Creating a family friendly culture in the workplace

How important are family friendly policies and benefits in organisational culture?

Is there a correlation between a high performing organisation and a family friendly workplace?

It seems obvious that the answer is yes…and yet, there are many organisations who put family friendly policies and benefits at the bottom of the pile.  Family friendly policies and benefits are known to increase retention, recruitment, morale and productivity.  Arguably, these policies and benefits come at a cost to the organisation, so do the benefits outweigh the costs?  It can be difficult to put a figure on this type of benefit and return on investment.

There is also the unseen or lesser known part of family friendly policies and benefits that organisations can adopt; these are related to family building options such as infertility treatment insurance coverage, adoption grants, sick leave (for miscarriage or medical treatments), flexible working and egg freezing.

Simply having these policies and benefits will certainly contribute to a family friendly culture…but there is something deeper than these – a family friendly organizational culture that builds on the policies nd benefits.

You may have heard the saying – “Culture eats strategy for breakfast”. This simply means that no matter how good the policies are they need to be supported by the organisation’s culture.

Going beyond the policies and benefits, leaders and staff need to develop the values and behaviours that make up the family-friendly culture:

Open Communication – on both work/life needs and institutional priorities.  Staff need to be able to freely communicate to their leaders and vice versa without incrimination or judgement. The ability to give 360 degree feedback freely about what works and what doesn’t contributes to this open communication environment.

Flexibility – at all levels of the organisation.  Creating an environment that makes it OK to ask for flexible working or time off by creating space to.  Believing that employees are less loyal or productive for asking for these creates will creates negative culture.

Commitment – recognition that a good work/life culture benefits everyone.

Fairness – fair doesn’t mean equal; leaders need to understand that one size doesn’t fit all, applying family friendly policies consistently is important.

These values can’t be written down in policy or given away as a benefit…they have to be enacted out by the people we work with every day and inspired by our leaders in our day to day lives.

What other values and behaviours do you think make up a family friendly culture that we can live by in our workplaces, including family building?

Do your leaders say they are family friendly but don’t live by the values they preach?

What drives you to advocate?

Last night I was talking with my local Resolve infertility support group leader about some things.  I asked her how she was able to find the courage within to tell her story to the world in order to advocate for change in family building policies.  She has done many inspirational things as an advocate and has an amazing way with finding the right words that hit home.  Quite frankly, sharing your infertility journey in the public’s eye is terrifying.  She told me her courage comes from an underlying belief that we have to fight for change so that our children don’t have to go through what we have been through.  It is so so simple, but so so powerful.  And it probably seems obvious, but it really hit me hard. In fact, I love it.

If I don’t advocate for change in family building policies…who else will? Who else will make the difference so that my unborn child and her friends won’t have to struggle with the road blockages that face us in growing our families when infertility hits?  Financial stresses, friend and family stresses, work stresses all on top of the physical and mental stresses of being infertile.  Some of these stresses can be removed with a little help of legislation and education.

I’m going to raise my voice and share my story of success.  I may be judged, I may be scrutinised, others’ words might hurt me on the way…but that won’t compare to the potential opportunity for positive change in the future for my children if I don’t speak out.

My blog is one way…writing letters to politicians is another, but there are many other ways, and I’m going to start by having the courage to fight with this mantra supporting me.

Watch this space my friends, I’m feeling empowered 🙂

Natural Conception after Adoption and Assisted Reproduction Treatment

Today at work I was putting together a presentation on “What is correlation?” (I know, my work is full of excitement and such geekery 😎 ), and I came across an interesting example of ‘illusory correlation’ from the infertility world that I thought I would share with you all.  I was about using it as an example in my presentation.

Have you ever heard someone say

“Adoption increases the chance of an infertile couple getting pregnant naturally?”

Many people have heard or say this, and many can tell you a story of someone they know/know of that this happened to.  The rationale behind this can be hypothesised as:

Once the pressure is off and the couple is less anxious, it will happen naturally.

But how true is that?

