Finding a good doc for YOU

Mary - posted on 01/04/2010 ( 11 moms have responded )

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So, this topic came up at work the other night, and I thought I'd seek the input of some non-medical mothers.

Many, many times in L&d, we have patients come in with some very elaborate and detailed birth plans. They specify a variety of preferences, including things like minimal intervention (such as no pitocin, no IV's, no continuous monitoring, no epis, etc.) or wanting to eat/drink while laboring. This is all fine and good, but often times we discover that we, the nurses, are the first to see this plan. The patient has never even discussed this with her doc...but rather assumed that all of her desires are going to be met, simply because she wrote it down. This becomes problematic when her OB is not ok with some/any of her preferences. I'm left astounded that this never came up during any prenatal visits, and that one of the most integral components of said birth plan was never included in it's formation. Had she discussed this earlier, she may have discovered that she and her doc had radically different ideas about labor management, and she could have switched to a practicioner who was more in sync with her philosophy.



This is not just an OB issue...it's true in all areas of medicine. I'm a firm believer in a patient's right in being an active participant in the care that THEIR body is receiving...but with that right comes a certain amount responsibility as well. I believe that when we are patients, it is our job to "interview" any prospective doctor, so that both parties know up front if they are on the same page when it comes to treatment of ANY kind, be it pharmaceutical, surgical, dietary, homeopathic, or whatever is an issue for you. Sadly, this does not seem to happen often enough.



You don't believe in vaccinations, or prefer an altered vaccine schedule for your child? That's your right as a parent, but you need to do your homework and find a ped that is comfortable with, and supportive, or at least accepting, of your choice. You want a birthing experience with minmal intervention? Again, that's your right, but then you may not want to keep seeing that OB who believes that all labors must be augmented with pitocin, an epidural is required, and all his patients get an episiotomy regardless of need. You can't always expect, or demand, that a doc radically change their practice just to suit your individual needs or wants.



I don't expect that many of you would (theoretically) disagree with this, but what I wonder is this...how many of you actually sat down with any of your doctors and thoroughly discussed these issues before determining that they were a good fit for you? Do you act as an advocate for yourself, and your family, or do you just expect that all doc's are the same, and your input isn't really valued, or even necessary? I see a lot of patients willing to tell me, as the nurse, all about their opinions, desires and beliefs, only to clam up and meekly acquiesce when the almighy physican enters the room. It frustrates the hell out of me...they have a right, and a responsibility to participate in their care, but only if they chose to exercise it.

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Lindsay - posted on 01/10/2010

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My current OB is the one who just happened to deliver my daughter when she decided to come 12 weeks early and my OB was not in the area. This was fine b/c my first OB was a total flake. I decided to stick with the new OB b/c he specializes in high-risk pregnancies. Before I got pregnant this time I sat down with him and discussed all the options and ways we would go with my next pregnancy. I am very happy that he has followed through with everything we discussed (some of which I had hoped wouldn't happen but were necessary...ick a cerclage). Being high risk, I would not have stayed with him if he had not taken the time to answer all my questions and is available to me whenever I have a questions (except now...he's out of the country for a month!).

I think my daughter's premature birth could have been avoided if I had "interviewed" OB's before that pregnancy, rather than just get one based on a referral. She didn't take any of my concerns seriously and even shrugged off issues I was having the morning my daughter ended up being born, telling me I was just a paranoid first time mom.

I think people should take a more active role in their medical care. We have even switched neurologists for our daughter when we were unhappy with her care. And pushed for therapy evaluations her ped said she didn't need...turned out she did qualify and went through 9 mos of OT and PT...which helped her GREATLY!

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We live in a small town and I didn't want to drive to the city to see a doctor. Luckily, my husband used to be a paramedic so was familiar with all the doctors. I let him chose our general practitioner, pediatrician and my obgyn. I think they are all wonderful doctors.
The only issues are:
-Our general practitioner is from Nigeria so he is very hard to understand. I make my husband come to my appointments because he can understand him better...lol.
-Our peditrician will only admit patients to a hospital in the city 45 minutes away. Otherwise she is fantastic. She shares our philosophy and is very supportive of breastfeeding which was a biggie for me. She always takes time to answer even the silliest of questions from me, the worried mommy!
-The obgyn is one of two in the community. The other doctor is terrible so I'm out of luck if she is the one on call and not my doc. Like the ped, he takes the time to answer my questions, no matter how trivial.

Guess I got lucky. So glad my husband knew who was good and was able to make those decisions.

Krista - posted on 01/07/2010

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Heh -- it took me over an hour anyway just to get to my regular obstetrician's. If I wanted the best ones, from the children's hospital, we're looking at over two hours. Bringing up your kids in the country is great. Getting ready to give birth to them? A royal pain in the keester.

