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IVF patients are dropping out and it isn’t just about the money.
Dr. Alice Domar, Chief Compassion Officer at Inception, discusses empathic communication and its role in minimizing patient stress and physician burnout.
With Dr. Domar we dive into:
Her definition of Patient Centered Care
How she measures patient stress (comparing against retention rates)
An example of a study she ran (the 67% difference in patient dropout)
Her format for teaching empathic communication
Common trigger points for patients (And their impacts on your reputation as a physician)
Dr. Alice Domar PhD
Chief Compassion Officer, Inception Fertility, Director, Inception Research Institute
Prelude Fertility
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Transcript
[00:00:00] Dr. Alice Domar: The clinics should worry because if patients drop out of treatment, they're not going to get the income. Pharma's not going to get the income. And I worry because the patient's probably not going to get pregnant. by the time she gets to IVF, and she drops that IVF, the chances of her conceiving spontaneously through sex are pretty low.
And so it breaks my heart to think that people get to treatment, may even have insurance cover for treatment. And find it so stressful they drop out. And that's, where we are doing something wrong. People should not be dropping out of treatment because they're too stressed to continue.
[00:00:37] Sponsor: This episode was brought to you by Prelude Fertility, where top REI physicians find their calling.
Practice anywhere with Prelude. The Prelude Network is the fastest growing network of fertility clinics in North America. With more than 90 plus locations, we're ready to support you and your individual career aspirations, wherever they lead. To learn more, please visit rei.preludefertility.com. That's rei.preludefertility.com.
Announcer: Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode and the guest's appearance is not an endorsement of the advertiser.
[00:01:32] Griffin Jones: IVF patients are dropping out and it ain't just because of money. You can't help people get pregnant. You can't help people have a family. You can't scale fertility treatment. If people are dropping out for reasons within our control. If you own or operate fertility clinics, what does that mean for your business?
And if you're a fertility physician, how does it all come back to the way that you communicate? What does it even mean to train fertility physicians in empathic communication? My guest today has studied all of this more than anyone as far as I know. She's Dr. Alice Domar. Now she's the Chief Compassion Officer at Inception.
And she's working on reducing patient dropout by reducing patient stress. And she's working on reducing provider and staff burnout by reducing provider and staff stress. Allie talks about the studies that she's done and other studies that have been done on psychological interventions and patient centered care.
I make her define patient centered care. We talk about how she's measuring patient stress now and how she plans to compare those to retention and dropout rates. We talk about an intervention that she did in the past of a sample of 166 women where half were given this intervention, half were not. It's one variable and there was a 67 percent difference in patient dropout.
I ask her to describe the format and how she's teaching fertility physicians empathic communication. What does that training look like? And I push Allie a bit on the tension between alleviating patient burnout versus alleviating provider and staff burnout. I think there's a natural tension there and anybody who says otherwise is lying.
I'm not saying that it can't be managed. And I think Allie has a way of managing that. Tell me what you think about her suggestion and tell me what you think about physician communication as it relates to IVF patient dropout. Join my conversation with Dr. Allie Domar. Dr. Domar, Allie, welcome back to the Inside Reproductive Health podcast.
Dr. Alice Domar: So good to see you.
I don't remember if this is your second or third time, but you were on one of the earlier episodes. You're someone that I've gotten to speak with at events before. I love seeing you speak at events. I love interviewing you. You're a chief compassion officer right now. And I am. One of the things about me is I don't like a lot of C titles.
I think C titles are way overused, but If there is a chief compassion officer and someone is qualified to be one, that is you. And so I want to talk a little bit about what it is that you do in this role at a network level that is a way of thinking about how we introduce things that are necessary for patient care and for patient retention.
But having somebody oversee at least some of the critical elements of that, Cross the scale of the organization. So what is it that you do at a, network level?
[00:04:19] Dr. Alice Domar: Nothing. I'm just, I just goof off now. I, we really, when I went down to Houston to meet with TJ Farnsworth and the rest of the executive team, no one really remembers who came up with the job title.
I think it was TJ. He thinks it was me anyway, doesn't matter. But it really is a perfect title because, I've spent my whole career working to decrease the stress level of infertility patients and people who work in the infertility clinics in the sector. And so I've since added another title as I'm director of research for Inception, which probably adds another 50 percent of my life.
