One clinic that badly needs a lesson in Health Psychology

Well, first off, I'd better explain what health psychology is. There are two major parts: the first is how your mindset affects your health (placebo effects), the second is how to use psychology to get the patients to stick to their medical regimen or healthy behaviors. The fertility medications, I would imagine, like any other medicine can be influenced by the placebo effect. The more I believe they will work and want them to work, the more they will contribute to the actual medicinal effect of the drug. And when it comes to medical regimens and health behaviors, I had to inject myself with up to 3 separate needles a day, abstain from alcohol, caffeine and sexual activity, and drink sports water. A tall order. This clinic was severely lacking in both areas of psychological encouragement, and really emphasized to me the importance of strict standards and health reform. Let me list their faults

• 
  They did not keep my files straight.
  
  They accused me of being 1.5 hours late to an appointment, then apologized when, after shuffling through papers, admitted it was another girl.
  They lost my initial application file, asked me if I had filled it out at all.
  They called me by my middle name.
  Most heinously, my nurse did not make a note down when I started my medication and at what dose, waiting until my next visit a few days later to write this down.
  
  Putting aside psychology, keeping strict track of records, files and patient information is pivotal to the welfare of the client. I could have been administered incorrect drugs or dosages, or been delayed (in fact, I was delayed). This represented a clear danger to myself and other patients, and if this were a cancer clinic instead of a fertility, it could have meant my life. This lack of a clear bookkeeping was not only dangerous for safety, but this alone completely shattered my trust in the clinicians. Why should I trust them with surgery when they can't even keep my files straight? It makes me more stressed, and decreases any trust I have in their treatments or advice. Less trust in my clinician means a decreased placebo effect and a decreased liklihood that I will respect their demands on my medical regimen.
  



• 
  They emphasized the negative effects.
  
  The nocebo is the placebo's evil twin: if you believe something will affect you negatively, then you will make it true. I was told by several people that the effects of the medicines would make me very moody, emotional, and in pain. While they are obligated to tell me negative effects, there is no reason to emphasize them, and in fact downplaying them would have helped. I chose to ignore their warnings of period symptoms and indeed I did not feel a thing. I suppose in this case, not trusting them possibly helped me. Or perhaps I just would not have been susceptible to the medicines anyway.
  




• 
  They did not give clear directions.
  
  Once it came to time to stick myself subcutaneously with needles, I realized that the nurse had not properly explained this even either. I was told to, "you know, swab the area, then stick it in". Luckily, I have injected rats before so I knew something about how to inject. I didn't realize right away though, that for humans you need to inject perpendicular, rats have thinner body fat then humans and need to be injected at an angle. Here are all the steps that the nurse left out: wash hands, swab the area, unwrap the needle, take off the cap, over-fill the syringe, push out the excess to remove the air bubble, always keep the needle on a sterile surface (inside of the wrapper), inject at a 90 degree angle, aspirate (pull the plunger up and see air to make sure you're not injecting into a vein), and slowly push the plunger down, leave it in for a few seconds and then pull it out. To make sure I was aware of all that, the nurse should have gone over a checklist with me, and even perhaps asked me to practice for her with saline, or maybe watched a movie.
  
  Another thing, they told me that while taking the medication, I was not supposed to drink alcohol, caffeine or have sex, and to drink vitamin water but they were never clear about which medications that applied to. Did I start abstaining once I started the birth control? The ovulation suppressant? Or perhaps not until starting the fertility meds at the very end? And when was I supposed to drink the vitamin water? I forgot about the water, and left it out because it was never brought up again after my initial appointment. I was delayed in my surgery, and I am not sure whether to blame the vitamin water, the weakened placebo effect, incorrect dosage, or even my own body.
  



• 
  They did not debrief me.
  
  The nurse just shipped a box of medications to me, without explaining the plan for my treatment regimen. When I open the box, I saw a miniature pharmacy and nearly had a heart attack. There were all sorts of drugs, and I had no idea what anything was for or when. I was overwhelmed, something that could have been avoided with clear communication and a general overview about my regimen.
  
  The day of and before my surgery I was not debriefed on what to expect after - how much pain, what sorts of activities I would be able to do, how to best recover. I was debriefed very thoroughly by an anesthesiologist about the anesthesia who explained everything she was doing, but I had no idea about what to expect from the surgery itself. I was handed a paper with all the information on it when I left, but that was it.
  



• 
  They had poor timing.
  
  I hate having my blood drawn and having gynecological exams, they make me feel faint for awhile afterwards. So of course my meeting with the nurse about my medications were scheduled to be directly after getting my blood drawn and my lower quarters prodded. Sometimes this was necessary - they needed to test so that they could advise me on dosages, but sometimes it was not. When it was not, I was unnecessarily placed in a situation where my ability to concentrate and ask questions was compromised. Not only that, but I was rarely asked if I had any questions, but was instead rushed out the door.
  
  When it came to my surgery, even, they tried to rush me out even with me still vomiting after 2 doses of one anti-nausea medicine and another of a second medicine were not affecting me. The nurse who was in charge of dismissing me was uppity about staying late and clocked out before I even made my first dry heave, leaving me with another nurse who was already in charge of a patient. Possibly she didn't have enough time to debrief me properly after the surgery, but I still would have preferred a pre-operative debriefing. I was really going into it blind.
  



• 
  The did not follow the most sterile procedure.
  
  Following atheist/xtian news, I had just read an article a few days ago about how a phlebotomist (blood-drawer) had been told that wearing jewelery of any kind violated sterile procedures because it could harbor germs that could be passed to new patients, and that she could keep the cross in her pocket. The woman of course claimed religious discrimination, but what had been an amusingly annoying xtian story a few days ago quickly became relevant to me as I noticed my anesthesiologist wearing a cross necklace. This woman with the germ-harboring neck jewelery cared more for her faith than me not getting infections. To my dismay, I looked down and noticed she was wearing several thin bracelets as well. Perhaps she just never thought about it. This was not the most reassuring thing to realize right before my surgery.