Tuesday, 22 January 2008

On being a 'good' patient

Thank you all for your supportive comments about my difficulties with Dr Abrupt - his ears must have been burning over the weekend!

Hekateris mentioned that she had had similar problems at another UK clinic, but didn't say whether she was being treated as a private or an NHS (National Health Service - i.e. state funded) patient. We are paying to have private treatment in an NHS clinic, which I think may go at least some way to explaining Dr Abrupt's attitude. I don't want this to turn into a lengthy post about the shortcomings of the NHS, so will only say that there is huge pressure on resources, and the impetus seems to be to get people in and out as quickly as possible. We were aware of this when we chose this particular clinic, as opposed to the fancy private one fifty miles further away; we decided that it was more important to be treated in a research-led clinic, rather than somewhere that offered fluffy dressing gowns and up to date magazines in the waiting room.

This does not, however, entirely excuse Dr Abrupt's behaviour on Saturday. I left the clinic feeling profoundly infantilised. Obviously, this may say rather more about me than it does Dr Abrupt - I was, after all, brought up to be a good little girl, and not to bother the grown ups. And yet it also says something about the authority patterns that continue to subtend our dealings with our doctors: however well-informed we may be, we are still led to believe that the Doctor Knows Best. As many others have already stated far more eloquently than I ever could, one of the most difficult things about infertility is the loss of control. In our bid to have a child, we hand our bodies over to the medical profession; we obediently take the drugs they prescribe, drugs which disrupt the cycles we have so painstakingly learnt to chart (one of the most difficult things about the last few weeks has been the feeling that I no longer understand what is going on inside my own body). We are rendered not only emotionally but also physically vulnerable, as we lie on their couches with our most intimate parts exposed. One of the ways in which I have tried to claw back some control is by finding out as much as I can about my own condition. I am an academic, and I approach infertility in the same way as I do any other unfamiliar topic: I read around the subject, and then I ask what I hope are intelligent and informed questions. And that is precisely why I do not like being patronised and dismissed.

We returned to the clinic yesterday for the IUI, still prickling with resentment towards Dr Abrupt. Despite some anxieties in the car on the way over, Mr H rose to the occasion and came up with the goods, and then at 1pm sharp we were called in for the treatment itself.

The whole thing felt a little perfunctory. I thought that they might do another scan to confirm that we were all ready to go, but no-one even asked if I had done the trigger shot on Saturday evening. We were both asked to confirm our full names and dates of birth, then Dr Abrupt got busy with the speculum. The procedure itself was over really quickly, and was far less uncomfortable than a smear test. From behind the curtain, I heard the sound of Dr Abrupt removing his latex gloves. I should lie there for about five minutes, and then I could leave, he said. I then heard the door opening. 'Dr Abrupt?' I called. He stuck his head round the curtain. I took a deep breath. 'I feel that our appointment on Saturday raised more questions than it answered, and I just wanted to make sure that we would have chance to talk through some of those issues in more detail before we started another cycle of IVF.'

'If the IUI doesn't work, then of course we will arrange a longer appointment in a few weeks time to talk about what we learnt from this cycle, and to think about what we'll do differently next time. But for the time being, try and think positively.' He even managed a reassuring smile.

Obviously, he does have something resembling a bedside manner!

Five minutes later the nurse came in. If I hadn't had a period in a couple of weeks, I should probably do a home pregnancy test, she informed me. Would I not have to come into the clinic for a beta, I asked. 'Oh no,' she replied, 'that's only if you were doing IVF.' Should I start using the progesterone pessaries, I asked. She did not know, but would go and ask Dr Abrupt. She returned a few minutes later. 'Oh no,' she answered - you've guessed it - 'those are only if you're doing IVF.'

So now we wait.


Waiting Amy said...

I'm glad you were able to do the IUI and left things on a slightly better note with Dr. Abrupt.

I know the other day was difficult and he probably wasn't as polite as he could have been. But I've found they really want to have those in depth discussions of protocols and planning in a separate appointment. It gives them time to really go through the progress of the cycle and then go through all the options with you. You will probably find that appt so much more satisfying. I understand you disappointment too at his lack of a recommendation as to the IUI. But that too they unfortunately don't always know all the answers. All he can really do is give you the data, the charts and statistics and let you play a role in the decision, because they just never know for sure.

Wishing you lots of luck!

luna said...

I'm glad you got to do the IUI and that you had a much better interaction with him. and yes, he even said the right thing. and now, the 2ww! good luck.

and I wanted to thank you for your kinds comments and support too, it means so much to me. ~luna

Hekateris said...

Oh I was an NHS patient, and we offered to go private (at the same clinic) about 3 months before I was kicked out of the program (after 4 years on the waiting list, I conveniently became 'too fat' for treatment).

I don't know about Dr Abrupt, but I can tell you that my overall experience with the doctors at the clinic were variations of Dr Abrupt, particularly Bitch Doctor From Hell, Dr "Calling My Patient When She's At Work To Tell Her She's Getting Kicked Off The Waiting List Is A Fantastic Idea", and Clinic "I'm Glad You're Not So Angry That I Kicked You Off The List Anymore And GOSH, You Should Be Grateful You're Not In Glasgow Where The Cut-Off Weight Is 16 Stone and Gee, At 37 There's Still Time!" Director. Personally, I think said Clinic Director should have been glad he had a med student in his office at the time, because quite frankly, I would have gone for his throat otherwise.

Anyway. My point is that my experience with infertility specialists in the UK was pretty effing awful. I don't know if that's how they're trained or if it's because they literally hold life in their hands and get off on the desperation of those of us who need to see them.

If I sound bitter, it's because I am (still), even though through the grace of the Universe I was able to return home and get treatment from a fabulous clinic. Mr Oro was stunned and surprised and to be honest, a little ashamed at our treatment in the UK, because he's such a big fan of the NHS otherwise. As am I...with some pretty big reservations.

I'll be straight out - I don't like Dr Abrupt at all, but I hope he does the best he can for you. Fingers crossed for the 2WW!

Frenchie said...

Glad you were able to go ahead with the IUI. It's so hard to get these doctors to look us in the FACE and talk to us (as the human beings that we are) about what is gong on with us. Good for you for being proactive.
I'm wishing you tons of luck with this IUI.

Malloryn said...

I'm glad to hear that things went a bit better with Dr. Abrupt. I also find myself taking an academic approach to infertility -- I can tell by the list of "Your Recommendations" on amazon.com!

Best of luck with the IUI! Here's hoping you won't need to have the long talk with Dr. Abrupt.