But I think to summarize it. I spend a lot of time trying to create and provide programs to our patients on how to decrease stress. So for example, tonight at nine o'clock Eastern time, I'm doing a webinar on, for family and friends of people who are going through infertility on basically do's and don'ts, like how can I best support someone I love with infertility?
And so I do monthly webinars. for patients. This is my first one for non patients, but I do monthly webinars for patients. I, if there's a patient in crisis, I talk to the patient. I write blogs on how to reduce stress. And I basically am just there for all of our clinics if there are any issues with the patient.
And as I said, I, talk to patients directly. And then another hat I wear is I try to provide programs to employees. Like in the last year, we've gotten a free subscription to the com app for all employees. I do this ask Allie column in their weekly newsletter. I'm starting a podcast this month for employees and how to reduce stress.
And if an employee is in crisis, either HR or their manager or the employee contacts me and I talk them through it.
[00:06:16] Griffin Jones: So you've got these two different sets of programs, one for decreasing stress for patients and the programs that fall within that line, and then the other line being for decreasing stress for employees.
Are there indicators that you're ultimately responsible for or looking at that, that help you to decide that govern what those programs become and how you measure their success?
[00:06:42] Dr. Alice Domar: Not yet, but that's in fact, I think one of the reasons why I'm running the Inception Research Institute because we're actually doing studies on the efficacy of different psychological interventions.
Although right now our research is mostly trying to understand. So for example, I have a study funded by MD Serrano where You know, for 10 or 12 years, researchers in Europe have been talking about patient centered care. And research actually shows that patients prioritize patient centered care over pregnancy rates.
women who are going for treatment right now really want to be cared for by compassionate, empathic physicians, nurses, and the team. And so everyone is always saying, oh, this is what patients want. But no one's ever really asked patients what they want. So we're doing a survey right now where we mailed a questionnaire to our patients to say, what are your priorities?
is it communication? Is it how to handle finance? everything. And so we will have the data hopefully released soon because I'm presenting it at PCRS. So we'll have the data soon. We're also on a LARC, gave the same survey to our physicians and asked them, what do you think your patients want?
And we're going to compare what the physicians think patients want versus what. patients say they want. And so once we know what the patient's priorities are, then we can make changes in the clinics to respect and reflect on what patients say they need, as opposed to you or I saying, Oh, I think this is a good idea.
This is what patients need. We're actually asking the patients what they need.
[00:08:21] Griffin Jones: How do you juxtapose what patients say they want to need versus what their behavior suggests they want and need? And I'll give you an example that I'm thinking of. I remember, it was probably like 10 years ago or 8 years ago or so, Wash U Fertility did a survey of fertility patients.
And they might have done it in connection with Sirona. I don't remember who they did it in connection with. But they interviewed patients asking them what they liked and what they didn't. Want to see in social media. And what they said is we don't want to see pictures of babies. We don't want, we want tips on fertility, but then I could pull up all of our different clients, Facebook and Instagram analytics and say, it was almost like reverse alley.
It was like the pictures of babies did ridiculously well. And so you can say I don't want to see this, but then they're clicking on it. that's what they're, that's what they're paying attention to. That's what they're being driven for. And so I, I see. I've, seen this, with, employees, I've seen this all over the place.
It goes back to that Henry Ford quote of, if I asked my customers what they wanted, they would have told me they wanted a faster horse. Don't know if he actually said that or not, but, people can get the idea. how do you juxtapose like what people say they want versus, making sure that the, tail isn't wagging the dog.
[00:09:46] Dr. Alice Domar: first of all, I think a lot of the data that's been collected in the past was done in focus groups where you have, six or eight or 10 people meeting with somebody who asks them. And I don't tend to believe results from eight or 10 or 12 people. In fact, this morning I was asked to review a study that included 13 patients and they drew all these conclusions from 13 patients.
And I said, that's. That's insane. You can't draw conclusions from 13 people. And so we've already collected data, I think, from at least 500 patients. We're hoping to have at least a thousand. And when you have numbers like that, you can relatively safely assume you're actually getting real data. And then.
