If it’s not clinically pertinent, then stay out of my uterus [PODCAST]

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“No matter how far we’ve come, women are still judged by fertility status but shouldn’t be.

If it’s clinically pertinent to ask about reproductive health, then yes, absolutely ask … in a respectful way. That doesn’t mean judging personal decisions or situations – it means asking pertinent questions and responding with an assessment of the need for support. Make appropriate referrals when that support is needed.

Don’t assume. Everyone has their own story.”

Gail Miller is a life and wellness coach and a maternal-fetal medicine physician. She is the founder, Path Onward Life Coaching, and can be reached on LinkedIn, Facebook, and Instagram.

She shares her story and discusses her KevinMD article, “If it’s not clinically pertinent, then stay out of my uterus.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Gail Miller. She’s a life and wellness coach and a maternal-fetal medicine physician. Her KevinMD article, which we’ll talk about today, is titled “If it’s not clinically pertinent, then stay out of my uterus.” Gail, welcome to the show.

Gail Miller: Thank you. I’m excited to be here.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Gail Miller: All right. So I am a maternal-fetal medicine physician. For those who aren’t familiar, that means I am a high-risk obstetrician. And you know, I, like so many other doctors, got to this place of, and I don’t like to use the word “burnout,” because it feels like it’s something intrinsic within us as opposed to the system. Just like everybody else: schedules that just are not doable, safety issues because of admin that doesn’t really understand clinical things. So I was, for quite a long time, trying to figure out what I wanted to do with myself. I needed to do something different. I found life coaching, which was immensely helpful for me clinically.

But I also reflected back on my journey of healing from being childless not by choice, went back over what I went through to walk that path, and realized life coaching can be so helpful for that. I wish that I had had that when I was going through that healing process and the grief. So I decided, this is what I need to do. I found my calling. So I became a life coach. I got certified, and I continue to go through other courses, just like in medicine, continuing education. So that is now what I’m doing. I do still do some clinical work. I work part-time as a locum physician. And now I’m going from helping women who have conceived to helping women who are not able to conceive.

Kevin Pho: So you are a maternal-fetal medicine physician. You do a lot of high-risk OB, and I think that sounds very, very stressful. I think that burnout is something that is certainly prevalent among, of course, all physicians, but perhaps more so in that field. And you mentioned life coaching as a way out of it. So tell me specifically, what exactly did life coaching do to help you through those times when you did feel burnt out?

Gail Miller: So the biggest thing, I think, was looking at this: We talk about how our thoughts create our feelings, and that’s how we create our actions and our results. For me, it just shined such a light on my own thoughts about things. So it was starting with that, learning how to set boundaries, and then also recognizing that just because I’m a doctor doesn’t mean I can’t do anything else. I had this mindset of, this is all I can do in life, this is all I was trained for. So it helped me open my eyes to what I was thinking, both in terms of how I was functioning clinically, learning how to set boundaries, and recognizing that there’s more to me than just being a doctor.

Kevin Pho: All right. Now let’s talk about your KevinMD article. It’s titled “If it’s not clinically pertinent, then stay out of my uterus.” Now, for those of you who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Gail Miller: Sure. So over the years, as a clinician, I’ve heard from women who had pregnancy losses, and they would tell me their stories of things that people would say to them in general, and then also within the health care system. Things like women who’ve had miscarriages hearing, “Oh, it was no big deal. At least it was early.” And women who’ve had stillbirths late in the pregnancy hearing comments like, “Oh, well, at least you didn’t have the child and have health problems.” Their feelings were minimized, and there’s story after story about hearing that no one understood and recognized the significant psychological impact, the impact of pregnancy loss, the impact of infertility. Even once you get pregnant, you’re still grieving that process that you went through of infertility.

So over the years, in my mind, I’d collected these stories, if you will. And now, myself being childless not by choice and working with women who are in the same situation, again I’m hearing story after story about comments from people within the health care system, and this lack of understanding of how we judge women by fertility status. There’s just this kind of disconnect, or not an understanding, of the impact on our lives. So again, I carried these stories with me.

And then I heard from one of the women that I talk about in the article. She’s a physician. She went to urgent care. She had two kids, and she and her husband really wanted a third child. Because of their personal situation, they decided not to. She went to urgent care, I think it was for back pain, and the physician brought up, “Why don’t you have three kids? You’re going to be sorry that you don’t have a third.” And here’s this woman who knows the system, and she was so taken aback and so at a loss for words, just tongue-tied, that she could not advocate for herself and say, “This is not OK.”

So that’s when I was like, OK, I need to really put all these stories that I’ve heard, and gather some more, which are unfortunately endless, of the judgment that women feel and experience during health care and how it affects their health. It affects their care and their desire to move forward and see physicians or go for health care visits. And I decided that I need to put these stories in and really try to advocate for my clients and for my patients and for all women regarding this issue.

Kevin Pho: So tell us more stories, because one of the things that you mentioned was that the feelings surrounding pregnancy loss were minimized. So help us understand. Tell us some more of these stories that really bring to light some of the issues that you talk about.

Gail Miller: So I was very fortunate when I was a resident. I had a fabulous attending who was a reproductive endocrinologist, and he had such a great understanding of this, the psychology behind this, and said, “Once you get that positive pregnancy test, you’ve already imagined your delivery, childhood. You’ve imagined the whole life of your child. So when you have a miscarriage, you have lost that whole life of a child, and your own life plan.”

