Happy Belated New Year, blog and blog friends! I will spare you the "busy, busy" rigmarole because you've heard it all before. Needless to say, it hardly seems real that the last time I logged on to post anything on the blog was back in October! Life and time have continued to move forward at the speed of light. Over the holidays we (or, more precisely, our builder) finished building the house, we closed (i.e. hemorrhaged money), and then, for extra fun, we moved in...the week before Christmas. Why (you ask incredulously)? Because I'm insane (in the membrane...er, sorry), apparently, and, more accurately, because I already had requested that week off in order to (HA, HA!) relax the week before Christmas. To add to the fun (and this torture was completely self-inflicted, by the way), we just didn't feel *right* about depriving poor little CindyLou and Bean of a Christmas tree and decorations until the week before Christmas (think of the *children!), so we bought a tree for the rental, decorated it and the rental house (including the outside, of course!), undecorated, bought a new tree for the new house, and the decorated the new house once again. I cannot vouch for my mental stability, that bit of madness was unbelievably ill-advised. Regardless, despite several snags, we arrived safely and soundly in the new house before Christmas. Santa even found us and everything! Whew!
So now, I am digging out of boxes, cursing the paper clutter and all of the things that can't be thrown away, but do not yet have a "home." Paper clutter is my true nemesis. We all love the new house. It is so nice to be in a home that is truly "ours" from the very start. Cindy Lou's bedroom is bedecked in lavenders, pinks, and fairies. Bean's is bathed in blues, "Cars" characters, and, let's not forget, monster trucks. We are very happy here, which is good, because (hear this internets) I AM NEVER MOVING AGAIN! (I hope.)
Work is going well, getting back into full swing since the holidays. I find I have so much less to complain about these days. Likely because I am not much on the front lines any more (no more midnight phone calls about cough syrup selection), I am getting more sleep, and more weekends off to play and love on my sweet little family. I still have the occasional fist-clenching moments, like the two sisters, due a week apart. The younger went into labor first, even though the older was *due* first, and the older got so p*ssed off she *refused* to come to the hospital bedside to support her sister. I mean, *dammit* she *always* gets *her* way. (These are grown ass women we are talking about here, you wouldn't believe the adolescent machinations, mostly on the part of the older sister.) Younger sister's baby ended up having an unknown health problem after delivery, which would have made me feel like a criminal that I wasn't there for *my* sister during that time. Older sister's baby was born about a week later and was *perfect,* and I got the vague impression she was feeling quite smug and justified about that. Sad, sad, sad.
There was also the patient whose MIL jumped all over me when, after going to have a "for fun" ultrasound where the US tech said the cord *might* be around or near the baby's neck, I tried to explain that, if indeed the cord was around the neck, there was not a thing in the world I could do about it! I spent 30 minutes with the patient and her MIL, even obtained a (completely normal and beautifully reactive) NST. At the MIL's visit to my partner the next week (for her own medical care) she expressed to them how I just "rushed" them right through the appointment, and how her DIL needed "more TLC" from our practice. GAH! The unmitigated *gall* of that woman! I give up. Haven't seen her or DIL since, and I'm not crying about that one little bit.
So anyway, time marches on...double numbers are luck for me, so I think 2011 is going to be a good one. Maybe, just maybe, I can lose the rest of that weight, organize my life, de-clutter, become a great cook, run a marathon, found a charity organization, and still find the time to be the world's best wife, mother, and doctor. Hmmmmm, probably not! Good to be back, and I hope to write more in the coming year. Hope you are still out there and listening!
Showing posts with label people are a-holes. Show all posts
Showing posts with label people are a-holes. Show all posts
Wednesday, January 05, 2011
Saturday, October 03, 2009
Overheard in a Beauty Salon
Who knew that having more free time would be counter-productive to blogging? The hardest thing for me is being able to let enough time elapse between bloggable events and actually writing about them, so as not to violate privacy issues. This post, however, happened somewhere that my profession should very rarely come into play, a hair salon. I'm not the first to bemoan the loss of a hairdresser when moving, and, while I held out as long as I could, the root situation was becoming very serious. I got a recommendation from my good friend who lives here in Newville. She's usually brutally honest, and her hair always looks fabulous, so I trusted her opinion. The hairdresser, herself, was fine. Despite trying to sell me on some "organic, sulfate free" shampoo (to a Suave-type girl) at twelve bucks a bottle, she was professional and did a nice job. The fun started when she set me aside for my highlights to process.
