Tuesday, October 28, 2008

Passing information / educating patients?

This is my response to a nurse's blog post:


This is a very touchy subject for me, and I appreciate you blogging about it. I didn't write a birth plan for my daughter's birth. I had gestational diabetes, and I was being induced for PIH. I knew that what I wanted, an unmedicated birth, wasn't a possibility. I accepted that I was going to have an IV. I knew I was going to have the blood pressure monitor strapped around my arm and the fetal monitors around my belly. I knew that it would be nigh onto impossible to move around. With every complication, I knew that my choices were being reduced to the point that I was determined to go with the flow to get this baby out safely.

Where the lack of information / education / understanding about my birth came in was after my daughter was born. Everything fell apart 30 minutes after her birth. I was hemorrhaging, the placenta didn't detach, and my uterus began to flip inside out. I was in so much pain and my body was going haywire from blood loss and a plummeting blood pressure that I couldn't understand what was happening. I couldn't participate in the decision-making process. I didn't understand the explanations my doctor was trying to provide. I knew that they were taking me into surgery, but I didn't know why I was going there or what they were going to do.

The lack of information continued after I was out of recovery. I knew something wasn't right. I had 8 IV's, and I was still in the labor / delivery room. When I asked what was wrong, all they told me initially was that I'd had lost a lot of blood. While this was somewhat true, it wasn't the whole story. I was at the point where I didn’t have the energy to fight for answers, and in all reality, my brain wasn’t producing the right questions to ask. When the doctor came to do rounds, he told me that the placenta came out in 20 pieces, the uterus flipped inside out, and my blood pressure plummeted from 190 / 120 to 50 / 30. However, he did not tell me that he had done a D & C after his attempt to manually remove the placenta failed. He did not tell me that the placenta not detaching was called placenta accreta. He did not tell me that my uterus flipping inside out was called a uterine inversion. He didn’t tell me that I’d lost 50 percent of my blood. He didn’t tell me what was running through the 8 IV’s that were still in my hands. Did he give me an explanation? Yes. Was it complete? No. There was no discussion of the consequences of these actions. Could I have asked? Yes. Should I have asked? Yes. Was I capable of formulating the questions? Not at that time. The trauma had taken too much of a toll on my body, and while I recognized that I wasn’t getting the full story, I wasn’t in an emotional or physical position to fight the battle to find out what had happened. I just wanted to go home. I wanted to lick my wounds in private, and pretend that it had never happened.

It wasn’t until my 6 week postpartum checkup that I found out the clinical diagnosis. At that time, I only found out because I asked if a c-section would have been a better choice than the induction. The doctor definitely wasn’t the one to initiate the conversation. Even then, it wasn’t until I was interviewing a new OB to find out what the risks were of having more children before I found out that my old OB had done a D & C.

I don’t think that my experience was all that unusual from an educational / informational standpoint. I think sometimes that the bare minimum of information is presented to the patient. Just enough information is passed on to keep them from being a pest.

This is a pretty complicated topic. There are a lot of things that are required for women to be educated about birth.

1. They have to want to be educated.

2. The information has to be accessible.

I wanted to be educated. I wanted to know about normal, typical birth. I wasn't into researching complications just to worry myself about them. I wanted to know the basic physiological aspects of childbirth. How your cervix changes to allow the baby to be born. How to handle the pain without drugs. How to move to make it easier for the baby to descend. When complications arose, I did research the specifics of those complications. I knew that high blood pressure presented all kinds of problems. I knew what to watch for as far as signals that it was getting too high. I learned about watching out for pre-term labor symptoms.

The problem was that I didn't end up with a normal typical birth. I don't think there's a single childbirth class that really explains clearly all of the complications I ended up experiencing. I could have done Bradley, Lamaze, or Hypnobabies, but would they really have educated me about having my uterus turn inside out? They talk about complications they consider "preventable", but I don't know that mine really were. If under anesthesia, the placenta comes out in 20 pieces it's pretty darn stuck. It's not just a little bit attached. As for the inversion, is it possible that the attempted cord traction caused this? Yes, but I'll never know for sure if this was directly the fault of that procedure, or if it was simply something that happened spontaneously.

