**Please don't copy any of this post. You can send readers to the link for this post which is off of www.yayastuff.blogspot.com:
http://yayastuff.blogspot.com/2008/09/rules-for-obgyns-after-patients.html
Thank you. Alicia**
1) When the news is told to the patient that their baby did not make it, please be sensitive to the fact that this is life-stopping news for the patient. They are completely and utterly devastated. This is the worst news in the world to them. Do not start telling them platitudes such as: "It's God's way", "It was meant to be", "It was just a bad pregnancy", "You can try again", "At least now we know you can get pregnant", etc etc. All you have to say is, "I'm so sorry". And don't refer to it as an "abortion", even if that is one of your medical terms for it, because that implies that we had a choice over this, and we did not choose this.
2) DO NOT make the patient check-out at the regular check-out counter where she will have to wait behind pregnant women to pay her co-pay. Also, do not have her leave without paying her co-pay so that in a month when she is starting to heal from all of this she will receive a bill in the mail that will remind her of this horrible day in her life. Handle the billing privately from your office.
3) On her follow-up visits to discuss the miscarriage, DO NOT make her wait in the main waiting room with all the other pregnant women. Find an empty office, or create a separate little waiting room for these moments. It is horrible to be sitting there because you lost your pregnancy and to be among women with big, beautiful, pregnant bellies.
4) Have something on the patient's chart to the effect that she has just had a miscarriage so that the nurses don't stupidly ask the routine question of "when was your last period" which causes the patient to get upset and have to explain that they just had a miscarriage, when your nurses should be well aware of this fact.
5) See #2 for how to handle paying the co-pay for this visit.
6) Try to have other magazines in your waiting room other than all pregnancy and parenting magazines. Not only do we have to sit among a room full of pregnant women reminding us that we lost our baby, but we have to stare at nothing but pregnancy and parenting magazines and posters.
7) Excluding molar pregnancies, do not tell the patient when they can/cannot start trying to conceive again. Some women cannot even fathom trying to conceive at this point in time, and other women feel the urge to try to conceive right away. Your personal opinion on this matter does not matter.
8) There is no "right way" to grieve. Don't judge the patient for their style of grieving.
9) Do recommend local support groups, counselors, and other methods of healing such as acupuncture to assist the patient on their (long) path of healing. Do offer a non-judgmental listening ear because at this point the patient is feeling completely and utterly alone in the world and you are the only person that they think might know any ounce of pain that they are going through.
10) Remember: you see miscarriages all the time because of your profession. But for your patient, this is their life and their miscarriage and they are feeling completely alone and empty. They are mad at themselves and at the world. They will get better and they will eventually heal, but not right away, and not in a day. Be compassionate to the grieving process. I realize that maybe doctors force themselves to become detached from such emotions so that they can proceed with their jobs without letting such personal feelings interfere and wear them down, but please, remember to have a moment of compassion and sympathy for the very real and very raw emotions that your patient is going through.
6 comments:
Alicia,
OB/GYNs certainly need to be more aware of the issues you described!
Jeanne
Dumb OB/GYNs and their staff. When a friend of mine went for her follow-up appointment the nurses asked her how the baby was doing.
How rude was that? It would seem like they would have it written on the chart that she lost the baby.
Hugs and Mocha,
Stesha
Hi Yaya, been lurking on your blog for a little while and was reading some of your older posts and found this....Thank you so much for sharing this! I am a Women's Health NP, and worked for 4 1/2 yrs. with a male dr. who I could not get to understand any of this "It is god's way" was one of his classic lines....I am fortunate enough to have never had a miscarriage, so I would not dare to wrongly say I know how you feel... but have friends who have and lots of patients and my heart goes out to everyone who has to experience this I can't tell you how many times I have made myself hold back tears when knowing I would have to tell someone this news....It always irritated the nurse when we would get busy and backed up in the office while I was pregnant, because I would not see anyone who had - had a miscarriage for the same reason you mentioned....How insensitive is that for a pregnant woman to waddle in and try to talk to you about what you are going thru with your miscarriage....and you are right many healthcare providers do get somewhat "desensitized" to this when they see it every day which is so very wrong....My dr. routinely put patients who had lost a baby on the same wing as postpartum patients which is beyond belief in my opinion. That was the uttmost lack of sensitivity! I could not believe he would never even stop to think about it.....Wish your post was required reading for OB/GYN's....Best of luck to you in the future......Prayers and positive thoughts to you....:)
Hey- just wanted to weigh in when I saw this on the sidebar. My husband is an OB/GYN...and although it was difficult and devastating to suffer through our many infertility issues and miscarriage- I believe it was so that he could experience it all with me and be a better physician because of it. He comes home truly grieving when a patient loses a baby-empathy that makes him a better doctor and person. Our experience and difficulty became a compassion training ground for his career.
I am so, so truly sorry for your loss.
blessings,
kijsa
Amen to putting something on the chart. I got asked by multiple nurses during those visits whether I thought I might be pregnant. It's probably a good thing that I was too shocked to react violently.
i think my old doctor's office must have read this blog. when i found out that i lost my baby, a year ago today, the staff was so sensitive. two weeks later when i went for a check up they whisked me in and out ahead of everybody else because they didn't want me in the waiting room with all of the other pregnant women. they did the same thing at my six week appointment. i could see on my chart that they had written what had happened. i thought that it was very nice for them to go to such lengths to try to help me.
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