Apparently it turns out there is NO empirical evidence to support such a hypothesis.  Research (from Resolve) has shown that the percentage of women who become pregnant without adopting is no different to the percentage of women who become pregnant without adopting.  What this means is that, while a small percentage of people who were having difficulty getting pregnant do not get pregnant after adopting a child, these are likely the same people who would have gotten pregnant after having difficulty, even without the adoption.  It has nothing to do with the adoption.

So why do so many people believe this myth?  Because many people can tell you of a story of someone they know that this happened to.  But the thing is, most people can only tell you ONE story.  And they don’t tell you all the stories they know about the infertile couples that adopted a child and didn’t get pregnant naturally afterward.  The examples of where it did happen are salient to them, perhaps because they remember thinking to themselves “This couple is going to have two babies within a few months of age of each other!”  What happens when something is salient – or when it produces a vivid memory – is that people tend to overemphasize the likelihood of its occurrence.  And they give it a lot of attention.

This is known as vividness bias.

The vividness bias is supported by what’s often referred to as an illusory correlation – the impression that two variables are related when in fact they are not.  In this example, because of one or two very salient or vivid examples, many people believe that there is a relationship between adoption and getting pregnant, when in reality, there is not.

(Extracted from: Intentional Interruption: Breaking Down Learning Barriers to Transform By Steven Katz and Lisa Ain Dack)

Similar to the case made for getting pregnant naturally after adoption, you may have heard a similar argument for couples who stop assisted reproduction and get pregnant naturally afterwards.  There is research that was published in 2012 that found that 17% of women who became pregnant, and gave birth, from IVF treatment, became pregnant again naturally (NB….within 6 years!).  For those women who were unsuccessful with IVF, 24% became pregnant naturally after stopping infertility treatment.

Other recent research has found that 16% of infertile women conceive naturally after stopping treatment (within 13 years!).  And by the way, let us not forget that a fertile couple’s chance of conception is 20-24% for every menstrual cycle!  So that 16% statistic still SUCKS.  In addition, the original cause of a woman’s infertility made a difference as to the chance of achieving a successful natural pregnancy after IVF – if the infertility was due to uterine, cervical or ovarian problems, endometriosis or infertility in their male partners, the women had a significantly greater chance of achieving a successful natural pregnancy after stopping IVF.  However in comparison, if the couple’s infertility was ‘unexplained’ or the problem was with tubal pathology, her chances of a natural pregnancy decreased 😦

So there are many illusory correlations out there in the infertility world.  And now you know how to respond to people that say to you:

“ohhh you will get pregnant naturally after adopting/stopping treatment, that happened to my friend/friend of friend”

you can reply

“……the evidence is contrary, my dear, and you are suffering from vividness bias”

It’s a whole lot politer, and factual, than – “F*#$ you”.

Reblog – Start asking friends and family for support —

Day 4 of the Bloggers Unite Conference at missconception.com!  I don’t know who this lunatic blogger is, she is harping on about something for infertility awareness week…..oh wait….it’s me! I’m excited to be part of the bloggers unite conference this year, and very grateful to Miss Conception for hosting it!

I discuss how we opened up to our friends and family about our infertility journey and yet had never actually asked for support from them.  I assumed I didn’t need it.  But I was wrong. People find it hard to know how to help their infertile loved ones, so if you ask, they will leap, I have no doubt about that as we have experienced.  I suggest ways you can ask for support from your friends and family.  You don’t need to be as open about your infertility journey as we have, but knowing when and how to ask for support will help get you through those tough days. Click the link below to read more!!!  XXX

Hi! My name is Dani. My husband, Chris and I, have been trying to conceive (TTC) since December 2013. We were diagnosed with ‘unexplained infertility‘ in January 2015. I decided to blog about our journey of TTC as I quickly realised that talking to friends and family about our situation can be difficult. It can be hard for them to […]

…..read more of my blog post here via #niaw – Day 4, Bloggers Unite Conference – Start asking friends and family for support —

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Why can’t we make a baby? #NIAW

Why?  Why me?  Why can’t I make a baby like all my other friends and family? I have so many questions about why after almost 2.5 years of trying to conceive and failing miserably, month after month.  What have I done to cause this?  Why won’t my body just get pregnant? What am I doing wrong?

