10. Healthcare Visits – A Little Thoughtfulness Would Go a Long Way

Jun 18, 2024

Many of us feel uneasy or anxious about visiting the doctor, but this discomfort is often worsened by the insensitivity and lack of awareness about involuntary childlessness. Today, we will be discussing some personal experiences and observations of how women without children encounter insensitivity and misconceptions from healthcare providers.

Unfortunately there is a significant lack of understanding within the medical community about the emotional and physical impacts of infertility and pregnancy loss. I am offering a few tips for childless women on how to advocate for themselves in medical settings. There is an immense need for healthcare workers to show empathy and sensitivity when discussing reproductive status

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Healthcare Visits - A Little Thoughtfulness Would Go a Long Way
Key Episode Takeaways:
  • Compassionate and empathetic communication is sadly often missing in healthcare.
  • Examples of common insensitivities and misconceptions faced by childless women during healthcare visits.
  • It is ok to advocate for yourself.
Listen to the Full Episode:
Full Episode Transcript:

Hi, you're listening to Childless and Moving Onward. This is the place where we talk about thriving in life when you're a woman who is childless not by choice, regardless of the road that brought you to childlessness.   Welcome to episode 10 of Childless and Moving Onward. Today's topic is health care visits, how a little bit of thoughtfulness would really go a long way. I'm speaking about this as both a childless not by choice woman, life coach who helps women who are childless by circumstance, not by choice and as a physician, I have been on the receiving end of like really inappropriate comments and behavior just as so many other women have when it comes to our health in general, when it comes to our reproductive health. Um, yeah. So this is both as like firsthand and coming from clients and hearing from patients as well. Now, I am very lucky because while there still isn't a general good understanding of the effects of infertility and pregnancy loss and childlessness in and medicine in general, there is starting, it is more common that people have some awareness. But I'm really fortunate because many years ago when I was a resident, I had a fantastic attending. He was a reproductive endocrinologist. So, an OBGYN who specializes in, um, infertility and other reproductive issues. And long before there was more of a general understanding of the pain of infertility and pregnancy loss and childlessness, he was well aware of this. He had begun to study it and so he passed on that knowledge, that understanding, um, so I'm very fortunate. He has unfortunately passed. I was lucky to be one of the residents who was taught that the minute that pregnancy test is positive, you've begun to dream of that future and so, If there is a loss, if it does not, the pregnancy doesn't go as planned, he recognized this was something women grieved over. But it was even before the first pregnancy test that's positive. Those thoughts start the minute you decide, yeah, I do want to have a child. I do want to become a mom. Even if it's, you know, yeah, someday I want to be. I'm not ready right now, that dream of what life will be like starts. And so when it doesn't happen, it's painful. It's a loss. It's a genuine loss. And it is something that you grieve. And he had that understanding again, long before this was starting to become more commonly recognized. And I was fortunate to have learned that. And, um, again, I didn't know at the time that I would be childless. I didn't even have a, there wasn't even that consideration. Um, but I benefited from it because it, it made me recognize this long before it became personal and it was something that I did research myself and learn about and take into consideration when taking care of patients, when speaking with patients. And learning to focus on compassionate, empathetic communication that is sadly often missing in healthcare. And I say that as a physician, knowing that there may be some physicians listening to this and who may be pissed off by my saying that. Um, but it's the truth. So I'm about to tell you a story about a healthcare visit. Um, it's just one story, but it illustrates a very common situation of misunderstanding, of a lack of awareness, of insensitivity. I want to make clear beforehand, though, this story happened to involve a nurse practitioner, but I'm not telling this story as an indictment of all nurse practitioners. It's just that in this case, that's who the patient saw. So these horror stories that I've heard from patients, from clients, from women in support groups, horror stories about the pain of health care visits when it comes to fertility status, when it comes to reproductive history. They are not isolated based on gender of whoever is taking care of you. They're not isolated to specific location or locations in the country. They're not isolated to right versus left. It's not rural versus urban versus suburban, in terms of locations. And it's also not specific or isolated, I should say, to specific level of the healthcare person. It happens across the country. Every political persuasion, race, religion, and level of education of the person who is providing care or assisting with it. So, it um, includes medical assistants through physicians and sometimes, yes, even the office receptionist, truly. So, the story goes, what happened was this was a woman who had gone, she'd gone through menopause, she didn't have children. She established care at a new, um, primary care office and was going for an annual exam. Beforehand, she filled out the history online, the section on gynecologic history, reproductive history, asks, you know, how many pregnancies, how many miscarriages, how many deliveries, how many were early, all that. The patient had no pregnancies and so that's what she filled out. So she goes to the healthcare visit, she's taken into the exam room, gets ready, the nurse practitioner walks in, again, it