More decisions; medical decisions, emotions, and infertility treatment

I often think that if I ever were to write a book on psychological issues, it would be on how individuals make decisions about their medical care.  I find it fascinating and sometimes frightening how much emotional issues can affect and impair the ability to make good health care decisions.  Unfortunately, I have seen this lead to very sad and perhaps avoidable negative outcomes,  in the area of infertility and in other types of illness as well.

In this post I will discuss some emotional issues that commonly interfere with the ability to make sound medical decisions.  The first, and perhaps most serious problem is an overuse of the denial defense.  We have all heard stories in which a person notices some significant medical change, like a lump, and copes with their anxiety about it by using denial.  They do not seek medical treatment and often don't alert loved ones about the problem until it is too late.  My own father-in-law, a dear, wonderful, and educated man, ignored the warning signs of his colon cancer for years.  When the family finally became aware of and responded to the problem, it was too late, and he died a few weeks after his diagnosis.

In the infertility world, this can occur when individuals fail to seek treatment even though they meet the criteria for infertility.  They often trust that it will "just happen when the time is right".  Meanwhile, the clock is ticking, and if there are ovarian reserve issues at play, time may be running out.  I sometimes see women in their late 30's or early 40's remain convinced of their ability to conceive naturally with their own eggs, despite much objective evidence to the contrary.  Perhaps in some of these cases there is an underlying ambivalence about having a baby, but regardless inaction at this crucial time may ensure that they lose whatever opportunity of using their own eggs that remains.

Another type of emotional issue that can impair medical decision making is feelings about the doctor-patient relationship (or transference as we psychodynamically trained therapists like to call it).  Feelings of loyalty to a doctor may make it difficult for some people to seek a second opinion.  They may have idealized their doctor and be unable to recognize or admit that their doctor has missed something or made a mistake.  Alternately,  they may find it difficult to trust others, especially medical professionals, and therefore are unable to provide a complete symptom picture, leading to under diagnosis or misdiagnosis, which then unfortunately only increases their mistrust.  Even if they do receive the correct diagnosis, their feelings of mistrust prevent them from following treatment recommendations, which can have tragic effects.

As you can see, making sound medical decisions requires the ability to deal with your feelings directly, and to be able to acknowledge anxiety-producing situations.  It also involves the ability to trust and value the opinion of others, but not so much so that you cannot examine these opinions critically.  These emotional abilities are not always easy to obtain.  In an emotionally charged situation such as infertility treatment, it is even harder to apply these skills.  Thus, it is important, when you are making treatment decisions, to take a moment and think about whether you are using denial, or if your emotions about your doctor could be interfering with your ability to critically examine their recommendations.

As always, thank you for reading, and please feel free to contact me with any questions, comments or suggestions you may have!