You arrive early to the office and start reviewing the schedule for the day. There it is…4 infertility consults scattered in the schedule amongst annual exams, postoperative follow ups, new obstetric patients, and “problem” visits. You know that infertility consults take much longer than the 20 minutes allotted for the appointment time. For a second, your mind jumps to how these appointments will undoubtedly make you run late for the rest of the day, and how being late will cause frustration to your other patients waiting to be seen.
However, you quickly remember that it is not the patient’s fault that your schedule is not under your control. You wish you could schedule this patient for the hour they deserve. It is not the patient’s fault that they are dealing with this complex issue with multiple layers of social, medical, financial, and emotional components. Your patient is hurting and confused and needs you at your best.
You give a quick tap on the exam room door and then introduce yourself with a warm smile. Your patient tries to reciprocate but you can see the nervousness behind their forced smile that appears it could crack at any second and lead way to tears. Her husband sits quietly in a chair next to her, his eyes glued to the ground for most of the visit.
So much is tied up into a consult for infertility. There is fear, hope, confusion, excitement, frustration. Fear that something may be terribly wrong and they can never have children. Hope that maybe you have an answer, a medication, or a treatment to help them. Excitement that they are taking the first step towards the road to concrete ways to get pregnant. Frustration that they have been trying for over a year on their own without success.
There is so much to go over in so little time. You have 20 minutes to find out about their health history, their struggles to this date, their medications. When discussing this painful struggle your patient breaks down in tears as this has affected her life in so many unspoken ways. You give her a tissue and time to compose herself and patiently wait for her to be ready to proceed. All of this occurs before you can even move forward with their reason for coming- answers.
You must review their insurance information as not everything may be covered for infertility services and they will want to know this moving forward. Cost is a huge part of infertility and testing/treatments. They need testing- a lot of it. Both your patient and her husband will need lab work. You order a special radiology test, hysterosalpingogram, to check if the fallopian tubes are open. You feel this test needs an explanation as this is an invasive procedure and somewhat uncomfortable test, so you take an extra 5 minutes to review what will be involved when she goes to radiology.
Finally, once the beginning plan is in place and your patient knows what tests are required, how to find out more about her insurance coverage, and what to expect in the coming weeks, she looks relieved. She feels heard, understood, and reassured. This health care environment is not easy for anyone to navigate, especially the patient.
You wrap up the visit, happy that you are going with her on this journey and look forward to her hopefully becoming pregnant and then delivering her much desired baby down the road. You know there is a long path ahead of her and there will be many future visits before that can occur. However, there is hope through modern medicine for couples with infertility that may not have been there decades prior.
You realize the tradeoffs and imbalances that are occurring in medicine. Innovation but with astronomical expense. If your patient requires IVF down the road this may be cost prohibitive to her as not all insurances provide coverage for this treatment which can require tens of thousands of dollars.
For physicians, there is pressure to see more patients with less time allotted for each patient, despite increasingly high risk, complex medical conditions. For employed physicians there is no financial incentive to do this and there is little control over the schedule. You take additional minutes with the patient where you can, save the documentation for later, and give the patient the time they need when the situation calls for it.