Balancing Trust and Advocacy: How to be a Physician Patient and Get What You Need

Have you ever worried about being THAT patient, with too many questions and off-putting your REI? You don’t want to be a “difficult patient,”  but you also feel you’re not quite getting what you need in terms of your fertility care. 

How do we navigate being physician patients—transitioning from being responsible for everyone’s care, and yet finding a safe space to let go and trust another physician (or physicians) to take care of us along the journey?

If this resonates with you, listen to this episode. It’s filled with practical questions to help you reflect on your current experience with your REI team, and how to figure out if there is anything else you need to feel confident and trusting in your path moving forward. You deserve the family you have dreamed of, and please trust me when I say it’s not all up to you!

As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.

If you found this conversation valuable, book a consult call with me using this link:

https://calendly.com/loveandsciencefertility/discovery-call

Also, be sure to check out our website: loveandsciencefertility.com

Follow us on social media:

IG: www.instagram.com/loveandsciencefertility

FB: www.facebook.com/profile.php?id=61553692167183

Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,

Dr. Erica Bove

Transcript

Hello, my loves, and welcome back to the Love and Science podcast.

This episode is by popular request because most of my clients and most of the people who listen to this podcast are female physicians with infertility.

And it is so incredibly difficult to be a patient.

It's also so difficult to navigate asking questions, interacting with your REI, interacting with the clinical care team, especially when you feel that you have questions that maybe are not being addressed to your level of satisfaction, or there's a lot of gray, there's a lot of ambiguity.

And the nature of the REI clinic is that you have your appointments with your REI, and then sometimes there's long gaps of time that go by between those appointments.

And then in the meantime, there's questions that are often fielded by wonderful nursing teams.

I will say, I've worked with some of the best nurses.

I will also say that sometimes it is hard because questions are very complicated and require really up to date view of the literature.

And a lot of my people, a lot of my clients ask me the question, like when am I being a squeaky wheel?

I don't want to be that patient, that difficult patient.

And yet I feel like I have questions that are either unaddressed or not being answered to the level of my satisfaction, whether it's about the why behind a treatment plan or either just like, what is the next treatment plan for me?

So that's what I want to talk about.

And I actually do have a module on this in my Love and Science course that I give to my clients who are undergoing the 12 Week Love and Science curriculum.

I sort of adapted that to this podcast because I want to arm you with the tools that you need to feel at peace, sort of, again, balancing trust and advocacy, like trusting the process, trusting your REI, and also sort of advocating for yourself.

If there's unanswered questions, if there's things that you really feel need to be addressed for you to move forward in a way that allows you to trust, then let's figure out how to get those needs in that.

So here's my framework.

So the first question I would ask yourself is, how do I feel in the context of my relationship with my REI in my clinic?

And I will say, I think some people are like in love with their REIs, like all of my patients.

I'm just kidding.

No, I really, I strive to serve when I see my patients, but actually part of why I form Love and Science was because I felt my patients weren't getting what they needed.

So full disclosure, this whole Love and Science endeavor is rooted out of an experience of feeling like I wasn't giving my own patients what they needed and deserved.

So anyway, I think that there are some people who truly do feel like they've got their A-team, they've got their REI, their REI answers their questions in a time-sensitive way they can get in for an appointment if they have things to ask.

I mean, I see it all because I have like all of my Love and Science clients and I sort of see the varying levels of when somebody really trusts their REI, when they really have a nice connection, and also when maybe people feel like they're sort of having a hard time getting what they need.

And I will say, I've been a patient before and so I understand what it's like to not want to see, even like I asked for a mammogram the other day and I was like, oh my gosh, this is off schedule.

I hate sending a portal message about this, but I need a mammogram.

So I understand, we all have these experiences of these patients who are super demanding and drain the whole system of all the resources.

And I think we more than anybody else have these complexes about not being that patient where regular people who are not physicians, that doesn't even cross their mind, they just ask their questions.

But it is an extra layer because what I say is it's really hard to be a physician patient.

It's really hard to be on the side of control, of giving the care, of having the answers to then literally cross that fence, actually take off the clothes, be in a gown, be vulnerable, not know the things.

Have a lot of uncertainty with your own health and your own family building, which is very anxiety provoking.

So part of why I love doing what I do is because I get to support female physicians and helping them be the best patients they can be.

And I think that sweet spot is where it's like we can get to that place of trusting the process and trusting the REI because we feel confident in the plan that is laid out before us and we have buy-in.

And so then we don't have to do the mental work of the hypervigilance because we've got our A team, we've got our REI who we adore and trust, we've got our coach, maybe that's me in your corner.

