Much has been written from the patients’ perspective of the ideal infertility physician. Over the past several years, we have had the opportunity to work together, as gynecologist and social worker, to attempt to meet the complex needs of infertility patients. Through our encounters with these patients, we have formulated our own concept of the perfect infertility patient.
There is a joke about the angels in heaven who were all lined up in the cafeteria waiting for dinner to be served. Suddenly a conspicuous angel appeared wearing a white coat and stethoscope, who started pushing his way to the front of the line. A new angel turned to the veteran angel and said, “Why in heaven would an angel act like that?” The senior angel shrugged her shoulders and responded, “Oh, that’s just God. Sometimes He likes to play doctor!”
What this joke underscores is the image that the public has of the physician as God. But, an image can also be made of the patient as an angel, who allows herself to be pushed aside and quietly suffers. Interestingly, the word “patient” comes from the Latin word “pati”, meaning to suffer. In fact, the adjective patient is defined as “bearing pains and trials calmly or without complaint.” Thus, we can see the implication that a patient must suffer silently, like an angel.
Through the years, we have learned a great deal from our infertility patients about their suffering in trying to have a child. However, we believe that there are things patients can do to increase medical efficiency and minimize emotional suffering from the treatment process. Here are our suggestions for “The Perfect Patient”:
1. The perfect patient approaches infertility as a couple problem. The fact that one spouse may be identified as having “the problem” does not negate the effect it has on both husband and wife. The infertility workup, evaluation, and treatment is much better dealt with when the spouse participates in at least some office visits and has an understanding of the tests they must go through. The more involved a couple is together in the medical treatment process, the better able they are to support each other and make a decision on options.
2. The perfect patient communicates honestly, openly, and directly with the physician. This begins by abandoning the concept of doctor but rather as a person with special skills. Communications can then flow more naturally and are less intimidating.
3. The perfect patient asks question about the treatment regime. Direct questions about the shortcomings, possibilities of failure, and alternative tests and therapies might include:
What are the advantages of this test?
Why does this test need to be timed in this manner?
Does this test cause any pain, discomfort or complications?
What is the percentage of complications from this particular test of treatment?
What are the benefits of this treatment over others?
Answers to these kinds of questions, or anything else the patient does not fully understand, should be very clear before undergoing tests or treatments. Then, having this understanding and knowledge, the perfect patient can more confidently follow directions.
4. The perfect patient tells the doctor when he or she is failing them. It seems that one of the hardest things for patients to communicate to a physician is when they are unhappy with the way they are being treated. For example, perhaps one of the office staff responded curtly or the doctor sounded demeaning. The hurt from such incidences can go deep and ultimately effect the doctor/patient relationship. However, the doctor cannot be held accountable without first being made aware of the patient’s feelings and then being given the opportunity to respond. As in any relationship, both the positive and negative issues that occur between doctor and patient need to be discussed and not avoided.
5. The perfect patient seeks education on both the medical and emotional aspects of fertility problems. Traditionally, infertility patients are often the most medically well-versed of all patients. However, they may overlook information about the feelings brought on by their infertility.
6. The perfect patient finds ways to reduce the stress caused by infertility. Patients need to understand that infertility is stressful, which is normal, expected, and not permanent. However, to deal with the stress, support mechanisms are needed. Guidance and understanding can be found through support groups (like the ones offered by your local chapter of RESOLVE), or by seeing a therapist whose specialty is infertility counseling. Hobbies, vacations, social interaction, and exercise can help make the problems less overwhelming. Infertility can be an isolating experience unless patients find other people with whom to share these feelings.
7. The perfect patient realizes when infertility treatment “burn-out” is being experienced. This may come out in unresolved marital conflict, sexual problems, or always feeling apprehensive, anxious, or depressed. The couple might consider finding ways in their sexual relationship to separate work (trying to get pregnant on schedule) from play (love making). Or they may want to think about taking a vacation from temperature charts, tests, and medications to alleviate some of the stress.
We feel that the perfect patient is an active participant in the treatment process rather than a passive recipient of medical intervention. These patients see the physician as a person, not as a deity, and thus don’t need to act like angels, silently in the wings. For ultimately, infertility patients are responsible for their own reproductive health.
Contributed by: Sharon N. Covington, MSW, LCSW-C Director, Psychological Support Services Paul R. Feldman, M.D.
