The role of your doctor and how to choose one

By Professor Charles Kingsland, Consultant Gynaecologist & Specialist in Reproductive Medicine

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WHAT IS THE ROLE OF YOUR DOCTOR?

Have you ever questioned what the role of your Doctor is? When you go into the Surgery or the Clinic, what do you expect from them? What do you think Doctors are trained to do?

After five long years at Medical School and then maybe another 10 spent training in some specialist area, followed by another couple of years subspecialising until we get to know more and more about less and less, and then if you’re like me, after 40 years, you know everything about nothing.

Well, if the answer you gave is to make you better or cure you from your affliction or infirmity, you’re wrong. What we Doctors are here to do, is not to make you worse. I know, daft isn’t it!

When we qualify, we all swear the Hippocratic Oath, named after the father of Modern Medicine, an ancient Medic, Hippocrates, who lived many years ago on the island of Kos, in the Mediterranean Sea off the coast of Greece.

There are whole series of statements, around treating your fellow Medics as if they were your brother, not procuring an abortion, and stuff like that. Rule number one, however, is, ‘first do no harm.’ and that’s it basically.

First and foremost is to not make your patient worse. There is nothing in any law, contract, oath or whatever you like to call it that says Doctors must make you better. It simply states that we must not make you any worse. Naturally, we want to make you better, and in the case of my specialty, help you to have a baby, and, most of the time we do, hopefully, and with a bit of luck.

I don’t want to be cynical here, but because I’ve just returned from collecting my second ever bus pass, the first one being for free travel on my school bus, I feel a bit sensitive, so I’m going to. ‘First, do no harm’ can be a bit of a get out of jail card, especially in our specialty of infertility. When patients visit my Clinic, or indeed if ever I have recourse to attend a hospital outpatient department to see a qualified practitioner, we tend to assume that the Doctor we see knows what he is talking about and what they tell us by way of advice, has certain merit. Is this necessarily true?

Who is the Fertility Doctor you are speaking to? Where has he or she trained? What qualifications do they possess? Does it matter? Similarly, is the advice they are giving us of any relevance? These points are of vital importance to your overall outcome, so I will deal with them in a separate booklet, but for now, back to the NHS.

HOW TO CHOOSE YOUR FERTILITY DOCTOR?

During my career, I’ve been lucky enough to have been invited to many interesting places and conferences, to lecture and/or participate in lively debates. Conferences and lecture tours are usually accompanied by a brochure outlining the conference programme and supplying information about the speakers.

Not once has a conference organiser ever said that they would provide biography on my behalf. They always ask if I could send them a biography or Curriculum Vitae outlining my achievements. Author, yours truly. Sometime later, I will read my biography in the published programme; “Charles is a fairly dull, slightly overweight bloke who spends much of his time drinking with his mates. In his spare time does a bit of fertility work”. Would it be in my best interests if I were to write that, even if it were true?

In a similar vein, a fishmonger wouldn’t write in preparation for a lecture at the 51st Annual Meeting of the Fish Filleting and Battering Society, Grimsby 2017; “Matthew is a fishmonger in Brighton. He sells fish that stink a bit of the sea”. That’s not quite how it’s done. If we are asked about ourselves, we want to describe and give a coat of varnish (or two) to our best attributes, which is what most of us do. However, there are some, and I’m sure you have all got friends who are a bit like this, who like to guild the lily somewhat. Others are downright fibbers.

I have read, in my time, some truly spectacular biographies, totally unrecognisable from the person themselves. This has been exacerbated by social media, readily available, popular and a ‘go to’ outlet (like you now, reading this). “Cuthbert is a World renowned Pioneer in Reproductive Medicine. He was present at the birth of the first IVF baby (always a good plug). He has written over a 1,000 books and was the first IVF Doctor to land on the Moon. In his spare time, Cuthbert is an international Caber Tosser.”

We all want to big ourselves up, but in the heady world of Reproductive Medicine, with its competitive commercial edge, it can all get a bit confusing. So, don’t forget, when you read about someone, on their clinic website or on the Internet, it has probably been written by themselves. There are, however, exceptions.

Some years ago, I was asked to see a patient at the end of a clinic as an extra. I do not know where she came from, but I graciously agreed. She was a slight woman, early to mid-30s, mousy fine hair, wearing a coat that was a little too large. On reflection, she was reluctant to engage in any eye contact and shuffled somewhat nervously. We exchanged pleasantries, and she then began to tell me her story.

She claimed that she was about to marry a man who had three sisters and as she was one of five female children in her family, she wanted me to help her to have a son. She only wanted one child and it simply had to be a boy.

The woman was not knowingly infertile, but was reluctant to start a family until she had assurances that I could help her to achieve her aim, of one single son. We talked about her having a 50:50 chance of having a boy naturally, but that was a risk she didn’t want to take.

I talked about my knowledge of claims that pre-conceptual dietary manipulation may help in sexing a child and that there were also some clinics that claimed to be able to sex sperm before conception. I then realised what she was getting at. For some time in Britain there has been a shortage of eggs available for donation for patients who have run out of eggs themselves. This followed a change in the Law regarding egg donation in 2006.

