100 Questions and Answers About Infertility

 John D. Gordon

Dr. John D. Gordon is a reproductive endocrinologist and co-director at Dominion Fertility and Endocrinology in Arlington, VA.  He’s practiced for over ten years, and trained at Stanford University and University of California, San Francisco.

Last year, he and his business partner, Dr. Michael DiMattina, published a guide for patients: 100 Questions & Answers About Infertility. To promote the book, Dr. Gordon launched a blog by the same name, and it’s still going strong after over 80 questions and answers. You can also find Dr. Gordon online at the International Council on Infertility Information Dissemination.

In his interview with Conceptions, we discuss how the Internet has changed his practice, how he handles problem patients, and what it’s like being a man in a woman’s field.

[Interview edited and condensed by Cheryl Miller. Part two to follow.]

How did you start blogging?

JDG: It was sort of a natural extension. For the last nine years, I’ve been answering questions on this other website called “INCIID” [pronounced “inside”]. They have different forums that are moderated by physicians. Basically, I post every day or two on questions that come up.

I served essentially as the Internet doctor for these couples. That has its own set of problems because you only get less than half the story usually. You get a modified version of what the patient understands their history to be so you have to be a little bit careful to avoid being dogmatic.

When my father-in-law was diagnosed with lung cancer several years ago, I went to a conference about lung cancer, and there was a book called 100 Questions & Answers About Lung Cancer. I thought it was a great book. I called up the publisher and said, “I see you have fifty titles but none of them are about infertility. Would you like us [he and Dr. DiMattina] to write a book about infertility?”

I thought, “Gee I’ve been answering questions several times a day for all these years.” So you start to see a pattern in the questions you get asked. Out of that grew the idea to have a blog to promote the book.

The other thing is I trained in California at Stanford and UCSF. It’s a different world out in California. Essentially, a male physician has to be twice as caring and communicative to get half the patients and respect of a female physician. My mode of practice has always been full disclosure, a lot of information to the patients, and getting them to be a partner in their healthcare decision-making. The blog is an extension of that.

How has the Internet changed your practice? Do patients seem more knowledgeable or maybe just think they’re more knowledgeable?

JDG: It’s a double-edged sword. I’ve never been threatened by patients asking questions. Patients have always come in–in the 12 years I’ve been in practice–with an article or two. The number of patients who do that has certainly increased with Internet.

The problem is that you do have self-proclaimed experts out there–usually other patients who have had their own experiences–and that can get patients completely turned around. Just this week, I had a patient who was almost having an anxiety attack because of some things she was told on the Internet by another patient. I told her, “You are an individual. You have a unique history to you. You can’t listen to what this other person is saying. We worked on a plan that takes in account your particular needs. Ignore her.”

The Internet also gives patients a bully pulpit. You do occasionally get a dissatisfied patient who can get out there and really throw rocks at you. But you can’t do anything about it. Because of doctor-patient confidentiality, you can’t say, “No, no, you got this backwards. Here’s why we told you that.” We can’t respond to it.

This happened just a couple of years ago. A patient on “INCIID” had posted a question saying, “My doctor wants to do a laparoscopy because he thinks my lining isn’t normal.” I thought, “That doesn’t make much sense. A laparoscopy isn’t going to see the lining because you’re on the outside of the uterus so you wouldn’t have any idea what was going on.” I replied to her, and then the phone rang. The receptionist said that a patient of Dr. DiMattina is on the line for you. I told her he would be back in a minute, and she said, “No, she wants to talk to you. She’s the one who has been posting questions to you.”

I pulled the chart and picked up the phone. I explained, “Your HSG test showed that your tubes are blocked. That’s why you need the laparoscopy.” She said, “Oh, yes, I remember. I don’t know why I got so confused.” So here’s a patient in our own practice who was told this is the procedure we’re doing and this is why we’re doing it, and then she gets completely turned around and relies on this disembodied Internet doctor for advice.

When people give advice without full information, you can really get into trouble. That’s why a lot of my posts end with, “Discuss this with your RE.” Patients are funny; they’ll put amazing stock in what this disembodied voice on the Internet has to say about their care when they’ve been under the care of a well-trained physician for years.

Do you think they’re “checking-up” on their doctors? Perhaps just looking for a second opinion?

JDG: There’s some of that. When people have bad outcomes, they’re trolling around looking for an explanation as to why things didn’t go well. We’ve all had patients like this. I usually say, “It’s obviously disappointing that things didn’t go well. Here are some thoughts I have as to how you should address this with the physician. Ask him about this.”

If their doctor stonewalls them and they want to have that discussion, maybe that’s not the right match. All physicians have different approaches. Some patients have left me because they don’t want to talk about [their treatment plans].

Do you read any infertility blogs?

JDG: On the patient side, I’ve read some of the infertility journey type of blogs. But I live it every day. I have enough of an emotional sine wave riding it with my own patients rather than signing on to someone else’s. It’s hard to read sometimes.

How do you decide what questions to post?

JDG: Every post has been one question from the book. I’ve got a hundred questions–actually 99 since the last one is “Where can I go for more information?” I’ve worked my way up to 80 so I only have 19 left to do in the year or so I’ve been blogging. My goal was to work through every question in the book. I will keep blogging on subjects of a more temporal importance.

I wish I could blog more frequently. You’ve got a full patient load; it’s hard to carve out the time. I have a wife, four kids, and two dogs. The days are full.

[Click here for Part Two.]