So the stories that I’ve heard were from women who had experienced, say, miscarriage and would come in just devastated. This was before I did my fellowship, so I was still taking care of women in general OB/GYN, and they were coming in with stories of people minimizing and saying, “It’s no big deal that you had a miscarriage. It was early. It’s first trimester. It’s no big deal.” And then, to make matters worse, they would bring stories of other physicians saying these things, really kind of invalidating this sense of loss. And I have similar situations with later losses, later in pregnancy.

I have friends who have gone through fertility issues and didn’t have a loss, but went through multiple rounds of IVF and finally got pregnant, and they are still grieving that process that they went through, the difficulty of something that you think is natural and should happen easily, conceiving a pregnancy, and it doesn’t. And again, within the health care system, at different levels, and it’s not just physicians, there are comments and questions that are hurtful and inappropriate, really a lack of understanding that, yes, they’re pregnant now, and they’re very excited, also nervous, but there’s also that element of grief for what they have gone through. And they may never, ever get, you know, you may have triggers later on in life. It may be something that you never get over, but we expect women to get over it.

Kevin Pho: So what are some things that we should not do in the exam room? For those urgent care physicians, primary care physicians like myself, physicians who aren’t normally exposed to situations like the one that you described, what are some things that we should not do or say in the exam room?

Gail Miller: OK. Well, I think I would step back and first just remind people that the decision to have a child or not have a child is the most personal decision anyone can make. So I think it’s first stepping back and being like, should I ask a question about something that is so personal, whether it’s between a couple or a single person wanting to have a child? So I think that’s where you start from, that point of view of, OK, this is really personal; it isn’t my business. And then just think about, OK, is this clinically pertinent?

So yes, if you’re going to be prescribing a medication to someone who is potentially trying to conceive, that is appropriate to ask. But if it’s not pertinent, you have that negative pregnancy test, you’re giving them something that’s not going to be a problem for pregnancy, and what’s going on has nothing to do with getting pregnant or being pregnant, I would say stay away from that. Stay away from that.

Now, if you are someone who is their primary care, and this is part of their care, of course you’re getting their history, their reproductive history. What I say is to stay away from the judgmental comments. Ask the questions that are clinically pertinent, but don’t put your own judgment on it: “Well, you know, you should have this many kids.” Or for the women who have chosen not to have children, the comments that “You’re going to regret having children.” That’s not really your place to comment on.

So I want to make clear, I’m also advocating for those women who have made the choice that they don’t want children. There’s nothing wrong with that. If you are someone who wants children, don’t impose your viewpoint and your decisions on them. So that’s what I would say. I think really step back and think about, is this really appropriate to talk about? And then, if so, ask, in ways that are nonjudgmental, what is needed for your care.

Kevin Pho: Now, if someone was the recipient of one of those comments that were less than appropriate, how would you advise that they respond?

Gail Miller: So I really do this on an individual basis with women, first because we all come to things with different abilities to speak up. So I always tell them the first thing to do is pause, take a deep breath, and then go from there. There are simple answers that make it very clear, “I don’t want to go down this road.” So my go-to is always, “That’s personal.” And for most people, when somebody says that, you get it: “Oh, I shouldn’t have gone there.” Yes, you have the occasional person who’s like, “You know, I’m going to keep asking.”

And what I remind people is, you are being asked something that’s not appropriate, or you’re hearing a comment that’s hurtful. It is OK to stand up for yourself. You don’t have to be rude and disrespectful in response, but it is OK, when someone pushes that boundary, to simply say, “That’s not OK for you to say. It’s not OK for you to ask.” If you’re with someone you feel would benefit or can listen to you explaining why it’s not OK, then go ahead and do that. If you’re getting the sense that this person’s really not going to get it, I would say just leave it at, “It’s not OK to ask me that. That wasn’t OK to say.” Or if you’re just not comfortable, I say stick with taking a deep breath, stay silent, and just move on.

Kevin Pho: We’re talking to Gail Miller. She is a life and wellness coach and a maternal-fetal medicine physician. We’re talking about her latest KevinMD article that’s titled “If it’s not clinically pertinent, then stay out of my uterus.” Gail, what are some of your take-home messages that you want to leave with the KevinMD audience?

Gail Miller: So one is to, again, remember that this is just the most personal decision someone can make. So really stop and think: Does this benefit this clinical care in any way if I bring this up? If it is a situation where it’s appropriate and you find someone who’s struggling, whether it’s with fertility issues or being childless, there are resources. There are a lot of coaches and therapists who now specialize in these situations, whether it’s someone who’s going through fertility, went through infertility, or is childless not by choice.

The other take-home message is that IVF is not the answer for everyone. I’m surprised to see how many people within health care think that’s just the go-to and perfect solution for everyone. So that’s another message that I would like people to understand: It doesn’t work for everyone. It’s not financially feasible for everyone. And even for those who can afford it, it doesn’t work for everyone. So please don’t make the assumption that, “Oh, you can just have IVF, and you’ll get pregnant.”

Kevin Pho: Gail, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

Gail Miller: Thanks for having me.

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