Tomorrow is another Ob appointment. Hopefully this time will be ok. I only had a salad for dinner, and as of this AM, I'd only put on a pound since 2 weeks ago....
A couple of months back, I ran into an EM doctor and his wife at the clinic. One of my favorite EM doctors, if you must know. The person who made me think that maybe I wanted to do EM. But then also made me think that maybe I didn't. It's complicated. Anyway, he offered to give me a ride home from the clinic, which was especially nice since I live almost 2 miles away and the walk had started to suck in a third trimester kind of way.
I bring this up because one of the things we talked about was how I (and his wife) liked the practice. I said it was ok, but that it felt a bit like assembly line medicine. His wife didn't feel the same way (supposedly), and they recommended that I ask for specific providers when I came in so that I could develop a relationship with someone and would hopefully not feel that way anymore.
I haven't done that, and here's why:
1. The clinic seems to rotate who is "on" every month or so. So I don't think I'd end up having the option of seeing someone specific even if I did want to pick.
and
2. Probably more importantly, I'm not going to be able to choose who delivers my baby (see #1), so I feel like it behooves me to get to know as many of the providers as I can before I show up at the hospital in labor.
Still, I wondered if I was just being really hypersensitive about this whole thing. So I asked Luca after one of the visits he accompanied me to what his impression was.
He said: Well, she spent the entire time looking at her computer and typing. I can see why you feel like she doesn't care about you.
I hadn't really thought about that, and it is true. Usually, we have about a 15 second introduction, and then whomever it is goes straight to the computer to (presumably) read off whatever numbers they have on me.
But I think what bothers me is the lack of humanness in the interaction, beyond the computer. The introduction will always be something that I don't really know how to respond to like, "How's the baby doing." I don't think they've asked me how *I'VE* been feeling once. Or if they have, it's been in such a way that I can just tell a lecture or some empty platitudes will be forthcoming if I tell them, "I've been really exhausted," or, "I haven't taken a normal crap in a month," or, "I'm worried that my PI is taking all of my interesting projects away from me because I'm pregnant." Or if I do bring something up, they're likely to address me in a confrontational way, like the Dr did 2 weeks ago about my due dates.* It's like they've lost all ability or interest in interacting with me as a person, let alone a person who has a brain.
Several of you have suggested that I switch practices, and I really do wish I could. But the thing is, a lot of people I talk to say that they like this practice, and I wonder if the problem is really that my expectations for human interaction are too high. I know that I will get high quality medical care at this practice, and to me that's what matters the most. I also don't have confidence that anywhere else I go would be any better.
I guess I just wish I could have some of the touchy-feely sensitive doctor stuff as well. Is that really too much to ask?
****
*As a side note, I located my copy of NMS Ob/Gyn to make sure I was right about how one dates a pregnancy. The section on this was written by my very own Ob/Gyn preceptor from 4 years back, who -- wouldn't you know -- is a dr at the practice I am receiving my care at now. In fact, I could have seen her as a patient tomorrow, but I decided that would be awkward, especially since I always got the feeling that she wasn't very fond of me when I was her student.
And as it turns out, you're supposed to use the LMP unless the 1st trimester ultrasound is off by more than 7 days, or the second trimester ultrasound is off by more than 14 days. Since my LMP and ultrasound are discrepant by 3 days, that means we're supposed to be going by my LMP.
So there.
Anyhow, after I read this, I fantasized about bringing my textbook to the clinic tomorrow, and having a discussion with the Dr about it. Ha! I doubt that would have gone over very well.... but it was fun to think about, anyway.
God I must be a horrible patient.
:-)
11 Pearls of Wisdom:
It does matter. The more stressed you are about your pregnancy, your birth, and/or your interactions with your birth attendants, it increases your chances of your birth not going well. The calmer you are, the more smoothly things are likely to go.
(The theory being that stress is more likely to cause vasoconstriction of the uterine arteries due to a sympathetic response, thus depriving the uterus of blood when it needs to do its important work.)
Having observed obstetrics and the UK, Canada, and the US, I'd recommend a midwife.
BB -- Several of these providers are midwives.