Before we actually implement these changes, we're going to do another study where we're going to take two of our comparable clinics, like maybe two of them in Florida or two of them in Texas, and take all the suggestions that patients said they wanted and make those changes at one of the clinics. And then compare patient satisfaction, patient dropout rates, things like that to see, yes, you're right.
People do say things that they want, but you also tend to get more. honest answers from these anonymous questionnaires versus talking to somebody, especially somebody who works at the clinic.
[00:11:06] Griffin Jones: Yeah. I think that's a good way of looking at it too, is can you see from their answers how well do they line up to some of those numbers like dropout or conversion or retention?
Is there a way to do something like this, Sally, I remember there was a conversion rate Specialist that I follow in marketing, I think his name's Brian Massey, and I was at one of his workshops and we were going through this type of thing. And very often when people are trying to workshop a new campaign or a new website, they'll ask questions like, was this website clear?
Was this website appealing? Whereas he suggests. studies that show, show, did people buy it more or not? Or in the case of, if you're trying to get some kind of brand messaging over the line and it can't be tied to a particular conversion, he'll still suggest asking people what is it that this website does, or what is it that this company does after looking at the website homepage, as opposed to Asking people if the website was clear, is there any way to do that in your survey mechanism?
[00:12:18] Dr. Alice Domar: I think you're right. it's, tough to assume that people report exactly what they want. So for example, in all this research, because in Europe, they're way ahead of us in this patient centered care. But they did, I don't even know how they got the data, if it was focus groups or what, but they, said there are five things that patients want in terms of patient centered care.
And I don't remember what three of them were, but two of them were more information on the semen analysis and more information on the impact of a high BMI. I've been in this field for 36 years. I have never had a patient say, I want more information from the semen analysis. And most of my patients. don't want to know the impact of the BMI because they know that being heavy or too light, impacts their chances and they don't want to hear more about it because they already know it.
So I think we have to be very careful how we collect data. it's if you look at some of the old data from like before 2000 on the psychological impact of infertility, there were a number of studies that showed that women with infertility had the same level of anxiety and depression as did anybody else.
Yeah, but they were also. being asked to rate their anxiety or depression in their clinics, sometimes with their doctor present. And they would want their doctor to think that they were fine, that they could handle treatment just fine. Cause they didn't want the doctor to know how upset they were. Cause then the doctor would say, Oh, you're too upset to do treatment.
And so a groundbreaking study happened in 2004, where they actually had. a psychiatrist, interview, do a structured psychiatric interview before patients saw an infertility doctor for the very first time. And 40 percent of them met the criteria for anxiety, depression, or both. So sometimes these self report mental health assessments, let me rephrase that, many times these self report mental health assessments are not very accurate.
And if you go to countries like Scandinavia where People don't tend to talk about being anxious or depressed. You're going to get scores of zero from people who in fact are probably very distressed.
[00:14:26] Griffin Jones: So you're working on getting some more of this data right now with the studies that you're doing.
In the absence of this data in the meantime, how do you decide which programs that you want to usher in and that you think will have the biggest impact?
[00:14:43] Dr. Alice Domar: I look at the research. there's been, I don't know, a hundred randomized controlled trials on the efficacy of different psychological interventions.
obviously I started the MindBody program in 1987, so I'm a little biased towards MindBody, but in fact, there's been a group in Denmark who've done two huge meta analyses on the efficacy of psychological interventions with infertility patients on both psychological symptoms and pregnancy rates.
And both of their meta analyses have pointed to, mind body stress management interventions as being the most effective. and that's not me doing the research, that's them doing the research. It just makes me feel good because that's the intervention that I'm most familiar with.
[00:15:28] Griffin Jones: tell us more about the programs.
What programs developed from that?
[00:15:32] Dr. Alice Domar: So the MindBody program, it used to be an in person 10 session program. Obviously, now everything is remote. But we've also shown, I had a graduate student from UVM who took the in person MindBody program. And we've done a bunch of randomness control trials on it.
But she took the in person program and made it into an individualized online program. And this is before COVID, and this was her PhD thesis. And we found that women who did the MindBody program by themselves on their computers, not only had massive decreases in depression and anxiety compared to the control group, but their pregnancy rate was four times that of women who were on the waiting list control group.
