Your Baby is Abnormal

[AnaKhouri]

We had a couple (very minor, but it seemed terrifying at the time) scares with Khan, and the midwives were wonderful. I can't imagine dealing with a doctor with that, but I guess also maybe she is so far along she doesn't want to change doctors at this point.

[NateTheChops]

God. My sister was born with a cleft pallette, so she needed surgery for that. But she was also gaining weight very slowly due to breathing problems (she couldn't suck on the bottle for very long) so she also needed a trach tube.

When she did start speaking, (at eighteen months, I should add) she was speaking in the usual baby pre-verbals. But you could understand some words like, "Matt-Matt," her cousin, "ment-ment,", which meant she wanted to go into the basement, and "Nat-Nat,", which was me, of course.

The therapist that was working with her insisted that she would have speech problems because of this. It's like...hello...she's eighteen months and you're expecting what? Shakespere? She's all ready pretty damn verbal for someone her age and can you tell me how many eighteen month olds know where the basement of their house is? (Seriously, if anyone said the word basement we had to take her down there or she'd get upset)

My mother was not at all impressed with any of the "proffessional" staff who worked with her in Mollie's first few years. By now, of course, if you just spoke to her you would wonder where said therapist ever got her degree from.

[Sparky]

Doctors use terms that have specific meanings. These may not be the same meaning that non-medical people apply to the word. Doctors tend to forget this.

Some examples of medical terms:

Abnormal = not typical
Surgery = removing a mole
Discomfort = severe pain

[blas]

My former coworker Mary got pregnant with her first child at 39 (it was a surprise and quite scary for her), and since she had never given any thought to children or anything that goes with pregnancy (not her fault at all), she was in for more surprises.

She came to work terrified one night before her amniocesis (sp? whatever that test that is they usually do on older moms or women with high risk pregnancies) because her doctor told her that older women tend to have abnormal babies. Worded as though it were a guarantee. As if she were the only woman to ever get pregnant at nearly 40.

She switched doctors, and of course, her baby was fine!

[wagegoth]

My former coworker Mary got pregnant with her first child at 39 (it was a surprise and quite scary for her), and since she had never given any thought to children or anything that goes with pregnancy (not her fault at all), she was in for more surprises.

She came to work terrified one night before her amniocesis (sp? whatever that test that is they usually do on older moms or women with high risk pregnancies) because her doctor told her that older women tend to have abnormal babies. Worded as though it were a guarantee. As if she were the only woman to ever get pregnant at nearly 40.

She switched doctors, and of course, her baby was fine!

It increases the chances, but the percentage of abnormalities is still under 3%.

[Sapphire Silk]

I add my hate to yours. They probably aren't even RNs. And the next time they make a comment, just say, "Are you a doctor?" When they answer, say, "Then giving me a medical opinion would be illegal, wouldn't it?" If they keep it up, tell the doctor and also ask for the supervisor to file a complaint. And don't back down.

As a nurse, I would not back down on that. Because education on health risks is a primary nursing responsibility, and the risk factors of diet, alcohol, drug use, and smoking are well known. Here's a dirty little secret of health care: nurses practice medicine all the time. What we really can't do is diagnose . . . which is fine with us as that is not our role. Our role is to provide education and care.

What they NEED to teach is called "The Hippocratic Oath." ("First, do no harm.") Telling someone their fetus is abnormal when it's just a bit chubby? Doesn't the doctor accept that as "emotional harm?"

It is true that many physicians (but not all) have forgotten Do No Harm. Such are more concerned with their financial goals than with what the patient really needs.

Nurses don't take the Hippocratic Oath. They take the Nightingale Pledge

Doctors use terms that have specific meanings. These may not be the same meaning that non-medical people apply to the word. Doctors tend to forget this.

Some examples of medical terms:

Abnormal = not typical
Surgery = removing a mole
Discomfort = severe pain

Here's another:

Abortion=end of a pregnancy without a viable fetus. An intention ending (whether for medical reasons or not) of a pregnancy is a therapeutic abortion.

A miscarriage is a spontaneous abortion. There are other types with equally confusing terms.

My former coworker Mary got pregnant with her first child at 39 (it was a surprise and quite scary for her), and since she had never given any thought to children or anything that goes with pregnancy (not her fault at all), she was in for more surprises.

She came to work terrified one night before her amniocesis (sp? whatever that test that is they usually do on older moms or women with high risk pregnancies) because her doctor told her that older women tend to have abnormal babies. Worded as though it were a guarantee. As if she were the only woman to ever get pregnant at nearly 40.

She switched doctors, and of course, her baby was fine!

Amniocentesis. Any woman 35 and older, 1st pregnancy or not, is automatically high risk. They are at increased risk of genetic disorders like Downs, for miscarriage, and to have to deliver by C-section.

However, high risk does not mean "always" or even "often".

[Mishi]

Here's another: Abortion=end of a pregnancy without a viable fetus. An intention ending (whether for medical reasons or not) of a pregnancy is a therapeutic abortion. A miscarriage is a spontaneous abortion. There are other types with equally confusing terms.

That is definitely something that the doctors should be reminded of!

[wagegoth]

As a nurse, I would not back down on that. Because education on health risks is a primary nursing responsibility, and the risk factors of diet, alcohol, drug use, and smoking are well known. Here's a dirty little secret of health care: nurses practice medicine all the time. What we really can't do is diagnose . . . which is fine with us as that is not our role. Our role is to provide education and care.

