I have a family history of skin cancer. I try to get to the dermatologist once a year (or so – sometimes things slip) to confirm that there are no melanomas. Last week, I went, and since it had been over a year, I was filling out a detailed medical history. It asked me if I had any change to my medical history recently and if I used intravenous drugs, so I said something about the IVF and how I was between cycles but would be starting a new round of drugs shortly. That’s about how much detail I gave.
Later, I was sitting in the exam room with one of the medical assistants. She reviewed my form. “Oh, you’re trying to get pregnant?”
That’s an understatement. “Not having a whole lot of luck,” I said.
She seemed confused. “I’ll mark down that you’ll be pregnant soon.”
“If we’re lucky,” I said, to offer clarification.
Later, the dermatologist herself came in and was looking over my skin. “So you guys are starting a family?” she said.
“That’s the idea.”
“Kids are… gosh, they’re really a lot to handle, you know. Mine drive me crazy sometimes. Maybe you should…” And I think she maybe stopped short here because I was giving her dagger eyes in advance of the part where she was going to offer to let me take her kids since they drive her crazy. “Well, mine have been really sweet lately.” Bad save.
She offered to freeze off a wart. (It’s a really tiny one and it’s not visible when I’m wearing clothes.) I asked her about cost, because we have so many out-of-pocket expenses. “Oh, is your insurance saying they won’t cover the IVF?”
“Nobody’s insurance covers it.” (Not strictly true, but it might as well be.)
“I didn’t know that!”
Finally, she said to come back in a year to look for moles again, “After you’ve had your baby and recovered a bit.”
I am well aware that both these women could have said worse things. However. They’re not bozo Aunt Suzie from Des Moines who berates you at every family reunion anyway, or the sad high school kid working the local pharmacy counter. These women are both trained medical professionals. A higher standard for sensitivity is in order.
In contrast, R. and I had to get a form notarized before starting the new cycle. We went to the bank yesterday. The banker noted what type of form it was just so she could put that down in her notary book but didn’t say anything about it. All she actually said was, “Good luck, and let me know how it goes!” (We occasionally see her about other matters.)
This was a banker. Not someone who had been to medical school. Her response to the presented information – which, by the way, was far more personal than what I put down on the medical history form at the dermatologist’s office – was entirely appropriate: polite, respectful, supportive.
As for the dermatologist, I kind of snapped. I told her and her medical assistant, “It might be comforting to someone who isn’t as educated in this area to assume that we’ll be successful right away, but that isn’t how reality works.” I informed her about the 45 percent success rate on a good day and our reduced odds thanks to my diminished ovarian reserve. “But you’re not that old,” she said.
I’m not sure how that was supposed to help. Was she trying to contradict me? Not sure.
“Sometimes this just happens,” I told her. “In my case, there was no indication until we began the medication.”
Bear in mind, I’m sitting there in the patient gown, lecturing an MD and her nurse at the same time. Gotta appreciate my nerve.
And you know what? I didn’t even stop there. That evening, I printed off this helpful resource sheet from Resolve.org about what to say and what not to say and a very direct cover letter and stuck it in the mail. The strongest language I used was to say, “I do not expect the staff at a dermatologist’s office to have a full understanding of fertility medicine. However, for the sake of any of your other patients who choose to be honest when filling out their medical history and information, as I did, I sincerely hope that you and your staff will learn enough about this condition to show greater sensitivity to individuals in my position, as befits a team of medical professionals.”
I have not received a response, nor do I expect to.
In fact, I would predict that the dermatologist probably glanced at the letter and quickly shredded it and the handout. It would be embarrassing if her business partner saw it. Also, you gotta appreciate how easy it would be for someone in her position, who has had more than one child without fertility assistance, to sweep my comments and suggestions under the rug, telling herself I was just hormonal, or I just needed to relax, or I must be one of those rare crazy patients and it’s best not to let things get blown out of proportion. One could argue that I overreacted; I think not, but it’s up for debate.
Here’s why I do not regret sending the letter: Her staff would have opened it. They would have read it. They would get educated as collateral.
If the letter got to her desk and her eyes, she would be reminded of an uncomfortable encounter in which her ignorance was revealed. The memory will stick that much longer.
My bitchy attitude at the dermatologist’s office hardly changes the world. However, I would encourage anyone else out there who receives ignorant comments from a medical professional to take advantage of the Resolve information, and force it in front of as many pairs of eyes as you can.
We can’t make everybody sensitive. Bozo Aunt Suzie will always be a bozo. But, if nobody holds other doctors and nurses accountable for insensitive comments and assumptions regarding the condition of infertility, then the stigma surrounding infertility wins the day. Dentists, general practitioners, other specialists: these folks should know better, and if they do, they can help change perceptions on a broader scale.