Care Plans

A Care Plan is probably the most important thing you can have in you fertility journey.

Of course, we all hope that we won’t have a “journey”, that we’ll achieve pregnancy quickly, on our own, like so many friends and neighbours and co-workers seem to do. But when it isn’t easy-when you find yourself on websites, or at your doctor’s office or a fertility clinic-then you are on a journey.

Many patients arrive at a clinic hoping for a very, very short journey.  Others are willing to let things take a little longer if it means fewer tests or medications.  Sometimes finances must be carefully considered.  A Care Plan will help you and your clinical team resolve these sometimes conflicting goals.

A Care Plan often consists of four parts: Assessment, Planning, Implementation, and Evaluation.  This may be a process that you clearly lay out with your doctor, or it can be something you refer to on your own, to keep yourself on track.

Assessment

From first contact, the clinical team will assess your situation through medical history, physical examinations, and investigations.

It can get quite involved.

But how far do you want your assessment to go?

Some patients want just the minimum.  I had a patient today who plans to carry the embryos for her best friend.  I can tell you, there are a lot of tests that I can order to “ensure” that she will be safe to become pregnant.  From ECHO cardiograms to 3D sonohysterograms, we can do it all.  She wanted almost none of it.  I insisted on a few things-infectious disease testing, for example, and legal counseling-but this patient had identified that she was going to minimize intervention.  Yes, she is taking a risk that something will go wrong.  But she feels that this is well balanced by the reality that it can be easier and gentler to do few tests.  Does this sound like you?

Some patients want to rule out everything. For some, the stress of a procedure or investigation is easily balanced by the pain of “not knowing”.  Some people need an answer, or at least need to know that they have explored the outer limits of what science can tell us.  Does this sound like you?

Some patients want the doctor to just do what’s right.  There isn’t really a “just right”, of course.  Every doctor handles this part differently.  This is where the art of medicine comes in.  It’s also where the challenges arrive in a therapeutic relationship…especially when the patient and the doctor have a different philosophy of what “just right” really means.  There’s often no right or wrong here, just different ideas.

When my patients are looking for guidance, I start with the easy tests-though if weeks or months are passing, I will suggest more tests and more aggressive therapies.

Of course, it’s easy for me to say “easy tests”, and not everyone will agree with how I might define them.  The ideal pace of change is different for every patient.

Once you have identified the tests or treatments that you want to do, you are ready for the plan to get you there.

Planning

Planning how to organize your treatments and testing is often done in concert with your nurse.

Some patients hope to get their investigations over with, and treatments started, as fast as possible.

But in practice, as-fast-as-possible can be totally consuming, and perhaps incompatible with other life goals (like keeping your job and your sanity).

A good plan will set expectations that can work for everyone.

Implementation

Implementation, at its best, can be a relatively low-stress experience: you are simply doing what you had set out to do.

(Your body may not co-operate with your plans, of course, which is what leads us to the final step):

Evaluation

At the end of every cycle, you should review your situation.  Are you happy with the level of investigations?  Of treatments?  With the pace and intensity of your care?  Is your plan clear? Are treatments being implemented appropriately?

A Care Plan will help ensure that you receive medical care that fits.

I hope this approach helps you.  I have found it a useful framework in my own practice to guide us at every step.

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