Yes, those risks are well known, so repeating the same thing time and time again only pisses people off, it isn't educating them. Also, you don't necessarily know what all my health issues are, so lecturing me about something like that isn't going to help anyone and it's going to make a mile-wide rift in the patient relationship.

[blas]

A lot of nurses smoke. So do a lot of doctors. I'd rather not be preached at when they probably stop at Starbucks every morning, smoke half a pack of cigarettes, and then eat Arbys on the way home, same as I do.

[Sapphire Silk]

Yes, those risks are well known, so repeating the same thing time and time again only pisses people off, it isn't educating them. Also, you don't necessarily know what all my health issues are, so lecturing me about something like that isn't going to help anyone and it's going to make a mile-wide rift in the patient relationship.

So you think I should just ignore the obvious and say nothing at all?

All too often I have patients who complain about chronic pain. If they lost the weight, a lot of their pain would go away.

Or patients who continuously have problems with asthma . . . that would go away if they quit smoking.

It is true some patients don't want to hear it. How far I'll go will depend on the willingness of the patient to listen.

But to ignore clear teaching needs is negligence . . . we have a legal duty to do that teaching, as well as an ethical one.

Most patients welcome teaching. You seem rather defensive about it. My suggestion would be to have it documented in your chart, "Do not educate me on risk factors related to weight, smoking, alcohol or drugs." Otherwise, the staff have no other choice than to do the education.

A lot of nurses smoke. So do a lot of doctors. I'd rather not be preached at when they probably stop at Starbucks every morning, smoke half a pack of cigarettes, and then eat Arbys on the way home, same as I do.

Actually, very few doctors smoke. Most doctors are of a healthy weight as well.

Nurses do have a problem with the smoking and weight issues. Personally, I do understand the objections of folks who see through the hypocrisy of someone who weighs more than they do trying to educate them on diet. I agree that nurses should practice what they preach. It's a controversial issue within the profession . . . and I've had colleagues get just as defensive about their weight as the patients they are trying to teach.

[Thrifty]

Okay so I had what I thought was a bad doctor experience during a pregnancy, and this new pregnancy all but confirmed it.

So the first time I got pregnant I had an ectopic pregnancy (baby starts to grow in the fallopian tube, not the uterus, very dangerous). If you have one ectopic pregnancy you are at a higher risk for others, very scary.

So I find out I'm pregnant make an appointment explain my fears. They have me come in for a blood test. They call and say you are pregnant, I ask for numbers they refuse to give them to me and have me come in a month later for my first check up. They run various tests and never tell me what any of the results are including the big ultrasound that looks very deeply at the baby. So I switch docs and all is well.

Well I'm newly pregnant again and go back to doc's office I was satisfied with. I called them on a Friday letting them know i had a positive pregnancy test, they got me in monday for blood work, and I have an ultrasound this Thursday.

It is amazing to me that one doctor's office can refuse any results and make me feel like I'm nuts for wanted to get some early tests, and another doctor's office is all over it, making sure me and baby are safe.

[Sapphire Silk]

I don't understand it, either. Patient care is enhanced when the patient is a partner with the physician.

I think it has something to do with the realities of our health care industry. Patient's aren't people. They are commodties. Get them in, get them out because you have to keep the volume up in order to make a living because the reimbursement is so low.

[Teskeria]

As a nurse, I would not back down on that. Because education on health risks is a primary nursing responsibility, and the risk factors of diet, alcohol, drug use, and smoking are well known. Here's a dirty little secret of health care: nurses practice medicine all the time. What we really can't do is diagnose . . . which is fine with us as that is not our role. Our role is to provide education and care.

Don't smoke, rarely drink, don't use non-prescribed drugs (and usually don't use all prescribed doses of painkillers. they make me queasy). However if:
1. Physically handicapped and unable to exercise (was only about 20 lbs overweight before the accident)
2. over 40 lbs of the excess weight was gained while exactly following they doctor/nutritionists diet (had both working together), after having explained to both that their diet was almost twice what I normally eat.
3. been at same weight over 25 years
4 (less important perhaps) every single female in the last 4 generations (except 1 with thyroid issues) has weirdly enough hit the same weight range around the same age (and that includes those like me who didn't see any of the family for a good 15 or more years at one time)

Lecturing me on how I need to lose weight goes in one ear and out the other. It's really fun when they ask for what I've eaten and I can tell them exactly and it's exactly what they intended to recommend as a diet. Get the facts before you lecture is my opinion.
Although I refuse to ever see again the doctor who's first words to me, while I was in severe pain were 'Oh you very fat'

[RecoveringKinkoid]

Some of these posts are skirting the fratching line. Let's keep the thread open by not going there.

[Seshat]

So you think I should just ignore the obvious and say nothing at all?

All too often I have patients who complain about chronic pain. If they lost the weight, a lot of their pain would go away.

<snip>

But to ignore clear teaching needs is negligence . . . we have a legal duty to do that teaching, as well as an ethical one.

Most patients welcome teaching. You seem rather defensive about it. My suggestion would be to have it documented in your chart, "Do not educate me on risk factors related to weight, smoking, alcohol or drugs." Otherwise, the staff have no other choice than to do the education.

My family doctor keeps track of my weight and stores it in my chart. I don't smoke, drink or do non-pharmacy drugs: this minimises the amount of repeat-education I get from that practice.

When giving my medical history, I almost always mention that I've done a chronic pain course at the major rehabilitation hospital in the state. That seems to reassure medical staff about what I know and don't know about managing my pain. That sort of thing might work for people.