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An unhappy patient - and an unhappy doctor

Posted Nov 18 2008 12:17am

I just saw a patient who had a distressing problem. He was a software engineer, and the couple had not been able to consummate the marriage. His problem was premature ejaculation, which was so severe that he would ejaculate before vaginal entry, as a result of which he had not been able to achieve intravaginal ejaculation.
Premature ejaculation is a complex problem to solve, because it is a learned reflex, in which the man cannot control his ejaculation. Psychologic problems always take a long time to resolve, and they wanted a baby quickly, because he was being posted to the UK in one month's time for one year.
He wanted me to perform an artificial insemination to bypass his problem; but I had to explain to him that because Nature was not very efficient at making babies, the pregnancy rate would be only 10% in one month. This was too low for him, and he wanted to explore alternative options.
I explained that it would be far better if they tried to solve their problem for themselves - after all, it was much more fun making a baby in the bedroom than coming to me !
I suggested they buy a book which described treatment options for premature ejaculation, such as the "squeeze technique", so that they could learn to treat themselves. I also told them there were alternative options, such as self-insemination, and we had a detailed description of this on our website at
www.drmalpani.com/selfinsemination.htm.
I felt I was being empathetic, and by trying to empower them to solve their problem for themselves, I was proving the best possible medical care.
For some reason, he was very unhappy with my advise. He expected a quick solution, and resented by suggestions that he do some "homework" and try to become an expert on premature ejaculation, so that he could tackle the problem more efficiently. I was trying to promote his autonomy, rather than making him dependent on medical intervention ( which I felt was uncalled for, since they were young).
We parted on unhappy terms. He felt I was being unhelpful; and I felt that he was too immature to understand that I was trying to look at the "long-term" picture, and just trying to help him to help himself ! I felt my role was that of a teacher, who goads a student into performing better; rather than trying to spoonfeed him so that he can ace the examination. He was focussed on short term results, which meant we ended up talking at cross-purposes.
I guess patients find the doctors they deserve - and that doctors get the patients they deserve. I wish him luck in his quest for a doctor who will pander to his desires - and I hope he will be able to appreciate ( maybe in a few years) that I was just looking after his best interests !

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