To Speak or Not to Speak- That Is the Question


Fertility clinics are busy places. With that comes doctors and clinical staff who are trying to keep afloat in the sea of patients. As professionals, most of us do our best to provide excellent, personalized care to each patient who walks through our door. In order to do that, we have to rely on the clinical support staff, which is usually comprised of RNs (registered nurses), LVNs (licensed vocational nurses), and MAs (medical assistants). Each type of medical professional comes with different levels of training, but with proper guidance and experience, you will often find them working side by side as case managers, for infertility patients.

Many patients know that their main point of contact is typically their case manager, and they usually work more closely with these professionals than their doctor. So what happens when your case manager is not up to par? Do you say something and risk potentially, biting the hand that feeds you?

Patients are often scared to question their case manager, for fear of alienating the clinical staff or physician, or for fear that they will not get good care if they say something negative about this very important staff member. Kind of like when you send food back at a restaurant, you worry that they will secretly spit in your food.

Here are some signs that you may be working with the wrong case manager, along with suggestions about how to approach each situation:

“Sorry I was not able to get back to you but I have a lot of patients…” Your case manager doesn’t return your phone calls, or handle tasks in a timely manner.

  • Each and every patient deserves to have their needs addressed in a timely manner. You should expect your calls to be returned within one business day if the subject is not urgent, or on the same day, for urgent needs. Keep in mind that what you deem as urgent may be different to your case manager. Usually, urgent needs are ones that truly cannot wait until the next day. Some examples of these include running out of medication, unexpected bleeding, or a side effect from medication. If you feel your needs are not being met, you should address it and let your case manager know what you expect. Asking them to give you a quick call or email with an expected timeline for your request is completely reasonable, especially if your request will take a few days to complete.

“Oh yeah, you’re right. I was thinking about another patient.” Your case manager repeatedly makes mistakes, or doesn’t pay attention to detail.

  • Working in this field requires a clinical person, who can manage many tasks efficiently, and accurately. The small details matter. Red flags would be: Your medications prescribed are different than what you were told in emails/on the phone. They get your medical history or treatment plan confused with somebody else. Or, it seems you are continually going for blood tests because your case manager is not thorough. You have to come to the office repeatedly for things that could all be handled in one visit. If this happens, ask about it directly. I spoke to my clinical staff and they all confirmed that if they made a mistake, they would prefer to hear about it directly from the patient. Often times “mistakes” turn out to be a lack of communication which can be resolved. Be sure to ask why there are so many things that are being done at different times. It’s ok to ask questions, don’t just assume it is the case manager making mistakes. You will know by their response if it is due to an ineffective case manager or by simple miscommunication.

They give you the wrong information

  • This is a tough one. Often times you won’t know that you received the wrong information until after your physician contradicts what your case manager told you. In the event that this happens, you will need to decide what to do. If you got the wrong answer to a very clinical, medically directed question, you may decide to reserve the complicated questions for the doctor, particularly if you like the case manager you work with otherwise. Know their limitations, and when you have very detailed questions, you can ask them to pass the question along to the doctor, just to confirm. A good case manager will not have a problem doing this. If you find that you are the type of patient who needs to know very detailed medical information rather than just the basics, you may want to request somebody who has more clinical training or experience, in which case I would address this to the doctor directly, or, to the clinical supervisor.

Your personalities don’t mesh, or, you don’t feel respected

  • Sometimes, despite everyone’s best efforts, personalities just don’t go well together. It happens, and we all understand that. If you feel this way about your case manager, chances are they feel the same way, too. Address it with them in a kind way. Tell them that you don’t feel like you are able to effectively communicate with them, and ask if they could find another person for you to work with. You can give examples if you want to, but you shouldn’t feel the need to defend your request. If you don’t feel comfortable doing this, it is perfectly acceptable to go to the physician, or supervisor. Just bring some examples of things you think could have gone more smoothly, so you can be reassigned to somebody who can work with you on your specific needs. This also pertains to sensitivity issues. If you feel that your case manager does not understand or approve of anything about you, such as your gender identity, marital status, or decisions about treatments, you have the right to request working with someone who does. You have the right to always feel respected when you come to the doctor's office.

Always remember that you are the patient, and deserve excellent care. Don’t be afraid to be your own medical advocate. Ask questions. Also keep in mind that you have to manage your expectations. Your case manager does have other patients, and needs to prioritize tasks. When you have an urgent need, you will bump to the front of the line, too. We know how important trying to get pregnant is to you, but try not to get too impatient. Give the professionals assigned to your care time to help you, on non-urgent matters. But, don’t be afraid to speak up if things go awry. A good case worker will always understand.

Wondering what questions to ask your physician on your first appointment? Check out this video for a great list you can use.

Suzanne Yahiro-Leibowitz has worked in the field of infertility for over 10 years. She is currently a physician assistant and IVF case manager for Reproductive Science Center of the Bay Area. Yahiro-Leibowitz is married and the mother of three children.

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