INFERTILITY SURVIVAL GUIDE: PART 2 – MEDICAL ESTABLISHMENT.

On one hand we’ve been practically beaten over the heads with the idea that IVF procedures are invasive on physical, emotional and financial levels, akin to cancer treatment. The cancer ward, a modern testing ground to doctor-patient ethics, can teach a lot. Oncologists are very bad at telling patients that it’s the last time they’re going to be treated. Yet, on the other hand, according to a recent opinion poll on the doctor-patient conduct, 96% of infertility patients would like to hear a realistic verdict, placing the doctor in a hmm, a challenging position. What is a good endocrinologist to do?

To find the answer, I dug deep- back to the basics, really. Instead of outright dismantling Reproductive Technologies as evil, I looked for signs of hope, something that upholds the finest merits and traditions of medical calling. And where did I find it? In The Hippocratic OathIncredibly, it spells everything out:

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

Severe cases like cancer treatment, life support in coma, infertility, all tackle the same profound question: When is a time to stop? Prolonging treatment may not improve results, but place the economic stability of family in jeopardy.

Yes, all right, maybe it’s a little outdated (Modern American version of The Oath was written in 1964). I spoke with Joseph Featherall to get a sense of the modern trends in medical establishment. Joseph works in the emerging field of healthcare engineering and is a thought leader in designing and improving the way that care is delivered to patients. He completed his postbaccalaureate studies at Columbia University and is currently a project manager at the Wright Center for Graduate Medical Education.

Joseph: For decades health care has been organized around medical science and technology, but this is now changing. The trend is toward patient-centered care. The Institute of Medicine defines this as providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. In simpler terms, the values of patient-centered care call doctors to place the human being to be the center. Doctors and healthcare leaders are rethinking their relationship to the patient, changing the roles of care providers, and even the way clinics are physically designed.

Irina: The chance to place the person in the center of medical equation is long overdue! In the experience of many bloggers chronicling their infertility treatments, as well as in my own experience, this liberty patients should enjoy may have been used to their disadvantage. A patient entering the treatments is lacking in specific knowledge and follows doctor’s lead, of course. For years, some patients have been prescribed Chlomid by their OBGYNs, when total recommended usage is no more then 6 months, some have continued up to 21 rounds of IUI, some have even been misled to pursue surrogacy. Patients have to become educated consumers to control the quality of care they’re given. Essentially, patients now must be responsible for fact checking their diagnosis and prescription.

Joseph: Every patient is making their own healthcare choices, whether we know it or not. Choosing a doctor is an important care decision; choosing to follow a doctor’s plan or to request a second opinion is an important decision. The important idea is that we, as patients, are empowered or engaged in our healthcare choices. We should understand doctors as partners, advisors, and experts, but each person comes to the clinic with a different set of values and life goals. Medicine should facilitate these goals, consistent with a patient’s values.

Irina: To further complicate things, there’s a significant divide between specialists. There are regular OBGYNs who take on Reproductive Treatment without proper qualifications; specialists who do not communicate with one another (seeing someone new translates into taking all the tests again). In case of infertility, the emotional toll of the treatment is not accommodated by psychological support, instead there is a box of Kleenex in the doctor’s office. Isn’t there a way to unite healthcare, like CIA and FBI have been united to combat terrorist attacks?

Joseph: An emerging and rapidly expanding model of care is the care team.  The traditional model is that counselors and physicians work in different locations and shuttle patients between them via referrals. Such a system requires a lot of time and energy to be expended by the patient to have her needs fulfilled. At a clinic that integrates mental health services, a patient who reports concern of anxiety might be seen at the same time by both an internal medicine doctor and a counselor or psychiatrist. The idea is that by bringing these two areas of expertise together, the patient’s needs are more comprehensively fulfilled and superior care is provided. One example of where this is being done is the AIMS Center at the University of Washington.

One could envision a comprehensive model for the fertility setting. Such a center might incorporate reproductive specialists, psychiatrists, and health coaches to assist with lifestyle changes that can positively impact fertility or, upon failure, help coach patients through a productive healing process.

Irina: A similar model is  familiar to me from childhood years in Russia. The system of a polyclinic united under one roof all specialists: one day a year all people had to undergo preventive check-up with all the specialists. The entire process would take no more then 3-4 hours, because all of them were under one roof. That was a powerful way to maintain preventive care.

You have attended the THE CYCLE: Living A Taboo Forum that addressed emotional effects of infertility. What brought you there?

Joseph: I as I came to know Irina, the forum’s producer, I became more aware of the impact and prevalence of infertility. It struck me that many of my classmates are heading into demanding careers that will likely move them out of their ideal years for motherhood. I wanted to learn more about infertility and how it may affect me and my peers.

While watching and listening at the event, two things had a tremendous impact on me. Listening to Dr. Barad speak with an auditorium of people upset by fertility treatments was amazing.  He had a very powerful way of delivering facts and facilitating a helpful discussion of the topic. Second, there were many young couples in the room who were very engaged in the discussion. It could be clearly seen that the expertise of medical professionals and the experience of other couples was helping to guide them along their way.

Irina: Coming together in a public setting and trusting a room full of strangers with very personal stories of unsuccessful fertility treatments has been a very powerful and validating experience for us, participants, too. Usually, we are conditioned to stay silent about our letdowns, but with unsuccessful infertility treatments the weight of the taboo we carry is truly crushing. Sharing with the audience, be it friends, family or strangers, and making it a subject suitable for a public discussion, is the way to find the emotional foothold for both, those who are still in treatment and hoping for a happy resolution, and those who have finished treatment and need to restore integrity to themselves and their lives. I’m very glad to hear that lessons of THE CYCLE: Living a Taboo are capable of benefiting not only patients, but also young people who haven’t started thinking about creating families yet.

Thank you for speaking with us, Joseph! And all the best with the exciting new initiatives. We hope to hear the update soon!

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As always, your comments are much appreciated. Your comments make my day and keep the conversation going. Please comment, wonder, praise, and contradict. All opinions welcome.

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