I think in this instance while I appreciate the social worker had good intentions, I think it is important to allow the patient to lead the conversation. What is his understanding of fertility? Does he know how fertility even works? What does he think will be important to him now or in the future. Sometimes throwing all of the options out can feel helpful to us but can just cause people to be overwhelmed and shut down the conversation.
It is so hard, we never know what people will take away from our conversations and what key points they will remember. I also wonder how many patients who say they were never talked to about fertility issues really were, but have forgotten. Or perhaps they shut down the conversation in the first place but don’t recall that. Regardless we need to meet patients where they are at.
I absolutely agree. While I think she did a great job of reassuring that there were many options, and approaching his frustration with the lack of education he had previously, she certainly led the conversation in every way. I always feel it’s better to start with open-ended questions or statements like, “Tell me about what you can remember being told previously about fertility.” or “What are your goals in regards to fertility?” and “What options are you aware of?”. I say “remember being told” because I agree – there is a good chance that he had this conversation but subsequently forgot, or could not process it at the time. That being said, the social worker is right in that people, including medical providers, avoid subjects they are not comfortable with, so he may very well be correct that no one educated him on fertility-sparing options previously.