I could talk for two days about The efficacy of these interventions. We know that our patients are distressed. We, know that a lot of them are anxious. A lot of them are depressed. Their partners are anxious and depressed. And, I was at a conference last year in Boston. I don't remember if you were at the same conference.
It was over Valentine's day. And it was on reproductive medicine, I think in women's health. And I actually got up at the end of the conference because they're all talking about all these technologies and all, AI and everything else that can be used in reproductive medicine. And I stood up at the end and I said, look, I'm the only mental health professional in this entire conference.
No one has mentioned. The emotional health of our patients. But if someone is really distressed, we know for a fact, they're not going to go see an infertility doctor. They're not going to start treatment. The more depressed a woman is before she starts IVF, the more likely she is to drop out after only one cycle.
all of us should be caring about our patient's mental health. I, as a psychologist, because I don't want these women to suffer psychologically. But the clinics should worry because if patients drop out of treatment, they're not gonna get the income, pharma's not gonna get the income, and I worry because the patient's probably not gonna get pregnant.
by the time she gets to IVF, and she drops that IVF, the chances of her conceiving spontaneously through sex are pretty low. And so it breaks my heart to think that people get to treatment, may even have insurance cover for treatment and find it so stressful, they drop out. And that's, where we are doing something wrong.
People should not be dropping out of treatment because they're too stressed to continue.
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[00:20:17] Griffin Jones: I want to come into how this impacts dropout. I wonder if one of the reason why they didn't mention that at that tech or that innovation conference, perhaps two reasons.
What are people in that sphere obsessed with? One is measurables of certain metrics and they want very specific attribution. And we talked about some of that thing that you're working on. The other thing that they obsessed with is scalability. it's got a scale. And so are there. Technological solutions.
You mentioned that one of the things that you all are doing is getting subscriptions to the comm app for your employees. are there technological solutions that scale to reduce stress for patients?
[00:20:55] Dr. Alice Domar: I haven't seen a whole lot of research yet. I know that Jackie Boyvan in Europe. is working on an app called Metaemo.
And the, at Esri a few years ago, she presented data that showed that women who use the Metaemo app were twice, who did IVF, were twice as likely to come back and do a second cycle than women who didn't use the app. We did a study, I, did it with Jackie. maybe six years ago, I don't remember how many years ago, where we recruited women, I think 166 women, who are about to do their first IVF cycle.
And we mailed half of them a stress management packet. So it was like cognitive behavioral skills. It was a relaxation CD. It was teaching them how to do mini relaxations. So we mailed them a half of them and then sat back for a year, didn't contact them, and then looked at retention rates. And the woman who got the packet, we don't know if they opened the packet, we don't know if they used the packet, the woman who got the packet in the mail reduced dropout rates by 67%.
Wow. And that packet cost 12.
[00:22:00] Griffin Jones: And there was no other control? So we know that,
[00:22:06] Dr. Alice Domar: no, we had a control group. We took 166 women.
[00:22:09] Griffin Jones: but otherwise the groups were identical, like demographics, where they lived, and Absolutely identical. That
[00:22:15] Dr. Alice Domar: was the only variable. Randomized controlled study. And then we just published a paper last year, and we tripped over this.
in my previous job, I was very interested in dropout rates. I'm in Massachusetts, six cycles mandated coverage. And we noticed that a lot of patients came in for a first visit and didn't come back. And I'm like why wouldn't they come back? They have insurance coverage. So we actually just sent them an email to say, Hey, we noticed that you saw an infertility doctor three months ago.
We noticed you haven't come back. We're just wondering why do you not like the doctor? Are you pregnant? are you taking some time off? what's going on? And we got a lot of answers, but. My research assistant noticed that a lot of the patients who got the email were coming back, like a lot of them said, Oh, I'll come back.
And then she went on maternity leave. So we didn't send the email out for four months. So we were able then to compare. When we sent the email out just asking, why didn't you come back versus when we didn't, massive increases in people coming back simply by getting an email saying, hey, we noticed you didn't come back.
So the conclusion I draw from those two studies, it takes very little to support patients to come back or to stay in treatment. And yet most clinics aren't doing anything.
[00:23:41] Griffin Jones: There's a bunch of rabbit hole questions I want to ask you, but I'm making notes of them because we'll get to them if we get time.
