Sunday, April 01, 2007

Life Gets in the Way

Hello to the four of you still checking to see if I'm updating! I have had a busy, busy March, both professionally and personally. The week after my last post I had 9 deliveries, and this past week my mother has been visiting and spoiling me by caring for CindyLou, doing laundry, and cooking! I have also been doing a little catching up on blogs, and I've been concerned with all of the uproar regarding HIPAA and medical blogging physicians getting threatened with lawsuits. I was really leery for the last 2 weeks, because I saw that I was being frequented by an IP near to my location, but then I found out that it was just my husband checking up on me! Whew. I do want those that read here to know that details of the medical anecdotes are altered and the time frames are changed and finer points are obscured so that the similarity to the actual cases is nominal. The way that I feel about the cases and my reactions, however, are 100 percent accurate. At any rate, I'm taking a bit of a break from the professional this week.

On a more personal note, the pregnancy is clipping along very well. I am 23 and 3/7 weeks, so therefore in a state of perpetual anxiety with regards to viability. Of course 24 weeks is the "benchmark" by which the pregnancy has about a 50/50 chance of survival. Survival, that is, with significant intervention and the very real possibility of far reaching disability and devastating, lasting damage. Next to the first trimester, the weeks lasting from 24 to 32 weeks can be terribly nerve-wracking for those of us that know too much. I'm trying to keep those niggling thoughts at bay and focusing more on the Bean's ever increasing movements, punches, and kicks. I'm also noticing occasional Braxton-Hicks contractions, which, while I know it can be normal, freaks me out just a little bit.

For all I know, I may have had these in my first pregnancy, and was just unaware of what they actually were. They are not painful or frequent, so I'm chalking it up to mild over-exertion for now. I was working much harder with my last pregnancy, and I did have a pre-term contractions scare, necessitating meds and bed rest for a few weeks, so I'm hoping that I will not have a repeat performance in this pregnancy. On the bright side, my nausea is becoming less and less frequent. I don't have to take meds every day, and I only puked twice this week! Woo Hoo! I'm up a total of 6 pounds for the pregnancy, but I started out well ahead of the weight curve, so my goal weight gain is only 15 - 20 pounds. (Trust me, I have plenty of fat.) I dropped so much weight breastfeeding with CindyLou, but like a dummy, didn't keep it off after we weaned. Since this may be my last pregnancy, I vow to keep it off this time.

I have an etiquette question for you budding Emily Posts out there. What is the protocol for accepting gifts from patients? Now that I am no longer able to hide my growing pregnant belly behind bulky white coats and baggy scrubs, plus the fact that news travels fast in a small town, the word is out that I am expecting, and my sweet patients are responding by bringing in baby presents for me to their office visits. I'm truly touched by their kind gestures, but, by the same token, it makes me somewhat uncomfortable. I purchased Thank You cards this week, and I am planning on sending them to the patients' home address. Is this acceptable? I don't feel like the patients need to buy me presents, but I feel like I would insult them to decline their kindnesses. It's a sticky ethical situation, so if anyone has any insight, I would love to hear from you.

I hope you all have a wonderful April Fool's Day. I haven't had much success with April Fool's pranks, though Guinness Girl from Red Red Whine to this day holds the "gotcha" award for best April Fool's prank played on me. Today I plan to finally call one of my friends that still doesn't know that I am pregnant. I hope she doesn't think it is an April Fool's Joke! Thanks for reading and don't give up on me!

33 comments:

Jawndoejah said...

I was in the opposite situation wanting to give a gift to my OB, a new mom. I asked the nurse before I gave the gift it she thought it was okay. She said as long as it's not too expensive...which it wasn't (just a photo album). My OB accepted the gift, and gave me a thank you card in the mail with no return address (wise woman). I think it's okay to accept gifts, just keep it professional like my OB did. I actually try to keep my distance (like I would with the pastor or anyone who gets to many "fans" because we are not in the same circles socio-economically etc.). Polite, professional.

I am sorry people think of suing for HIPPA when someone blogs. I really would not want to see my name or medical case word for word, but am not opposed to a story about my case that leaves me anonymous. I wish people would lighten up.

geena said...

If I bought someone (even *gasp* my doctor!) a present and then they said they could not accept it just because I was a patient, then I'd be sad.

We nurses get presents all the time from patients/family (in the form of food, usually) and no one bats an eye.

