked him about my day 3 bloodwork. What were my FSH levels this time round? 'I really don't think it would be helpful for you to know these,' he replied. I disagreed. I said I thought that knowing as much as I could about my treatment was very helpful. Grudgingly, he told me that my FSH was 6.

On the way home in the car, we decided that this is very probably the last cycle of treatment we will undergo at the Great Big Fertility Clinic. Neither of us can escape the feeling that we are paying vast amounts of money for what seems to be very cursory treatment. I have no sense that I have been given a protocol that has been tailored to my individual needs; instead Drs Abrupt & Knows Best appear to be trying a series of default options. Possibly my feelings about them both may change if I get a positive result from this cycle - it's just, at the moment, that feels a fairly remote possibility.


shinejil said...

I'm sorry you got such shoddy treatment from the men you're shelling out your precious savings to! I'm rarely impressed with specialists social skills, but this is really inappropriate. I think you're right--if this cycle is a bust--to look elsewhere for treatment.

But I'm cheering your ovaries on this cycle, sending all the eggy vibes in our corner of the world your way.

Malloryn said...

How awful! I think that in dealing with infertility, you need to have some give and take between doctor and patient. No one knows your cycle and body as well as you do. Everyone doesn't fit the same mold, and it doesn't make sense to use the same regime for each patient. He sounded like a patronizing ass as well. I'm sorry that you had to deal with that.

I hope that you respond well to the stims this cycle. I'll be cheering those follicles as well!

luna said...

ugh. dr. patronising ass sounds awful. I hate when they don't answer your questions, especially when they think it's because they know best. how is a person supposed to make informed decisions about treatment? I guess that's the point -- they know best.

anyway, wishing you luck with a good response.

and thanks so much for your sweet comments, as always. ~luna

Mrs.X said...

I can see now why you would miss Dr. Abrupt - compared to Dr. Knows Best, he's a veritable angel. I hope you know that there are doctors out there who are genuinely caring and not pompous asses like these two! I think it's a great idea to depart the Great Big Infertility Clinic for greener pastures, if things don't work out this time.

Best of luck on this latest cycle. And that you don't strangle any of these guys with your knickers (love that word) in the mean time.

Kim said...

What an ass!

You have every right to know and understand your protocol. If I had a nickel (or Euro?) for every time a doctor missed something in my history then I would really have gotten fabulously wealthy from my infertility treatment.

I'd look elsewhere too if this cycle doesn't work.

By the way, I was forced to leave my first practice when i moved - they were very nice but my RE in Washington quickly found a major mistake that led to a failed IVF (oops, they didn't noticed I'd ovulated before the extraction). I was feeling totally hopeless until I met him. said...

EXCUSE Me!! He actually said -'You've obviously been spending too much time on the internet' - he just thinks he is Dr Knows Best.

Docters are not gods - they just like to be treated that way - trust me I'm a nurse!!

It is important to feel comfortable while you are going through this process. You need to be heard, you need to be listened to, your opinions need to be respected, and you do not need to be treated like a silly little girl.

I think you and your husband were remarkably restrained.

You are abolutely entitled to have answers to all of your questions. I think you are right about moving on to another clinic.

I'll be cheering on your ovaries and hope that this is the cycle that means you won't have to see these people again.

Good luck.

PS: Thanks for the comments at my blog.

Lisa Rullsenberg said...

You deserve far better than this shoddy response from your doctors. if you are able to go elsewhere - if you have the money and emotional energy to do that - then do it. As said, Dr. Abrupt may be just that but at least he did actually give you information rather than essentially patronising you and making your feel information about YOUR BODY was an optional thing for him to share with you.

J.J said...

Breath taking arrogance from Dr K'sB. Gosh - how dare you actually read up about the treatment YOU are undergoing and YOU are financing.

Really hope this goes right for you.

the Babychaser: said...

Oh my god. What an asshole. I'm stunned. Any doctor that thinks you "don't need to know" your own medical information definitely has got to go.

Oh, and you could also tell him he's breaking the law. Part of HIPAA involves guaranteeing patient's rights to their own medical information--whether the doc thinks we'll understand it or not.

Sheesh. I'm really cranky about this jerk.

Good luck with your cycle. Hopefully you'll respond well and you won't have to worry about another cycle.