just happened to be a nurse practitioner in this case, but the scenario I'm describing plays out at every level of care and education in medicine. In any case, the, uh, the nurse practitioner was looking through her chart, you know, reading through and then confirming some things about her health history. And when she got to the section for this woman's gynecologic history, she didn't ask anything, but she began talking, talking at the patient, it felt like she was being talked down to the, being lectured because she started by saying she couldn't imagine not having children. That this patient, she told her she had no idea what she was missing, that she, this nurse practitioner would've done anything necessary to conceive. The nurse practitioner, she didn't ask a single question about her gynecologic history. She just assumed based on the answer that she had no children. And she assumed a whole lot about this woman and was degrading and made negative assumptions about her. Oh, you don't have children, so you must be a bad person. I mean, that may not have been specifically what she said. But you know, frankly, even if this was a situation where this was someone who chose to be child free, this person had no business at all saying what she did. It was filled with judgment. It was filled with assumptions. It was filled with negativity. It was uncalled for and it was unprofessional. And also, total lack of understanding. I would have done whatever necessary to have a child as. If there's always a way. So even within the health care system, you'd think one, this would should be someone who has some empathy, some ability to understand, and you'd also think that they would have some knowledge. But no, having a child isn't always possible. And in fact, this patient's reality was that she went through years of trying to conceive. Um, she and her husband went through multiple evaluations, multiple rounds of IVF. They had traveled across the country to see experts. And after, I believe it was five years, it may have been seven, um, but after all the years of, of trying to get pregnant unsuccessfully. She and her husband made the very difficult decision, they could no longer keep trying. They couldn't go through the heartbreak, heartache they experienced after each unsuccessful round. Adding to the heartbreak was just a part of it. The physical torment that she went through with each round of IVF and there was never full recovery, going back to her baseline, so just kept piling on. None of that is minor but insensitive and dismissive comments are frequent in healthcare, and they trivialize women's feelings about childlessness. So these, the assumptions and the stereotypes about childless women aren't limited to the general public. They're spread far and wide. Including the medical community as well. Where you would think there would be some knowledge about how this affects someone's well being, their emotional well being, their physical well being, and that what manifests from this, this pain, is sometimes physical. I am not implying that it's always in your head because, come on, as women, we get that all the time, right? Who has not experienced at least once, if not multiple times, going for a healthcare visit and you're treated like, ugh, you know, it's all in your head. There's nothing wrong with you. You're anxious. when in fact, the other root cause isn't always that, but yes, um, our emotional health and, um, challenges do sometimes manifest in physical ways with physical symptoms. But there is, when it comes to, um, reproductive health and reproductive status, there's no understanding of that, there's no recognition of the long term effects of all of this on someone's physical well being and emotional well being. And it gets in the way of good care because in part, again, you're missing opportunities to recognize maybe there's some underlying depression as a result of being childless not by choice, as a result of pregnancy losses, as a result of fertility treatments, infertility. So there's that missing piece. There's the missing piece of the opportunity to refer women for help with their emotional well being when this is an underlying issue. And it certainly gets in the way of establishing a good relationship with patients. The poor communications, the lack of sensitivity and biases within the healthcare system can leave women who are childless, not by choice, feeling even worse. So the dread that's common when you're going to the doctor, I mean, even if you're going, it's like, I go for my annual exam, I'm feeling well, there's still that little, what if they find something, right? So, there's always, or for most people, there's a touch of dread going to the doctor that what might they find even if you're going in feeling healthy. That dread is only heightened by the insensitivity and the lack of awareness, the lack of comprehension about involuntary childlessness, even among those you'd think would understand. So now, as a physician, I completely understand that the time allotted for appointments, especially for doctors who work for healthcare systems, you know, they're not, it's not their own practice. They're working for someone. The time allotted is a pittance of what most doctors need and want. The complaints from people about, you know, no time, the doctor has no time for them. Trust me, so many doctors feel the same way. Granted, there are also many who don't care, but many, most, aren't any happier about this kind of next, next, next type of scheduling, the production line type of scheduling. It is the reality of healthcare these days. The reality is that physicians very commonly have no say and it's administrators making the decisions about the amount of time for visits. So the bottom line of all that is doctors don't have the time to address these issues, but that's not an excuse. That doesn't mean that doctors, nurse practitioners, PAs, and everyone down the line in that visit, it doesn't mean that you can't practice some thoughtfulness. No matter how far we've come, women are still judged by fertility status and marital status but shouldn't be. And