As many stylists do, she had stagger-scheduled a client to come in during the time that my highlights were processing. The second client, SC, breezed in and perched in an adjacent seat, waiting for her turn in the chair. "You aren't *pregnant* any more!" exclaimed the stylist to SC. "Nope, delivered 8 weeks early!" SC countered brightly. Needless to say, my interest was piqued, and while I don't make it a habit to eavesdrop, we were the only 3 people in the shop, and they were not discussing things quietly. It wasn't SC's story that surprised me, it was her incredibly flippant tone. I discovered, through their conversation, that SC had developed pre-eclampsia during each of her pregnancies, and this pregnancy was no exception She was admitted to the hospital, where those "incompetent doctors" had the gall to check her blood work every 6 hours and put her on this "vile medication" just in case she had seizures. SC didn't understand while they just didn't "take the baby, already." Finally, she says, after 2 days, her platelets *finally* started to drop, and the decision was made to deliver. She was angry, actually angry, that the baby was delivered after midnight so she couldn't have the "cool birthday date" that she had wanted. Oh, and where was the baby might you ask? He was still in the NICU (no big deal) because he was still apneic, of course. She had just delivered the week prior, by C-section, was obviously in HELLP a very short time ago, and she had driven herself to her hair appointment because she "couldn't stand" the way she looked. She was *glad* she delivered early, because she had only gained 20 pounds, and she was also glad she had "tan lines" so the doctor could see where her bathing suit hit so as not to go above it.
As she went on and on, you could have knocked me over with a feather. I was just shocked and appalled at this woman, so nonchalant about her premature baby, apneic in the NICU, and so unconcerned about her own health, that she was out driving to the hair salon a week after a c-section and HELLP syndrome so she could *look better.* I was blown away at the priorities here. The rest of the hair appointment passed without incident, but I was left to ponder how very differently patients can view their medical situations from their physicians. I am sure that her physician agonized over the decision to deliver her son so early, yet SC had wanted it all done even earlier. I also found it amusing that I cannot escape my profession, even in a place where most go to relax. Have you ever been appalled by an overheard conversation? Maybe next time, I'll bring my i.Pod.
As many stylists do, she had stagger-scheduled a client to come in during the time that my highlights were processing. The second client, SC, breezed in and perched in an adjacent seat, waiting for her turn in the chair. "You aren't *pregnant* any more!" exclaimed the stylist to SC. "Nope, delivered 8 weeks early!" SC countered brightly. Needless to say, my interest was piqued, and while I don't make it a habit to eavesdrop, we were the only 3 people in the shop, and they were not discussing things quietly. It wasn't SC's story that surprised me, it was her incredibly flippant tone. I discovered, through their conversation, that SC had developed pre-eclampsia during each of her pregnancies, and this pregnancy was no exception She was admitted to the hospital, where those "incompetent doctors" had the gall to check her blood work every 6 hours and put her on this "vile medication" just in case she had seizures. SC didn't understand while they just didn't "take the baby, already." Finally, she says, after 2 days, her platelets *finally* started to drop, and the decision was made to deliver. She was angry, actually angry, that the baby was delivered after midnight so she couldn't have the "cool birthday date" that she had wanted. Oh, and where was the baby might you ask? He was still in the NICU (no big deal) because he was still apneic, of course. She had just delivered the week prior, by C-section, was obviously in HELLP a very short time ago, and she had driven herself to her hair appointment because she "couldn't stand" the way she looked. She was *glad* she delivered early, because she had only gained 20 pounds, and she was also glad she had "tan lines" so the doctor could see where her bathing suit hit so as not to go above it.
As she went on and on, you could have knocked me over with a feather. I was just shocked and appalled at this woman, so nonchalant about her premature baby, apneic in the NICU, and so unconcerned about her own health, that she was out driving to the hair salon a week after a c-section and HELLP syndrome so she could *look better.* I was blown away at the priorities here. The rest of the hair appointment passed without incident, but I was left to ponder how very differently patients can view their medical situations from their physicians. I am sure that her physician agonized over the decision to deliver her son so early, yet SC had wanted it all done even earlier. I also found it amusing that I cannot escape my profession, even in a place where most go to relax. Have you ever been appalled by an overheard conversation? Maybe next time, I'll bring my i.Pod.
Saturday, May 16, 2009
Dear OMFH
I'm writing you this letter because I know I'll never get to say any of these things in real life. You are a major contributing factor to why I am leaving this practice. This, I am certain, is no surprise to you. You are the *worst* office manager I have ever had the good fortune to know. From the beginning, you have viewed me as a threat to your husband (and to you) and have treated me as such. Your sabotage is blatant. From telling patients that they were not *allowed* to transfer to me, to conveniently *not billing* for procedures that I have done, to blatantly attributing payments meant for me to your husband...trust me, I know what you have done.
