May 2, 2012
When Doctors Won’t Listen (Part 2)
In Part 1 of Monday’s blog, we learned about Angela Burgin Login, a first-time pregnant mom who was developing pre-eclampsia but the signs were ignored by her physician. Angela almost lost her life because the recognition of her diagnosis was delayed. While most pregnancies are uneventful, a “normal” pregnancy will not always mean a “normal” birth. Things can change quickly, especially in the labor room. In order to have a favorable outcome at the end of a pregnancy, the healthcare provider and the patient must be in total agreement regarding expectations and treatment. Sometimes that may not happen. The most important task of a pregnant mother is to select the right provider and Chapter 1 of The Smart Mother’s Guide to a Better Pregnancy addresses this issue in detail. What then should a patient do if her physician is not responsive to her concerns? Here are a few strategies:
- Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
- If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
- If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.
By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.
Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 30, 2012
When Doctors Won’t Listen (Part 1)
We recently celebrated the arrival of a new addition in our family and it was a delivery made in Heaven. Our relative’s membranes ruptured, contractions started and she delivered a healthy baby 45 minutes after her arrival to the hospital. The doctor came 10 minutes before the baby was born and all she had to do was basically “catch the baby.”
Sadly, everyone is not as fortunate. Each month I review medical malpractice cases and shake my head in frustration because many of them could have been avoided if only someone had listened to the patient or paid attention in the labor room. Last week, the listeners of a popular morning radio show listened in horror to Angela Burgin Logan’s interview about her missed diagnosis of pre-eclampsia that almost killed both her and her unborn daughter. Fortunately she lived to tell the story which is now a movie entitled Breathe. Although Angela and her daughter are well, other women have not been as lucky.
Pregnant women need to start thinking in terms of “outcomes” regarding their pregnancy. As the healthcare “industry” moves deeper into the 21st century, healthcare providers and hospitals will be measured and paid according to the outcomes of the patient. You will hear terms such as “pay for performance” and “performance measures” used more frequently. A “normal” pregnancy does not necessarily mean a “normal” outcome at birth (aka healthy baby) if someone misses a sign or a signal of a potential life-threatening problem. Why does this happen? For reasons too numerous to count but the main culprit is lack of communication. A lab report with important results was not reviewed or signed. High-volume practices leave little time to provide quality care for patients and then of course, there is arrogance.
Two of the most empowering things a pregnant woman can do in order to improve her chances of having a healthy baby is to (1) select the right healthcare provider and (2) have strategies at hand in the event that she encounters administrative or clinical complications. In Part 2 of this discussion, I will provide some of those strategies in the event that you have a healthcare provider who will not listen to your concerns. Until then, remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
June 13, 2011
Do Most American Women Experience Complications During Delivery?
The answer is an astonishing, yes. The Agency for Healthcare and Research Quality (AHRQ) released a report on May 19, 2011 stating 9 out of 10 American pregnant women have complications while pregnant and during their delivery. Angela Burgin Logan was one of those women. She almost died because of pre-eclampsia but beat the odds and has produced a movie, called Breathe that tells her compelling story. She was also the topic of my previous blog almost a year ago.
The AHRQ’s report was enlightening. Of the 4.2 million deliveries that occurred in 2008, 94.1 percent has a complication. Some of those complications include urinary tract infections, anemia and vomiting. The treatment of these conditions is usually straightforward and uncomplicated. However, hypertension and the dreaded pre-eclampsia is a different matter. These conditions are unforgiving if misdiagnosed or not properly treated.
The hospital stay of women with complications who didn’t deliver was an average of 2.9 days compared to 1.9 days for women who didn’t have complications or a delivery. It is also expensive with a price tag of $17.4 billion dollars and represents 5 percent of all U.S. hospital costs. The average age of women who were admitted for complications was 27. Older women between the ages of 35 to 44 represented 15% of hospital admissions with pregnancy complications.
Pregnant women who live in rural and large urban communities are at greater risk for having significant complications that include umbilical cord accident, hypertension and preeclampsia. The West and the Midwest regions of the U.S. have the greatest delivery complications. Medicaid pregnant patients were admitted to the hospital and treated more frequently than non-Medicaid patients. However, pregnant women with private insurance had more complications at the time of their deliveries according to the AHRQ’s report.
What does all of this mean? That no one is exempt from having a complication during their pregnancy or delivery. To be forewarned is to be forearmed. Ask your OB provider whether he or she participates in “hospital simulations” regarding “what if?” scenarios. For example, “What if I don’t feel the baby move?” “What if I start to bleed?” Your healthcare provider should be able to articulate a detailed plan regarding your management.
And please pick up a copy of The Smart Mother’s Guide to a Better Pregnancy. It was written to empower patients to recognize potential red flags of their pregnancy and how complications could be managed before they spin out of control. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 12, 2010
Pregnant Woman Almost Died Before Her Doctor Would Listen
Every time I want to retreat from medicine, stories Like Angela Burgin Logan’s give me reasons to press on. Angela almost died having a baby because her physician was too careless to listen. Stories like Angela’s is what inspired me to write The Smart Mother’s Guide to a Better Pregnancy. I saw too many “near-miss” and “near-death” occurrences among pregnant women and decided to do something about it because most of them are preventable.
Angela is a 30-something year old African American alumnus of Syracuse University who has extensive business experience as a marketing executive for celebrities and is also married to one. She had an uneventful pregnancy up until her late second trimester when she developed signs and symptoms that any trained obstetrician would have immediately recognized as impending pre-eclampsia. She gained five pounds a week and developed swelling. She could only sleep propped up on a pillow because she couldn’t breathe pillow. She complained of shortness of breath and difficulty walking. All of her complaints were disregarded by her physician and staff in a condescending manner. It was only after she gained 15 pounds in one week did her physician reluctantly order lab tests based on her insistence.
On the night of her delivery, she went to the hospital because she could not breathe. Her blood pressure was extremely high, her platelets were low and she had significant protein in the urine. Angela had a lethal variant of pre-eclampsia called the HELLP Syndrome. Against Angela’s wishes, she was forced to lie on her back for a nursing procedure and fluid seeped into her lungs. She lapsed into a coma. An emergency C. Section was performed and it was discovered that she had an enlarged heart. Her infant daughter was born in distress and there was an 80 percent chance that Angela would die. Thank God she didn’t. Angela is now on a mission to warn pregnant moms about pre-eclampsia and urges them to “trust their instincts.” I totally agree.
Arrogance and condescension have no place in a patient-physician relationship and is a sure-fire way to end up in court. I urge all pregnant women to become proactive regarding their prenatal care and above all, trust your instincts. The days of the passive patient are gone. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
