Consultation Guidance

Making the most of your fertility consultations

Introduction

No doubt you have been to see the doctor before, and must be wondering about the purpose and benefit of this guidance note. For the couple seeking fertility treatment the conventional doctor-patient relationship does not go far enough. Neither is it enough to give the doctor a full and comprehensive history and trust he/she will help you conceive. This is because modern fertility treatment requires active participation of the woman or the couple in all aspects of treatment – the diagnosis, planning as well as the implementation of the chosen or recommended treatment option.

The Kind of Relationship to Expect With the Doctor & the Fertility Team

Right from the first consultation a unique relationship should progressively develop not only between you and the doctor but with the entire fertility team responsible for your care.

At the first consultation the all important first impression takes place in a friendship and relationship building atmosphere and environment. You will see the Lead Clinician – the Director of Fertility Centre. Time permitting there may be opportunity to meet and get to know the rest of the fertility team.

If not already provided, you will be given the take-away pack of information leaflets to start building your knowledge and understanding of the complex treatment and care you will require.

The desired outcome of the ground breaking first consultation is the development of the conventional patient-centred relationship. At this stage the initial tension should abate and the relationship with the doctor should become more relaxed and down to earth. Your ability to communicate should improve as your knowledge of the biology of reproduction and the fertility problem increases.

You would have further medical and technical consultations as well as fertility counselling and psychosocial assessment. A host of investigations including blood tests, x ray and ultrasound examination would be carried out. During this time you would have the opportunity to meet the other fertility team members at work in their respective specialist field.

The relationship between you and fertility team moves a notch higher from a passive partnership to one of a co-operative, and working partnership as you discuss with the team the choice of ART treatment appropriate to the fertility problem and your personal circumstances such as personal beliefs, working arrangements, and available finance etc.

You should expect the human dimension of the fertility care to grow and develop naturally as the working partnership with the fertility team solidifies. The combination of the human and clinical dimensions underscored by emotional bonding and grounded on knowledge-based empowerment would be the ultimate and ideal relationship necessary to underpin your treatment and care.

Unique Features of Fertility Consultation

Many patients as well as some leading fertility experts are subconsciously too wedded to the routine medical consultation and conventional doctor-patient relationship to realise fertility consultation is different and requires unique and innovative approaches.

Paragon Fertility Centre believes fertility consultation differs markedly from the well known disease or symptom orientated consultations. The following key distinguishing features have been identified:

  • The central presentation is the natural instinct and the unfulfilled wish to have a child and not a physical disease such as malarial fever or highly visible skin infection.
  • Often the associated physical aspect such as fever, pelvic pain or painful testis due to mumps complication is no longer active.
  • The treatment involves a team all of whom are specialists in their own field and with whom you will interact to various levels or degree.
  • Treatment comprises a combination of highly technical and equipment based care as well as psychosocial counselling.
  • All aspects of treatment are intertwined with sensitive, private and intimate aspects of the life of the couple.
  • The treatment usually involves several cycles of intervention which succeeds in some couples but unfortunately not in every couple. Often the reason for failure is not obvious.
  • Treatment is a long drawn out process and not involving just a couple of tablets or capsules for a few days but lasting weeks and can be quite taxing and demanding as well as stressful.
  • Treatment involves not only the couple but often includes a third party donating the gamete or carrying the pregnancy.
  • Treatment is expensive and costly not only in monetary terms but also in terms of effort, energy, dedication and time.
  • Treatment involves psychological, social, ethical, moral and legal aspects as well.

Your fertility team are up to speed about their role in providing the care you require. And they are acutely aware of what makes fertility consultation different from the usual medical consultation. The issue now is how do you get the most out of the professional and expert fertility team?

Get started with common courtesy and lots of common sense.

It is important to get started with the usual taken for granted common sense and courtesy. Greet the doctor and the other fertility team you interact with by name. “Good morning Dr. …………….. I am pleased to see you today.”
This basic interaction sets the scene and creates the environment for a relaxed and tension free consultation. Besides it triggers reciprocal response from the fertility team member, to recognise you as a person to be treated with courtesy, kindness and VIP attention.

Further, you should not forget to build relationship with the administrative support staff responsible for keeping the wheels of PFC turning smoothly.

You should remember being courteous does not mean you should not be assertive in asking questions and seeking explanations as necessary. Remember you are the most important person in the entire fertility centre.

Come as a Couple.

At the initial consultations it is advisable to come together as a couple. The presence of a spouse provides mutual support and reassurance that reduces anxiety and builds confidence necessary to communicate precisely and effectively to the doctor or nurse and to ask questions. Besides the presence of a spouse is vital in understanding information the fertility team are saying.