I think too many of these classes assume that everything will happen normally, in which case interventions aren't necessary. The problem is that things don't always happen normally. There are situations where interventions really are necessary. When these classes teach you, don't trust your doctor or midwife, aren't they doing a disservice to the women who truly are at risk? They teach you to obsess over the procedures instead of creating a relationship with your caregiver. When things to wrong, they leave you dangling. You're the screw up. You didn't follow their teachings. You never should have listened to the doctor. They're all out to get you. Their only goal is to get everyone out alive, and on and on and on...

Some childbirth books have sections on complications. Few of them give as much information as I ended searching out once I knew what had happened. Was the information accessible to me? Yes, if I searched medical journal articles and medical school powerpoint presentations. Does that mean the average mom needs to research birth at this level? I certainly hope not. It seems ridiculous to have every woman searching out the most rare pregnancy complications for absolutely no reason. There are enough concerns when you're pregnant without looking for trouble.

I also think that caregivers need to think about their role in educating women. I really think that they need to step up to the plate a little bit in making sure that their patients really understand what happened. Did my doctor's explanation meet that criteria? I didn't know how to look it up or research it, but I did have a pretty good grasp of the complications from a layman's perspective.

It just wasn't enough for me. I needed more.

Sunday, October 26, 2008

Birth Rape?

Birth Rape

Isn’t that an ugly term? The first time I heard it, I thought a bunch of radical feminists were making a big deal out of nothing. How can those two words possibly be spoken together? Birth is about innocence. Is there anyone more innocent than a newborn baby? Rape is so ugly, so violent, so brutal. It offended me at the core of my being. However, I think there may be something to it.

Some people believe that birth rape can only occur if a woman has been previously assaulted. They believe that the birth itself isn’t a rape, but that the woman is experiencing a flashback to a prior criminal act. This flashback is so real, that they transfer their feelings about the original assault to the act of giving birth.

This experience impacted me the night my daughter was born:

I’d met this guy six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the bed while we were talking. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Doesn’t this sound like a date rape experience? I trusted this person. I invited them into my personal space. I didn’t give permission for this to happen. I tried to get away. I was violated. I must have had a flashback to this prior crime during my birth if I think birth rape is a valid term.

Now, let me change six words:

I’d met this doctor six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the hospital bed while we were talking after my daughter’s birth. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Does that change you opinion of my experience? Do you believe this behavior is suddenly acceptable? Why is it that behavior that is unacceptable every where else in society suddenly becomes acceptable in a delivery room? Before my daughter was born, I’d never been the victim of a violent crime. I’d always been treated respectfully by the men in my life. No one had ever touched me in an inappropriate manner. This wasn’t a flashback. It’s my reality.

Birth is an incredibly intimate act. It requires you opening parts of yourself that you keep hidden from the world in order for it to happen. It’s deserving of the same respect that women expect when giving themselves to their lover. It’s something to be treasured. If consent is so essential to a healthy sexual experience, consent is also necessary to healthy birthing experience.

It took several months before I admitted that my daughter’s birth had resulted in my birth rape. I didn’t want to admit it had happened. I tried hiding from it. I tried ignoring it. I didn’t report it. I blamed myself for it. But I’ve learned that this doesn’t help, so now I’m talking about it. I’m not sure yet if I’ll discuss this when I meet with the doctors at the hospital, but I’m thinking about it. I know they don’t want to admit that this happens. I know they want to bury their heads in the sand, but someone has to speak out. There was a time when people didn’t believe that one spouse could rape the other, but now we recognize this as a truth. In this time we live in, people believe that a woman in labor cannot be raped, but a time will come when we will believe in this truth also.

Friday, October 17, 2008

PTSD after Childbirth?