The audience probably isn't as interested in those as I am. We'll get to the meat and potatoes first, and then if we have time, we'll, get to some of that dessert. So I, you're painting this picture for me. You've got 166 women in your mail. Half of them, stress packet, and half of them don't.
And then you have a 60 seven percent decrease in dropout for those that did get the packet. And then you've got this other, it wasn't a, it wasn't a study, but you could at least see in practice from the response rate that you were getting from emailing patients, asking them why they chose not to come back and.
Versus the time when your research assistant was out and didn't send that. So how does, what are the factors as far as you can deduce that impact patient retention?
[00:24:41] Dr. Alice Domar: it's interesting because at my previous job, I spent about 10 years studying patient retention. And so we ended up interviewing maybe 250 or 300 patients who had insurance coverage.
for six IVF cycles and dropped out and didn't go to a different doctor. They just dropped out. And we asked them why. And most of them said because of communication, either from their physician or someone from the nursing team or whatever. They just had a conversation that just upset them so much.
They realized they couldn't keep up with treatment and they dropped out, which means, as I said, they're probably giving up genetic Parenthood by dropping out. And so then I got on my, my, whatever you want to call it. And I thought, okay, we need to teach people how to communicate more empathically.
And so one thing I've been doing at Inception for the last year is holding dinners for our physicians and teaching them empathic communication. And I do it in a, I don't want to say a mean way because none of them have, we go to dinner and it's, the physicians from the clinic and often the practice, the clinic manager, whatever.
And we, we're at like an ice steakhouse in a private room. And then I talk about empathic communication and all the things that indicate empathic communication. And then I give them vignettes. And I'll have a physician in a difficult situation practicing with either another physician or someone who works in the clinic.
And then I criticize them and it's gone over really well and they've learned there's some insanely easy ways. I, we, we're doing some training videos now at Inception where we just recorded last week training videos on how to communicate the six most difficult conversations that physicians have with patients.
And again, for both scenarios, I talked about how to. communicate empathically. And one of the easiest things you can do is to make eye contact. And so when I was trained in empathic communication, the tagline is never have a conversation with anybody unless you can walk away and tell anybody else what eye color that person had.
[00:27:00] Griffin Jones: Say that again, never make eye contact with anyone, never have a conversation with anyone unless you can walk away.
[00:27:08] Dr. Alice Domar: So I noticed right away from what I can tell on the computer screen that you have brown eyes, right? Okay, that means I made eye contact with you.
[00:27:16] Griffin Jones: I barely know what color my wife's eyes are.
I'm thinking like, am I that crappy at talking? It's, something that wouldn't occur. Not something that would occur to me to pay attention to necessarily, or I guess better said, I would have to make a point to pay attention to someone's eye color.
[00:27:37] Dr. Alice Domar: But that's one of the ground, the basis of empathic communication, that when you talk to somebody, especially if it's a physician talking to a patient, they need to make eye contact.
They can't be on their computer. They have to look at the patient and make eye contact. And that has enormous meaning. And if you look at the data coming out of Empathetics, which is an offshoot of Mass General Hospital, they've all this data on the efficacy of empathic communication. When you communicate empathically, patients perceive you spend far more time with them.
One of the number one complaints right now about physicians is that they don't spend enough time with their patients.
[00:28:17] Griffin Jones: So is, with regard to eye contact specifically, do you find that older physicians are better than younger physicians in that particular regard? Or because I think very often it's said, the older physician is, might be the closer they are to.
[00:28:37] Dr. Alice Domar: That era where the doc was the authority and it was, it's really interesting 'cause I was in Dallas and then Nashville last week recording these physician training videos and we talked a lot about age, like our older reiss, better at communicating, better at being empathic than, for example, fellows. And I think you can't generalize because yeah, older physicians.
Don't tend to look at their computer screen as much because they are more, but some of them are maybe a little bit stuck in their ways. But, it was interesting. So the way we did these training videos, we had these six scenarios. Like one of them was, how to tell a patient that she was miscarrying.
she just had a prenatal scan. There's no heartbeat. And so for each physician, we had them record a non empathic interaction. Or an, a non compassionate one and then a good one. And we had, either, like usually it was an employee of the clinic acting as the patient. And even though it was fake, obviously the employees would say to me, wow, like I could viscerally feel different when the physician was talking to me in a cold, aloof way versus when they were making eye contact and leaning forward and not crossing their arms and things like that.
