True Story: When a friend of mine was in medical school he did his obstetric rotation in a center city hospital. He prescribed birth control pills for one woman and carefully instructed her to take one a day. When she came back pregnant four weeks later, he couldn’t help but ask, “Didn’t you take the pills?” “Of course!” she replied, “I inserted one in my vagina every night.” We can laugh at this story, and have sympathy for the woman’s plight and my friend’s frustration, but what a clear example this is of miscommunication between doctor and patient!
Physicians and their patients often experience a lack of communication, but this is commonly heightened in the midst of crisis. Life and death issues are faced, and emotions increase. It is more difficult to think clearly, much less to ask appropriate questions and hear and understand the answers. There is a certain crisis mindset that takes over, which appears to allow only a small amount of new, frightening information in at a time. No matter how hard a patient tries to comprehend a doctor’s descriptions, she may not be able to retain more than a small bit at a time. This is a natural, healthy response. It helps a person to maintain some semblance of equilibrium, and gradually to develop coping mechanisms. But this “bit by bit” approach feeds into another common reason for lack of patient/professional communication: A patient’s fear of appearing unintelligent. It seems that if a patient asks the same questions over and over, she must be stupid. In reality, this proves that the patient really does want to be an active member of her healthcare team, and that she is smart enough to ask the right questions to get the answers she needs. One study was done in a pediatrician’s office, recording the number of calls made by mothers of babies up to six months old. It was found that the mothers who made frequent calls during the first few weeks were those who were the most intelligent, caring mothers –not the dumb, neurotic ones! These mothers also gained confidence during that time and made far fewer calls in subsequent months.
Many patients don’t ask questions because they are afraid of the answers. This is a realistic fear when faced with a complicated pregnancy. No one wants to have problems in pregnancy, or to think of the inherent risks. On the other hand, it is vital to understand as much as possible about what is happening in order to comply with whatever care is needed to treat the problems. A mother who is experiencing hypertension, for example, needs to know what symptoms to look for and how to care for her body in order to prevent the problem from accelerating.
One big complaint patients have about doctors, especially in big hospitals, is the lack of time doctors spend with each patient. Most doctors, if given their choice, would spend much more time with each patient. Some, especially medical students, seem to see patients as symptoms rather than people. Finding something personal to comment about –even something as small as the doctor’s tie or the weather- may break the ice a little, and allow the professional to see the person being treated rather than the problem. A patient should feel it her right, however, to request a reasonable amount of time to speak with her doctor. This won’t occur every day, but a planned appointment will provide for more time for needed explanations.
Many patients are afraid they appear stupid, but many doctors make the opposite assumption: they assume a patient is educated and aware of the problem, and doesn’t need to have the details explained. This especially occurs when the patient is a medical professional herself. In this situation, the physician may also use medical jargon, which has little meaning to the layperson. While it is important to understand the meaning of “hemorrhage”, “intraventricular”, or “abruptio placenta”, for most people plain language would be “bleeding”, “in the vein”, etc., will make a more lasting impression.
So how do you go about talking clearly with your health-care provider?
1. Consider yourself an important member of your health care team. Indicate an interest in knowing all about your pregnancy. Be your own advocate!
2. Approach your physician with respect, and demand the same back. This means learning to be assertive, but not aggressive. Be friendly, straightforward, and respect his or her time constraints, while seeing that you’re own needs are met. Recognize that your doctor is a human being who may have a lot of knowledge about high-risk pregnancies, but who is human just the same.
3. Ask direct questions. It is valuable to prepare questions beforehand, and jot down the answers while speaking with the physician. Many people find it easiest to understand the workings of their internal organs if they can see a sketch. Once a doctor is assured his or her artistic merits are not being judged, he or she may be willing to draw pictures of a placenta previa or a cerclage for an incompetent cervix, for example. Seeing what is happening inside you may make all the difference for you.
4. Express your feelings, in a direct but non-threatening way. “You don’t spend enough time with me!” may be better expressed as, “I understand that you have a busy schedule, but I feel a need to talk with you at greater length. When would be a convenient time?”
5. Be specific. Just as it is frustrating to have a doctor say, “You’re on bed rest” without explaining exactly what he considers “bed rest”, it is equally detrimental if you remain general in your descriptions. One woman we spoke with was feeling a lot of pressure in the area of her cervix, but she reported to her doctor that she was “feeling heavy.” Assuming she meant that she was feeling overweight, her doctor assured her that that was normal in every pregnancy. Fortunately for her, she went in for an appointment and discovered that she had started to dilate, and was put on bed rest. Even if you don’t know the exact medical terms for your problems or parts of your body, describe exactly what you are experiencing and where, how often and at what time of day (or following what activity). Only you can offer this type of information.
When you and your healthcare providers understand each other and work together to treat the risk to your pregnancy, you will feel empowered. This in itself can help to alleviate some feelings of helplessness, hopelessness, incompetency, anger and fear. It can reduce your level of stress, and perhaps even lengthen your pregnancy. Caring so much about what happens in the pregnancy will engender feelings of motherliness and the beginnings of attachment for your baby. What far-reaching effects such a seemingly minor experience can have!
I want to thank you for the wonderful packet of information that you sent me so speedily. It was the most comprehensive source that I found. At the time, I could not talk with others about what I was going through. That packet of information offered me hope, information and a direction to take as we proceeded with the pregnancy.
We know we are truly blessed to have both boys with us and that they are healthy. They were born at 36 weeks on September 24th.
Thank you so much. You are doing great work and it is appreciated.
Lynn and John
Annie, Will, Ben and Ian