I know a lot of people can't understand how a woman can develop PTSD, post-traumatic stress disorder, after giving birth. After all, it's supposed to be one of the best days of your life. It's a day that's supposed to be filled with joy, sunshine, and flowers. The angels in heaven are supposed to rejoice alongside the new family. Most of the time childbirth works that way. It's painful, but the women put it in the past. They might develop PPD, but that usually goes away.

I was so overwhelmed in the first 6 weeks of my daughter's life, that I didn't realize anything was going on emotionally. It was all I could do to get through those first few days and nights. Yes, I was tired, but all new moms are tired. Yes, I was struggling to physically recover, but all new moms struggle with that too. It wasn't until I saw my doctor again for my 6 week postpartum checkup that I realized things weren't quite right.

I got undressed, and laid down on the table for him to do the exam, and I found myself squirming to get away from the doctor. I didn't want him to touch me. I was terrified. I fought myself into submitting to the exam. I stared at my baby girl sitting in the carseat on the other side of the room praying for the exam to be over. He finally finished up, and I sat up on the table. I asked the one question that had been in the back of my mind for the last 6 weeks, "would a c-section have been safer for me?" It opened up the door for a pretty frank discussion about what had happened. I had never heard the terms uterine inversion, retained placenta, postpartum hemorrhage or D & C until then. Can you believe it took 6 weeks to get the clinical names of the complications I had experienced? I took that information home, and started googling the living daylights out of those terms. I read everything I could get my hands on - journal articles, medical school presentations, and any other reference I could find. I was obsessed. My husband would walk in the door, I'd hand him our daughter, and I'd race to the computer to start researching. I went back to work two weeks later, and at every break or over lunch I'd be googling those terms. I was an expert, but I still felt like I didn't really know what had happened. I finally broke down, and requested my medical records.

So 2 1/2 months after my daughter was born, I realized I had to do something about my mental health. My husband was frustrated with what he called my "OCD tendencies". He didn't like the person I was becoming, and I realized that my behaviour was impacting our daughter. I saw my family practice doctor thinking I had PPD, and I did score high enough on the screening test that it could have been the cause. However, when discussing it, he mentioned that it might be PTSD instead. But, it couldn't be PTSD, right? Soldiers in Iraq get PTSD. The I-35 bridge collapse victims developed PTSD. Childbirth is normal. It's a common part of life, so it couldn't be PTSD. I tried anti-anxiety pills, but they didn't help. After a few weeks of my husband pressuring me to do more than take pills, I finally asked for a referral to a mental health professional.

My husband went with me to the first counseling appointment. Imagine my surprise when the counselor begins introducing herself, and tells us that she's married to Dr. XXXX at XXXX clinic. The doctor who delivered our baby. I was so betrayed that my family practice doctor had referred me to someone that was closely related to my former OB. Since I was paying for the visit anyhow at this point, my husband and I gave her the abbreviated version of the story. She confirmed that it was PTSD, and told us that she could help me even though her relationship did bring up questions. After the visit, I made the choice that I would try to find someone else to help me since I knew I'd always have questions in the back of my mind.

It took several weeks to find someone else. I tried the counseling service through my employer, but that was a fiasco. I finally started googling counselors with EMDR experience. I found the new counselor 3 1/2 - 4 months after my daughter's birth. Once again, my husband went to the first visit with me. We told the story, going into a bit more detail this time, and once again I was diagnosed with PTSD.