Millennials demand. Patient centered care.
[00:29:59] Griffin Jones: Tell us a little bit about some of the gentle corrections that you made, some of those specifics. you told us about, about making eye contact and the way people pose, but what are a couple of specific things that you've said to people?
[00:30:12] Dr. Alice Domar: I know, one of the most difficult conversations for physicians is telling a patient that she's above their BMI cutoff.
And the instinct for a physician would be to say, I'm really sorry to tell you, if, again, if I'm sitting behind them and they know they're being empathic, they say, I'm so sorry to tell you, but, your BMI is too high. I'm going to refer you to a nutritionist so you can lose weight.
and get your BMI below the cutoff, then you can do IVF. And that is an effective conversation. If I hear them do that, I would probably say, okay, so maybe we could do it a different way. how about, how would you feel if you said to the patient, something to this effect, there are a lot of things that can contribute to IVF success.
And we, I, the lab, everybody, we're doing everything we can to increase the chances that your next Psycho will lead to a healthy pregnancy and there are some things that you can also do that can increase or decrease your chances and one of the things that we look at is lifestyle habits and you're doing great with this and this but you know your BMI is a little high so how about we talk about ways that you can eat more healthfully to get your BMI below the cutoff so you can move ahead and do IVF.
No, which way would you rather hear it?
[00:31:35] Griffin Jones: my, my preference is probably contrary to how a lot of people want to hear it. But it, the point is that it's not what you say. It's what people hear. And I remember when we were doing online reviews for fertility clinics or helping them with their online.
reputation management, I would look at the reviews and I would see very often she called me fat. He called me old. And I'm like, I wasn't in there. I wasn't in the consult room. I know that person. I don't think. I doubt, maybe she did, but I don't think she did. I think that she said something that in a vulnerable state was too close, too readily interpretable as I'm fat or I'm older, I'm not good enough in some way.
And, so I think that communication is clutch to be able to do. You have to be able to communicate in that way. And that was always something that And when we would help docs with this, it's I can't help you with that part. And so you're starting to. And so you're starting to do dinners. Is there plans to scale this, like beyond dinners and having this be like something that every doc goes through?
[00:32:44] Dr. Alice Domar: I think that's why we're doing the training videos because it's really, we have clinics. It's all over the US and Canada. And so having me go to every single clinic and do this and, not every physician can make every dinner. So it just seems more practical for us to do these training videos.
And I felt that, it was so interesting last week when we were doing them again, hearing the impressions of for one of the training videos in Dallas. the physician's MA was her patient. And she told us later that, she was faking it. She wasn't an infertility patient. She was probably, way too young for that.
And she said, when the physician spoke to her in a classic, somewhat detached, very factual manner, that she felt herself just feeling Like this doctor doesn't really care about me. And then when the physician followed through with all the empathic training and the skillset she has in communicating, the MA was like, I felt different.
I could feel myself reacting to how this physician was communicating with me. And it's, it's not hard. And it saves time, it's interesting because, Liz Grill, she and I once a year teach a course on a cruise ship for physician burnout prevention. And it's actually really fun. We get to go on a cruise together.
And one of the things that I, teach, one of the classes I teach for that course is empathic communication. And the physicians, these are not REIs, these are, all kinds of physicians and they come in yeah, blah, blah, blah. And then I list all the data on empathic communication. And it makes sense.
[00:34:26] Griffin Jones: It just makes sense. So I want to, bridge these two things because, and I don't want easy answers because sometimes people give me easy answers when I'm trying to reconcile the tension between patient burnout and, patient fatigue and, the needs that patients have versus the needs that staff and providers have.
And the answer that a lot of. Leaders give me ally is, oh, they're both, they both have the same interests. They both wanna do great. It's like bull crap that they don't have interests that are at odds sometimes. I'm not saying there's no way of being able to align their interests, but I'm saying that it, when you have patience that have certain demands that costs something on you when you're trying to, be able to deliver that.