So that is really the first question is like, how do I feel in the context of this relationship with my REI and my clinic?

Do I get my questions answered to my satisfaction when I have them?

Can I get an appointment say I have an unsuccessful cycle?

Is it like three months before I can meet with my REI or can I get in relatively quickly?

I will say it's tricky.

Hey, I practice in Vermont.

It is a small town area, even Albany, where I used to practice New York.

You go to the grocery store, you see your patients, you see people around, you see people around the hospital in the cafeteria.

What I always say to my people is like, I want to be accessible to you.

And I think setting those expectations from the very beginning is very important.

So even at your first appointment, ask those questions.

If I have questions in between my appointment, what is the best way to get those answered?

What if I feel like my questions aren't being answered?

Can I contact you directly?

Do things always go through the nurses?

How hard is it to get an appointment in real time?

Again, I work with the best nurses.

I work with so many amazing nurses.

So this is to say that I think some things, like most things are able to be addressed through the nursing team, et cetera.

I will say though, like say somebody reads a research paper, they have questions about physiology that maybe require more in-depth conversation.

We can all learn, right?

I'm always all about empowering my nursing teams too.

And I learned from them too.

So this is not about like doctor versus nurse.

This is just about like, in the complicated arena that is fertility care, how does a person get their questions answered?

And I think sort of understanding how the clinic functions in general ahead of time is really helpful.

Some people's REIs give their patients their cell phone numbers for questions, but then I can't tell you how many times I hear, but I don't want to bother her.

I don't want to be that person asking questions.

And what I say to them is I'm like, hey, if your REI has given you her cell phone number, that means she trusts you to sort of be a patient who asks appropriate questions.

If I ever give somebody my cell phone number, it's because I trust that they're not going to abuse that.

And even my clients who, I mean, I give my clients my cell phone number always, and I just say, listen, I'll get back to you as quickly as I can.

If I happen to be sleeping, like I was last night when a text came through, guess what?

I'll address it in the morning.

People understand.

So I think sometimes, again, we have these complexes about like, am I going to be that person?

Am I bothering her?

Am I bothering him?

I don't want to be that person.

Just really setting that stage ahead of time and maybe even say like, hey, if you find that I reach out to you and you're starting to feel stressed by my messages, please just tell me because I don't want to be that person and I really want to respect this relationship.

I think that's a beautiful thing.

So just clear expectations from the beginning, I think is a really important thing.

And hey, if you're in the middle of that relationship, the messy middle, and you're still not clear, maybe it's a time to just like ask the question, just say like, Hey, you know, I, I love the care I'm receiving.

I think, you know, we've got a pretty good plan moving forward.

I will say there's a few things I'm wondering about.

And I just wanted to kind of clarify how things work in between appointments and such and, and just start the conversation because I think that, you know, if part of you is feeling that your needs aren't being met, your needs aren't being met and you've got to figure out like what you did, maybe it's a slightly different relationship with your ongoing team.

Maybe even might even be a different REI.

And I will say like on my clinical, I mean, we all have had experiences where sometimes we work with a patient and we're like, I don't think this is a good fit.

Like this is, has to be a two way street.

It's kind of like a relationship.

And so, you know, sometimes it's like, even though I want to serve my people at the highest level, my patients and my clients, like every now and again, it's like, Oh wait, this isn't a good fit.

And maybe this patient would be best served with one of my partners.

Like all those things come up and that's all normal and expected.

So I just want to kind of normalize that because I think a lot of our internal dramas come from the fact that we don't accept these sorts of things.

And that's where we get into trouble.

Okay.

So that's the first question is like the context of the relationship with my REI and how to get my questions answered in my needs.

The second thing to think about is am I seen as an individual?

Am I getting what I need?

So I think, I mean, I've seen the full gamut of REI clinics.

I think that there's kind of smaller programs that are like mom and pop and like every single person knows your middle name and they know your birthday and they celebrate with you and they cry with you.

I mean, I've been part of those teams and those are absolutely amazing.

I think, you know, some of those clinics are not quite sustainable.

And, you know, I think the medium sized program is usually where it's at in terms of like, you have a beautiful level of the team knowing you, maybe they don't know every single detail, but you do feel loved and seen and understood by your team.

You can get what you need.

You know, your care is still tailored to you and you feel that you are an individual and that people are considering you and your situation and your goals.

I will say that the trend in REI care is these larger conglomerations.

You know, there's private equity involvement.

There's clinics buying up other clinics and merging and, you know, how do you retain that level of personal touch when there's so much administratively going on and about higher levels?

