Choosing Wisely – Dr. Claire Jones

COVID-19 has not been kind to people seeking fertility treatment.  Clinic closures and treatment delays have added stress for people already enduring a period of great uncertainty in their lives.  Yet, as with many such challenges, there is a silver lining.  The COVID-19 pandemic inspired changes, originally out of necessity, which have greatly improved patient care.

 Minimizing Inconvenience

For most people, time spent travelling to a clinic is wasted time.  And if that travel time is longer than expected, a late arrival at the clinic can cascade throughout a doctor’s day, delaying future patient consultations leaving more patients waiting even longer times to be seen.  COVID-19 forced the medical community to move the majority of appointments online, and it is hard to see how we will go back to the old ways.  Now, patients can sign into a doctor’s appointment from the comfort of their couch.  No need to drive through Toronto traffic, miss a day of work, find and pay for parking and wait in a full waiting room. Consequently, clinics are more likely to run on time and everyone is likely to be a little less stressed.

 Testing, Testing 1, 2, 3.  How about just 1?

More information is better, right?   We know that people, and doctors no less, are big believers in knowing more about patient health.  Yet sometimes the pursuit of that information is not actually helpful.  For example, if knowledge is not material to a decision or gaining that knowledge creates risks without benefits, then we need to think twice about why we are pursuing it.

In the current environment, each time we run a blood test or perform an ultrasound, this will require coming out to sit in our clinic, and each time a patient leaves their home to do this, there is a chance of their being exposed to covid-19. Is it worth it?  For some tests, it has become apparent that the answer is no.  In those cases, test results are not likely to change the plan for patient care or the chance of having a child.

As medicine evolves, continual improvements overtake the old best practice and some times this involves adding new tests or treatments, and other times it requires removing old tests and treatments that are no longer helpful.  With this in mind, our physician team at MSF spent many hours thinking about the tests that we order, with the goal of eliminating those that we deemed unnecessary and/or replaceable.  We met our goal as we have eliminated some tests while others have now been replaced by simpler at-home alternatives such as a urine home pregnancy test or an ovulation predictor test. We know that even at the best of times no one wants to leave their house to visit a clinic to take an uncomfortable test that isn’t going to change the chance of successfully achieving a pregnancy.  In a pandemic even more so. These changes will stick because they improve patient care and just make sense.

Despite the stress of COVID-19, or perhaps because of it, our fertility care has improved.  Not only are patients receiving better access to doctors and nurses from the comfort of their home but patients are also undergoing fewer unnecessary tests.  We believe that these changes meet our ongoing goal of improving our patients’ experience during what can be a challenging journey towards developing a family.

• Dr. Claire Jones, BSc, MD, FRCSC (OBGYN/GREI) Assistant Professor, University of Toronto Gynaecologic Reproductive Endocrinology and Infertility Mount Sinai Fertility, Sinai Health System