It’s human nature to want to know why things happen.  But these are the type of questions that run through my head round and round, continuously ever since we decided to grow our family.  I have yet to answer any of these questions.  It is exhausting.

Chris and I are 1 in 8 couples of child bearing age in the US that struggle with the disease that is infertility.  We tried the good old fashioned way – sex – for 11 months before we went to seek specialist help from a reproductive endocrinologist doctor after we discovered that Chris’s testosterone levels were “below normal”.  It turned out for us that testosterone levels do not actually matter that much when it comes to fertility.  Chris actually had super sperm, and lots of them!  But it did lead us to start the typical tests for diagnosing infertility.

We thanked our lucky stars that all our test results came back normal – there was nothing seriously wrong with either of us.  In fact, we passed all our tests with flying colours, we were top of the class!  But this put us into the category that 20% of infertile couples are diagnosed with – unexplained infertility.  This meant that the doctors could not tell us why we hadn’t been successful so far in trying to conceive the way they teach you at school.  We were about to embark on a journey that was going to take us beyond what they taught us at school – we were going to try to get pregnant with medical assistance.  We were heading into the world of the unknown.  We knew little to nothing about infertility.

At first it was difficult to explain to our friends and family why we were seeking treatment, because there was nothing ‘technically’ wrong with us.  The infertility was inexplicable!  It was embarrassing, it was awkward to explain.  So this is why I started this blog, to help us get over this difficulty in explaining what we were doing and why, as well as helping to explain our feelings about our disease in general.

Unexplained infertility in someways has been a good thing – there is always hope that this treatment will work.  But ultimately it is difficult to accept that there is just no known reason that this isn’t working for us.  In some cases, going through medically assisted treatment for infertility can reveal the explanation of a couple’s infertility.  But in our case, after 3 IUIs (Artificial Insemination) and 3 cycles of IVF (In-Vitro Fertilisation), 1 suspected ectopic pregnancy,  and over $90k of medical bills we are none the wiser as to why we do not have a baby in our arms yet.

Conception is a wondrous act of nature, but it is also an incredibly complex process  – there have to be many stars in line for a healthy baby to be born.  For something that is the very basis of our human race’s existence, we still know very little about the disease that prevents us from growing our families.  It’s incredible, right?

I am currently in the dreaded two week wait of our third (and final) IVF cycle.  If this cycle fails, apart from being devastated, I do not know how we will ever be able to move forward without knowing why this has happened, why medical treatment didn’t work for us.  Our infertility will never leave us.

For National Infertility Awareness Week (NIAW), the national non-profit infertility organisation Resolve is promoting this year’s theme #StartAsking.  The theme is about promoting the questions that we want to be answered, whether this is asking for our Employers to provide insurance coverage, asking for legislation that supports family building options or asking our friends and family to support us.  For me, the one question I have and want to raise more awareness about is to:

 #StartAsking for more targeted research on unexplained infertility.

Perhaps if we can understand more about how or why some couples are infertile, then better focused medical interventions can be developed to defeat infertility.

I want answers!!!! But we won’t ever get answers if we don’t talk about infertility and unexplained infertility.  It shouldn’t be a secret.  We can do this by speaking openly about infertility, by getting organisations like Resolve to help raise our community’s voice and build awareness.

If you would like to know more about infertility, please visit Resolve.org.

If you would like to help, you can contribute by fundraising or donating for Resolve.  Or just comment below with your questions and thoughts to join in the discussion!

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National Infertility Awareness Week #StartAsking

It’s almost National Infertility Awareness Week here in the US, 24-30 April 2016.  I don’t know if there is an equivalence in the UK, Canada, Australia, NZ or wherever you are in the world, but seeing as my blog lives in an international community I believe it should be an International Awareness Week (So doth Dani declares!).  So join us!