The result was that many of our patients, who were not able to access eggs for treatment in the United Kingdom were going abroad, in particular to Spain, Cyprus and the United States, where eggs were still in plentiful supply. Although sex selection is illegal in the UK, except under exceptional circumstances, the procedure of sexing an embryo is perfectly legal in the USA and Cyprus.

At the time, Consultants in Liverpool were sending patients overseas and particularly to Cyprus, for egg donation when treatment was not available to them at home. I informed the patient of this. I advised her of the illegality of sex selection in this country. I also advised her that she was open to treatment in Cyprus or the USA, but I could not be involved. I told her that I could advise her how to seek the treatment, but warned her that it may be very expensive with no guarantee of success.

I personally do not believe in sex selection of embryos for social reasons, so called '“family balancing” but, like abortion, which I also am against for my own personal reasons, I advised her that I would refer her to a colleague who may be able to help. I reinforced the suggestion that she should try naturally and risk the chance of having a girl, because, after all, it hadn’t seem to do her any harm.

Finally, and just before she hurriedly left my clinic, I asked her whether she would like me to share our conversation with her General Practitioner. She looked at me rather quizzically. I informed her that our conversation had been confidential, and as such there was no compulsion for me to write. She said she would prefer me not to write to her GP and with that she was gone. I gathered my notes, finished my dictation and then headed out of the clinic. As I left, the Receptionist handed me a brown envelope, which had been left for me by the last patient. I tore off the top and inside were a bunch of twenty pound notes, ten in number, a total of £200.

A little confused and still with an inability to deduce that if you add two and two together, they invariably make four, I asked Liz, our Receptionist to return the money to the patient. Liz informed me that she was unaware of the patient’s address, which was rather strange as all patients attending the hospital would have completed records, which included a current address. I thought no more of it and went for lunch.

At 16:50 that evening, a Friday, I received a phone call to my personal mobile phone. It was the very same patient. She then went on to tell me she had been telling me ‘untruths’ when we met earlier in the day. She was not a patient; she was, in fact, a journalist working for a national tabloid newspaper that was running a story on me at the weekend. Now I was not only confused, but alarmed. I couldn’t understand why this newspaper would want to tell a story about me.

Rather naively I asked her why she hadn’t told me the truth about her identity at the outset of our conversation. She responded by informing me that she might not have got the story she wanted and that I would have to wait until Sunday to discover the nature of the story.

When you realise that you've been lied to and deliberately deceived, you develop a very unpleasant adrenaline dominated sensation that starts with a tingling down the back your neck, followed by a dry mouth and a rapidly increasing heart rate. I was experiencing those symptoms at that moment. It didn't make me feel good. I waited anxiously until Sunday morning, and there it was, in its full glory. ‘Leading NHS Fertility Doctor making money by sending couples abroad to choose the sex of their unborn baby – a procedure that is illegal in Britain’. The story was also embellished with all sorts of nasty, unpleasant snipes. ‘The 53 year old Doctor.’ Why do people want to know my age or the fact that I live in a £500,000 house in Cheshire? I ask you. At that time, I had been a Consultant in the NHS for almost 20 years, I would have thought, a half million pound cottage was rather modest, hardly something to use against me. The reporter also went to great lengths to suggest I attempted to cover up our conversation and keep it our sworded little secret. What I was trying to do was to maintain confidentiality.

I immediately informed the HFEA, our governing body with whom I had a very good relationship. My unit was well respected. We were the seventh unit ever to acquire a licence, unit 0007 and I had been the Doctor Responsible for the safe and legal running of our service since 1990 so I knew them very well.

The Reporter, attempted to persuade her readers to think differently by inferring that I was relatively unknown to them. The following day, I was summoned to the Hospital Chief Executives office and was told that an investigation was being commenced under the Leadership of the Head of Nursing and Midwifery. The two charges against me were that I had broken the Law by performing Sex Selection and that I was practicing privately in NHS time by accepting money. How the Managers love this sort of thing. You could almost hear the licking of their lips as another member of the Medical Staff was put in the spotlight.

If found guilty, I would be taken from the Hospital to a place where my eyes would be removed from their sockets using size nine knitting needles. I would then be immersed in tub of boiling E45 cream whilst having a heated vaginal speculum inserted up my bottom. That’ll teach him. Guilty as suggested m’lud! Hangings too good for him.

As it turned out, the Hospitals Solicitors took less than 24 hours to find that there was no wrong-doing on my part. During the same time span, my secretary had received 34 calls from women wanting sex selection. I was subsequently told by a Solicitor specialising in such cases, that the way newspapers works to publish a story and see what the response is.

If the newspaper receives over 100 responses, they will run the story again and perhaps dig up more details about the hideous Doctor who once maliciously stood on and squashed his pet Hamster, (it was an accident and it was dark, honest). Worse still, he once threw his four year old daughter down the Hall after she had bit her five year old brother for nothing more than he refusing to pass her the Red Sauce at the dinner table.