And we could make patients really, happy if we answered their calls all at all times of the day and, like sped, didn't have dinner with our family to make sure we got them what they wanted. And, but then, Providers and staff are facing the burnout on that side.
And, you talked about inception a lot of who's your employer, but they are not a feature sponsor of this podcast episodes, which means they don't have editorial control. So you can say whatever the heck you want about them, your own consequences, consider those, but on my show, I don't have to do a damn thing.
I think one of their brands is, the brought to you by a sponsor, but. They don't get, they don't get editorial control. So how do you reconcile this, the needs that patients have versus the needs that the people providing those needs have?
[00:36:10] Dr. Alice Domar: when I got to Inception, as I said, almost two years ago, it was a little overwhelming because they have almost 2, 000 employees.
And I don't know, at any given time, what, 100, 000 patients. And so I was trying to think through Where would I start? And it's, and I still say this, it's very obvious. You have to start with decreasing patient distress, because if you can decrease patient distress, patients will be easier to work with, and that decreases employee stress.
So I've spent a lot more time trying to design ways. To make our patients have less psychological pain because that will then have a domino effect and make it easier for the employees.
[00:36:52] Griffin Jones: How do you incentivize the employees to do that when they're already feeling burned out? So if, one of the things that de stresses patients is maybe either more communication about finances or more communication about some of the things that you need and you could even come up with scalable ideas like Modules for the patients, but that takes staff time and provider time, and you have to take some of those staff and providers away to do that.
how do you incentivize the staff and the providers to say, listen, I know you've got needs here, but if we don't de stress the patients, then your needs are only, the burden on your needs is only going to get worse.
[00:37:37] Dr. Alice Domar: it's, a separate thing because I provide a lot of entities for patients and for employees.
And so I feel like it's, on me to do that. obviously teaching empathic communication is a good thing, but for example, I've spent the last year and a half going to our clinics. I think I have three more to schedule and I do what I call a stress lunch at each clinic. And most of it is talking to them.
about where infertility patients are coming from, about how depressed they are, how anxious they are, how it impacts every area of their lives. And I talk about the unbelievable jealousy they have when anyone else gets pregnant and how agonizing that is and how hard it is to be part of a partnership.
where two members of the couple don't feel the same way at the same time and that puts them into crisis and their sex life goes to pot and they can't go home for holidays because their sister or brother has a baby and they can't be in the same room as the baby and you know I think when you explain to them where patients are coming from and why they seem so demanding and irrational and everything else it makes it easier to care for the patients because they then understand the patients.
It's different from pretty much any other aspect of medicine. You have a patient population who are as depressed and anxious as cancer patients and AIDS patients and heart disease patients, but they're young and healthy. And so when I talk about where patients are coming from and what their triggers are, I think it helps the employees because then you have compassion because you understand.
[00:39:16] Griffin Jones: I think that I could benefit from something similar in my own business and a lot of businesses could. benefit from something similar where you're training your team. This is what our user on the other side, whether it's a customer or a client or a patient is going through on this side, and I think that allows them to take better care of the patient that or the customer or the client That that reduces the burden on the team. I think that could be. I think that I think you have threaded the needle in that way. It still starts with the end user and it starts with educating your team. But if your team is educated on the needs. Of the user, then they can, in this case, the patient, they can reduce, the amount of stress that comes their way down the pipeline.
[00:40:09] Dr. Alice Domar: But it goes, I do a lot of couples counseling. I still have a small private practice. And I think the key with couples counseling is your partner can't read your mind. And you guys are not going to feel the same way about things. And you have to distinguish between what they. Can't do versus what they won't do and so the key to a successful relationship in any relationship is learning to understand Where the other person is coming from whether it be a marriage or a parent and child or being a nurse or doctor in a Fertility clinic you have to understand where the other person is coming from and what their triggers are
[00:40:49] Griffin Jones: I think sometimes it goes too far one way and like in 2021, it was like, this is what employees need.
And, but then you had a bunch of employers get burned out. It's always, whenever you have more than one person, it's not just what wives want or what husbands want. It's wives and husbands or husbands and wives, whoever it may be, employees and employers. I think that's a really good point.
I guess some of the, I wonder, do you see. Is it helping in a way where you're starting to see turning the corner for reducing the stress in providers? Because I think of the companies that used to be really good at knowing what the customers needs were and servicing them. I think of companies like Apple.
