For the past 12 years I have been giving lectures to the students and residents from The George Washington University (and more recently VCU). I usually give my lectures in a room that is located on the campus of Inova Fairfax Hospital and you can usually find me there every week at 7:15 am trying to keep the audience awake, entertained and educated. I usually hook up my MacBook Pro to the LCD projector that I keep in my car. After my lecture last week I noticed an LCD projector that was mounted on the ceiling of the room. Looking around I noted a VGA adapter on the wall and I plugged my laptop into the correct slot and voila....I now had a full-sized projection on the screen compared with the dinky little projection from my own LCD projector which I have usually placed closer to the screen.
My problem with all this is that it bothers me that I cannot recall how long that damn projector has been mounted on the ceiling of the room! Has it been there for days....weeks....years?? I really have no idea. Why did I suddenly just notice it last week? Why did none of the medical students or residents ever say "Hey, DrG why not use the ceiling mounted LCD projector instead of your ancient projector that barely casts a bright enough image to keep us awake?" Beats me.
In dealing with patients, I like to go over where we are, how we got there and why we chose the path that we chose. If you keep your head down and never take stock of where you are then you are sure to get lost. Hence, following a failed treatment or a series of failed treatments it seems absolutely crucial to reassess what we have learned and what options may now make sense. If the patient is doing IVF with ICSI but the sperm now are much improved then maybe we should consider IVF. If the stimulation was suboptimal then maybe we should consider a different protocol or Natural Cycle IVF. If nothing is going right then maybe it is time to consider adoption, embryo adoption, donor egg or donor sperm.
One has to keep looking but more importantly one has to keep seeing....