You don't know shit about running an office. You couldn't manage personnel if your life depended on it, and you let the inmates run the asylum. You say it is "inconsiderate" of me to make patients reschedule an appointment when they arrive 30 minutes late (without calling), yet is perfectly considerate (in your opinion) to let patients wait 3 hours to see your husband's nurse, as he is off at the hospital for another delivery. Oh yes, and it is also very *considerate* of patients to tell them they need to transfer to another office if they want to see me as their physician. Totally ethical. It is abundantly clear that the *only* thing you care about is money (really, $6000 window treatments and a new Mer.cedes every 6 months??) It is no wonder that your husband works like he does: 1) he needs to support your inordinate spending, and 2) I am sure he'd prefer to steer as clear of you as possible. You think that you are my boss, and can tell me who I have to see, but let me assure you, you have no power over me. I'm sure it gives you great pleasure that you are the one that makes the call schedule, and you relish not putting out the new schedule until half of the month is already over.
You treat my nurse, who is the best freaking employee in that office, like she is dirt beneath your feet, all the while claiming to be a "good Christian." You kiss the ass of the employees that sleep on the desk, shop online during office hours, and shirk their responsibilities. Your hypocrisy sickens me. Your faux concern is laughable, and I cannot *wait* to be rid of your fake, bitch ass. Every physician that interviews here, I am telling to steer the eff clear of you and your "office management." If the hospital had any idea how much money you were costing them, perhaps it would motivate them to grow a pair and fire your ass.
So, yes, mission accomplished, you have run me out of town, but you won't have another physician in my place to screw over and to split your overhead. As for your humanitarian shortcomings, "Judgement is mine, sayeth the Lord." I'd be making atonement, if I were you. Here's hoping that you get *everything* that you deserve.
Most Sincerely,
Dr. Whoo
You don't know shit about running an office. You couldn't manage personnel if your life depended on it, and you let the inmates run the asylum. You say it is "inconsiderate" of me to make patients reschedule an appointment when they arrive 30 minutes late (without calling), yet is perfectly considerate (in your opinion) to let patients wait 3 hours to see your husband's nurse, as he is off at the hospital for another delivery. Oh yes, and it is also very *considerate* of patients to tell them they need to transfer to another office if they want to see me as their physician. Totally ethical. It is abundantly clear that the *only* thing you care about is money (really, $6000 window treatments and a new Mer.cedes every 6 months??) It is no wonder that your husband works like he does: 1) he needs to support your inordinate spending, and 2) I am sure he'd prefer to steer as clear of you as possible. You think that you are my boss, and can tell me who I have to see, but let me assure you, you have no power over me. I'm sure it gives you great pleasure that you are the one that makes the call schedule, and you relish not putting out the new schedule until half of the month is already over.
You treat my nurse, who is the best freaking employee in that office, like she is dirt beneath your feet, all the while claiming to be a "good Christian." You kiss the ass of the employees that sleep on the desk, shop online during office hours, and shirk their responsibilities. Your hypocrisy sickens me. Your faux concern is laughable, and I cannot *wait* to be rid of your fake, bitch ass. Every physician that interviews here, I am telling to steer the eff clear of you and your "office management." If the hospital had any idea how much money you were costing them, perhaps it would motivate them to grow a pair and fire your ass.
So, yes, mission accomplished, you have run me out of town, but you won't have another physician in my place to screw over and to split your overhead. As for your humanitarian shortcomings, "Judgement is mine, sayeth the Lord." I'd be making atonement, if I were you. Here's hoping that you get *everything* that you deserve.
Most Sincerely,
Dr. Whoo
Thursday, January 15, 2009
Commentary
There were a couple of comments from sarai on my last post that were rather lengthy, so rather than leave them in the comment section, I am posting them both here, in their entirety, along with my response. Italics are sarai's words, and the regular text words are mine
It can be very hard for the patient however, after having the doctor be wrong numerous times over the years with drastic consequences to your life. I don't watch Oprah, and the articles you mentioned irritate me, but yes, I do look for reputable internet sites, and before the internet was available, I researched.
sarai, I realize that your postings are coming from a place where you have been burned by the medical profession, but I certainly do not believe that physicians are anything more than fallible human beings who will make mistakes. That was not the point of the post.
That doesn't mean that I approach the doctor like I know more, and like I expect them to act as my puppet. But if I go to an OB appointment and say my baby isn't moving as much, and I am concerned about placental insufficiency, for example, I DONT want to hear "you're baby is moving just as much, it just doesn't feel the same because he has less room". Excuse me, doctor, YOU are not the one that's actually pregnant here, DON'T tell me how much my baby is or is not moving. YOU are not the one that will have to live with a dead child if there is a stillbirth (which the medical world is completely unable to understand how to prevent) I and MY HUSBAND ARE.