I think of companies like Southwest. I think of companies like Trader Joe's. And I think with the exception of Trader Joe's. They have decreased. you go into the Apple store and they are not as nice as they were five years ago. And I think it's perhaps like what you're talking about. It's a two way street, and that niceness has been presumed upon too much.
[00:41:57] Dr. Alice Domar: But see, that's why every company needs a chief compassion officer.
[00:42:01] Griffin Jones: Yeah, maybe. I really think so, because you're able to come in and balance this. And how are the providers responding to that piece of it?
[00:42:11] Dr. Alice Domar: I have to say, I think I have probably met 95 percent of Inception's physicians, I'm guessing. And they've been lovely.
Like, really lovely. Like when I go to clinics, they hug me pretty consistently. And as I said, when I started doing these empathy dinners, I thought I was putting myself out there. I'm putting my neck on the chopping block and they've responded really, well. And it's been so much better and so much easier and so much more rewarding for me working with these physicians, because, as I said, they went into medicine to care for their patients and, some of them are, it's harder to work with millennials who are like, I was here at 730, where are my blood results?
And so I think, you They also respect the fact that I'm a researcher, and so when I talk about stuff, I don't just say this is what I think. I'll cite 16 different research projects that are randomized controlled studies that have been published in peer reviewed journals back up what I'm saying, and that's what you have to do.
You have to, you can't just pontificate what your thoughts and feelings are. You have to back it up with science, especially in this field.
[00:43:26] Griffin Jones: Is the retention and dropout for third party a different animal? Does it all fold into this, but is, or is there something else that needs to be considered for retaining patients in such a way that allows them to then move on to third party IVF after failed cycles if they need it?
[00:43:46] Dr. Alice Domar: the transition from, for example, cycling with one who owns eggs to egg donor, when you transition from, treatment with each partner's eggs or sperm and the woman carrying that embryo that they've created, that's a different animal than third party because then you get into big bucks and a lot of mourning and grieving, excuse me, that is involved.
I think most clinics or all clinics follow ASRM guidelines. Or that those patients all have to see a mental health professional to, or hopefully they do, to help them process. Because you can't just say, Oh, my cycle didn't work. Let's do egg donation next month. You can't do that. So I think at some level, these third party patients can be more challenging to work with because the financial stakes are so high.
And because a lot of them have moved into it before they're really ready. And so they can be prickly. So there, there are a couple of things. On the other hand, they're highly motivated, but it's tough. I think third party is almost like a different kind of patient population.
[00:44:56] Griffin Jones: Yeah, I think so. Are there special interventions that you've noticed for them, like, the sending of the email to, to ask why they didn't come back?
Is there anything equivalent to that you've noticed with third party?
[00:45:09] Dr. Alice Domar: It's been very little research. It's interesting because I'm about to submit a grant for the first time. No one ever has looked at this, is what about patients who come in who want to electively freeze their eggs? Because when patients come in for that first consult, half of them don't come back.
And we're going to be doing an inter, hopefully if it's funded, an intervention site to see if we can better support them. Because what the research shows is women who freeze their eggs, very few of them regret freezing. Women who don't freeze their eggs, the majority regret not freezing. And so again, I as a psychologist want to see what can we do to support these women to make the decision that they are least likely to regret.
[00:45:54] Griffin Jones: I want to ask you the rabbit hole questions of where psychology meets neuroscience, but people would be less interested in that. And you got to go. But if people see us talking, sitting down at a bench someplace at the next conference, that's what I'm asking Allie about. Allie, I wanted you to conclude based on how you would like to conclude about empathic communication, about reducing dropout and increasing patient retention for either providers or staff or any of the threads that we talked about today.
How would you like to conclude?
[00:46:28] Dr. Alice Domar: I think we all need to accept the fact that patients need to be cared for in a different way than they needed to be cared for 20, 30 years ago. That we have to learn, as you said at the beginning, what patient centered care is. But it starts with empathic communication.
[00:46:47] Griffin Jones: Dr. Allie Domar, thank you so much for coming back on the Inside Reproductive Health Podcast.
[00:46:53] Dr. Alice Domar: My pleasure. Always happy to see you.
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