And so, you know, that is really like a lot of these larger programs.

I've been a part of larger programs before.

I think, you know, each individual doctor can try and provide the best possible care possible.

You know, I will also say there are some clinics where there are certain limitations on what doctors can do.

Sometimes, you know, if a doctor wants to do a day three transfer, it's like, sorry, we don't do day three transfers here.

It's too much for the team and we've got a lot of patients.

We've got a streamline or, you know, gosh, what's another example?

Like, I don't know, you know, as pertains to like, you know, is your REI the one during your procedure?

Like, you know, usually not, especially even in small size programs.

I mean, you know, sometimes that is the case.

I know my friend Carolina Swatto has her own boutique practice in Fort Lauderdale and she will be the one doing your retrieval if you are her patient.

But again, I think that's more the exception than the rule.

And so just understanding that there may be some cross coverage and understanding how those things work.

But even still, like whenever I see one of my partner's patients for retrieval or a transfer, you better believe I've read the chart.

You better believe that I've sort of understood their situation, how many transfers they've had before, if they have any living children.

I like to understand a little bit about, you know, how they spend their days and like where they live and all those things.

I just think it makes the process a lot more human.

But I also think we know when we're not feeling like a human being, we know when we're feeling just like another number.

And so if you really do feel like you're just a number and it's more of a factory, I hate to use that word, but I know because people tell me these things that people just feel like it's factories and times, you know, maybe really look at that because this is why I call my practice love and science.

Like, you know, it really does take love and science and maybe the science is there, but that sort of feeling of being held, that feeling of somebody really sees you uniquely and cares about your individual journey.

Some clinics are just so big that they really cannot provide that.

And so maybe another place would be a better fit for you.

I understand there's geographic concerns.

I understand there's medical deserts and all those things, but you know, if it's your fertility and your outcome and you deserve to feel like a human being as you're undergoing this process, I would really examine that and really do ask yourself that question.

Am I seen as an individual and am I getting what I need?

If the answer is yes, or most of the time, yes, fantastic.

But if your gut is telling you that something is off, it's off.

I mean, that's one thing that I've learned through this whole coaching journey is like, I can trust myself.

My intuition will steer me in the right direction always.

And that is one thing that if you decide to work with me, I will help you with is, you know, that sort of inner knowing that inner trusting, like you can lean in and feel if something is right, fantastic or mostly right.

Right.

Some, sometimes things aren't right a hundred percent of the time, but like if in general you're like, yes, I'm getting good care.

Yes.

People care about me.

Yes.

They understand me and my own situation.

Great.

But if like people are frequently making mistakes or, you know, you truly just feel like you're one more person, I really would like lean into that and think about it and think what other options there might be.

Okay.

So my next question for you is, are there any questions I have not yet asked, which would make, would help me make important decisions?

If yes, how can I find my authentic voice to ask those questions?

So I guess it's two questions, right?

So the thing is, are there any questions I haven't yet asked, which would help me make important decisions?

Like something that comes up all the time is like, you know, do I have silent endometriosis or not?

Or should I get evaluated for, I don't know, my own sister or not?

Like, again, those are questions where there may not be like a clear cut answer in medicine.

But I think if you're like, Hey, I'm on my fourth embryo transfer.

Why aren't things taking like, can we look into things a little bit more?

You know, if, if asking those questions would be helpful to you, like, you know, is growth hormone a possibility for my next, you know, I have cycle again, as a doctor, when people ask me those questions, I don't know exactly what to say to them.

Like I, I review the benefits and the risks and all those different things.

So again, it's not that there's like one right answer, but it's, it's worth the conversation, right?

I think there's a lot to be had.

Okay, well, these are the benefits.

These are the risks.

This is what's known.

This is what's not known.

Based on all that information, what is the best thing for you so that you can make an empowered, confident choice moving forward?

One of the biggest traps I see people get into is this analysis paralysis.

So it's like, okay, agree on the strong plan.

A leave the appointment.

And then for the next four to six weeks until the next fertility thing happens, it's like, Oh, wait, like what if there's something better?

What if, you know, there was something else on pub med that I haven't considered.

What if I go on my fertility support group and you know, all these other people had XYZ and maybe that would benefit me in my situation.

It's like, there's not confidence in the treatment plan moving forward.

And so I think that is like really insidious because what it does is it makes us be hypervigilant to the point where we actually cannot relax into the patient role.

We actually try to micromanage our own care, which then something energetically shifts and I swear it doesn't work as well.

Like we cannot be our own doctors in this process.