Personally, I think it's fine to accept presents and to send thank you cards. Be glad that you're so loved!

jmb said...

Hi
I'm a lurker. But I put you on bloglines when you got to be rather infrequent. Glad you are doing well.
Gifts: As a lay person, I'd say thanks and send a thank you card. It's tricky for you but some people just love giving baby presents, no matter how remote the connection to the mother. I make all my daughter's friends patchwork baby quilts, because I love quilting small projects. I even made one for my Italian teacher once.
If you get too many I'm sure you can find a good home for some elsewhere. The problem is if a pregnant woman gives you a gift (I'm assuming the gifts are from the OB patients, maybe not) do they expect you to reciprocate. Do you feel you have to?
Just some random thoughts, I'm sure you'll get lots of advice on the topic.
Regards
jmb

rural_obgyn said...

Why yes, I will volunteer as your Miss Obgyn Manners. The gifts from patients mean they really, really like you. Accept them with gratitude and do write the thank you note as you would for any gift. I treasure my hand-crocheted blanket (used on-call at the hospital) and other smaller gifts that remind me of dear patients. It is sometimes easier to give than receive, so look on this as good practice in receiving thanks, and the gift, gracefully.

Lizzie said...

I'm an OB/GYN nurse who had three babies while working with pregnant patients. I think it's okay to accept gifts and send thank you notes to patient's homes. Also, having been on the other side as a patient, I know there were times when I really wanted to show my gratitude to a doctor in the way of some type of gift. There have been a few doctors who have truly gone "above and beyond" and you want a way to acknowledge that. Sometimes "thank you" just doesn't quite cover it. Your patients must feel the same way!

MarlaQuack said...

Love the blog. If a patient gives you a gift in person, smile and say thank you. If they leave a gift at your office or for you somewhere else send a card so they know you recieved the gift. You must be a very special person to be receiving gifts from patients.

Marla

Ottoette said...

Glad you are ok and so is Dude Whoo. Yes, I marked the 24th week also, with the same trepidation. Update as possible, stay away from professional if you're still feeling squeamish.
Etiquette-wise - I really don't know.

B said...

Hi there Dr Whoo
Great Blog.
From my perspective (30yo Australian divorce lawyer 24 weeks 3 days pregnant with first child (a boy too hoorah) also in receipt of gifts from clients, ethically I take the view that (a) it is ok to accept the gifts; and (b) the patients, by giving the gifts are implicitly giving you the green light to use their personal details (after all this is your only connection) to send the thank you cards!
Sit back, open the loot, enjoy the attention and stop working so hard!!!
Cheers
B.

3carnations said...

I don't know the protocol on gifts from patients. Personally, I wouldn't give a gift to one of my doctors, but maybe your patients know you better than I know mine...

I received gifts from people who worked in the same building that I didn't really know, and some other surprise people. I just said thank you, and sent a thank you note. As uncomfortable as you might be with the gift, they gave it because they wanted to, and it would probably cause hurt feelings to decline. Just send a thank you note. :)

medstudentitis said...

Oh man. I just erased my comment accidentally. I think accepting gifts from patients is fine, but if you don't feel right about it, there are lots of charities that would love to have the gifts I'm sure. Thank you cards are a must! You are a member of these people's community, a very important part since you deliver their babies! I think you should be flattered that they have embraced you :)

guinness girl said...

I swear, Fat Doctor once posted about gifts from patients. I think. Maybe? Hrm. As a non-medical-profession person, my thought is that, unless the gift is over-the-top (like a crib or somethign), it's perfectly okay to accept it. But that's just my two cents.

What was my April Fool's Day joke? Man, I don't even remember! Did I claim I'd slept with PJ after he had become an EX-boyfriend?

Nicole said...

I had a scare with pre-term labor at 32 weeks. I got lucky (midwife who listened to me, steriods, meds, bedrest, made it to term), but even I knew how scary 32 weeks was. Scary.

Also, I'm not sure you really need to write thank you notes at all -- I'm guessing your patients are giving you things to thank YOU.

S. said...

Well, I'm a patient, not a dr. But I just don't see any issue whatsoever! Your patients are happy for you and want to celebrate your baby. I think it would be incredibly rude not to accept a gift, and of course, you should write a thank-you note. But maybe other drs. feel differently. Yes, those weeks between 24-32 are stressful.