I think you are misunderstanding me. I *do* appreciate an informed patient. As I stated before, I practice collaborative medicine, not paternalistic care. I take my appointment time with patient to educate them and talk about treatment options. I even have a list of reputable internet sites on which to research information. That is completely different than someone coming in (or better yet, just calling the nurse line) and telling me that they have already diagnosed themselves, and now would like me to prescribe this medicine or order this test for them.
Again, I know that you've been hurt, but I am not the doctor that didn't listen well enough to you when you knew something was wrong, so please don't cyber yell at me. Just because I may vent my spleen on anonymous blog about things that irritate me about patients does not mean that I quickly dismiss them or am rude to them, quite the opposite actually. I take my patient's complaints seriously and act quickly on alarming symptoms. The dismissive attitude you are attributing to me does not apply in real life. You only see the seedy underbelly of my brain here.
You doctors don't always know how many times in person's life a previous doctor missed something important and the patient paid a heavy price. The doctor may have done nothing wrong, they may have met the standard of care, but to the person living with the consequences, it just doesn't matter, and they will do anything they can (watch Oprah, read really stupid Reader's Digest, surf the net) to try to make sure they get more observant care next time around.
Yes, as I said, "we doctors" are not omniscient. I did already know the patient about whom I posted, and have been doing her GYN care for 3 years now ( and each time I did her pap, her small speculum was warmed and lubed). She is not new to me or my practice. My care of her has been as observant as can be. Doctors are human, we do our best, and sometimes, despite our best efforts, it just isn't good enough. It sucks, and we try hard so it won't happen, and it bothers us perhaps more than you will ever know.
As a nurse, I've seen term babies stillborn, (decreased fetal movement, doctor ignored, or minimized), diarrhea was actually Ecoli, which turned into HUS, by the time treated (after being sent home 3 times) kid had stroke and ended up needing kidney transplant, a "viral upper resp infection" was actually a bacterial pneumonia, doc wouldnt believe patient couldn't breathe well 'cause sat was OK, vomiting and increasingly decreased LOC was actually juvenile onset diabetes (also sent home a few time before ER doc figured it out -- kid almost died.) This may be why some people are reading articles and trying to advocated more vigorously for their own care. I know I am. Even as I feel sincere empathy for you as I see the look on your face when you see my internet sheets........
See above, and there are even term stillborn babies where there were *no* warning signs. No decreased movement, no pain, no bleeding, sometimes babies just die. We do everything we can to prevent it, but despite our best efforts, babies still die. Yes, there are physicians that dismiss patient concerns, or miss pertinent signs, but we are not all the same person. Advocating for your own care (what you are talking about) and telling the doctor what to do and how to do it (what my post was about) are two different things entirely.
And here's something that just kind of bothers me about your blog, which, BTW, I otherwise enjoy reading.........it's judgement both from you and commenters, about women's birth choices.
Well, I can't speak for my commenters, but part of my job is to regard "women's birth choices" with my own clinical judgement. That's my job. If women come to me for care, they are, in fact, asking me to use my clinical judgement in their care.
If I'm reading your blog right (and correct me if I'm not), the "ideal" expectant mother in your practice wants to go into labor naturally, not mind being past due date, and not object if you feel at the last minute she needs a crash c-section. Moms who want to be induced (God forbid a week or two early) prefer a c-section straight off, or "insist" on a "happy vaginal midwife birth" even if things don't go according to plan are subjected to the eye roll.... Kind of a tall order, Dr. Whoo.....
I don't know if there is a "right" way to read my blog, so who am I to say who is "reading it right" or "reading it wrong?" I do think that you may perceive my words in a more malicious way than they are intended, and this is probably only highlighted by your bad experiences. I vent on this blog when things get tough to take, a safety valve, if you will, so that I do not blow up in the presence of an actual patient. There is no actual eye rolling going on in the presence of my patients. No matter their circumstances, personality quirks, or clinical needs, they are treated fairly and equally.
Loosely speaking, my "ideal" patient (as you put it) doesn't exist. My guidelines for delivery, elective or otherwise, are dictated both by the standard of obstetrical care, my clinical judgement, and the individual aspects of each patient. What I expect of my patient is a relationship of mutual respect and trust. Those are things that must be earned...by both parties. There is no "laying down the law." There is a give and take that is natural in these kinds of professional relationships, and quite honestly it doesn't merit many blogging entries because it is so routine. I don't think that you understand, you only see so much of me here.