And so whatever it is that allows that balance of trust and advocacy, like I said, even if it's just that you've had a conversation and considered the pros and cons with somebody who has your best interest in their heart, I think that's worth a lot.

And so really being empowered to maybe your transfer is in three weeks and you really don't feel like you can move forward without having another conversation in your REI's on vacation.

Like maybe you actually say, hold up.

Like I, you know, that embryo is going to stay frozen as long as I want it frozen.

And so why don't we put a pause to the cycle?

I have a few more questions and you know, and then let's reconvene after we think of some more things.

Again, a lot of this stuff is not, it's not like, you know, an appendectomy that needs to happen in like two hours.

There's a lot more agency that we can find.

There's a lot more creativity, flexibility, curiosity, right?

And my goal is to have each one of my patients and my clients feel that they understand their own situation and their diagnosis, that they understand the different treatment options, that they have made an empowered choice moving forward, and that they feel confident in that plan.

Because when they feel confident in that plan, that's when they can hope for the best and let go of the outcome, which is that sweet spot where I think the success rates are the highest, but until then that can happen.

So again, if there are any important questions you haven't yet asked that would help your treatment plan, please do feel empowered to ask those questions for your care.

And then also, if you're having a hard time finding your authentic voice, let me help you.

Part of it's about asking uncomfortable questions.

Part of it's about ditching the people pleasing part of ourselves that maybe at one point led to our success.

But these are really, really important things.

And I promise you, if you do not speak up and you have an outcome that is less than ideal, you're going to always wonder.

It may or may not have made a difference in the long run, but you will always wonder if you had advocated for yourself, if it would have been different.

And I want to squash all of that out.

Okay.

Next question.

Am I using my resources wisely?

Are there any resources I need to tap into or contain better, i.e. social media to better serve me in my fertility journey?

So that question about am I using my resources wisely?

There was a conversation recently on one of the fertility boards.

In my state, an IVF cycle is either a stimulation or an embryo transfer, and they count each one and I only get three total cycles.

And so the conversation was about, well, obviously, three retrieval cycles is going to cost a lot more than three frozen embryo transfer cycles.

And so the way to maximize that insurance coverage, if as long as there's no fine print, is to do the three retrievables and then pay out of pocket for the pets.

Again, that's an example of understanding the system.

But I also think that some people ask about acupuncture, some people ask about coaching, some people ask about containing social media, stress reduction, some people ask about supplements.

All those things are important.

I'm about to record a podcast on how do I live my life while undergoing this process, like exercise, sex, food, travel, all the things.

How can I live my life while undergoing this?

And I think we have so many resources available to us and I think we have a lot of limiting beliefs about what we can access and what we can't.

Maybe it's that you ask your colleagues to cover you while during rounds so that you can get to your IVF appointments.

Whatever it is, I think all these things require outside of the box thinking and solutions and I'm here for all of it.

So my last question that I would ask you is what is my next right thing?

I will tell you that at all of our support group meetings, we start with the win of the week, right?

Because there's always wins that we can focus on.

Then we get into the meat of the conversation, but we always, always, always end with what is my next right thing?

Because when you think about being a physician patient and turning in the direction of your ideal future, your ideal family, maybe that's like 20 steps ahead.

Maybe that's 30 steps ahead, but if we are oriented in the right direction and we face that direction and we take just one step in that direction, then the next right thing will become apparent.

So I don't know about you guys.

I mean, I've never been able to make an algorithm for these things because it's just too complicated and there's too many eventualities, but if I focus on where I want to head and I help people take that next right thing step, that's when everything opens up, right?

That's when you then see the fork in the road that you need to take.

That's when you make the values based decisions.

That's when you come together in community and support each other and come up with outside of the box solutions.

So I think in terms of balancing trust and advocacy, if you feel confident in what your next right thing is, that's what's going to propel you with that momentum on your journey to feel confident and empowered in your treatment plan.

So I know we talked a lot about a lot today.

I know we talked a lot about sort of expectation setting.

A lot of this is truly introspection about how things have gone so far and how you would like things to be and truly asking those hard questions about like, are my needs getting met in this relationship?

And if not, how do I get them that either within my current situation or maybe even by pulling in some outside resources as well?

So I think there's a lot of hope.

I think it is a unique position being a physician patient, but that's why I focus mostly on physicians because I love, love, love helping people navigate this.

So I hope this was helpful.

I hope that you can ditch all those complex, all those complexes about being quote unquote, that patient and that, you know, this just gives you that little nudge to say, it's okay.

I'm a human being.

I do deserve good comprehensive fertility care and I'm going to find a way to get that.

With that, I will leave you until the next time I loves.

Bye.