Rather disappointingly, amongst those letters of support, I received a number of emails as to how, and by whom the story was constructed. I still retain the name of the individual, a member of our specialty as it so happens. I suppose that’s jealousy for you. Sadly, I now treat most unusual enquiries as if they are reporters wanting a story, as most of my senior colleagues do. I still witness some quite outrageous reporting about our specialty.

I appreciate that the reporter in my case was only trying to do her job and maybe I should have added up the numbers a bit more readily. However, I visited her Facebook page a couple of years later and saw her big beaming face and crazy photographs with her drunken mates at some London party and reflected as to whether her conscience allowed her to think of the upset she had caused to myself, my family and my friends and whether she would ever imagine the tears rolling down my daughters face just after she had told that journalist to go away in haste. No probably not.

Not always, therefore, do we write our own blogs. Sometimes others do it for us. As a quick word of warning, always be wary of the person who calls themselves a pioneer, they usually aren’t. A pioneer in shiny suit, with grey shoes and a stethoscope around their neck, involved in ‘cutting edge’ technology should be avoided at all costs.

HOW TO CHOOSE YOUR DOCTOR

So, how do you choose a Fertility Doctor? Geography is very important. Ideally you want your Doctor to be fairly close by. There is absolutely no need to travel long distances and pay lots of money for your initial consultations. There will be somebody of note who is fairly close. You just have to find them.

Next, back to the CV. Doctors qualifications tell you a lot, particularly in the world of Fertility. Your Doctor should be Medically qualified. I know that may sound obvious, but in my years in the specialty, I have met many practitioners who claim to be Doctors, quite legitimately in some cases but they are not Medically qualified. They may be extremely capable with brains the size of planets, but they have not been trained nor should they be allowed, to treat patients. Be extra careful of these masquerades.

The Highest Degree a University can confer on a Postgraduate student is the Degree of Doctor of Medicine (MD) or its non-medical equivalent, Doctor of Philosophy (PhD). If you ever attend a University Degree Ceremony, they are the graduates who collect their awards first. To obtain such a qualification, it takes years of additional and often painstaking study and requires extraordinary discipline. There are no shortcuts to this degree. More than anything however, it takes determination to achieve this award for excellence.

I have met many in the past who have made excuses as to why they didn’t achieve such merit. In some cases, the stories are quite legitimate, but if you are seeing a Doctor who has an MD or PhD from a British University, they are, in general, at the top of the pile. It was a pre-requisite for all my trainees to have obtained an MD if they wished to work later in my unit. Unfortunately this does not make them nice people.

If you are like me, you want your Doctor to be nice to you, empathetic and understanding. Let me give you an example; you go to see a GP because you have a very nasty cold. Not as severe as man flu, but unpleasant nevertheless. Doctor A examines you, tells you it’s viral in origin slightly dismissively. He then tells you to go home, take aspirin and you will feel better in a few days. Doctor B, however looks down your throat and says “Ooh, that looks nasty, good job you came to see me when you did”. He prescribes you antibiotics and says you must stay in bed and off work for a week. He then says he will pop into see you in a couple of days to see how you are progressing.

Now here are two questions: Who is the best Doctor? Which Doctor to you like the best? GP A is the Best Doctor, but you like Doctor B the best, even though he’s done you no good whatsoever and maybe even harmed you in the long-term because he’s given you antibiotics that you don’t need. The next time you are really ill and you need those antibiotics, they won’t work, because you have built a resistance to them.

It’s extraordinary how we, myself included, will tolerate all sorts of inadequate medical care because we happen to like the medic who is providing it. As my Grandma used to say about her old GP, Dr Weeks, in the days when Doctors were revered, “I know Dr Weeks is old and out of date, but he’s really lovely”.

It would be great if we could find a Consultant who is both knowledgeable and pleasant, with the right qualifications. Unfortunately, as I hope I’ve explained to you, the internet is not a great predictor. Word of mouth however, can be. So it is always worthwhile to ask around togged advice. Friends who may be going through the same treatments you need, may be of help. So will your GP.

Chat rooms or groups on the internet may also be of help, but beware of trolls or patients on these sites who may have an axe to grind about someone for no good reason. I’ve seen really unpleasant comments made about colleagues who I think happen to be exceptionally good at what they do. I’ve also witnessed the ‘manicured’ opposite.

We are all different and most of us want slightly different traits from our carers. That’s just human nature. We in the Medical Profession know who we would like to treat us because we have years of experience and inside information about who we know to be good and who maybe not so.

I get very frustrated when I can’t find a decent electrician, for example. So when you do find one, you hold on to them, and tell your friends. I’ve got a fantastic gardener. The problem for me is that I’ve told so many people over the years about him that he is too busy now to come and mow my lawn. He spends too much time at my friends’ houses mowing theirs!

There are so many aspects to finding the most suitable Fertility Consultant. Luck plays a big part and you can take comfort that, the majority of NHS Consultants working in big fertility units are of excellent standard, as with the rest of the National Health Service.

If you were to ask me the one single factor to help you choose your Doctor and don’t forget, it is your choice, and the NHS says so, after your research is complete. Gut feeling.


Juliana Kassianos