I struggled with this diagnosis. I just couldn't figure out how it could be correct, so here's the criteria from the National Center for PTSD:

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.
So, how does this apply to me? I was absolutely terrified that night. I thought I was dying, and so did my husband. The doctor made decisions and performed procedures based on inaccurate information that caused me great pain. I wasn't notified of his intention to perform these procedures prior to his performing them, so I had no control, choice, or opportunity to understand what was happening. I was objectified to the point that my husband and I both felt that I was treated like a vessel, and not like a competent woman. With all of the physical complications, I retreated inside myself, and was for the most part unaware of anything else happening in the room. Some things made it through, but for the most part, I was locked in my mind scared, in massive amounts of pain, and consumed by everything that was going wrong. Those feelings continued throughout my stay at the hospital. Questions were given half-answers. The nurses continued to trivialize the experience when I desperately needed validation that the event hadn't been typical. I was weak, and incapable of voicing my true needs. I finally just gave up trying to get answers, and focused on getting discharged. I wanted away from all of the people who were supposed to be taking care of me. I wanted out of the place that had failed to keep me safe. I was traumatized.
I didn't want a PTSD diagnosis. I grew up in a house where my father had PTSD from the Vietnam War. I know that while the symptoms fade over time, this never really goes away. PPD would have been easier - take drugs for a year, and you're all better. This was a gut shot. It never goes away. The nightmares have tapered off, and the flashbacks are becoming less frequent. However, I always have to watch out for triggers. Things like people not listening to me can send me into a rage. A call from the hospital, or catching sight of my former OB at the clinic can send my blood pressure screaming high. I have to remind myself to stay in the present when I'm talking to mom's with new babies. I avoid telling the story of my daughter's birth because my feelings are still to raw. It's a lot better than it was. I'm not as obsessed, but this is the new me that I'm learning to live with.

Wednesday, October 15, 2008

The Power of Words

I picked up the mail yesterday, and found a flyer from the hospital foundation. On the exterior of the envelope, along the bottom, left-hand side was their new motto: Transforming Lives. It made me start thinking about all of the comments that have really struck me to the core in the last 17 months. Most of the time, the comments were meant to be reassuring or innocuous, but they weren’t either of those things to me.

The first one was, “do you want to hold your baby?”, and my subsequent response, “No”. Doesn’t that seem like an innocuous question and response? The only problem was that question was asked just as I was realizing that things were going really wrong. I didn’t know what, but I was starting to feel dizzy, spacey, and a little woozy. Holding my daughter would have been a huge mistake, but I couldn’t get past my feelings of failure that I didn’t “want” to hold my baby. It would have been easier to say no to “Are you ready to hold your baby?” There’s a huge difference in the connotation of ready and want. One implies ability while the other implies desire. I desired holding my child, but I recognized that physically that wouldn’t have been smart.

When I went back to work, one of my co-workers asked me when I was going to have another child, “after all, popping out another one is no big deal”. Wow, what I experienced was “no big deal”! Everyone sure thought it was a pretty big deal that night. People were in and out of the room, trying to find the anesthesiologist, and shoving needles in my hands. So, just for the record:

hemorrhaging 60% of the blood in your body, no big deal
attempting to delivery your uterus, no big deal
needing the placenta to be surgically removed, no big deal
doctors debating if you should go to the ICU, no big deal
blood pressure crashing from 200 / 120 to 50 / 30, no big deal
needing 8 IV’s to pump all of the drugs into you, no big deal
believing that you’re dying as they roll you into the operating room, not a big deal

It’s amazing the things people assume about birth. They have no clue what your experience was, and yet they make the assumption that it was just like their sister’s or wife’s or friend’s experience. Even my parents and in-laws were guilty of this. They were too caught up in the moment to see beyond the baby.

The first time I interviewed a new OB, he told me, “The worst OB in the world can give you a better birth experience than you had the last time.” I know it was meant to be reassuring. I was supposed to be comforted by that statement, but to me it was a condemnation of my skills in finding and choosing my previous doctor. After all, if the “worst OB in the world” is more competent than my previous OB was, what does that say about my choice? It was patronizing, and I never went back to him. The last thing I needed was someone else patting me on the head like a child.

