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Re: Was this fair and appropriate treatment? I miscarried last week at 11 weeks..From: anonymous@obgyn.netWed, 22 Apr 1998 20:12:07 -0500 (CDT)
Sarah- Most doctors, myself included, are extremely reluctant to answer posts about other doctor's behavior. It's not because doctors "stick together" (contrary to popular belief we don't), but because it's impossible to be an armchair quarterback and second-guess someone else's clinical decisions. However....I would like to address some of your very valid questions and concerns. First, your story first made my wife (who is also a doctor ) and I think of very poor customer service by your physicians. It is, however, doubtful that any amount of "watching over" or ultrasounds would have saved your pregnancy. Although we would like to think we can intervene and save pregnancies when there is a threatened miscarriage, neither the patient, or her doctor can do so. It is also extremely doubtful that intervention during your first ER visit would have changed anything. I have probably cared for at least 500 women having a miscarriage, and I have never had a patient almost bleed to death like you did. Your experience was very rare, and could not be predicted. I think your doctor showed extremely poor judgement in refusing you consent for an ER visit. You were scared and worried about your baby, and reassurance by the ER staff may have helped. On the other hand, since it would not have usually made any *medical* difference one way or the other, it increases costs without *medical* benefit (although it often helps psychologically). You are insured, but somebody has to pay for the $200 ultrasound, $80 HCG level and $150 ER visit. Still, if the patient is bleeding and wants to be seen after hours, an ER visit is not at all unreasonable. The second biggest problem was having the "house staff" take care of you, when you are a memeber of a private practice. Believe it or not, that happens in my city, also, where patients come to our hospital and their doctor can't be bothered to come see them because it involves a 15 minute drive late at night. My partners and I, because we take in-house call and supervise residents, often end up caring for these grateful patients. Sometimes these doctors grouse about how "slow" their practices are, when our practice (and other nicer doctor's practices) are busy. Well, who would go back after that kind of treatment? It is possible you got better care by the supervising doctor on call, but it is still ridiculous that your doctor or one of the doctors from the group did not see you. As you have seen, not all doctors are nice people. Many of these folks are actually excellent "technical" physicians, but don't good people skills. Sometimes they feel they are overworked and thus too busy or too tired to see their patient. They should reevaluate the situation and change careers, or fix the workload problem. It's not your fault you were in need of medical attention. You should also know that poor attitudes towards patients cross all gender, racial, and religious lines. Since you can't test for a positive and compassionate attitude, the best you can do is ask friends in the medical field, or your primary care doctor, for a referral to someone they would go to. Nurses often know who the best doctors are and are more than happy to steer you to the good ones. I hope that this does not lead to a permanent distaste for physicians and the healthcare system. As you have seen on this forum, there are many doctors, nurses, ARNPs and CNMs who are eager to help and who like their jobs, colleagues, and patients. It's extremely hard work taking care of sick people, making difficult and dangerous decisions all day long, working 80-100 hours a week, performing complicated medical procedures, always being compulsive, fighting for patient rights with managed care organizations, and keeping up with changes in treatment, but most doctors I know really love taking care of patients and enjoy helping them feel better. Best wishes as you heal from your miscarriage.
-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida
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