She was a young woman undergoing evaluation for infertility. She had been with us for quite some time. When I saw her, I found that she had undergone all possible tests, including endoscopy, and all were normal. She had undergone three cycles of follicular monitoring, and had been found to be ovulating in all three cycles. I also found that she had been advised the second and third cycles by another unit as well as by my own unit residents. I could not question the other unit residents because they were working in the OT. But I could question mine.
"If she has been found to be ovulating once, why did you advise her more cycles of the same? It was not as if you were performing some procedure like intrauterine insemination/"
"....." the face of the resident concerned was blank.
"What is the rationale of subjecting her to to repeated ultrasonography? Think of the discomfort associated with prolonged periods of full bladder, the expense, the time wasted, and also the time and energy wasted of the sonographers? Think of the money wasted."
"....." the face of the resident concerned was still blank. She kept looking at the patient's case paper intently.
"Do you have no answer?" I asked. "You cannot find the answer in the patient's case paper.
"Er......um...."
I left it at that. I knew many others did this. The idea that follicular study had to be repeated only if the woman did not ovulate and her treatment was modified in the next cycle to achieve ovulation was eluding these poor residents.
Another event was on the next day. They showed me a pregnant woman in the ward. "She has undergone laparoscopic myomectomy prior to this pregnancy, but the details are not available" I was told.
"Let her get old case papers" I said. the papers were duly produced the next day.
"The papers state she has undergone only a diagnostic laparoscopy, not myomectomy" I was told.
"Did the doctors show you the lumps they had removed? How were they?"
"They were tiny brown lumps, 2 mm X 2 mm in size" she said.
"That must have been endometrium removed by dilatation and curettage" I said. "By the way, how many ports' insertion scars does she have on her abdomen?"
"Only one" said the same resident who had contributed to the other patient's repeated follicular studies.
"If she has a single scar, and single port laparoscopy is not done anywhere in our country much, you had to know she could not have undergone laparoscopic myomectomy" I said.
"Um ... I did not realize that" she said.
"I want you to think. Think. A mechanical mind would be a great thing perhaps for a mechanical engineer, but not you as a doctor."
I said it only to make my statement more interesting. I did not mean to insult mechanical engineers, who I know have great innovative minds. However if I hurt them, I apologize for my inadvertent slip.
"If she has been found to be ovulating once, why did you advise her more cycles of the same? It was not as if you were performing some procedure like intrauterine insemination/"
"....." the face of the resident concerned was blank.
"What is the rationale of subjecting her to to repeated ultrasonography? Think of the discomfort associated with prolonged periods of full bladder, the expense, the time wasted, and also the time and energy wasted of the sonographers? Think of the money wasted."
"....." the face of the resident concerned was still blank. She kept looking at the patient's case paper intently.
"Do you have no answer?" I asked. "You cannot find the answer in the patient's case paper.
"Er......um...."
I left it at that. I knew many others did this. The idea that follicular study had to be repeated only if the woman did not ovulate and her treatment was modified in the next cycle to achieve ovulation was eluding these poor residents.
Another event was on the next day. They showed me a pregnant woman in the ward. "She has undergone laparoscopic myomectomy prior to this pregnancy, but the details are not available" I was told.
"Let her get old case papers" I said. the papers were duly produced the next day.
"The papers state she has undergone only a diagnostic laparoscopy, not myomectomy" I was told.
"Did the doctors show you the lumps they had removed? How were they?"
"They were tiny brown lumps, 2 mm X 2 mm in size" she said.
"That must have been endometrium removed by dilatation and curettage" I said. "By the way, how many ports' insertion scars does she have on her abdomen?"
"Only one" said the same resident who had contributed to the other patient's repeated follicular studies.
"If she has a single scar, and single port laparoscopy is not done anywhere in our country much, you had to know she could not have undergone laparoscopic myomectomy" I said.
"Um ... I did not realize that" she said.
"I want you to think. Think. A mechanical mind would be a great thing perhaps for a mechanical engineer, but not you as a doctor."
I said it only to make my statement more interesting. I did not mean to insult mechanical engineers, who I know have great innovative minds. However if I hurt them, I apologize for my inadvertent slip.