it happens at health care visits also. You'd think there would be some empathy and understanding, but there isn't. So I said earlier this wasn't limited to like, you know, level of education or, you know, where you are in the pecking order of things in the, you know, employment area and that includes sometimes things said even by the people you would think, where is this coming from? Right? So there was a, someone I know who went in for a follow up visit after she'd had a miscarriage. And she was greeted by the receptionist with, well, at least it was early. She went in, checked in, here's my name, I'm scheduled for, you know, whatever time it was. She didn't know the receptionist. She took it upon herself to bring up, well, at least it was early, not the appointment being early, her pregnancy loss. It's wrong in so many levels, not the least of which it's a privacy issue. It's a HIPAA violation as she's talking to this patient in a waiting room, but nurse practitioners, physician assistants, nurses, doctors, medical assistants, receptionists, phlebotomists, everyone on the spectrum of training has said all of these things or said things like this. I don't mean that every single person in healthcare, but at every level there's been experience with someone saying things like this experience with being harshly judged and stereotyped for being childless. So for those who are in healthcare, think about, is this clinically relevant? Do I need to ask about this? And if so, if reproductive health is something that is pertinent, of course, ask, but in a respectful way, without judging personal decisions or situations. It means asking the person pertinent questions and responding with an assessment of the need for support. And making appropriate referrals or suggestions when the support is needed. But don't throw in your personal judgments or assumptions. So, when it is clinically relevant, explain in simple terms why you're asking. We know why, and we often assume that patients do as well, but they often don't, or they've read something on the internet that's incorrect. And so they don't really know the real reason. Remember that most healthcare visits are stressful. And when you're under stress, it affects your ability to, to comprehend, to take the information and to remember it. And when I, you know, as a physician, when I went to the healthcare visit with my father and he was diagnosed with prostate cancer. The minute the word cancer came out of the doctor's mouth, I couldn't hear anything else. I didn't understand a thing. And I'm a physician, so think about how your patients who don't have medical background you know, are, are experiencing this. I've had to explain to countless women why they were asked about pregnancy before an x ray or before being given a prescription. No one explained it to them and the patient misunderstood and was angry at whoever was taking care of them. I get it. The time is limited, but it takes like 20 seconds to explain why you have to ask about this. Now, for those of you who are on the receiving end of this behavior, this what feels like torture sometimes, here are three tips for navigating health care as someone who is childless. The first is plan ahead of time what you're okay with discussing and what you're not okay with. If this is an annual exam or establishing care in a new practice where your whole history is going to be reviewed, you can let them know if you don't want to discuss the details of your reproductive status. You can tell them this is, um, you know, sensitive for me, you have the information, unless you need more for other reasons, please don't ask about it or comment about it. There is nothing wrong with that. There is nothing wrong with advocating for yourself. So one example is it's becoming more common for doctors, primary care physicians, OBGYNs to bring up and educate women on the effects of age on fertility to let women know because it's often not common knowledge. And so this is about making sure patients are informed. Um, so they may still need to ask or bring it up if it has an impact on something else. So just understand that sometimes they will bring things up because it may have some effect somewhere and they want to make sure you're informed. But now that takes me to the second tip, if it's brought up and you don't know why, ask. Ask why they're asking it or bringing it up. Again, advocate for yourself. And if it's something that is pertinent, then they should be discussing it in a non judgmental way. Which brings me to the third tip. If it's not pertinent, you can speak up. You can ask why they feel it's necessary to bring this up. If you've said to them, ask them, you know, what, what do you need this for? And they don't have an answer. That's just, ask them, why are you bringing it up? And the other part of that is, if it is pertinent, they need to know this for your care. Maybe, you know, they need to know about your history of DNCs, because that's going to affect um, something else like they need to know what your surgery history was for your gynecologic history. Um, or that you went through infertility treatments that were not successful. They may need that in terms of figuring something else out that's going on. So sometimes, yes, it is pertinent and they do need to ask about it even if you've said please don't. But it should be brought up in a, in a judgment free way, they should be explaining to you why. So speak up and let them know you're not okay with how they're saying things to you, how with how they're asking. Please keep your judgment out of this. Again, advocate for yourself. There's nothing wrong with that. All right, that is the end of today's episode. Thank you for joining me and I will see you next week.    Thanks for listening to Childless and Moving Onward. I hope this episode was helpful to you. If you liked what you heard, you can get more help from me with my guide, Steps to Overcome Self Doubt and Feel Worthy When Being Childless Isn't by Choice. Click on the link in the episode notes or you can find it on my website, pathonward. com. Until next week, thanks again for listening.