:-P
Nah, don't say that you are a horrible patient (even tho med pros are notoriously hard to treat). Horrible patients are non-compliant with eclampsia eating fried foods and chasing it with Mt Dew. (yummy soda but way too weird to really drink)
Pulling for you here in the land of GoldenGateBridges and UnionSquareMacy's.
happy New Year.
I did the "different provider each time" bit for the same reasons as you, and I definitely preferred seeing the same provider each time in my first pregnancy. And honestly, I would have preferred to be delivered by a doctor I'd never met than the doctor I knew I didn't like (who actually did wind up delivering my baby). When I saw her name on my wristband, I felt disgusted, even though I knew that the person who delivers you isn't nearly as important as your nurse.
I complained a lot about my practice and some people told me I'd be happier with a midwife, but considering I wanted an epidural the second I walked in the door, I don't think that would have been a good fit either :)
It's the EMR. I've noticed it in a couple of different practices that are using it during the appt. They (doctors AND nurses) talk when typing but you don't interact with them because they're too busy entering things on the screen. The best ones are the ones who close their laptop and talk with you and then enter stuff in afterwards. The very best ones didn't bring in the laptop at all.
For both my pregnancies, I had an OB/GYN who was in a group practice also. I almost always saw him and he would walk in without a computer and we'd talk while measuring. He was super-busy but always had time to listen. He even gave me a hug and sat with me when I went nutso and burst into tears during my 2nd pregnancy (I had horrible hives covering my entire body from a just-discovered allergic reaction to a sulfa antibiotic) and THAT comforted me.
My OB/GYN was on-call for the delivery of my first and I got a different on-call doctor when the twins needed to come out via c-section.
All in all, I really liked seeing one person during the nine months for the consistency of care - and he knew what to ask me and what to blow off. I found I didn't care at all who was delivering the baby(ies) when the time came. It could have been Oscar the Grouch - as long as he knew how to deliver babies.
There's really no point in Monday morning quaterbacking your decisions about how you managed your care during this pregnancy. Since getting good medical care is paramount to you, and you trust the care you'll get from this practice during labor, it doesn't sound like an 11th hour switch is something you are interested in/willing to do. You will just have to trust that you are not an unreasonable person, that you've handled things the best you could and that you'll learn from the experience, not just for any (unlikely, it seems) future pregnancies, but also for future occasions to consume health care. Good medical care matters, but so does the human experience. How we feel about the care we're given matters. What can you do to feel better about the care you are getting from now until the baby is born? and in labor? Knowing that you value that aspect of your care will help you make better decisions. Don't second guess yourself!
The personal relationship IS important - but I have no idea how it is possible to achieve it in the US as I don't know the system. But I would say that treating your mum to be as a person is essential - she is as much of importance as the baby - and they can't talk yet so it would be only polite to acknowledge your existence.
What I DO know is that doctors can be not very accepting of you knowing when your baby was conceived :-) and that happens in any country! I had a U/S at 27 weeks that was normal, I had another scan at 31 weeks that was also normal - for 27 weeks :-( . Instant admittance "small for dates", panic. This was in Germany so they decided I didn't understand them talking about dates - they thought I was a month out, I KNEW the night in question. So they sent a itty-bitty student who spoke reasonable English - no, I was still adamant about the dates. In the end I said "Look, you aren't suggesting I'm anything more than a month out are you? No? Well the latest possible time of intercourse was x/x/xx." How could I be so sure? Well, 3 days later my husband broke a metatarsal or two and was in a plaster cast for the next couple of months. Very big damper on the physical side of a marriage I can tell you. Bless him, he went away very red-faced ;-).
Anyway - babies come when they want to. The due date is a guide, and only a guide. It doesn't mean you will go into labour on that day on the dot. 3 days here or there is pretty immaterial and nothing for them to get their knickers in a knot about.
Nancy: I get what you're saying about EMR, although I have to defend it a little bit. (My hospital doesn't have EMR, but I've worked in places that have.) When a doctor doesn't bring the laptop into the room, that puts an onus on them to remember everything that goes on in that room after that fact. Say your OB measures your baby's heartrate at 148... what are the chances she'll remember that number again after a ten minute discussion, having measured 50 other baby's heartrates that day? Other stuff can very, very easily be forgotten too.
And documenting after the fact slows things down too. OB/GYNs have a huge patientload and if they have to spend even five minutes documenting after every patient, that can slow things down a lot and increase patient wait time or decrease the volume of patients they can see. Unless they document sloppily.