Here are some ways you can ALL get involved to help spread awareness of this disease, whether you are infertile or an infertile loved one’s supporter.

Learn more about infertility.  Because knowledge is power.

If you are family or a friend of an infertile loved one then change your facebook profile picture to this.  You can download the picture from here.

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If you are 1 in 8 couples you can change your facebook profile picture to one of these:

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or my favourite…..

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Let people know that infertility is a disease by using the phrase, “the disease of infertility” whenever you talk or write about infertility.

If you don’t know what to say to someone who has infertility, then you can read this article: “25 Things to say (and not to say)” from Resolve.  If you are finding that some friends just don’t understand your infertility and are saying unintentionally hurtful things – share this link with friends and family so you can help them to help you.

Infertility is a couple’s disease, there is a mis-perception that infertility is a woman’s disease, this is not true.  So don’t forget all the men who are affected too.

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So what am I doing for National Infertility Awareness Week?  I have been prepping some microblog posts, one-a-day, on the subject of this year’s theme #StartAsking – I will also be posting on my personal facebook page – eeeeeeek!!!!

I am participating in Miss Conception Coach’s Bloggers Unit Conference!!!!  Watch this space for my article!  You can follow her on wordpress and see all the inspiring articles for the conference, her instagram is @missconceptioncoach – she posts lots of beautiful and inspiring words of wisdom 🙂

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My local infertility support group is running an information desk at our local clinic throughout the week, and I will help man it for a few hours to make people aware of who we are and what the support group does 🙂

As part of Resolve’s Advocacy day some members of my local infertility support group are visiting Washington DC to talk to members of congress about important family building issues.  I can’t go because I have to work (Boooooooo) but they will be taking my letters I have written to our Senators and Congressman with them!

And of course I will be doing all the social media stuff too.

 

OK that’s a lot for now!!!! TTFN!!!

 

Infertility is a disease

Infertility is a disease.  It is a disease that results in the abnormal functioning of the male or female reproductive system.  The World Health Organisation, the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynaecologists recognise infertility as a disease.

So why don’t I think of infertility as a disease?  Why do people not think about infertility is a disease?  Because we don’t understand it.  We don’t learn about it at school.  We might learn about it through friends and family, but only if they choose to share their diagnosis and treatment.  Many do not because they are embarrassed that they cannot successfully procreate.

But I am finally beginning to understand infertility, and I have been suffering from it, for over a year now.  It’s taken me a while!  So how can I expect non-infertile people to understand when I live and breathe it daily?

Why is it so important that infertility is recognized as a disease?  Because generally people understand that a disease is something that is fought against.  The concept of letting a disease consume a human being is horrifying, whether it is physically or mentally consuming.  Disease is bad.  Disease should not be tolerated.  Disease should be researched and studied until we figure out how to overcome it.

I personally have been ignorant to the fact that we are fighting a disease.  I have advocated for education and learning about infertility through my blog, and yet I have only just realized that I was ignoring it.  That might seem to be an absurd statement considering the number of blog posts I have made in the past year….I think about my infertility every waking day.  May be I am obsessed by it.  But I have ignored it at large too.  Why?  Because I have been led to believe that I have a choice to procreate.  And luckily, I do have a choice.  I can choose not to procreate.  But my choice to be able to procreate has been taken away from me by this disease.

Here’s an analogy for you.

One day I wake up and notice that I have an open wound on my arm. Hmmmm. I don’t know where that came from!  Well, it doesn’t hurt, so I get up, get dressed and continue with my day.  That small bloody wound on my arm is noticed by a couple of people at work.

Someone asks me…

”Errrrr……Dani……..do you know you have an open wound on your arm?”

I reply nonchalantly,

“Oh yes, I saw that this morning, it doesn’t hurt, so I figured I’ll be OK, I’ll just let it heal on its own”

My colleague looks at me strangely and says, “OK…..if you say so! You may want to get that checked out though, it looks a little nasty”.

