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Re: Rhogam From: Glen Elrod (dr99645@yahoo.com) Thu Feb 26 17:44:57 2009 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: Rhogam" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Rhogam" Maybe in reply to: Glen Elrod: "Rhogam" Next in thread: Glen Elrod: "Re: Rhogam" Gordon, I'm not obligated to take these patients. In this community the lay midwives have had an adversarial role with the OBs in the community (three currently). I was led to believe that it was the MW that started the tensions. Because of this, they would bypass our hospital and travel another 45 miles to Anchorage during an emergency. About 6 months ago I had my first interaction and it was positive. I figured out quickly that it wasn't the midwives causing the tension, it was the stigma and perceptions placed by the medical staff on their patients that started it all. Since then, we have had more hospital interactions and now I am essentially the 'go to' guy for them. I have reviewed their state guidelines, reviewed all the charts I've seen from them for appropriateness of care/testing/referrals and I haven't found anything shady at all. Some of my most challenging OB cases have come from them. >From a business model for me, it has been a great asset to my young practice. Just this week, I have delivered four patients connected with the midwives. this one, a trisomy 18, a transfer in labor and a transfer to me several months ago. I've done 1 of 'my own' patients in that time. Now I see all their colpos, tubals, etc. so it works in that way as well. There are a few that are just a bit different and figuring out how to take care of them with their limitations on 'traditional' ob practice is a challenge, but one I'll hopefully figure out. Glen ________________________________ From: Gordon Goldman <obgyndoc@swbell.net> -- ________________________________ To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> Sent: Thursday, February 26, 2009 3:08:53 PM Subject: Re: Rhogam Glen, Are you in a practice setting where you are obliged to take this kind of patient on?? Personallly, I would most likely have sent that patient to the SOB down the street. Gordon On Feb 26, 2009, at 5:35 PM, Glen Elrod wrote: Transfusion was the only thing I could come up with. but the liklihood is so low. Why the objection? Probably the same reason she objected to fetal monitoring, pit, vit K, eye ointment, etc etc etc. Glen ________________________________ From: "art fougner, md" <evsono@pipeline.com> ________________________________ To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> Sent: Thursday, February 26, 2009 1:59:12 PM Subject: Re: Rhogam Oh transfusion reaction down the road, difficulties if a transplant needed ... what exactly is her objection? Art At Thu, 26 Feb 2009, Glen Elrod wrote: > >Pt today is s/p delivery and is refusing Rhogam. Baby was Rh +, but they are certain they are done having kids. He is having a vasectomy. She states she will not have other children even if her children die, husband dies, etc. > >Is there any NON-pregnancy risk to not getting Rhogam now? > >Glen -- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: Garry E. Siegel, M.D.: "Re: Rhogam" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Rhogam" Maybe in reply to: Glen Elrod: "Rhogam" Next in thread: Glen Elrod: "Re: Rhogam"

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