One thing I did NOT NOT want with my first child was a crash c section. Either a vaginal birth, or a planned section, didn't care which. Of course, doc wouldn't do a c-section just because I wanted one, so we had a crash vag delivery with vacuum, (baby crashed too late to get c-section) where I got to experience watching my firstborn be revived, separated for her for hours after birth while she stabilized, and was so sore and torn up that I didn't want to have sex for months and months, and still deal with stress incontinence since that delivery well over a decade ago.....but because I didn't go to med school I didn't get to decide what would be better for me. I would like to argue, both as a nurse and as a mom which was physically better for me -- ugly vag birth or planned c-section. Yep, I'd choose c-section. Sorry.
I'm sorry that you had such a traumatic experience, and that it still haunts you. There is no way to predict when something like that is going to happen. Crash deliveries of any kind are heart stopping, but it *is* the physician's decision, in that moment, what will lead to the best outcome for mother *and* baby. If there is a terminal deceleration, and the baby is on the perineum, it is much more likely you will get a better fetal (and maternal) outcome with an assisted vaginal delivery.
I'm sorry that your bottom got torn up, and you had to undergo the trauma of seeing your daughter (successfully?) resuscitated. But, if I'm reading correctly, your baby survived. If your physician did what you wanted them to do, what you *perceived* to be "physically" better for you, and did a c-section, your baby's brain could have been deprived of several additional minutes of oxygen, with possible disastrous consequences. Whose fault would it be then? Yours? No, it wouldn't, it would be the physician's fault, who let the clouded judgement of an overly involved party (read, you) make the call. Instead of a torn up bottom, you could have hemorrhaged and required an emergent hysterectomy, precluding any future deliveries. Would you take the responsibility of zero future fertility, just because you *wanted* a surgery? Or is that the physician's responsibility? So yes, when you put your medical care into the hands of your physician...in that critical moment...you may not get to make that final call on what you *think* may be best for you. That is what a physician is there to do.
The recovery from next delivery was even worse, crash section, nobody's fault, but if I had it to do over again, possibility of crash section or planned section, well, I'd choose planned every single time. The crash carries psychological scars --- many of them. If you are lucky, you get to go to sleep and miss your baby being born. If you are unlucky, you have to stay awake, with no one talking to you, while your baby gets CPR. and your husband is God knows where. Physically, its a lot harder, too, and wound healing is not nearly as good than it is when the surgeon has time to take his time.
Agreed, but the point is the same, you cannot always predict these things. You said yourself, nobody's fault. Precisely. Planned surgeries are often more controlled than emergent surgeries...but not always. There are exceptions to every single "rule." Again, I sympathize that you have had such traumatic experiences, but the neither medical profession at large (in general) nor I (in particular) are to blame for this. I didn't have the perfect, ideal, rainbows and orgasms births that I would have loved to have, either, but I was fortunate and had 2 viable, healthy babies. I wouldn't trade that for any "experience."
The reason that patients want to run the show is because THEY have to live with the outcome!!!!!!! Tell yourself over and over and over again, its not about me, its not about me, its not about me!!!! especially in your profession where the stakes are so so high.......
But in order to be safe, objective, and effective the patients cannot feasibly run the show! They can (and should) be involved in the decision making process and development of a treatment plan, and they can consent or not consent, but they *cannot* "run the show." That is what a physician is supposed to do. Run the health care show.
This blog *is* about me! How I feel about the things that I do and that I see. Here, in this little corner of the internet, it *is* all about me. That doesn't mean that I disregard what my patients want. It also doesn't mean that I haven't had to make a decision that a patient was not capable of making on their own.
Maybe they really want to be induced when they know YOU, whom I'm sure they all really like, will be there. Maybe they are tired. Maybe afraid of late 3rd trimester stillbirth. Maybe they are struggling financially and need tax break. Maybe already not able to work anymore and trying to maximize maternity leave. Wanting to be induced at 38 1/2 weeks is not a sin.
Perhaps it isn't a "sin," per se, but it isn't valid medically. There is a lot of research to read about elective inductions, especially prior to 39 weeks. Often the outcomes are less than stellar, both maternal and fetal. Wanting your own physician, or "being tired," or "being afraid," or "needing a *tax* break (!)" are not viable indications for medical procedures that can have lasting impact on fetal and maternal health and well being. Elective induction of labor is associated with higher rates of cesarean deliveries, fetal distress (and dreaded "crash deliveries"), and fetal hospitalization for various immaturity issues.