I think about this encounter, thinking may be my colleague is right, perhaps I should get it checked out and then wonder when I can fit in a doctor’s appointment to get it looked at.  I look through my calendar and see I have an open space in three weeks’ time after I have made a trip to Europe and back, and a major milestone is complete in my project.  After all….it doesn’t hurt so I’ll be fine.  I make the appointment to see the doctor for 3 weeks and 4 days time.

Meanwhile, I begin to learn that my arm wound offends people, so I cover it up in creative and inventive ways so as to not gross people out or distract them in meetings.  But the wound is getting bigger by the day…it is spreading and now covers my entire forearm.  But don’t cry for me, I can still type OK so, thankfully, I can still do my work.  So no more questions are asked.

3 weeks and 4 days comes and my boss asks me to complete an urgent piece of work.  I think about my arm and weigh up the pros and cons of not going to the doctor’s appointment.  After all…what is the worst that can happen?  My arm might need surgery. May be.  OK I can cope with that, they will give me anesthesia, I’m sure.  Or the absolute worst case scenario.  I lose my arm.  They have to amputate my arm.  Yeh, that would REALLY suck.  But I mean it doesn’t hurt now so that probably won’t happen.  But who needs an arm anyway? Not me….Lots of people cope without their arms. I’ll be fine!

Infertility is the flesh eating disease on our arm.  If it was visible, people will be telling us to go the doctor’s EVERYDAY to get it fixed.  And infertility is like this analogy, because for the past year I have been constantly trying to fit in my infertility treatment around my work life.  Like this anology, if I don’t do anything I could end up losing my arm – and we all know that I’m not going to die if I lose my arm.  My life would just SUCK a lot.  And people would feel sorry for me.  Similarly, if I don’t attempt to fight this infertility like this flesh eating thing, I would just end up with no child.  I’m not going to die.  But that would SUCK a lot, and people would feel sorry for me.

But today, no more, I stand to FIGHT THIS INFERTILITY AS IT IS – A DISEASE.  I will make sure to do my best to fight it, by keeping myself mentally healthy as well as physically healthy.  If this means I need to make sacrifices at work, then this is what I will do to fight this disease.  No more will it simply ‘fit in around my work life’.  If I am going to advocate for infertility awareness and education, I need to fight it like I mean it, and it starts with recognizing infertility as a disease.

At least you know you can get pregnant

I think I’m quite a tough lady when it comes to receiving mis-informed and unintentionally hurtful infertility advice from the more fertile.  I experience it frequently because I am open about our infertility journey.  I forgive them because I know they don’t understand infertility as a disease and they only mean the best for me.  And I also know they couldn’t possibly truly understand how I feel because it has never happened to them.  Similarly like to people who have suffered from other diseases such as anorexia or depression or cancer, I don’t know what it is like or how it feels…I would never offer my uninformed opinion about treatment options or ways to overcome the symptoms of these diseases.  I won’t offer consolation that attempts to make them feel better about their disease.  Rather, I will offer my ear and my hand.

So why is infertility any different to any of these other diseases in how we talk to other people about them?  Why do so many bloggers end up writing about this struggle?  Is lack of education really the cause of this? May be other disease sufferers experience similar unhelpful comments too.  I really don’t know.

Have you seen that film about depression where friends and family offer their advice about depression, but the recipient of the advice is portrayed as a cancer sufferer?  The point of the video is that you wouldn’t say these things to someone who has cancer, so why would you say these things to people who have depression?  I think it is a great educational video (it’s at the end of this blog post if you want to see it).  Ultimately, I think there needs to be a film in a similar light about infertility.  I know there has been outrage on some forums of comparing infertility to cancer.  I understand that it is outrageous because people generally won’t die from infertility.  Comparing depression to cancer may also outrage many people as well…but depression can lead to suicide, it can kill too, but it is not a well understood.  So what is my point?  My point is that there are helpful things you can say to someone with infertility, and then there are unhelpful, even hurtful, things you can say to someone with infertility.