If a spouse is unable to attend because of compelling competing reasons, and the appointment cannot be rescheduled say so to the team member involved. That helps to maintain a balanced and positive impression.

What to do Before Seeing the Doctor or Fertility Team Member

Time is money. Besides ART consultation as well as treatment is expensive. So make the most of each visit. Do your homework beforehand. Read the information leaflets provided. And as necessary do extra research and reading from other sources including the internet. Prepare written questions and highlight points you like clarified. And remember to take your notes along with you.

There are two main benefits for the pre-consultation preparation.

  • It allows you to identify your priorities and to focus on them at consultation
  • It lays the foundation for creating and solidifying your role as an engaged and highly focused working partner in the doctor patient relationship.

What to do at Consultation and at Return Visits

Irrespective of the team member you would see, each consultation is different in content, as well as emphasis, but there are common themes as well.

History taking is a key common theme of consultations, undertaken for obvious reasons at the first consultation and amplified or topped up with progress report in subsequent visits. In this regard, remember the doctor or fertility team are not mind readers. It is up to you to open up and tell them everything you know, think and feel about the fertility problem.

Vanquish shyness or embarrassment about sensitive subjects such as sexual problems or sexually transmitted disease. Accurate and comprehensive history is crucial to reaching accurate diagnosis, setting the best treatment plan and implementing highly focused follow-up.

Remember the team are not there to pass moral and ethical judgement on your conduct. As professional experts they are there to help you. And remember and be reassured they have “heard it all” and “seen it all”. They are no snoopers.

Your team are acutely aware medical procedures, examinations and diagnostic investigations can cause physical as well as psychological distress. While they would take the necessary care to minimise distress, it is important for you to warn and discuss the previous distressing experience with the team member.
Ask questions and seek satisfactory explanation to any aspect of your care. If you do not understand your doctor’s explanation, ask him/her to repeat everything in simpler language. Ask to for written explanation, diagrams and leaflets.

You need full and satisfactory answers to:

  • What bothers you
  • What is unclear
  • What is not understood

Remember no question is too small. No question is stupid. The stupid thing is not to ask a question at all. Remember asking questions helps in building partnership with the doctor and the fertility team.

Talk to your doctor and become a working partner in your care delivery. The following approaches can be helpful when you talk to your doctor:

  • Please tell me more about that
  • In simple English what does that mean?
  • Can you repeat the explanation
  • Can you show that to me in a diagram
  • Can you write that down for me
  • Where can I find more information about this?

By this stage you would have developed emotional bonding with the doctor and the fertility team. But things can unravel if the bonding element does not include capacity to manage and handle hiccups such as communicating and receiving unfavourable or bad news, inconvenient appointment or long waiting times.

How to Receive and Cope with Bad News

Do not kid yourself nobody can prepare enough for bad news. Yet bad news is part and parcel of ordinary daily life. Inevitably in one form or another it is bound to surface during the cause of your fertility care. The duty of your fertility team is to generate, interpret and communicate all information, good or bad about your care. As healthcare professionals the team have duty and responsibility to communicate to you honestly, truthfully and fully.

As the key stakeholder the information held by the fertility team is yours. For this reason, as part of fertility counselling your fertility team have put together the framework for effective communication between you and the team. The counselling topics include topics such as confidentiality, communication, and managing unexpected or negative outcome etc.. Counselling is strongly recommended as part of your fertility care.

How to Deal with Waiting Time

As far as is practical and reasonable you will be seen on time or as close a to your appointment time as possible. However, you should be aware unavoidable delay is common and inevitable in care giving environment because time overrun and emergencies occur.

Avoid:

  • Loosing patience
  • Getting upset
  • Getting fed up

Relax and be occupied:

  • Read informational or educational leaflets
  • Read newspaper and other literature
  • Watch videos

Remain constructive:

  • Work on you lap top
  • Get on the phone and deal with work or home issues.

Seek explanation for the delay and make alternative appointment as appropriate

Concluding Comments

Try your level best to be the ideal patient and couple. Take the opportunity to be an active and participating partner in your own care. The streetwise expression is Keep Cool.

The fertility team will endeavour to guarantee the ideal consultation at each visit as relationship develops through the stages of: offering a friendship and partnership environment, conventional doctor/patient relationship, partnership building, active and working partnership phase and ultimately the emotional bonding phase.

In order to continuously improve the quality of fertility service, the fertility team values your comments and fed back on all aspect of your care including your experience during consultation and subsequent return visits.

Your views and comments, verbally or in writing should be sent to:

Director Fertility Services
Paragon Fertility Centre
6A/7A Luthuli 5th Close. Bugolobi
P.O. Box 21387
Kampala
Tel: 256-414-220028. Fax: 256-414-220024
Email: fertility@paragonhospital.org

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