Welcome!

Welcome!

This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Thursday, August 26, 2010

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.

185 comments:

  1. Thank you for this. Reading your list of reasons why patients do not want to change doctors was a wake up call. I am exactly number two. The logical part of me knows that it will not hurt the doctor's feelings, really. But, loyalty is a HUGE thing in my life and family and it is a hard thing for me to let go. I think it is time for me to change doctors because I have been questioning my RE's treatment for a long time, now, but it has been a very hard thing to do.

    ReplyDelete
  2. Thank you very much for starting this blog.
    I found you from LFCA.
    Your post about choosing a doctor based on success rates and not how much you personally like him is very helpful.
    I look forward to following your blog.

    ReplyDelete
  3. Here from LFCA. Thank you for an interesting post and a different perspective. I have a lot of residual bitterness to the way I was treated by some medical professionals along my infertility journey. Seeing things from their side helps in my healing.

    ReplyDelete
  4. Thanks so much for your comments! It is my belief that relational issues have a huge impact medical treatment in general, and infertility treatment in particular. Katie mentioned feeling bitter about some of the things that have happened in her treatment, and I think that is very common. I think IVF clinics are continuing to work on becoming more sensitive to the patient's perspective, but we probably all have more than one upsetting example to share.

    The most important thing is to try not to let it derail you from your process, and to take up too much of your emotional energy.

    Thanks again for reading and commenting!
    Please let me know if you have any questions or suggestions for future topics.

    And best of luck to everyone in their infertility journey.

    ReplyDelete
  5. Thanks for this. It is good to see both perspectives.

    (here from the creme)

    ReplyDelete
  6. I am lucky enough that I have never been to an RE but I can totally understand how these situations would arise. Thank you for explaining all of this so clearly, I'm sure it is very helpful to a lot of people.

    ReplyDelete
  7. I'm here from the Creme (a little late, but still here).
    As I'm getting ready to change IF doctors (because of insurance coverage, not because I want to), this is interesting stuff to ponder.

    ReplyDelete
  8. Thanks for this post! It helps me a lot to see things from a different perspective. I was also very disallusioned by many drs, some gynaes and some RE's, and I am the complete opposite of the loyal people. I must have seen something like 12-15 gynaes and RE's in the last 15 years or so and I've changed many times after only one consultation when I was unhappy about the dr's response to us. Some were not very friendly and or blunt and uncommunicative which I did not like much and others did not respond well to my questions and suggestions about treatment options, saying that they are the dr and know best, and that I should stop reading up on the internet.

    I never realized that the doctor could have been counter transferring (is that the right frase to use?) from what I said or done. I was not the easiest of patients, especially when it started to take a long time to get pregnant.

    In the end and after many years I found 2 RE's at one clinic that fit us perfectly - someone who was friendly, caring and communicated well and who listened patiently to my questions and actually took my suggestions seriously and that was the clinic that finally got me pregnant (after 10.5 years of ttc,I might add).

    And I must say with a treatment approach that they did not think would help us (intralipids), and after my pregnancy and one other about 2 weeks later they use it all the time now with their other patients. I was told recently that they talk about the other lady and I as pioneers! So I my case it was a good thing to educate myself and insist on specific treatments (I can understand that it might not be best in all situations), but I was just getting tired of hearing that I should have been pregnant by now, yet it didn't happen. I kept on looking for other possible problems and treatments, and the only way to get to that stage was to get to a RE that was responsive to suggestions.

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