German family physicians' attitudes toward care of involuntarily childless patients

Abstract

Background and Objectives: Many family physicians regard fertility counseling out of their scope of practice, although key elements in the care of involuntarily childless couples fall within the theoretical framework of family practice. This study analyzed the doctors' value system concerning the care of infertile patients and whether a personal interview leads to a greater sensitivity toward fertility issues. Methods: We conducted 57 baseline and 51 follow-up interviews with family physicians in the area of Gottingen, Germany. We performed quantitative and qualitative analyses. Results: During the baseline interview all family physicians placed involuntary childlessness within the domain of fertility specialists or regarded it as patients' private matter. Fourteen family physicians (27%) considered fertility counseling more important at the follow-up interview than at the time of the baseline interview Judgemental views of infertile couples could be detected in both interviews. More than one third of the family physicians assumed a connection between the patients' childlessness and their personal behavior or way of living. Although the majority (73%) of the family physicians regarded involuntary childlessness as a disease and considered assisted conception techniques as legitimate, a recommendation for fee reimbursement for fertility services was rejected by more than half of the physicians. Conclusions: Most German family physicians do not consider that care of involuntarily childless couples is within or appropriate to their scope of practice.