What about, “you didn’t advocate for yourself” and “you didn’t educate yourself”. I love these ones, because it puts all of the blame on mom for the poor outcome. No one else has any responsibility because she “didn’t advocate or educate” herself. So, moms are supposed to read the doctor’s minds. We’re supposed to be more educated than the caregivers we hire. We’re supposed to argue, refuse, or question every time a medication is adjusted, a tool is picked up, or a twinge is felt. We’re supposed to have eyes in the back of our heads, and no matter what our physical and emotional condition we’re supposed to be able to force medical personnel to answer questions truthfully. We’re supposed to know if a homebirth is a better option than a hospital birth or a water birth. We’re supposed to know if we should take Hypnobirthing, Bradley, Lamaze, or the hospital childbirth education class. We’re supposed to know which books are the proper ones to read. Wow! Did you know that pregnant women have superhuman, omniscient, god-like powers? What a crock! Advocacy requires open and honest communication between caregivers and patients. Without that free-flowing information a patient cannot be an effective advocate for themselves. As for education, there’s no way for any one person to know absolutely everything about birth. Most of the time it works just fine, but sometimes interventions are necessary. We all make the best decisions at the time with the information we have at hand. All these statements do is blame the mom for her experience, and sometimes mom’s not the one who should be blamed.

“Transforming lives”, the hospital certainly transformed my life. They didn’t just make me a new mom; they traumatized me in the process. I became a victim of medical assault. I was trivialized, de-humanized, and objectified. They dismissed my attempts to advocate for myself. They ran roughshod over me and my husband. We didn’t leave as a happy family of three. We left broken. I had a husband who hated his child because she “caused” mom to be so sick. I left unable to give my daughter a bath without triggering a flashback. I was weak from blood loss, and emotionally destroyed by the experience. Then they re-traumatized me by asking me to fund their initiative to create a hotel-like atmosphere in the birthing center so they can “transform lives” when what they really need is to make sure they’re properly staffed for an emergency. Private rooms, rugs on the floors, pretty drapes at the windows, and sofa beds for dad to sleep on aren’t going to help the mom who needs immediate surgical care, and there’s no anesthesiologist on the premises.

Finally, my two favorites that always seem to come together. “You should be grateful that you have a healthy child”, and “all that matters is a healthy child”. Why do people believe that being grateful it all turned out okay doesn’t mean that you can’t be angry about how it was achieved. The two feelings aren’t mutually exclusive, and the co-existence of those two emotions is part of what makes recovering difficult. I’m grateful that the OB I chose was competent. I’m grateful that he held everything together until the CNA and the anesthesiologist got back to the hospital. I’m grateful that he was capable of resolving the issues without resorting to a hysterectomy. However, that doesn’t mean I’m not angry that he failed to communicate what was going wrong to me while I was capable of understanding it. It doesn’t mean I’m not angry that I was treated like a vessel, and not like a human being. It doesn’t mean I’m not angry that he didn’t ask if the epidural was working before he tried to pry the placenta out of me. There’s this dichotomy of emotions that I struggle with everyday. As for the “all that matters is a healthy baby” statement, does mom not count? Does dad not count? A healthy baby needs a healthy home. They need parents who care for them. When a parent can’t stand the thought of holding their own child, they’re broken. The home is broken, the family is broken, and the baby will eventually grow to be broken too.

Words have amazing power. Choosing the right ones can be difficult. For moms with PTSD or other post-partum mood disorders, the wrong words can wreak havoc on their recovery. They cut us to the bone, instead of building us up. I know it’s not intentional, but words can cause damage too.

Blindsided, continued

Well, I decided what to do. I tracked down an e-mail address for the hospital foundation. I wrote a brief, polite e-mail to them asking to be removed from their call list. Letting them know that I could no longer support their organization after the poor quality of care I had received as a patient 17 months ago. I've spent thousands of dollars in counseling costs, time off work, and gas costs to learn how to cope with the PTSD. Funding my tormentors is simply not going to happen.

They've responded to the e-mail, so hopefully this issue is now resolved.

Tuesday, October 14, 2008

Blindsided

Why is it that just when I think I'm getting better something blindsides me again?

