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Saudi Journal of Kidney Diseases and Transplantation
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DOCTORS DIARY Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 1  |  Page : 95-96
Simplicity in Medicine

Formerly Professor of Obstetrics and Gynaecology, Salhieh, Parliament Street, Damascus, Syria

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How to cite this article:
Pharaon S. Simplicity in Medicine. Saudi J Kidney Dis Transpl 2006;17:95-6

How to cite this URL:
Pharaon S. Simplicity in Medicine. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2020 Jul 7];17:95-6. Available from: http://www.sjkdt.org/text.asp?2006/17/1/95/32453
Nowadays, more than in previous times, a doctor notices an array of complicated and perplexing protocols used in management of different illnesses and syndromes. In my specialty, many women who complain of infertility are frequently subjected to such dizzying pharmaceutical formulae, with frequently disturbing complications: hyper­ovulation, twinning, triplets, quadruplets and upwards… with ensuing questionable, if not really worse, results. In our daily practice, one frequently faces cases of infertility that are treated with pell-mell piles of highly effective medications, with disappointing results, most of the time. If one looks close to such cases, one discovers that they are newly married couples who are pressed by the surrounding family and/or tribe and that only a month or two would have elapsed after their marriage, without signs of a long­awaited cyesis. Looking closer at such cases, which really are merely cases of short delay of conception, one would discover that the miserable young woman is under heavy psychological stress that has caused in her a form of anovulation. All what would be needed is to re-assure her that everything is fine and encourage the young submissive husband to stop, or ease, the nagging of the mother-in-law. It should not surprise anyone if the young woman would return to you in the following month saying she missed her period. A colleague might disagree with such an appeal for simplification and argue that most cases of infertility are caused by multiple factors like tubal occlusion and polycystic ovaries etc. However, the majority has much simpler etiologies.

Let me go a bit away from infertility. As a young doctor, I complained of a sudden and debilitating vomiting that obliged me to stay at home. I asked one, and then, another colleague, both American Board Certified, to treat me. They described piles of drugs and of intravenous infusions, to no avail. I felt very weak and fed up with that obstinate vomiting. I consulted my old professor of internal medicine. He was a calm and excellent clinician. He came to see me, made a detailed clinical examination, without resorting to further lab tests, and stressed to my wife that I should stop taking all the medicines piled at my bedside with their puzzling schedules and stipulations. He affirmed that I should have sips of some traditional herbal tea! My wife was more than skeptic, but she obeyed the old doctor's directive. The following day, I was out to work! You might very much laugh and think this was a case of some psychiatric ebb! But I believe that I am a robust human, both physically and psychologically. Another instance: look at most prescriptions and you notice piles of drugs that do not tell you what is exactly wrong with the patient. Look at the very many appendices that are surgically removed, mainly from young girls, and you notice they're normal ones.

What is unexplained infertility? It is either unexplained or we have not pinpointed the real cause and we, therefore, over-prescribe and over-carry out certain daily procedures. I can never forget one of my early patients of primary infertility. She lived with her mother-in-law and her shy husband. She didn't conceive for nearly twelve years although she was constantly consulting all famed doctors in the area. Although her husband was shy, he did not submit to his mother's nagging about marrying a second wife. The lady's mother-in-law died and the following month, my patient missed her period, and she required a Cesarean section because of a giant baby. She was a case of gestational diabetes. This is one of the very many cases of so-called un-explained infertility; either it is true infertility or, more often, we cannot precisely identify the cause.

I believe that we doctors, should not overcomplicate what is already complicated i.e. illness. If we succeed to correctly pinpoint the criminal, one bullet would suffice to kill him; of course, here it is the illness we are referring to! We do not need to use ultra­sophisticated weapons and kill piles of creatures so as to kill one suspect, and finally to discover that we have killed many that are innocent, and missed the intended one, as we see around us daily!

To conclude, let me confess to my colleagues as to what prompted me to write on this topic. I read in a London paper that a renowned English doctor carried out a certain protocol of ovulation induction and in vitro fertilization. The young patient developed an ovarian hyperstimulation syn­drome after she went home. They took her back to hospital where she succumbed to hemodynamic changes, that are notorious but extremely rare end-results, of hypersti­mulation. It suffices that one young woman, now and then, here or there, would die because of over-enthusiasm in inducing ovulation, to prompt us to re-evaluate our attitudes and re-think whether we have overcomplicated cases that could have been treated with simpler and certainly much safer methods? I sincerely hope that none of us would face such a case in his/her daily practice. In English they say; we keep our fingers crossed. Let us do that, whether we believe it or not.

Correspondence Address:
Sadek Pharaon
Formerly Professor of Obstetrics and Gynaecology, Salhieh, Parliament Street, Damascus
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PMID: 17297546

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