Today’s guest, Gabriela Rosa, provides a fertility specialist’s perspective on healthcare. She is the second guest from the “Land Down Under” on the Perspectives on Healthcare Podcast with Rob Oliver. A naturopathic doctor with a specialty in reproductive medicine, Gabriela is a member of Generation X. She joined the podcast from Australia.
Here are 3 things that stood out as Gabriela Rosa shared a fertility specialist’s perspective on healthcare:
· One of the biggest issues for couples with fertility issues is with mental health implications
· 1 in 6 couples experience fertility issues
· Quality healthcare gives patients the opportunity to express themselves and to be a part of the process
You can learn more about Gabriela Rosa and connect with her through the links below. She is offering a free physical copy of her book to any of the Perspectives on Healthcare Podcast listeners using the promo code “Rob”.
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Here is the transcript of Gabriella Rosa: A Fertility Specialist’s Perspective on Healthcare:
Rob Oliver: Thank you. And welcome to another episode of Perspectives on Healthcare. And you’re going to be picking up on a theme here because we are going back down under to the land of Sunshine and Sharks, home of as Monty Python told us. Wallamaloo University. My guest today is Gabriella Rosa. She is a naturopathic doctor with a specialty in reproductive medicine. She is a member of Generation X. And listen, Gabriella, welcome to the show.
Gabriella Rosa: Thank you so much for having me, Rob. After that amazing introduction and Monty Python being part of it. Wow.
Rob Oliver: You just get a little bit of… listening to a podcast with Rob is a little bit like Forest Gum box of chocolates. You never know exactly what you’re going to get.
Gabriella Rosa: Love it. I love it.
Rob Oliver: Let’s jump right into this. Tell me a little bit about yourself and about your role in health care, please.
Gabriella Rosa: Sure. Thank you. Well, as you’ve mentioned, I’m a naturopathic doctor. I specialize in infertility treatment of infertility. Specifically, we help couples overcoming fertility miscarriage when other treatments have failed. Generally speaking, most of the patients who come to us, they are in that type of situation where they’ve even either have been dealing with longstanding time to pregnancy have experienced many difficulties and challenges along the journey, and often they tell us when they come to me, I really don’t know what to do next. I’m not sure how I can actually help myself because everything else that I’ve tried hasn’t worked. And we then dive into that very distinct and unique situation to figure out what are the challenges here? What are the things that haven’t worked? Why is it that they haven’t worked and most importantly, how to resolve them, how to address them?
Rob Oliver: Yeah. Okay. This is a little bit of self confession here. My wife and I went through some infertility issues, and there is nothing that takes the joy out of what should be one of the most enjoyable experiences of a married couple than the stress and the pressure and all of the anxiety that goes with is it the right time of the month? All of that stuff. Can you talk about the mental state of the folks that come to you in addition to just the desire to have children, what they’re going through emotionally?
Gabriella Rosa: Yeah, absolutely. And that’s one of the biggest considerations for a lot of the patients that we treat because mental health becomes severely impacted by the inability to conceive or imagine the trauma of repeated miscarriages. When you get to a point where you’ve had an ultrasound, you’ve seen your baby’s heartbeat, and then all of a sudden you go for a follow up examination and discover that, well, actually, your baby is dead. I was talking to a friend yesterday or the day before where she was explaining to me how she had a recent miscarriage and she had gone to see a reproductive specialist and was told here’s a Jaffer that you can catch the thing when it comes out. She was so devastated by hearing those words because she had already created a connection. She had had a gender reveal. She was over 15 weeks pregnant at this point, and she was told that her baby had died in neutral, and for her, it was her baby. She knew she was having a girl, she knew all of these things and that her baby had died in neutral at nine weeks, and she had already had this connection. So you can imagine by being told by a doctor that he catch the thing when it comes out. Gosh can be traumatic at the very least. And she ended up having to have two surgeries because it was a miscarriage, but not all of the products of conception and the tissue came out. These types of situations, they add an extra layer of complexity to what as we’ve mentioned, is typically a natural out in the population out there. The vast majority of people can see without trying. And that is the reality. The people who then have difficulties and it’s in the millions of one in six couples experiences in fertility. The challenges that they face are several, even from a relationship perspective, there’s a lot of dynamics that are inserted into the relationship as a result of infertility. So there is conflict, there is self hatred, there’s judgment, there’s judgment of your partners. There’s a lot of extra components that end up making up. And domestic violence has actually increased amongst couples who experience because of those really difficult, challenging emotions that both partners experience. And for a woman, typically, women express these things very adversely, whereas men tend to bottle those emotions up a little bit, but they end up coming out in different ways. And so sometimes it can be a real challenge for a couple of relationship on many levels.