Anonymous said...

This may not be a perfect answer, but if you have enough baby stuff you may consider donating some of the gifts to Nurses for Newborns or some other worthy organization.

You don't have to tell patients that you have done this, but it may help you feel less dicey and its a pretty nice way of passing on the good karma patients are sending your way.

Gifts that keep on givin'
How cool is that?

Ms. SuperScience said...

Hi - I'm not a doctor, nor am I Emily Post, but I had a similar situation. I'm a teacher, and for my wedding and the births of my children, I received gifts from my students & their parents. While it was very kind and sweet of them, I also found it a bit awkward (as you alluded to). I wound up accepting the gifts, thanking them in person, and sending thank-you notes to home addresses. I think it would be rude to decline - the gift-givers in either situation clearly don't feel obligated to give.
Anyway, take care - love the blog :)
Ms. S

Ashley said...

I think it's perfectly acceptable for you to accept gifts because they wouldn't give them to you if they didn't want you to have them. Just send a thank you to their home and make sure and sign it with whatever name they call you.

Dr. K said...

I am so glad to read that you and Bean are well (simply busy).

As for your patients giving you baby gifts: I don't think that you can stop it! You obviously have patients who really like you and are thrilled with the news of the Bean (why else would they give you gifts?). So if you can't stop it then I think that you are going above and beyond in sending thank-you cards ... and I think that little above and beyond gesture is probably part of why your patients adore you enough to give you gifts in the first place. :)

I suppose the bottom line is that I completely understand your discomfort but it sounds as though you are "fighting" a (happy) losing battle.

L.B. said...

I am 24 weeks pregnant as well and living in a very small town. Word does travel fast. I would just mail the thank you cards and not worry about it.

Genevieve said...

I'm hoping that I can help - and that you can help me.

I think a TY note to the person's home is fine. I'm sure you're already thinking this, but clinic (not personal) address as a return address for your own protection. I think, generally, just follow your gut. If you think the gift is excessive, you can always thank them for the thought but explain that you just don't feel comfortable accepting something that (large/expensive/whatever). But I think little outfits, toys, blankets and the like are just fine.

From that patient's perspective, though, I have a question. I have a WONDERFUL FP doctor that has served as my "OB" for both of my pregnancies. It was our intention that we would be here for all our pregnancies/births and keep her on as our doctor for all of them. However life got in the way and we'll most likely be moving before our next pregnancy. I'd really like to give her something as a thank you for her care for me and our kids (she's their doctor, too). Is that appropriate? If you had a patient do that, would you freak out? I sure don't want to come across as creepy or stalkerish (I doubt I would - we're from the same denomination and have run into each other at conferences and such and she has sought me out to say hi at such events, and we've had indepth politcal discussions over an issue here in the last election). If it would be okay - what? Something homemade, a gift card to a local restaurant, just a nice note, picture of the kids?

Devan said...

I think sending the TY notes is the right way to go. If I gave my Dr. (or anyone) a baby gift it would only be because I truly wanted to, but I would appreciate the TY note. :)

Nine Texans and friends.... said...

As a patient who frequently brought gifts (usually things like fudge, cookies, cake...) to her OB/midwife office I have to say, accept the gifts graciously. They are doing it because they LIKE you and probably feel quite connected to you (I"m sure much more than you do to them) because of having concurrent pregnancies.
As long as the gifts aren't over the top, meaning I wouldn't bat an eye if someone brought you a cute pair of booties,a couple onesies, even a homemade quilt or blanket.
Just enjoy it.
Glad to read the HEG is letting up. I know how you feel. I *really* do. Ended my last pregnancy with a net loss of 6 pounds even with PIH at the end :-p

Amanda said...

I'm just an occasional dropper-by (and rather far from being a doctor), but from my experience as a patient who has occasionally given a doctor a gift for one of these "life events," I'd say send out the thank you notes to their home addresses, with your office address as the return.

Which is probably what you were already planning to do :)

For BH contractions, I had them with both of my boys from about 28 weeks on. That's when I officially declared myself "done" with pregnancy, much to the amusement of my HCPs. Of course, I went 41 1/2 weeks with both of them. Me and my big mouth.

