Stupid $%^! my doctor says--clinical insensitivity and infertility treatment

A few weeks ago I had to go to a doctor for a minor gynecological procedure. I had never met the doctor performing the procedure before, and so I had to briefly go over my infertility history with him. I was rather surprised when he told me, in a jovial, joking manner, that I was obviously "really, really, fertility challenged"--and fact, he mentioned had another term for women like me, but he couldn't use it in polite company! He thought this was hilarious. He then proceeded to comment upon and mock my c-section scar ("Of course you had a c-section--you just can't do anything the easy way, can you?") He also found fault with the fact that both of my children have their birthday in the same month, although since my older daughter is adopted, I hardly see how I could be held responsible for that. It's not as if I received a call from India, 9 years ago, with someone saying, "Hi, you don't know us, but we are young and in love. Do you think we should have unprotected sex or not?"

In any event, what was perhaps most shocking to me about this one-sided conversation is that this doctor, in the course of his work, deals with women struggling with infertility all the time. I would have expected a bit more sensitivity and tact. This doctor seemed to have absolutely no awareness that my medical condition wasn't merely fodder for his jokes--he just seemed thoroughly amused with himself. In addition, he and I didn't have a prior relationship in which he could sense that "joking" around with me about this was okay. A decade or so after this all started for me, my feelings about my infertility are much less intense and raw than they were, but he had no way of knowing that. I could only imagine that if I ran into this doctor several years ago I would have left his office devastated instead of as I did, merely annoyed.

After my appointment, I started thinking about all the examples of clinical insensitivity that I've heard about in my practice lately. I wish I could say that insensitive comments from medical professionals, like the ones I received, were a rarity, but in fact, they are not an unusual occurrence. One common type of insensitivity I've heard from several clients about different RE's is that when the client does not respond as hoped to a given medication or protocol, they are told they are "stubborn" or "misbehaving". Most women find these comments upsetting because they imply that somehow, the women have conscious control over how their bodies are responding to treatment, tapping into deep-seated feelings that they are somehow to blame for their infertility. Rationally, we all know that isn't true--if it were in any way possible to control how our bodies respond to infertility treatment, we would have already done so and had success. But hearing this idea from a doctor, even in an attempt at humor, gives it a little more weight.

A client of mine has graciously allowed me to share another example of clinical insensitivity. She had seen another psychotherapist for different clinical issues, and asked for feedback regarding them during the termination session. Instead of providing her with any, the therapist told her that she needed to work on her feelings of sadness and anxiety because they could be causing her recurrent miscarriages, rather than any underlying medical condition. (Just to be clear--there is no clinical study that shows that negative feelings, such as sadness and anxiety,are a definitive cause of miscarriages.) To her credit, my client fought back, asking the therapist if she believed that her negative feelings caused her miscarriage due to chromosomal abnormalities. And how did the therapist explain her first miscarriage, which occurred when she was elated about her first pregnancy? The therapist refused to back down or let my client off the hook, insisting that her feelings of sadness and anxiety "couldn't have helped" the situation. Again, the implication that my client was somehow to blame for her miscarriages was unavoidable. Needless to say, the treatment did not end well.

In preparing to write this post, I have struggled to come up with a cohesive explanation of why these situations might occur. But to be honest, I'm a little bit stumped. In the case of my doctor, I had such limited contact with him that I could not get any sense of his psychological motivations for acting in this way--except for the idea that perhaps, he was also someone who could be referred to by a term that could not be used in polite company. In situations where RE's tell patients they are "stubborn" or "misbehaving", I imagine it may be some of their own feelings of powerlessness and frustration coming through. Presumably, they really want to help their patients, and when they can't, it probably makes them feel powerless and bad about themselves too. So they might try to deflect these feelings by "jokingly" implying that it's the patient's fault, and not their own.

As for my client's experience with her former therapist, I again find myself hard-pressed to rationally explain that therapist's behavior. Perhaps she is uneducated about infertility and recurrent pregnancy loss, or perhaps she was angry at my client for terminating the sessions. Not knowing her, or more of the surrounding context, it is impossible to say.

As a clinician myself, I'm sure I've unknowingly said many stupid and insensitive things, although I like to think that I am trained to watch for people's nonverbal responses to what I say. If I see the eyes widen, or a lip quiver, it is my usual practice to inquire about these responses. But more importantly, I would hope that when I do inevitably put my foot in my mouth, that someone would tell me that what I said was painful, stupid, and/or inappropriate. I think most clinicians, whether they are in the medical or psychological field, feel the same way. That is why I very much admire my client for her responses to her former therapist--even though in that case, they didn't produce the desired response.

If you find yourself feeling hurt or upset by a doctor or nurse's comments about your infertility, I would urge you to discuss this with him or her. Most often, the clinician in question is going to be very understanding and apologetic. If during the course of that discussion, they are unable to acknowledge how their comments could have been viewed as hurtful or insensitive, then I think that may be a cause for concern. If the same type of comments happen repeatedly, you may need to think about making a change. It has been argued that individuals experiencing infertility often have a heightened sensitivity to comments by others. Even so, if a doctor or healthcare professional feels the need to habitually make upsetting comments to you, you can be pretty sure that it's not you--it's them.