Take a page from your midwives book. Listen to your patient. Ask questions. Try to figure out what the patient is afraid of. What she values. Try "why is this so important to you?" instead thinking "I can't believe she wants to have her baby by Christmas!" Find out what other experiences she has had with other health care providers. Maybe the last doc that did a pelvic jammed a large cold speculum where the sun does not shine, and she thinks you respect Oprah more than her. And remember, if she wanted a midwife, she'd probably be seeing one, so try to tactfully ask what she wants from your expertise, if you feel like she is treating you like her puppet.
Not to beat a dead horse, because I'm already feeling nuts for defending myself for talking about the way I feel on my own freaking blog, but how do you know that I *don't* listen? You don't know. You don't know me. You don't know how I treat my patients. The last doc that patient had for a pelvic exam was *me*, and I did not jam a cold, extra large speculum into her.
I've found that being a patient and having really horrible medical experiences makes me a lot less offended by my patients. Because if a patient asks me "will the doctor use a small, warmed speculum like it says to in Oprah's magizine?" my first thought is not to roll my eyes, it is to ask, "what has your past experiences with pelvic exams been like...."
Unfortunately, having really horrible medical experiences makes you a lot *more* offended by the things that I say, anonymously, on this blog, and causes you to extrapolate and frame my commentary in a less than favorable light. I hope my response has given you some insight. And truly, for all the snarking on the blog, I never forget that my patients are just people, just like me, with a different frame of reference. Even if it doesn't translate in text, I'm certain it translates well in person. I wish you healing as you attempt to move forward from your painful past experiences.
It can be very hard for the patient however, after having the doctor be wrong numerous times over the years with drastic consequences to your life. I don't watch Oprah, and the articles you mentioned irritate me, but yes, I do look for reputable internet sites, and before the internet was available, I researched.
sarai, I realize that your postings are coming from a place where you have been burned by the medical profession, but I certainly do not believe that physicians are anything more than fallible human beings who will make mistakes. That was not the point of the post.
That doesn't mean that I approach the doctor like I know more, and like I expect them to act as my puppet. But if I go to an OB appointment and say my baby isn't moving as much, and I am concerned about placental insufficiency, for example, I DONT want to hear "you're baby is moving just as much, it just doesn't feel the same because he has less room". Excuse me, doctor, YOU are not the one that's actually pregnant here, DON'T tell me how much my baby is or is not moving. YOU are not the one that will have to live with a dead child if there is a stillbirth (which the medical world is completely unable to understand how to prevent) I and MY HUSBAND ARE.
I think you are misunderstanding me. I *do* appreciate an informed patient. As I stated before, I practice collaborative medicine, not paternalistic care. I take my appointment time with patient to educate them and talk about treatment options. I even have a list of reputable internet sites on which to research information. That is completely different than someone coming in (or better yet, just calling the nurse line) and telling me that they have already diagnosed themselves, and now would like me to prescribe this medicine or order this test for them.
Again, I know that you've been hurt, but I am not the doctor that didn't listen well enough to you when you knew something was wrong, so please don't cyber yell at me. Just because I may vent my spleen on anonymous blog about things that irritate me about patients does not mean that I quickly dismiss them or am rude to them, quite the opposite actually. I take my patient's complaints seriously and act quickly on alarming symptoms. The dismissive attitude you are attributing to me does not apply in real life. You only see the seedy underbelly of my brain here.
You doctors don't always know how many times in person's life a previous doctor missed something important and the patient paid a heavy price. The doctor may have done nothing wrong, they may have met the standard of care, but to the person living with the consequences, it just doesn't matter, and they will do anything they can (watch Oprah, read really stupid Reader's Digest, surf the net) to try to make sure they get more observant care next time around.
Yes, as I said, "we doctors" are not omniscient. I did already know the patient about whom I posted, and have been doing her GYN care for 3 years now ( and each time I did her pap, her small speculum was warmed and lubed). She is not new to me or my practice. My care of her has been as observant as can be. Doctors are human, we do our best, and sometimes, despite our best efforts, it just isn't good enough. It sucks, and we try hard so it won't happen, and it bothers us perhaps more than you will ever know.
As a nurse, I've seen term babies stillborn, (decreased fetal movement, doctor ignored, or minimized), diarrhea was actually Ecoli, which turned into HUS, by the time treated (after being sent home 3 times) kid had stroke and ended up needing kidney transplant, a "viral upper resp infection" was actually a bacterial pneumonia, doc wouldnt believe patient couldn't breathe well 'cause sat was OK, vomiting and increasingly decreased LOC was actually juvenile onset diabetes (also sent home a few time before ER doc figured it out -- kid almost died.) This may be why some people are reading articles and trying to advocated more vigorously for their own care. I know I am. Even as I feel sincere empathy for you as I see the look on your face when you see my internet sheets........
