Relationship issues with your reproductive endocrinologist; the other kind of "transfer"

One of the most important facets of infertility treatment is managing your relationship with your reproductive endocrinologist and fertility clinic. If you do not have open lines of communication and a certain level of trust in your doctor, your ability to make treatment decisions can become compromised.

While on the surface it may seem straightforward to develop and maintain your relationship with your doctor and his or her staff, in truth obstacles often develop. Many times, these stem from emotional issues and expectations on both the part of the patient and the part of the doctors and nurses. In this blog entry, I will describe some common emotional patterns that can impact the quality of the doctor/clinic/patient relationship from both the patient and clinician perspectives.

The patient side of the equation

In my opinion, one of Sigmund Freud's greatest contributions to the field of psychology was his development of the concept of transference. Transference occurs when we transfer our feelings and expectations about one emotional relationship (let's say our parents) to another relationship. Although Freud observed this within his therapist-patient relationships, in truth we all do this with many different types of relationships all day long. As children, we develop basic patterns of interactions, and expectations of how others are going to react to us. We then use this as a sort of emotional "shorthand" and apply it to other situations and relationships in our lives. As long as our early relationships with those important in our lives were reasonably healthy, this usually doesn't create any problems, especially if the relationships aren't emotionally intense. So transference, while it may be occurring, shouldn't pose any problems with your relationship with the person behind the counter at the drug store, or your dog groomer, etc.

However, infertility treatment is often an emotionally intense situation. The desire to have a child comes from some of our deepest and most central feelings, and these feeling often get stirred up by infertility treatment. So it is quite likely and understandable that infertility patients will at times experience strong emotional reactions to their doctor, nurses, or their clinic as a whole. A problem can occur when these reactions interfere with a patient's ability to listen to or communicate with their treatment providers. Let me give you some common examples I see in my practice.

1. Not wanting to challenge authority

Many times, I have observed clients who have been quite reluctant to ask questions or challenge their doctors on diagnoses or treatment decisions that didn't make sense to them. Despite feeling uncomfortable (and often, by the way, being correct in their own assessment of the situation) they were willing to go along with the doctor's opinion--until I started questioning them about their reasons for their passivity. Then it would often come out that they tended to have parents who were more authoritarian--and thus they were more likely to view others in emotionally important positions in their life as authority figures, rather than as peers or collaborators. Questioning someone they viewed as an authority figure was not something with which they felt comfortable. Although doctors have a great deal of knowledge and experience, they are still human, and thus not perfect. They may misunderstand things, miss some details, or just plain make mistakes at times. Without feeling like we can advocate for ourselves in medical situations, we put ourselves in danger of not getting the best possible treatment.

2. Not wanting to hurt the doctor's feelings

Many times, I have noticed that clients are resistant to getting a second opinion, even when it is obvious that their situation is very complicated and they are stuck in their current treatment situation. When asked, they often say they don't want to hurt their doctor's feelings by requesting their records and getting an appointment elsewhere. Often, these clients had families that placed a high value on loyalty, and they feel that being disloyal is one the worst things they can do. I personally think loyalty is a wonderful and essential part of human relationships, but it may be a bit misplaced in the context of a doctor/patient relationship. After all, reproductive endocrinology is a big business, and fertility clinics aren't treating clients just out of kindness and love--they want to make a profit. In addition, different reproductive endocrinologists have different strengths and areas of expertise, and thus fit is extremely important. Most physicians I have talked to about this issue are very open to and welcome the idea of a second opinion. So overvaluing loyalty in this context may prevent you from finding the best treatment providers and options for you.

3. Not wanting to listen to anybody

This relational pattern is on the opposite end of the spectrum of the first two, and perhaps the most dangerous of the three. Sometimes, if people have control issues with authority figures, they tend to take a rebellious stance with others, refusing to follow directions and advice even when it is in their own best interest to do so. This can spell disaster in infertility treatment. Although doctors may not be perfect, it is pretty likely that they still do know more than you do about this particular subject, and ignoring their recommendations on principle can make it very hard to proceed.

The doctor's side of the equation

In addition to describing transference, Freud also observed the phenomena of countertransference, which is simply the doctor's emotional reactions to the patient. Just like transference, countertransference occurs all the time, and most of the time, it doesn't cause any problems at all. At times, though, countertransference can create difficulties in the reproductive endocrinologist/patient relationship.

To see what I mean, I want you to think about what psychological factors might contribute to a person wanting to be a reproductive endocrinologist in the first place. In all of our career choices (and don't even get me started on the factors that might make someone want to become a psychologist!), our emotional issues or challenges are often a large part of why we are drawn to one career over another. So it stands to reason that your RE is no different from any of the rest of us. And getting lots and lots of people pregnant can't help but be an emotionally interesting experience. For example, I once had an RE who, whenever I was at the crossroads in making a treatment decision, would put his arm around me and say, "Lisa, if you were my wife, this is what I would tell you to do." Which was a little confusing and a little weird, frankly. How do you argue with that? After spending more time hanging around the clinic waiting for appointments, and talking to other patients, I soon realized that he was saying this to all of us--we were all his "wives". Once I overheard him comment to a nurse that his patients in the waiting room were different than those of the other RE's--they were friendly to each other, and fun to be around. Clearly, this was a man who liked his "wives".

I don't think it's a stretch to say that this doctor was getting some other psychological benefits out of his job other than the joy of helping others. And I think it probably impacted his ability to be objective about his patients and for them to be objective about him, which can't have helped their treatments.

This is just one type of example of how countertransference could cause problems for infertility treatment. As people are so unique, there are endless possibilities for transference and countertransference to occur.

So as you consider your own relationship with your doctor and clinic, think hard about what patterns and expectations you might be bringing to the table--as well as those that might be occurring with your treatment providers. By being more aware of these patterns, you can make the conscious choice to do something different--and that may make the difference between success and failure in infertility treatment.