Mary - posted on 01/07/2010

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Krista brings up a point that I sometimes forget about. Living in the greater Baltimore area, I am spoiled by an abundance of choices in both physicians and hospitals. BUT...how far is too far to drive for the best possible care? When I was going through infertility treatments, I did my research, and University of MD had the highest success rate, so I chose to go there, instead of the clinic that was only 5 minutes away from where I worked. It was a 25+ mile drive one way, and in traffic, it could take me over an hour to get there. I felt it was worth the extra time and hassle. My sister, on the other hand, had a HORRIBLE experience with her first delivery, and received truly sub-standard care. She was clearly a high risk patient, that would have been best served by being cared for by a perinatologist. The closest one was about 20 or so miles away, and again, factoring in N. VA traffic, may have been a 30-60 minute drive. SHe refused to even consider that kind of commute. It infuriated and scared me, but she went back to the same local hospital, with a different doc. She got sick as shit with her 2nd as well, and I ended up intervening, and having one of perinatologist I work with doing phone consults with her OB (and basically managing her care remotely).



I realize that it could be impossible for some families, but I also see numerous patients who choose to deliver at my hospital that live over 40 miles away...and bypass 2 community hospitals to do so. I know that I would do the same in their situation, but I am not only a nurse, but the daughter of one as well. the importance of a GOOD doc was drilled into me at an early age (a lesson obviously lost on my sister!).

Johnny - posted on 01/06/2010

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When I was 24, my GP, who I had "interviewed" and carefully chosen, left her practice to look after Geriatrics at a mental hospital. She was a fantastic doctor and I agreed with her style of practice. Her practice was purchased by another female doctor and so I decided to stay. I was not that comfortable with her, she was always seriously late (like at least an hour), and she often seemed confounded by basic medical problems, frequently consulting her "book". At the time, I was dealing with recurring bladder infections, and she just kept prescribing every antibiotic in the book. My file listed me as being allergic to sulfa, but she prescribed me a medication that is related to it and my kidneys failed. I had a severe allergic reaction which could have killed me. When I began to feel seriously unwell, she just suggested I had the flu. I went to emergency and they rushed me in and started treatment immediately. They also discovered that I had developed resistances to several of the antibiotics she had put me on repeatedly, and I had to have IV antibiotics for a month to treat the persistent infection. Basically, I ignored my gut instinct and an incompetent physician nearly killed me.

Now, I'm very choosy about which doctor I will see. I love my GP, because he does his research, stays up to date, and if he doesn't know, he's honest about it and refers to a specialist right away. He is very straightforward and now my whole family, even 2 uncles, go to him on my recommendation. He does not handle maternity care, so when I was pregnant, I found a midwifery practice on my own. I knew that I wanted the least interventions possible and I looked for someone who would be supportive and encouraging of that. The practice I ended up with was a bunch of OB's and midwives who work together with doulas through a kind of program called "Centering Pregnancy". They provide all the pre-natal classes and care, birthing, post-natal care, lactation consultation, and doula care services together. As it turned out, I required interventions due to labor-induced hypertension. But I felt great trust in my care providers, their competence and respect for my wishes. Even though things did not go as I'd hoped (do they ever in childbirth?), they still stuck as closely to my birth plan as possible. The midwife delivered my baby, the OB was there to deal with my hemorrhaging, and the doula was there to comfort my husband and help me to breastfeed in those first minutes.

By the way Mary, great topic!

Krista - posted on 01/05/2010

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That's great advice, Mary. Unfortunately, in less populated areas, often what you've got is what you've got. I had the choice of two obstetricians, who work out of the same practice. I liked them both, but the female doc was more in line with my own philosophies and birth plan, whereas the male doc, while very kind, was a bit more traditional (pro-epidural, pro-episiotomy, etc.) I gave them both copies of my birth plan and discussed it with them, and they were both on board. But, when the time came, it was the male doc who was on call. And things wound up being a lot more...medical than I would have wanted. Of course, it's hard to second-guess someone who's been delivering babies for years and years, but there were just little things that I wondered about. Namely, they induced me because my membranes were not broken, but were leaking. Nothing was happening with the pitocin, but then when my water DID break, I had so much pitocin in me that the resultant contractions were agonizing enough to make me beg for an epidural. Then while pushing, Sam's heart rate started to drop, and the doc wanted him out NOW, so he gave me an episiotomy (he did ask, and I was too scared to say no, due to the urgency of the situation.) In retrospect, I should have asked them to break my waters first, before trying the pitocin, to see if that would have brought on a more natural labour. And you're right -- I should have been more educated. I had read about induction, but hadn't really studied out the different ways it can happen and what I would prefer. In retrospect, I should have read up a LOT more on that.