I never had an early labor scare, though, so I can see where things might be nervewracking. My concern was quite the opposite and worrying dealing with pitocin contractions from an induction. OUCH! Fortunately, my kids took the doc at his word concerning their imminent eviction and moved out of my body post-haste without any more prodding.

Anyway, I like the blog, obviously, as I'm here and commenting at ridiculous length. I'll shut up now, LOL.

Anonymous said...

Please accept your gifts in the manner in which they are given - a baby gift for a doctor whom they like and appreciate. I have given Christmas and baby gifts to doctors and office staff over many years and have never expected anything in return. Until FD wrote about it, I never suspected that a doctor might be apprehensive about it. While I don't work in medicine, I do work in a field where I serve others and often receive a gift after a program or for Christmas. Just thank the giver. It seems like you have lots of people rooting for you in this pregnancy.

Midwife with a Knife said...

Hey, congrats on everything with the pregnancy and all. You could get a cervical length if it would make you feel better....

I think there's nothing wrong with accepting a small token from a patient. Well, most of the time. I wouldn't accept anything from most of my current patients because they're so poor, in general; but that's a whole different issue. I've never been pregnant, but I have accepted cookies and baby pictures from patients in the past. I'm no Emily Post though. And I think that sending thank you cards to their homes is the perfect response! Your mileage may vary, though.

Nancy said...

Hello back. I'm glad you're OK because I was worried about you and the baby and thinking you would be so tired working and caring for your family.

I don't have any insight on how you should respond to the gift giving except to tell them 'thank you' and you've already got that covered.

Anonymous said...

re the thank you cards; i think the verbal thank you, assuming you had the chance to say it, was probably enough for the pts? I wouldn't expect a card from a doc, but then I don't live in a small town. I'll be interested to hear what others say.

Anonymous said...

A thank you card is totally appropriate! How lucky are you to have so many people who want to celebrate this new little bean!
Congratulations...
one of the lurkers who has been checking back every once in a while. Not even in the same country, let alone county! tee hee.

Mo said...

Hi,

I really enjoy reading your blog. I noticed from the last entry you mentioned about IP addresses... in case you are wondering, I'm from New Zealand... I'm not a stalker, I just don't make a habit of commenting on folks blogs if I don't know them in real life. Congratulations on your pregnancy.

Cheers

Mo

CappuccinoLife said...

I have had rather frequent BH contractions in this (my third) pregnancy since about 20 weeks. Anecdotally, it seems pretty common.

My parents both had many patients over the years bring gifts for them for various occasions. Maybe it's geographical, but I don't remember them having any ethical qualms (they felt much worse about being offered free turkeys at Christmas from drug reps, knowing many of their patients would have a hard time affording such a huge bird!). But I think thank-you notes are a lovely idea!

Quietly enjoying your blog, btw. :)

Labor Nurse said...

I would be uncomfortable with receiving gifts from my patients, too. But on the flip side these patients must really like you to go out and buy baby gifts.

I suppose you could continue to accept the gifts, which hopefully aren't too expensive (baby clothes are typically pretty cheap unless it's The Gap) and start writing those thank you's.

amelia said...

Hi--I have been a reader for a while....I don't know how you feel about homeopathic medicine since you are coming from a medical mindset but... I can relate about knowing too much about pre-term birth. My second was only 6 weeks early but it was a terrible two weeks after he was born and I have been very cautious/anxious about going early again. My early labor was undiagnosed....I am pregnant with my 3rd and at 20 weeks already notice some BH contractions. I talked about it with my midwife and she suggested something called Cramp Bark. It is a plant tincture used to help your muscles relax and also helps your uterus. I have been taking it everyday and noticed a difference in how often I have had BH contractions. If you are open to trying something a little outside the box it might help and/or give you peace of mind.

Shawnee said...

Since you live in such a small town (which sterotypical has more hospitality-seems to be true in all my experience). I would accept the gifts and send thank you cards since most likely more offense would be taken if you don't accept the presents. I can see where ethically you probably shouldn't but why not bend the "rules" and get some good gifts in the process?

scissorbill said...

If the gifts make you uncomfortable I wouldn't accept them. Tell them that it's against your policy to accept gifts from patients, though you deeply appreciate the gesture. If they insist suggest that you will accept the item to donate to a local women's shelter. Or something like that. But I think accepting gifts would create problems in the future: "I don't undersy=tand why you won't refill my Vicodin! After I knitted you those baby booties!"