The Physician Paradox

“How would you deal with a patient in this situation?” 

Even after so many years, I find myself often talking to other scientific experts or clinicians to ask for opinions in complex scenarios. 

I had a patient who wanted to travel abroad to explore a novel treatment for premature menopause (which is not available in the UK). She was quite distressed, understandably, at the prospect of losing her fertility and no longer being able to have her own biological children. She wanted to know whether it would be worth spending a significant amount of money to travel across countries to have this treatment and what the success rate would be.

I discussed her clinical situation with my colleagues, especially her background medical issues and the novel treatment she wanted to attempt regarding fertility. It was helpful to discuss as a team as we each expressed our opinions regarding the utility of treatment she wished to attempt and to explain these to the patient so that we could help her with her decision making. Throughout the process, I felt an intense sense of responsibility for the patient to make sure she was presented with the right evidence-based information and protect her from any harmful unproven interventions.

As individual doctors, we don’t always have the answers. But we come together as a team when we have challenging clinical scenarios or stressful situations that need to be sorted out with each other’s help, and both senior and junior colleagues always come forward with valuable advice. We sometimes have to get in touch with scientific experts or clinicians from other parts of the country or world who are working in a very niche or specialist area. 

We were able to get into contact with the relevant clinical team abroad and explained the clinical situation to them. They were very helpful and provided both us and the woman with information regarding benefits versus risks of the procedure and evidence base for it. Not many centers in the world offer this treatment as there remains limited scientific data regarding efficacy and long-term safety of the procedure. As scientists, we could not recommend the treatment to the woman on the basis of available data. The treatment was expensive, and the chances of success were small. 

In the end, the woman opted against the treatment. But the story has a happy ending, as we were able to find an alternative for her – using donor eggs and in vitro fertilization. The procedure was a success, and she is still receiving support from the clinical and counselling teams. 

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