Sarah - posted on 01/05/2010

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Well, for the first 20 odd years of life i had the same GP as my parents. So i knew him well as i'd known him from birth! There had been mainly the same GP's at my doctors surgery my whole life, so you kinda see all of the them at some point. I've liked them all.
Then just before i got pregnant with my eldest, my GP retired and a new GP took his place (we were given the option to go to another GP within the practise if we wished)
Anyway, i'd heard some bad things about him to be honest, but the first time i saw him (to say i was pregnant) he was FAB!! He's just really no nonsense and straight to the point. I guess some people don't like that, but i really like his attitude.

The midwife part of my GP's is a bit poor. I saw the same midwife mostly through my first pregnancy (tho she wasn't there at the birth!) with my youngest i saw a different midwife every time. They were all nice tho. As i knew they wouldn't be there at the birth, i guess it didn't really matter.

I didn't have a birth plan (i'm too disorganised for such things!!) good job too as neither of mine would have gone anywhere near to plan!

If i had any issues with my GP i would certainly look to get another one, luckily tho, i really like mine! :)

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I guess I lucked out. I never even considered interviewing my doc, the thought never occured to me, but I love my doc. He's been great to me and we agree on most issues. But I'm also not afraid to ask him questions and express my views. If I didn't like him, I wouldn't hesitate to start looking for a new doc.

As for a birth plan, never made it that far. I delivered the week before my first visit with my OBGYN. But the OBGYN that I was supposed to see had a great reputation, was the head of the department and came highly reccomended by family and friends who had had him.

Now that you've mentioned it, it makes sense to me that you should interview possible docs. If I ever ahve to switch I'll keep it in mind.

Esther - posted on 01/04/2010

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My "birthplan" didn't extend beyond getting Lucas out in one piece. I had decided that I wanted to know as little as possible so as not to freak out, and to trust my body and my doctor. And I did and I have no regrets. I also just didn't see the point of coming up with a birth plan since there are so many variables and so many unknowables that I just didn't think it was worth the time, effort or anxiety (it would have created anxiety for me, but I know to some it has the opposite effect).

I also agree that it makes no sense to think up a detailed birthplan and then fail to discuss it with the very person who is supposed to help you make that a reality. I had a miscarriage before I had Lucas and I went to an OBGYN I had never been to when I was 8 weeks pregnant with that baby. The OBGYN I visited then was horrible. She showed no sympathy, no interest in me, ignored my husband completely etc. I went to her once. Then I sent her a letter explaining why I would not be coming back and asking her to please send over my file to my new OBGYN who I love. He was there for my eventual D&C and then for my pregnancy & the birth of Lucas.

For my pediatrician I interviewed. If a pedicatrician didn't do interviews (there were some) they were automatically struck off my list. I did this when I was still pregnant (obviously) and we discussed things like vaccinations, use of drugs to deal with things like the common cold etc. to make sure that our general philosophy and hers were compatible. Again, I have no regrets. I think it's very important to find a doctor that you have faith in and that is more or less on the same page as you.

Sara - posted on 01/04/2010

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In all honesty, I can't say I've ever interviewed a doc, mostly I just have been referred by a trusted source. I would not go back to a doctor that I didn't jive with though. When I was pregnant, however, I had to switch doctors at 18 weeks and had very few to chose from and I did not get along with my doctor on all issues. Technically, I had faith in him and we did discuss a birth plan, which we agreed on, but he was a worse case scenario kind of guy and left me crying more than once (he gave me the "babies can die at any time" speech around 28 weeks, that was a classic). I have since found a new OB/GYN that I go to and will go to for the next baby that I am more comfortable with (they didn't accept my insurance previously). My point with all that is that sometimes you don't have many options, escpecially if you're talking about a specialty. I feel I am a very informed person medically and am an advocate for myself, but I found myself in a less-than-perfect situation, it's easy to do. If you throw in someone who doesn't have a lot of medical knowledge or know how things work, I can imagine it would be a difficult situation, like what you've described. Some people just don't really understand how it all works...and that's nobody's fault but their own.

Lindsay - posted on 01/04/2010

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I feel like I have been very lucky choosing doctors. The only doctor I see personally is my OBGYN. I love her and feel comfortable and confident telling her what I want and how I feel and she's also not scared to voice her opinion. I actually started going to her because my mom did and recommended her to me. It's been a great fit!



Then I didn't have a hard time choosing a pediatrician because the one we have I have known my whole life. Her parents and mine are great friends. She started practicing here about 1 year before I got pregnant with Madeline and it was a given that I would choose her. I have never once regretted that decision.



So ultimately, I've never been in a situation where my doctor and I just didn't see eye to eye. But my doctors are not strangers and we've discussed everything before going into something. I do feel that we only hurt ourselves by not communicating what we want and finding the right doctor be it the 1st or the tenth we try.

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