Several years ago, my co-worker's wife died. My co-worker asked that donations be made in his wife's name to the hospital where I ended up delivering my daughter. I chose to make a donation, so I ended up on the fundraiser mailing list.

Last night, I received a phone call from the hospital foundation. The volunteer was expounding on the great things the hospital provides to the area, but all I could think about was the damage they had caused me. I clammed up, and let her ramble through her spiel. Obviously, I didn't respond in the typical manner because she suddenly stopped mid-sentence and asked if another time would be better. To give myself time to think about what to say, I told her that she could call back another day.

There's no way that I can donate money to this organization. They're more concerned with their expansion plans than providing good care to their patients. They're more concerned with the aesthetics of the birth center than the safety of the women birthing there. I've spend thousands of dollars on counseling. I've taken tons of time off work without pay to go to the counseling sessions. I nearly lost my marriage because they didn't care enough to make sure their patients were treated well.

Obviously this volunteer doesn't need me to go off on her about the poor care I received, but how do I get the point across that their "care" is lacking? I know I can "just say no", but I'd like to give them an explanation why without really delving into the details.

Does anyone have any suggestions?

Monday, October 13, 2008

Building Relationships

If having a relationship with your physician is essential to building trust, who should initiate the relationship? The patient? The physician?

I didn't form a relationship with my former OB. I went to my appointments. I was honest. I took his advice. I asked questions when I had them, but being the last of my friends to become a parent left me with most of my questions answered. I read books. I searched the internet. I didn't write a birth plan because I recognized that each complication eliminated choices, and there was no point in getting myself hung up on a specific vision of the birth when I knew how quickly things could change. Was it my fault we didn't form that relationship?

I walked into my first appointment with him scared because I'd spotted over the weekend. It stopped after an hour, so I didn't feel it was necessary to go into the ER to get it checked. I simply set up an appointment for right away Monday morning. Throughout my whole investigation into choosing a new doctor, it had never occurred to me that I would stay with this one. My thoughts from the get go were simply to find someone to help me get this baby out safely. I had every intention of going back to a family practitioner after the baby was born. Was that the "fatal" flaw in my thinking? Should I have been committed to this relationship before it started?

I saw the situation similar to that of needing any other specialist. The family practice doctor refers you to a specialist for a specific condition. The specialist helps you resolve that condition, and you go back to your original doctor. There's no need to see an ENT if you sprain your ankle, right? Was I wrong in considering my pregnancy to fit this model? Or, was he wrong in not instigating it? Should he have done more than ask the specific diagnostic questions that helped him guide me down the path. Was he responsible for bringing up his birth philosophy to me, his patient?

After I left his care, I interviewed several doctors around the metro. I checked out doctors at the large urban hospitals. I checked out doctors that my co-workers saw. I didn't "click" with any of them. Instead of being reassured, I felt devalued. Instead of being calm, I felt anxious. Instead of feeling autonomous, I felt trivialized. Even my family practice physician, someone I'd seen for 15 - 20 years, contributed to my feelings of betrayal. He made a huge mistake in referring me to my former OB's wife for counseling, and this destroyed our relationship. I felt uncomfortable seeing him. I was afraid to be betrayed again, so I kept trying to figure out what to do since I knew I couldn’t remain in that relationship.

I was surprised when I met Dr. B for the first time. She really initiated the beginning of our relationship. When I tried to trivialize my experience, she forced me to expound on it. When I tried to change the topic, she circled me back around to the problem. She made sure I was getting help. She offered different options for treatment based on my current issues like flashbacks, anxiety, and dissociation. She made sure I was comfortable. She didn’t rush me out the door. She made sure I was okay with my daughter. She made sure I was okay with my husband. She looked for emotional well-being as well as the physical which ended up being easily cured.

As for my old OB, well, I have to accept some portion of the responsibility for not building a relationship with him.

Maybe we failed each other.

Friday, October 10, 2008

Trust

Do you trust your doctor?