See above, and there are even term stillborn babies where there were *no* warning signs. No decreased movement, no pain, no bleeding, sometimes babies just die. We do everything we can to prevent it, but despite our best efforts, babies still die. Yes, there are physicians that dismiss patient concerns, or miss pertinent signs, but we are not all the same person. Advocating for your own care (what you are talking about) and telling the doctor what to do and how to do it (what my post was about) are two different things entirely.
And here's something that just kind of bothers me about your blog, which, BTW, I otherwise enjoy reading.........it's judgement both from you and commenters, about women's birth choices.
Well, I can't speak for my commenters, but part of my job is to regard "women's birth choices" with my own clinical judgement. That's my job. If women come to me for care, they are, in fact, asking me to use my clinical judgement in their care.
If I'm reading your blog right (and correct me if I'm not), the "ideal" expectant mother in your practice wants to go into labor naturally, not mind being past due date, and not object if you feel at the last minute she needs a crash c-section. Moms who want to be induced (God forbid a week or two early) prefer a c-section straight off, or "insist" on a "happy vaginal midwife birth" even if things don't go according to plan are subjected to the eye roll.... Kind of a tall order, Dr. Whoo.....
I don't know if there is a "right" way to read my blog, so who am I to say who is "reading it right" or "reading it wrong?" I do think that you may perceive my words in a more malicious way than they are intended, and this is probably only highlighted by your bad experiences. I vent on this blog when things get tough to take, a safety valve, if you will, so that I do not blow up in the presence of an actual patient. There is no actual eye rolling going on in the presence of my patients. No matter their circumstances, personality quirks, or clinical needs, they are treated fairly and equally.
Loosely speaking, my "ideal" patient (as you put it) doesn't exist. My guidelines for delivery, elective or otherwise, are dictated both by the standard of obstetrical care, my clinical judgement, and the individual aspects of each patient. What I expect of my patient is a relationship of mutual respect and trust. Those are things that must be earned...by both parties. There is no "laying down the law." There is a give and take that is natural in these kinds of professional relationships, and quite honestly it doesn't merit many blogging entries because it is so routine. I don't think that you understand, you only see so much of me here.
One thing I did NOT NOT want with my first child was a crash c section. Either a vaginal birth, or a planned section, didn't care which. Of course, doc wouldn't do a c-section just because I wanted one, so we had a crash vag delivery with vacuum, (baby crashed too late to get c-section) where I got to experience watching my firstborn be revived, separated for her for hours after birth while she stabilized, and was so sore and torn up that I didn't want to have sex for months and months, and still deal with stress incontinence since that delivery well over a decade ago.....but because I didn't go to med school I didn't get to decide what would be better for me. I would like to argue, both as a nurse and as a mom which was physically better for me -- ugly vag birth or planned c-section. Yep, I'd choose c-section. Sorry.
I'm sorry that you had such a traumatic experience, and that it still haunts you. There is no way to predict when something like that is going to happen. Crash deliveries of any kind are heart stopping, but it *is* the physician's decision, in that moment, what will lead to the best outcome for mother *and* baby. If there is a terminal deceleration, and the baby is on the perineum, it is much more likely you will get a better fetal (and maternal) outcome with an assisted vaginal delivery.
I'm sorry that your bottom got torn up, and you had to undergo the trauma of seeing your daughter (successfully?) resuscitated. But, if I'm reading correctly, your baby survived. If your physician did what you wanted them to do, what you *perceived* to be "physically" better for you, and did a c-section, your baby's brain could have been deprived of several additional minutes of oxygen, with possible disastrous consequences. Whose fault would it be then? Yours? No, it wouldn't, it would be the physician's fault, who let the clouded judgement of an overly involved party (read, you) make the call. Instead of a torn up bottom, you could have hemorrhaged and required an emergent hysterectomy, precluding any future deliveries. Would you take the responsibility of zero future fertility, just because you *wanted* a surgery? Or is that the physician's responsibility? So yes, when you put your medical care into the hands of your physician...in that critical moment...you may not get to make that final call on what you *think* may be best for you. That is what a physician is there to do.
The recovery from next delivery was even worse, crash section, nobody's fault, but if I had it to do over again, possibility of crash section or planned section, well, I'd choose planned every single time. The crash carries psychological scars --- many of them. If you are lucky, you get to go to sleep and miss your baby being born. If you are unlucky, you have to stay awake, with no one talking to you, while your baby gets CPR. and your husband is God knows where. Physically, its a lot harder, too, and wound healing is not nearly as good than it is when the surgeon has time to take his time.
