A lot of our women run into challenges with their OBs, GPs, midwives, nurses, and even perinatologists not taking their concerns seriously. Women and their concerns are treated with everything from good-natured condescension to downright contempt. While there are many women who have positive and validating experiences with their doctors, we do find that more women have a less positive experience than not.
Here are some of the common comments our women encounter from health care providers and some proactive ways to address them:
1) You should not worry yourself--it will raise your blood pressure.
While your pulse can heighten with increased anxiety--sustained elevation in blood pressure or preeclampsia is a disease that is set in motion in the placenta and not from anxiety. More often than not--anxiety is a symptom of an elevated heart rate and actually evidence that your blood pressure is rising.
2) You should not believe everything you read on the Internet.
While it is true that the internet has a reputation for unpoliced and bad information--particularly in the area of medical information, the Preeclampsia Foundation takes its obligation to put out medical information very seriously. Our website was reviewed, edited and approved of by not only our medical board but also by Dr. Christopher Redman (Oxford University and author of "Pre-eclampsia: The Facts")--considered the world's authority on preeclampsia. There are a LOT of website with very good and solid preeclampsia information--the NIH, the American College of Obstetricians and Gynecologists, etc...The Preeclampsia Foundation has been cited as a reference by CNN, the New York Times, the BBC News, the TODAY show, as THE source on preeclampsia.
FOUR of our five Medical Board members (+ me) WROTE the National Institute of Health's Hypertension in Pregnancy Task Force GUIDELINES. Happy to send them a copy if they have any questions.
(Drs James Roberts, Marshall Lindheimer, Baha Sibai, and Phyllis August). Drs. Roberts and Lindheimer edited the latest edition of THE medical school textbook Chesley's Hypertension in Pregnancy and all the members of our medical board are members of the International Society for the Study of Hypertension in Pregnancy, the North American Society for the Study of Hypertension in Pregnancy, The Society of Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.
3) I'm the doctor
Yes s/he is. You need to listen to your doctor. But your doctor needs to listen to you. You, or your company, or your taxes are paying for those health services so essentially--you pay that person's salary. This is your baby. This is your body. You deserve to be treated with respect. You deserve to be taken seriously. You deserve to understand the decisions (or lack thereof) that your physician is making. You can take your business elsewhere--AT ANY TIME--even at 38 weeks--even at delivery. It is nice to be polite--but your greater obligation is to your health and your baby. You can apologize later if you were rude. You cannot undo medical mistakes.
4) You should trust us.
Doctors are people and people make mistakes. Over half of doctors surveyed by ACOG do not agree on diagnosis or treatment of preeclampsia. Experts do not agree on diagnosis and treatment of preeclampsia. Some doctors think aspirin will save lives. Others think it is dangerous. If the doctors don't agree--you are certainly reasonable to ask reasonable questions about your body and your baby's health.
When in doubt--there is nothing lost in getting a second opinion.
5) You're military--these are the only doctors you can see...
The last Tricare funding bill included a provision that permits any pregnant woman to get care outside of the military system. (I think
a Congressman's daughter had a similar problem). If she is not happy, she should ask to go else where. The request should be in writing and probably forwarded to the hospital commander. It would not hurt to forward it to her congressman if her requests are ignored. If they refuse a referral, I would get the refusal in writing - ask to place a note in the medical record that you requested a referral.
6) You don't need that test...
If your doctor is refusing to do basic testing (such as a 24 hour urine after signs of proteinuria, an ultrasound, Non-Stress Test, or blood work to check liver and kidney functions--AFTER you show signs of preeclampsia) use the following language with a kind and respectful voice:
"Fine. Please note in my medical record that I asked to have "x" on this date and that you feel that test is unnecessary." Check to be sure that note is there. Ask for a copy of the note.
7) You have preeclampsia because you are fat/overweight/or other disparaging remarks.
While we recognize that diet may be a factor for some women, and that obesity is a risk factor--unkind, unhelpful and frankly rude remarks do nothing to address the problem and ultimately only damage the patient-doctor relationship. If your physician treats you rudely--we encourage you to consider changing caregivers to someone who treats you with more respect. It is important that your physicians can handle delicate issues such as weight and other potential risk factors with compassion and tact. It is important that you feel "safe" emotionally as well as physically with your care provider. Regardless of your weight--you did not "cause" the preeclampsia and you do not deserve to be treated unkindly. Such remarks should be documented and reported to hospital/clinic/or office management.
8) You are overreacting (your partner, doctor, or others think you are a hypochondriac or at the minimum a drama queen).
Maybe you are. You should check yourself and see if there is validity to that...do you routinely see the worst in situations? Do you have a history of looking for the bottom to fall out from under you? Do you always seem to have crisis in your life? If so--consider as well--do you contribute to that crisis? Do you make bad choices, or avoid hard decisions that would make things more straight forward?
Maybe you are not. After checking yourself--and really giving that some careful thought--consider--pregnancy does involve a hormonal shift--so there is that factor. It is unfortunate but when pregnant women must present their fears and concerns with as much calmness and intelligence as they can muster--because you will be treated as a) a woman and b) in a state of perpetual PMS. These factors will allow people to dismiss or invalidate your concerns. Use words to describe your symptoms that are specific and without drama. Don't say, for example: "My stomach hurts"--say "I have a sharp/dull/stabbing/throbbing (pick the best one) pain here" and point to the spot. Sometimes just spelling things out to your doctor will aid in the diagnosis.
9) You are pregnant.
This is true. Preeclampsia mimics many normal symptoms of pregnancy. That is why it is important to attend prenatal visits and to follow up on doctor's advice. It is important to be educated, empowered and proactive.
10) You never told me "x".
This is also true. Many women run into problems because they fail to mention something "key"--such a blurry vision, or spots in front of their eyes. Better to say too much than too little. At the risk of forgetting something key--write down your questions, concerns, symptoms, and raise them with your physician. Don't go on and on--these folks are definitely running overtime and they will lose their patience--so if you are organized before you go in and can just go down the list--it will make them appreciate you more and ultimately you will likely get better care because they will take you seriously.
The bottom line is a good doctor takes his or her patients seriously...if you feel you are not being taken seriously and have honestly tried some or all of the above recommendations...maybe it is time to see another doctor.
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