From our own interviews with patients and clinicians, and a variety of industry surveys, there are three main traits fertility doctors and nurses share that helps them stand out as providing excellent care. They:
Treat the patient as an individual
Promote health as well as treating disease
Provide support in ways patients respond to best
1. They respect individual experiences
Truly fantastic clinicians working in the fertility sector not only treat people equally regardless of who they are, their lifestyles and orientations, but differently, too.
A survey by the UK's fertility clinic regulator, the HFEA, found that the top driver of patient satisfaction was the “interest shown in you as a person.”
This, rather surprisingly, came before subsequent drivers such as quality of counselling, coordination and administration of treatment, respect and courtesy patients are shown and how safe patients felt during treatment.
It can be easy to categorize fertility patients as fairly uniform: on the surface of it we are simply people in need of care to prevent or treat infertility.
But in reality we span decades in age, sexual orientation, motivation, medical history, relationship status, family-building desires, emotional state, financial position and many other factors that will influence our desires for and responses to treatment.
A "whole person understanding” of a patient means understanding the patient's values, mental state, family, and beliefs.
Being able to take a sensitive judgement call on which questions to ask, and what support to offer a patient in the limited face-to-face time available, can only come about by thinking of the patient an an individual.
This is a principle that begins from the moment the patient walks through the door. We've heard stories of single patients being asked when their partner is arriving, and of forms pre-printed with inappropriate gender pronouns or prefixes. Those things may be unlikely to radically affect the efficacy of the treatment protocol, but they matter to patients, in particular when they are in the vulnerable or anxious position of stepping into a fertility clinic.
"Some feel undignified during medical procedures," says the HFEA survey report. "They are not always acknowledged by medical staff during treatment – either ignored and overlooked, or treated like a ‘piece of meat’ – which can lead to an undignified experience."
The care delivered by the clinical team throughout the nuances of every single interaction combine to influence the overall experience the patient has of treatment (and how they review care).
“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” (Frances W Peabody in The Care of the Patient.)
Often the hardest aspect of clinical care to achieve is good communication with patients. But it simply starts with listening to them, and trying to be empathetic with whatever they are experiencing, without them feeling like they're being rushed out the door. Some patients tell us they felt "like just a number" and found care staff could be dismissive with some concerns they had. Although fertility treatment is something doctors and nurses are around every day and are at ease with, it can be disorienting and a source of real fear for many people.
Being recognised as a whole person, not merely a patient, is an essential part of managing some of that anxiety.
2. They promote health as well as treating disease
Clinicians that stand out as providing incredible patient care do so in part because they take a holistic view of their patient's condition, and actively and appropriately encourage healthier behaviours as part of treatment.
The ultimate responsibility for not only health decisions, but encouraging good health, is the patient.
An unwritten partnership exists between the doctor or nurse and the patient, whereby they must work together for the best outcome and experience of fertility treatment. Considering the whole person, including their lifestyle, habits, mental health and genetics, instead of their illness in isolation is not only more likely to offer effective care pathways, but also creates a sense of agency in the patient whereby they will feel empowered to take personal responsibility for aspects of their health.
Excellent care providers spend time asking questions about diet, stress, sleep and exercise, and have ready answers to patient's questions about the efficacy of certain adjunct therapies, such as acupuncture.
This is particularly obvious if a patient should be encouraged to stop smoking, or to reach a healthier BMI, but is applicable to every patient.
3. They provide support for patients when and where needed
Fertility treatment is a highly emotional and anxious time in most patient's lives, and so support – whether informal or formal, is a hugely important aspect of great care.
While many patients are offered counselling at some point during fertility treatment, the availability, frequency and quality of provision is mixed. Around 1 in 5 patients (20%) say they are not offered any form of counselling at all.
"There is a [patient] demand for a more robust offering," says the HFEA. "With one to one counselling, a degree of choice and availability at key points in the journey such as when treatment is not going to plan."
A survey by ELANZA Wellness found that patients want support from different people at different times during the treatment journey, including informal support from family and friends throughout. Patients primarily want to hear about formal support, such as counselling services, via clinical staff, namely doctors and nurses.
Currently, surveys suggest nurses are providing that care more effectively.
"Nurses are perceived to be the most approachable [members of clinic staff]." - HFEA