Agreed, but the point is the same, you cannot always predict these things. You said yourself, nobody's fault. Precisely. Planned surgeries are often more controlled than emergent surgeries...but not always. There are exceptions to every single "rule." Again, I sympathize that you have had such traumatic experiences, but the neither medical profession at large (in general) nor I (in particular) are to blame for this. I didn't have the perfect, ideal, rainbows and orgasms births that I would have loved to have, either, but I was fortunate and had 2 viable, healthy babies. I wouldn't trade that for any "experience."
The reason that patients want to run the show is because THEY have to live with the outcome!!!!!!! Tell yourself over and over and over again, its not about me, its not about me, its not about me!!!! especially in your profession where the stakes are so so high.......
But in order to be safe, objective, and effective the patients cannot feasibly run the show! They can (and should) be involved in the decision making process and development of a treatment plan, and they can consent or not consent, but they *cannot* "run the show." That is what a physician is supposed to do. Run the health care show.
This blog *is* about me! How I feel about the things that I do and that I see. Here, in this little corner of the internet, it *is* all about me. That doesn't mean that I disregard what my patients want. It also doesn't mean that I haven't had to make a decision that a patient was not capable of making on their own.
Maybe they really want to be induced when they know YOU, whom I'm sure they all really like, will be there. Maybe they are tired. Maybe afraid of late 3rd trimester stillbirth. Maybe they are struggling financially and need tax break. Maybe already not able to work anymore and trying to maximize maternity leave. Wanting to be induced at 38 1/2 weeks is not a sin.
Perhaps it isn't a "sin," per se, but it isn't valid medically. There is a lot of research to read about elective inductions, especially prior to 39 weeks. Often the outcomes are less than stellar, both maternal and fetal. Wanting your own physician, or "being tired," or "being afraid," or "needing a *tax* break (!)" are not viable indications for medical procedures that can have lasting impact on fetal and maternal health and well being. Elective induction of labor is associated with higher rates of cesarean deliveries, fetal distress (and dreaded "crash deliveries"), and fetal hospitalization for various immaturity issues.
Take a page from your midwives book. Listen to your patient. Ask questions. Try to figure out what the patient is afraid of. What she values. Try "why is this so important to you?" instead thinking "I can't believe she wants to have her baby by Christmas!" Find out what other experiences she has had with other health care providers. Maybe the last doc that did a pelvic jammed a large cold speculum where the sun does not shine, and she thinks you respect Oprah more than her. And remember, if she wanted a midwife, she'd probably be seeing one, so try to tactfully ask what she wants from your expertise, if you feel like she is treating you like her puppet.
Not to beat a dead horse, because I'm already feeling nuts for defending myself for talking about the way I feel on my own freaking blog, but how do you know that I *don't* listen? You don't know. You don't know me. You don't know how I treat my patients. The last doc that patient had for a pelvic exam was *me*, and I did not jam a cold, extra large speculum into her.
I've found that being a patient and having really horrible medical experiences makes me a lot less offended by my patients. Because if a patient asks me "will the doctor use a small, warmed speculum like it says to in Oprah's magizine?" my first thought is not to roll my eyes, it is to ask, "what has your past experiences with pelvic exams been like...."
Unfortunately, having really horrible medical experiences makes you a lot *more* offended by the things that I say, anonymously, on this blog, and causes you to extrapolate and frame my commentary in a less than favorable light. I hope my response has given you some insight. And truly, for all the snarking on the blog, I never forget that my patients are just people, just like me, with a different frame of reference. Even if it doesn't translate in text, I'm certain it translates well in person. I wish you healing as you attempt to move forward from your painful past experiences.
Wednesday, September 03, 2008
Response
This is a response to the scathing comment below from a very "brave" (ha) anonymous poster, 9/3/08, 5:06 pm. Actually, I *am* quite fed up and burned out. It comes with the territory of being taken for granted and treated as less than human. Chances are, your physician(s) are too, whether you get to see it or not. I'm all about patient education, in the office, during normal work hours. Not at 2 am in the morning. Sorry, and I don't think you'll find another professional around who would be happy to "educate" their clients about trivial things in the middle of the night. (Just try calling your plumber to ask them which drain cleaner is best at 2 am, see how far you get.) Again, it's people like you, who seem to think that doctors should be superhuman, that are driving physicians out of the practice of medicine...in droves. Also, anon nasty poster (9/9)that I chose not to publish. I'm glad you aren't coming back, and it is *my* blog, so *of course* it is self centered! Geez. Apparently *some* people don't get the concept of venting!
Subscribe to:
Posts (Atom)