Wednesday, August 29, 2012

Be Your Own Healthcare Advocate

This post is not about my emotions or the grieving process, but is still related to our loss.  I'm writing today to relay my experience at the doctor's, and hope that this conveys the importance of being an informed healthcare consumer.

Yesterday was my postpartum follow-up visit.  I didn't know what to expect as far as medical exams and whatnot, but I had a long list of questions related to future pregnancies that I wanted answered.

When the doctor came in, he shook our hands (hubby went with me), and asked if he'd seen us in the hospital.  DID YOU READ THE CHART BEFORE YOU CAME IN HERE?  He then asked me to relay the medical events leading to Morgan's passing (AGAIN, DID YOU READ THE CHART?), and did I understand why things went the way they did.  Somewhere along my retelling of the story, his memory was jogged and he asked, "Oh, are you the one who delivered everything in the sac?"  (My water never broke, so the baby was delivered in an intact amniotic sac.)  After that part of the conversation was done, he said he saw no need for a pelvic exam (I didn't either, honestly), and asked us to come to his office rather than be in the exam room.  He wanted to discuss the plan for future pregnancies.  Perfect, because I did, too.  However, at no point in the above exchange did he ask how I was doing, either physically or emotionally/mentally (RED FLAG, RUN!).

In his office, he explained, as if we weren't already aware, what cervical insufficiency is.  Then we began to discuss the plan of action for future pregnancies.  From my reading before this visit, and what we were told before leaving the hospital, I thought I knew what he would say.  I was wrong.  This doctor wanted to go the route of expectant management, which is a watch and wait approach, with more frequent monitoring until cervical changes are observed, then more aggressive action.  From what I've read in various blogs, as well as the scientific literature, I was expecting him to discuss placing a preventive cerclage at the end of the first trimester, frequent cervical length checks, and some period of bed rest. NOPE.  He didn't feel the evidence was there to indicate that preventive cerclages are necessary.  Apparently, of every 100 women who get them, 96 don't really need them. Thus, he would not place the stitch until after 2 losses.  I have not come across this statistic.  I have come across multiple studies showing that around 90% of women with  a preventive cerclage (not an emergent cerclage) carry to term.  Whether or not preventive cerclage is beneficial may remain to be seen, but it seems to be a viable option.  Why on earth would I set myself up to go through this hell again by flying without a net?  And why would I stay with a doctor who isn't willing to do everything in his power to get us a success story until the third time around?  To his credit, he did send an email on my behalf to the other docs in the group to see if anyone else would place a stitch after a single loss.  Only ONE doctor out of about eight would agree to it.  That whole practice just got fired.  Period. End of discussion.

LESSON 1: Be an informed consumer of healthcare.  Research every viable option, and if your doctor is not willing to consider them, move on.  I know this is hard to do when your insurance plan restricts you to certain doctors within a network, but do the best you can.

While at the office, I raised my dissatisfaction with the way larger group practices, and teaching hospitals work.  I felt that there were too many chefs in the soup here.  Every time a doctor walked into the room, it was a new doctor, asking the same questions as the last doctor.  DID YOU READ THE CHART BEFORE YOU CAME IN HERE?  He had some suggestions, but also made several excuses.

Lastly, don't let your doctor treat you like a moron.  You may not have a slew of initials behind your name, but you CAN understand what your doctor is saying to you.  I've mentioned that I'm working on a PhD in epidemiology, and this means that I spend a lot of time reading medical literature.  Probably more time than the average practicing physician.  Yet, I don't try to throw my weight around.  But yesterday, when I was discussing some of my concerns, I prefaced myself with saying, "I'm getting this degree, and my research area is preterm birth...yada yada yada..."  My husband, who is neither an MD nor an epidemiologist, commented later that as soon as I threw that out there, he started talking to me in a completely different manner.  Before I put my credentials on the table, this man asked me every way but down how many pregnancies I had had.  Apparently, either I don't know how to count to one, I forgot about those past miscarriages and abortions, or he couldn't believe that a thirty-two year old black women would wait until she was ready to have a child.  Afterwards, we spoke as peers.  I shouldn't have to put on my big girl panties to be treated like one!

LESSON 2:  Take a trusted relative or friend to an appointment with you.  If between the two of you, you don't understand what's going on, ask the doctor to explain it again in everyday language.  I recently saw a quote attributed to Albert Einstein: If you can't explain it simply, you don't understand it well enough.  These doctors didn't always speak of "occlusions of the upper great vessels leading to myocardial infarction".  Once upon a time, they said, just like a regular person, "the veins were blocked and he had a heart attack."

LESSON2a: Fake it til you make it/Don't be intimidated.  I think that people assume that doctors, because they have many more years of education than the average person, are somehow smarter, or better, and let that intimidate them.  Don't!  If you're not happy, speak up.  If you want more (or less) treatment, say so.  This is your health we're talking about.  You only get one chance to do it right.

That being said...

LESSON 3: Don't be their cash cow!  If you're not happy with the quality of care you receive, don't keep paying for more crappy service.  THEY work for YOU!  For the 7 days of our journey to keep Morgan, which included 4 days at home, not the hospital, the insurance company was billed nearly $30,000!  I don't know about you, but imagine if you were paying out of pocket.  Would you be willing to pay that much for slipshod service?  I know people who won't go back to a restaurant for a $7 burger if the service is bad.  The same applies to healthcare.  In addition, as I mentioned above, I wasn't asked how I was doing presently.  This doctor was ready to jump straight into getting us back on the baby train.

I know this seems like it's easy for me to give this advice, as someone who is more familiar with medical speak.  I haven't always had this knowledge, so I do know what it's like to be overwhelmed with what's going on around you when you or a loved one is sick.  But I refuse to learn the hard way what will happen if I stay at a practice where my voice is not heard.

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