Rob Oliver: Yeah, I’m sure that I have no idea what you’re talking about with women expressing things and men muddling things up. But you gave us an example of really what I would qualify as very poor health care. But the question that I have for you is, what does quality health care mean to you?
Gabriella Rosa: It’s a great question, and it’s one that I have pondered with for so many years because of these repeated kind of tales that are retold to me when patients go in and experience rushed interactions with their providers. And it’s a function of the healthcare system. It’s a function of how I think that the paradigm is set up to a certain extent, being slightly outside of the standard care paradigm. Being a naturopathic doctor, I have had the privilege of being able to actually set things up within my clinic in the way that I felt was most beneficial to the patients that we serve. And mind, you know, I’m doing a master in public health at Harvard right now. So my practical project was evaluating the effectiveness of our program and figuring out how it can actually be something that can be standardized and integrated into standard therapy. Because I see that quality health care is patient centered. It gives patients the ability to express themselves as well as to be able to be a participant side by side with their provider, not someone that is subjugated or who’s spoken down to or who’s seen to no less than the care provider, because I think that when we get into those interactions where the practitioner, the clinician feels that they understand these days because of the Internet, patients are so educated, they are often more educated about their specific condition than any doctor in that specialty. Uncanny how many times patients will come in and how many times has happened over the years where patients have come in with questions that I go, oh, hang on a second. I have to look that up because they have done so much education of themselves on their health conditions that they often will bring in different perspectives into treatment and into care that I hadn’t even considered that my team hadn’t even considered. And then we sit down together and we go, OK, let’s huddle about this because we need to figure out how do we not only address this particular situation, but what does this mean for all of our other patients who might be in a similar case in a similar situation? And I think that that really is part of quality health care. It’s understanding. What are the challenges, what are the difficulties? What are the emotional States of your patients? The technical aspects are incredibly important, but that you get trained on those technical aspects. The soft skills which people often don’t pay enough attention to are ultimately the most important. I forget who said that. Nobody cares how much you know until they know how much you care.
Rob Oliver: Right.
Gabrielle Rosa: And that ultimately is going to be the differentiator of whether a patient will listen to their clinician and actually act upon what the recommendations are versus dismissing that person’s recommendations because they think he doesn’t care about me or she doesn’t care about me. What would they know about my situation? So I think that there’s so much there in the care.
Rob Oliver: Definitely. I don’t know if it’s original with John Maxwell, but my father in law always attributed that quote about not caring how much you know until they know how much you care to John Maxwell. But in the meantime, you gave us an example of terrible health care of low quality health care. Can you give me an example of what quality healthcare looks like?