That said, I've had a few doctors just stare at the computer the whole time we were together, and it's horrible. Maybe they could fill in the data that's needed, then turn to the patient to give them full atttention. Also, I think there are doctors who are better at making eye contact while using the computer.
Having recently dealt with a very similar (OK, probably the same) practice, I do have some thoughts.
First of all, while in theory switching practices sounds like a great idea there are several problems with this. #1: its a little late in the game for you #2: there really aren't too many options in this city. seriously. #3: convenience shouldn't be underestimated---would you want to have to spend a significant amount of time commuting to a different location for frequent visits while hugely pregnant and trying to finish up all the work you want to do? Plus the L&D nurses at this hospital are EXCELLENT, there is a NICU and any specialist you'd ever (hopefully never) need on site, and as an employee (not sure for students) you do get some minor perks.
In terms of the rotating providers model, they recommend you see different people yet during this pregnancy I ended up seeing the same two for most of my appointments (midwife and CRNP). In my first pregnancy I did see different docs, but wouldn't you know, the one that delivered me I had never met before. I didn't really care that I didn't know the docs that delivered me. Like Fizzy said, I'd rather have a complete stranger than the one person I hated.
I HATED that ubiquitous "how's the baby?" question. HOw the f&c! should I know, I'm here for YOU to tell ME how the baby is doing! You're right, no one ever asked me how I was feeling. THAT I could've answered! I think some standard questions about the mother's health and normal or worrisome pregnancy symptoms (constipation, GERD, fatigue, pains--i.e. a REVIEW OF SYSTEMS!) should be included in the visit and it never was. The only thing we ever talked about was my freakin' weight when they saw it, and then I had to bring up other stuff if I wanted to discuss it.
The EMR is tricky. I get the pressure to get the note done during the visit; our clinic mandates they are all done in 24 hours because closing the encounter drops the bill. I don't do the notes in my clinic (I do them later the same day) but I only do one clinic a week so I have the luxury of going back afterwards and finishing them. If I saw patients full time, I would HAVE to try to finish the notes as I was going both due to time constraints and the likely possibility of forgetting/confusing the details of patients. I don't know the answer to this, I find it really really difficult to type AND give personal attention at the same time. Even docs that SAY they have this figured out---I'm not sure the patients will agree. I don't think there is any way I can feel that someone is giving me their full attention if they are not looking me in the eye.
So, no, its not you. Yes, it matters. Just not sure it matters ENOUGH to anyone in charge to make any changes happen at this practice.
As an assisted conception survivor, of course I knew when the conception occurred, but the nurse doing the paperwork for my first OB visit (incorrectly) insisted on using my LMP which changed the due date by weeks. Having to argue the dates with first the nurse and then one of the practice doctors, as an introductory transition from a warm/fuzzy RE's office, gave me a bad taste of the practice for the rest of the visits. And I'd been going to that OB practice for years...
Regarding the EMR -- I know some patients hate it, but I actually don't think that's the part that bothers me, though I can see how it can be difficult to look like you're listening AND type at the same time. I know that it's hard to remember everything from a visit, and I'd rather that they get my #s right and tell me the right thing than mis-remember and tell me the wrong thing/write the wrong thing down after the encounter. I know myself how easy it is to forget important details the second you step out of the room (let alone after you see the next patient).
I just wish they'd ask me about me. Today was better, at least. My husband and I have a good dynamic I think when we go together.
As a side note, today the weight was fine but now they're concerned about growth (2 weeks ago I'd grown by 3cm, but there wasn't any growth these past 2 weeks). So, either this cold has kicked the crap out of me more than I thought and there's been no growth, or the baby is starting to drop into my pelvis and it's a measurement issue. So, I got to schedule a growth ultrasound. Fun times!
And yes, I am coming here because they are really smart, and have EXCELLENT neonatal facilities, which in the end is really important to me. Also, they are the most convenient to my house and office, the importance of which cannot be underestimated, especially since who knows how often I'll have to be schlepping my hugely pregnant self to the dr for the next month.
And Ana is also right, the L&D nurses here are fantastic. I can deal with the occasional caustic resident / attending as long as the person who I spend the most time with while laboring is good.
Post a Comment