Is trust essential to the doctor – patient relationship?

I’ve read several blog posts by healthcare providers talking about trust. In one, the author basically requires trust from her patients. She believes that she works hard to develop a trusting relationship throughout her client’s pregnancies, and in an emergency those clients should immediately acquiesce to her demands because she’s built a relationship on trust, and in an emergency she shouldn’t have to stop to explain the complications, the patients should simply react. In another blog, the caregiver demands that patients who don’t trust him should find other care. In a third blog, the caregiver wants to find a way to study a trusting relationship, and bring the concept into evidence based practice. However, is trust too strong a word for what they really want?

Trust is difficult for me to give. I don’t trust my parents. I sometimes trust my husband, but not always. I don’t trust my daughter. After all she’s only one, and she doesn’t have any concept of the long term consequences to her behavior. I don’t know that I’ve ever trusted a physician. I respect them. I’ve found most of them to be well-educated in matters that I’m not educated in. I’m willing to take their advice because I believe that they’re actually looking out for my best interests, although I have been willing to negotiate other treatment options with them when I believe it’s justified. Isn’t that enough?

I lost all trust I had in my former OB after my daughter’s birth. His lack of communication in an emergency destroyed my respect for him. Without communication, information, or knowledge there is no consent. Without consent, there is only anger, fear, and violation.

My husband lost his trust as well. His was lost due to non-verbal communication during the emergency. He recognized the "Oh shit, I'm fucked" look on the doctor's face before he started verbally communicating. At that point, my husband checked out of the room. It brought up all of his barriers, and he never heard anything the doctor said after that.

Communication, especially during an emergency, diminishes fear. It keeps the patient feeling like they’re still in control even though chaos may be swarming around them. It gives them something to cling to when they’re fading in and out of consciousness. Open and honest communication during an emergency, even if it’s not a full explanation, can keep a patient calm, focused, and rational enough to comply with the needs of the medical staff. Knowing what and why things are happening helps patients to process the event as medical procedures.

It took me several months to find a new caregiver after I left my former OB and my former family practice doctor. I found that I couldn’t stand the thought of having a man examine me. I just kept waiting for the other shoe to drop despite the 15 – 20 year relationship I had with my former family practice doctor. Our relationship wasn’t strong enough to withstand the distrust I now experience with male doctors. I even interviewed a new OB at a different hospital. He tried to sound positive and uplifting, but instead came off as patronizing. The last thing I needed was another doctor who believed that he is or was infallible.

It was a fluke that I found this new doctor. I called the clinic to make an appointment to see any female doctor, and this is the one that had an opening. It wasn’t well-researched, but she listened to me. She didn’t let me off with the dismissive practiced answers I had for my pregnancy. She ferreted out answers, and as a result I switched my and my daughter’s care to her. Patients need to develop a relationship with their doctors. I don’t know that it has to be built on trust. I do believe that respect is a strong enough bond. However, it’s difficult to build a relationship when you only see a physician once or twice a year. By having her care for my daughter I increased the number of times I see her in a year to almost once a month. I don’t trust her. I don’t trust any doctor, but I respect her knowledge. I respect her training. I respect her ability to listen to my concerns, and help steer me down a path that meets my needs.

Maybe it is trust, I don't know. Personally I think it's too strong a word, and yet when I researched this issue for the presentation I'm giving at the hospital, this is the word used in all of the articles I found on improving patient care. Patients who trust their doctors are more compliant. Patients who trust their doctors are less likely to file a malpractice claim. Patients who trust their doctors get better care. However, hospitals are adding patient advocates to help facilitate communication between doctors and patients. I wish my hospital had instigated this program before I was a patient.

If it is trust, I know it takes a long time to build, and only seconds to destroy. It's kind of like handing your sixteen year old the keys to the car for the first time only to have them call you 5 minutes later to tell you they've been in an accident. More than likely it will be a long time before you let them drive by themselves again. Eventually you might give them a second chance. I never let my doctor have one.