Gabriella Rosa: To be honest, quality health care is being human. It’s literally treating the person in front of you with the care and compassion that you would like to Stowe upon yourself. Right. If I go into a health care setting as a patient, I would appreciate at the very least, I would appreciate being treated with regard and care and being looked in the eye and being reassured about what’s going on. Nobody can give me a definitive answer about whether I’m going to be healed or not, whether I’m going to have a baby or not, whether my issue is going to be resolved or not. But they can give me absolute certainty that they are on my team, that they care about me as a person and that they are doing their very best for me and my situation. And I think that that is one of the most important things. Sometimes it’s not even it’s not the technical, as I’ve mentioned before, it’s not the technical that counts because the patient doesn’t really understand. But if you actually just sit with that person and look in their eyes and just say, I’m here for you, and I hear your challenge. I hear your fears. I hear what’s going on for you, not even necessarily with those words by just giving them the presence, the focus and the attention when they’re speaking? How many times have I gone to a doctor who doesn’t even look at my face as they’re making notes on their computer? And I’m trying to explain something that is important to me or that I’m experiencing and that I would like to resolve. And then they’re like looking at whatever it is that they’re doing, not even acknowledging that. Hang on a second. Underneath my question, there is actually some concern. There is some uncertainty. There are some fears. There are some issues. So I think that if you’re delivering quality health care, you are going beyond the practical aspect of what it is that your patient has to get done to understanding how it is that you make them feel in that interaction.
Rob Oliver: Yeah. And what you said it hearkens back. We had a guest, Anton Gunn. He was on, and he said you’ve got to answer yes to three questions. And it is, do you care about me? Will you help me? And can I trust you? I thought that was very powerful, and I think that it fits right in with what you are talking about. And while we’re referencing former guests, Christine Ko was on and she was talking about how important it is to make eye contact. So that when you’re coming into the room, you’re not looking down and you’re looking up from the computer, you’re looking at the patient all very important. What do you wish people understood about your role in health care?
Gabriella Rosa: That it shouldn’t be a last resort, that it actually shouldn’t be a first resort.
Rob Oliver: Tell me more about that.
Gabriella Rosa: Understanding. You see a lot of what we do in terms of holistic and integration medicine. So we utilize all of the same diagnostics. We utilize all of the same treatment processes when necessary. But a lot of what we do is understanding and recognizing, first and foremost modifiable risk factors to disease and understanding how we can really effectively modify those risk factors to get a different outcome. Because you see, the statistics tells us that in order to have a close to 80% life birth rate through IVF, a patient or a couple needs to undertake approximately, on average, eight IVF cycles. Now, in my treatment program, we have a close to 80% life birth range with patients not needing IVF at all. In fact, almost more than 70% of our patients actually conceived naturally despite having failed through standard therapy before. So we know that what we’re looking at, the fact that we’re looking at a person and in this case, two individuals, because again, central therapy focuses on the woman and what needs to be done for the woman. The man comes in as almost the donor giving in his little jar and going, Goodbye, I’ve done my bitch. Well, actually, no, because fertility is a King sport. It is a 50 50 equation. And if we can optimize every aspect of a person’s health and biochemistry, we get a different outcome. Infertility miscarriage. All of these things are an end result. They are an outcome of a biochemical chain reaction that starts much earlier in the process. So if we’re looking at how do we, first and foremost leverage the two pieces of the equation that are going to give us the outcome that we’re looking for, ie the baby and to optimize every aspect of their health and their biochemistry, clean up their lifestyle, clean up in areas that may be not working as effectively as they need to be. And then we start that process of figuring out. Ok, what else is there to address in terms of infertility and to all miscarriage? Then we end up already much further forward in being able to get a different results and a different outcome. So understand, these people understood that they have much more power than they realize from even just the aspect of the things that they put on their body, the things that they put into their body, the things that they eat, the environmental chemicals that are present in their day to day. All of these factors are so important. And most people, not only do they not realize that they have the power to make changes that will optimize their reproductive function, they are told by the majority of those in standard therapy that, oh, no, there’s nothing you can do to improve your chances. Just come here, give me your egg, give me your sperm and everything’s going to be fine. And of course, we know that that’s not the case for the vast majority of patients to go through RVF, because if that was the case, we wouldn’t have a 32% 40% success rate. Pregnancy success rate through standard therapy.
