BB when is your appointment? I found these great great tips about negotiating when I was trying to get my doctor to explore AS. I have adapted it a bit to suit your case but otherwise it is completely plagerised from a lovely lady called heather (from AS support group) Hope its in time to help. xxx
First: hard as it is to do, leave all of your emotions at the door when you discuss this with your doctor. You want to win this one based on logic, fairness, and holding the NHS to standards they have set for themselves.
Second: What is your goal? Keep it clear in your head that your goal is to get your doctor agree verbally (?) or put in your notes (?) that they will prescribe you progesterone from the moment of BFP . Is that correct? Make sure you know exactly what your goal is. You are the least important person in the negotiation -- your goal is utmost.
Third: Read everything you can about what the NHS has said about its treatment of women with recurrent mc. Is there any language used that you applies directly to you? Ask them to tell you what, exactly, treatment is for? Is it just for general health considerations or to give you the best possible chance of successful pregnancy? Are they generally willing to try explore more avenues if the initial recommendations have failed?
Fourth: Can you point to ANY instances in which others in your situation or a similar one has received this treatment? (you are looking for recurrent mc consultants/GP?s who have prescribed progesterone in similar cases) Are there other instances for which ?exploratory? prescriptions have been made?
Fifth: Are there any third parties who can intervene on your behalf? This could be (recent) published material recognised by NHS that states that progesterone is useful. Or a letter of recommendation from another doctor? Can you take your case to a RCM consultant and ask what they think of the NHS's policy on prescribing progesterone after 4 mc?
Sixth: Look online at NHS guidelines. What standards does the NHS state it holds itself to (fairness, transparency etc...)? If they are violating their standards in their treatment of your case, it's fair to ask why or whether they are aware of the discrepancy in standards.
Seventh: Try role reversal. Sounds wierd, but it works. Sit down with your husband/friend. Have him play you, and you play the GP. Really think about why they believe you shouldn't get the treatment. If you understand their point of view, it's easier to come up with an argument that gives them a reason to help you. Has there been flood of similar requests in the past ? Is there a fundamental ignorance about what has/hasn?t been tried in your case? Do they not believe the treatment will work/be cost effective?
Eighth: If you get "this is the way we've always done it," be ready to provide examples of other ways the NHS has changed with the times in the past. (It probably has done a U turn on certain medications in the past , for example. Reccurant miscarriage clinics are doing knew trials all the time and making new discoveries etc...whatever is relevant.) Tradition is not stagnant.
Don't take no for an answer. Here, I'm going to quote a negotiations professor: A negotiation is over when you say it is, not before. It doesn't matter how many times the other person says no, or disagrees with you, or gives you a hard time. Keep asking, stay focused on your goals (without making yourself the issue). Persistence, after all, is a focused effort over time to meet your goals. If the other party bridles at your persistence, say something like, "Well, I'm just trying to meet my goals. Is there some way I could do this better?"
Keep asking questions. Value the other party. Stay calm and polite, but firm.
Good luck!