I have written about things that hurt, what to say, what not to say to someone with infertility many times before (ignorance is bliss, a voice of the child free family, Grow some thicker skin, you are so lucky you don’t have kids, Understanding: #YouAreNotAlone, Reblog from Que Milagro: Pardon Me While I burst into flames).  Today’s post adds to this list.  Today I am writing about one particular comment I have received multiple times since our loss from IVF cycle 1 from both fertile and infertile people:

“At least you know you can get pregnant”

I’m just going to put it out there straight away.  There is nothing consoling about this.

I get that there are many women who have never seen those two pink lines, me being one of them until our fist IVF cycle.  So I understand how hard it is to get negative after negative 25 times in a row.  But being pregnant  and losing a pregnancy is not consoling, knowing that I ‘did get pregnant’. I didn’t stay pregnant.  Maybe they would say “But it’s one step in the right direction”, yes perhaps, but it was then like ten steps back after our loss.

Would you say this to someone after they lost their baby during childbirth?  No.  Would you say this to someone who lost their baby in their third trimester? I doubt it.  Would you say this to someone who has suffered from recurrent pregnancy loss and miscarried 6 times? Definitely not. Would you say it to someone with secondary infertility? For goodness sake, NO.  So why does this need to ever be said at all?  It makes absolutely no sense at all and simply reminds me that we simply FAILED.

I am due to have my first beta test on Friday and in some ways, I am afraid of a positive than a negative.  Don’t get me wrong, I WANT A POSITIVE MORE THAN ANYTHING.  But I am afraid of when the positive comes, I know that even if this is my one successful pregnancy, my journey through the first trimester is going to be a psychological challenge.  If we ended up in a similar position to last time with a slow rising beta levels, pregnancy of unknown location suspected ectopic, yes it will be easier knowing the process the second time around, but it will be bloody damn hard to go through it all again.  And that is why I cannot accept the statement  “At least you know you can get pregnant” as consoling.

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Ignorance is Bliss

Has anyone ever said something to you along the lines of: “If you knew how much responsibility was involved in parenting you wouldn’t ache so much for a baby?” or worse, “Here, take my children then see if you still want a baby so much.”

People who say this to you most likely care for your well-being.  It’s kind of like your bestie asking you just before you walk down the aisle – “are you absolutely sure you want to do this??”.

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My Bridesmaids asking me: “Now are you sure you want marry this man?!?”

But what these people do not realise is that their message also comes across that we are ignorant.

If anything, I am more certain of my future responsibilities because I have had much more time to think about them.  I am lucky in the sense that I have the time to prepare.  Some women may only have 9 months to prepare for their future responsibilities.

I understand that I will never fully appreciate the responsibilities involved in parenting until I become a parent myself.  But please, let me dream about it for now.

What-ifs? And Bias in Diagnosing Ectopic Pregnancy

Yesterday Chris and I were talking about the ‘What-ifs’ of the future.  We tend to find ourselves having these kind of conversations regularly.  It’s difficult to plan anything when dealing with infertility.  Not only because of things we can’t do ‘when we are pregnant…’ but, also what to do with our savings.  We want to buy a house together, but it’s difficult to have these conversations with little knowledge of where our infertility journey is going to take us.  For example, if we bought a house now, we might not be able to keep our options open to afford egg donation, surrogacy or adoption.  So we hold off on making these big decisions for now.

We talked about what we would do if I am pregnant again and we face a similar scenario that we faced after our first round of IVF – slow rising hCG, nothing seen on the ultrasound (Pregnancy of Unknown Location), suspected ectopic pregnancy.  Chris said that at least we would know what to expect!  This is very true.  But, I think I might do things differently.  There is a small part of me that feels guilty for giving in and taking the methotrexate treatment.  Part of me wonders – what if?  What if I hadn’t taken the treatment.  Would I have just prolonged the inevitable?  Or would I be into my second trimester by now? I actually feel sick writing those words!