Rob Oliver: Sure. Okay. What excites you about the future of healthcare? And I’m expecting this answer to not involve technology, but that’s a guess on my part.
Gabriella Rosa: Yeah. No. I think that technology is a part of the solution. It’s a huge part of the solution. And there are patients who will never concede without IVF and IXI who will absolutely need those strategies. And it is a very important part of the process. Technology is not only a part of the process in the treatment side of things, but in the diagnostics aspect. I’m extremely excited about artificial intelligence and machine learning for reproductive medicine, because if we can get better at diagnostics, if we can get better at understanding the problem, you see the huge issue that I find we have in our industry, and I say our industry of reproductive medicine in general is the fact that the vast majority of patients get diagnosed with unexplained infertility. Now, Rob, you tell me when was the last time that you solved the problem you didn’t know you have.
Rob Oliver: Right You can’t.
Gabriella Rosa: Right. Very different. Exactly. So literally, what you’re doing is you’re trying to pin the donkey’s tail without really even knowing where the donkey is. You know, it’s one of those very interesting situations. It’s not going to work so well.
Rob Oliver: Right. Okay. I’ll give you just two quick reactions to that. One is having gone through this. I know exactly where the donkey is. It’s right here inside my shirt, because the issue, it actually has implications in the marriage relationship, even if the fertility issue is not on demand side, there’s still a feeling in that I’m not able to provide for our family, the thing that we most desire, which is a child. And so there’s that feeling of like that makes me the donkey. Right. The other piece of that is I think about the analogy is when you’re going through all of this fertility stuff and you want to have a child and it’s not happening in some ways. It’s like the check engine, like, comes on, but there’s nowhere to plug in to get the diagnostic code that says, okay, the air filter is clogged or whatever it is. It’s just, yeah, there’s a problem with your car and we don’t know what it is. Hopefully you can figure it out and get it fixed.
Gabriella Rosa: Yeah. And this is the thing, Rob, in any other industry, if somebody said to you, okay. So the air filter lie is on and you’ve changed the air filter and it’s consistently on. Right. You go, hang on a second. That has to be something else, because clearly we’ve changed the filter. It can’t be that that’s the issue. But you see, in reproductive medicine, we just keep changing the filter, expecting that we’re going to get a different result. And that doesn’t happen. And we continue just changing the filter, you see, and that’s the issue by that.
Rob Oliver: Excellent. Okay. Last question for you what is one thing medical professionals can start doing today to improve the quality of health care?
Gabriella Rosa: I don’t know how to best put this in words, but one of my mentors, she said to me, Gabriella, the day that you love your patient in the way that you love the most loved person in your world is the day you will be successful. And I really took that advice to harsh. I really thought first and foremost I thought, how can I love my patients in the same way that I love the most loved person in my world? That’s not viable. I can’t do that. But she prompted and pushed me so hard when I used to say to her, no, I can’t do that. I can’t have that same feeling for my patients that I have for the most last person in my life. And I kept pondering on that idea, and I kept practicing and figuring out that. Hang on a second. What if I could? How would I actually go about doing that? And what I figured was that every single person has this soft, cute, loving five year old within themselves. They all have this really irrespective of how we externalize our behavior, our emotions. Five year olds also throw tantrums, and we kind of don’t love them as much at that point. But overall, if we think about the fact that that person has a heart and is a human and it’s soft and it just needs to be cared for and loved. And that was when I got it. I got that analogy of being able to love my patient like the person that I love the most. And honestly, that did transform my world. So what I wish that medical professionals could do is again extend to others how they would like to be treated first and foremost, but also try and connect in a really loving and kind and compassionate way to that five year old within because you will get so much further.
Rob Oliver: Got it. I think it’s a very powerful way to end our conversation. Listen, Gabriella Rosa, you have been phenomenal. I appreciate you sharing your perspective on healthcare.
Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.