Interview your doctor

May 7, 2010Carole No Comments »

Okay, you have narrowed your candidate list down to one or two doctors you want to interview for the job of your fertility doctor. Now what? Call and ask for a new patient appointment. Find out how much they will charge for the appointment. Rarely, you might get this first appointment for free. You might think that you can get some initial answers over the phone and you might, but from my experience, programs are loath to let their front office staff answer too many questions, because things that matter to you (success rate and cost) are determined by what help you need (diagnosis and treatment plan options) which is usually too patient-specific for a phone consult.

How does a patient find a good ART program?  The American Society for Reproductive Medicine (ASRM) is the primary professional society for healthcare providers in the fertility field. ASRM has recently updated their website  with patient resources containing useful information for patients that is worth checking out. ASRM used to publish their guidelines for clinical care that health care providers are expected to follow to stay in good standing with ASRM. Unfortunately, these practice guidelines which used to be publicly available-are now restricted to ASRM members –which is a shame.

In my humble opinion, beyond some preliminary testing (semen analysis) and maybe a Clomid cycle, if you are serious about getting fertility treatments, you should briefly say goodbye to your favorite ObGyn (you’ll be back when you are pregnant) and interview board certified reproductive endocrinology and fertility specialists for your fertility doctor. You’d go to a specialist if you needed knee surgery, right? So go to a specialist already. It will probably save time and money in the long run, especially if your fertility problems are due to underlying hormonal problems or you need in vitro fertilization.

Find out how your doctor’s team communicates with patients. Besides not getting pregnant, poor communication is probably the biggest frustration for patients. Because you will be responsible for taking your medications (including shots) correctly and on time,  how the program communicates this training is important to your success.   Some programs have enough nursing staff that every patient gets a one-on-one training session with the infertility nurse that may last an hour. Other programs, especially the bigger ones, will do this training classroom style with lots of other couples. Some programs have embraced technology and will give you a DVD to play at home or send you to an on-line source. Other programs offer several methods to educate their patients. I won’t try to tell you what is best for you but you should be aware there are different educational methods.

Some programs make their nurses available to you after hours by pager or answering service. Others take calls only during office hours unless it’s a medical emergency.  You need to find out what they are offering in terms of educational and emotional support at appointments and after hours and decide if that’s a good fit for you. There are some programs in which the physician will call the patient back personally for routine questions but that is a rare bird, and frankly, may not always be as useful as a heart-to-heart chat with a good nurse.

Fertility doctors are like any other doctor in that they retain the right not to offer treatments that are morally objectionable to them which is why you need to be sure that you and your doctor are on the same page. Hopefully, you’ve checked out the CDC Fertility Clinic Tables and ruled out programs that don’t offer treatments you might need.  For example, if you are a single woman, you won’t waste your time interviewing a doctor who does not treat single women.  Likewise, if you are older and interested in donor egg or donor embryo, you can identify programs that offer these services in advance.  If you are aligned with your doctor in what he or she offers, that prevents future problems.

You probably won’t get a cost estimate for your treatment plan on the first interview meeting but be sure that you get a written specific cost estimate with cpt (insurance) codes for every procedure and test your doctor plans to order so you know in advance what your bill will be before you start treatment. If you have insurance coverage, your insurance company will be able to tell you if your doctor (and his lab)  is in network and exactly how much they will pay for each procedure and which portion is patient responsibility. You might be surprised that even in the same area, doctors fees can be significantly different –and NOT correlated to CDC outcomes!

Be wary of the doctor who guarantees you that you’ll be pregnant in no time. Maybe he is just optimistic and trying to maintain your hopefulness, but last time I checked there were no guarantees in this medical field. In fact, if you carefully read over your consent documents, you will actually see the NO GUARANTEE clause in writing, near the end of the document. You may or may not get pregnant. You may or may not bring home a healthy baby. ART treatments can’t detour every infertility problem. What your doctor should be able to guarantee is that she will do her very best to diagnose your problem correctly, educate you about all your treatment options and give you realistic expectations about how likely each option is to be successful so you can make good treatment choices.

In her blog Stirrup Queens, Mel Ford, has posted the most comprehensive list of questions to ask your reproductive endocrinologist that I have found. You might not have the hours you’d need to ask every question on that list but it might help you identify issues that are most important to you.  I would add a few lab questions: is your lab accredited? Is your lab director on-site or off-site? If off-site, how often do they visit and is there a technical supervisor on-site the rest of the time?

Happy interviewing!

Carole

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