We made the decision to take the methotrexate treatment after 5 doctors from our clinic had suggested we should do that.  Our doctor had spent 20 minutes meticulously looking for an ectopic pregnancy on the ultrasound, said she couldn’t see anything that looked like an ectopic, and concluded that I must have miscarried already (I had started bleeding two days before) and then effectively released me from monitoring.  The next day she phoned to say she changed her mind.  What made her change her mind?  Did something not fall into place?  Did another doctor tell her she was leaving herself exposed to liability for misdiagnosis?  Did the other 4 doctors tell her she had made the wrong call?  How did she make her decision?  Did she review the evidence afterwards in a more objective manner?

It got me thinking – FIVE doctors told me I should take the methotrexate to terminate the {ectopic} pregnancy.  That should be enough to qualify for my ‘second opinion’.  But I never really thought about it until now, that organisational bias may have come into effect here.  All these 5 doctors work together every day.  They all make decisions on their own every day, but sometimes they ask each other’s opinion when making a decision or a diagnosis.  Not only do doctors face their own personal biases but they face bias that becomes systemic in their clinical practices.

I am not a stranger to these biases – I teach methods and techniques to the military to help them overcome all kinds of biases when they make decisions.

There are many opportunities for a doctor to become biased in their own decision making or diagnosis, here are some of them:

Confirmation bias:  The tendency to over emphasise data that supports an existing hypothesis rather than data that refutes that hypothesis.

Overconfidence Bias: Over-reliance on the opinions of the expert that can before (the attending or consult etc)

Availability Heuristic: this patient has whatever your last patient who looked like this has or whatever is commonly discussed

Premature closure/anchoring: the tendency to decide that the patient’s current problem is related to the first thing we diagnose rather than more than one issue.

Commission Bias: the tendency to need to do something rather than stand there.

Hassle Bias: the tendency to take course of action that is easiest or exposes the physician to the least amount of grief

Regret Bias: the tendency to take course of action due to guilt from a missed diagnosis

Commission Bias: the tendency toward action rather than inaction.  An error arises when there is an appropriate committal to a particular course of action.  It is more likely to occur in someone who is over-confidence, and reflects an urge to ‘do something’.  It satisfies the obligation of beneficience in that harm can only be prevented by actively intervening.  Commission bias may be augmented by team pressures or by the patient.

One or more of these biases may have played a part in my doctor’s decision making process for my diagnosis*.

In addition to the individual and organizational biases doctors face, there are also the established guidelines that doctors follow.  Every clinic will develop its own guidelines for diagnosis and treatment of ectopic pregnancy, generally based off national best practice and research – my clinic is within a medical school so I like to think they are up to date on their practices.  Guidelines will vary from clinic to clinic because they have the freedom to do so.  However, in the UK, the NHS is very transparent about many of these national guidelines by publishing them on the internet, and so I know that if I was in the UK I probably would have been treated very differently to how I was treated by my clinic.  In the UK I would have been sent home and told to keep taking home pregnancy tests until the date for next ultrasound scan or until I received a negative pregnancy test or if my situation changed to go to the hospital if I had developed any signs or symptoms of ectopic pregnancy.

I can’t help but wonder “what if”….I know the chances were slim that my pregnancy was going to be successful – the statistics told me that.  But I have read about a very small number of cases of women having slow rising hCG level after IVF, with nothing seen on the ultrasound up to 9 weeks and delivering to full term healthy babies.  There is a facebook group called “Misdiagnosed Ectopic Pregnancy Given Methotrexate”, and I have learned that research in this area is lacking, particularly for women going through IVF and women with retroverted/tipped uteruses.

I don’t regret my decision to listen to the advice of 5 doctors to take the methotrexate.  But it does make me think about how difficult a doctor’s job is to make that decision, the biases they face on a daily basis when making those diagnosis decisions, and the overall lack of research in this area.  I hope I never have to face this scenario ever again.

If you have found my blog because you are facing this situation, please feel free to contact me: dani@thegreatpuddingclubhunt.com because I wouldn’t wish this upon my worst enemy and will try to offer you a hand through it.

 

*If you would like to know more about bias in clinical decision making there is an excellent website that provides more information: http://www.improvediagnosis.org/?ClinicalReasoning