HOW TO FIND A COMPETENT PHYSICIAN YOU CAN TRUST: WHEN TRUST IS LOST
In one situation of lost trust, a woman I'll call Laura gave up the doctor who had helped her to become pregnant after four frustrating years of infertility. Everything was splendid until one night near the eighth month of her pregnancy, Laura's water broke at home. Her husband rushed her to the hospital.
Fearful that a premature son or daughter would die, the expectant father was drenched in perspiration and visibly trembling by the time Laura's doctor joined them in the labor room. They had waited two hours for him.
"Don't worry. Everything will be fine," the doctor assured them as he examined Laura. "The baby is in the correct position. Its heart rate is normal. You will have an easy and natural vaginal delivery," he announced. "Just relax and remember your Lamaze."
Laura breathed deeply.
The obstetrician patted her on the arm, looked at his watch, and excused himself.
Hours passed and Laura was still in labor. She wondered why the doctor hadn't come back to reassure her. She hadn't seen him since he had checked the time and left. Her husband was there, of course, but she couldn't shake the feeling of having been abandoned by the person who had cared for her for months, the person she had come to trust and depend upon for guidance and moral support. No one in the hospital seemed concerned about her or her baby, no one but an intern who stopped by on his rounds and perfunctorily examined her. She was delighted to see a medical man enter the room, but her pleasure changed to anxiety when she noticed his look of consternation.
"It's a breech . . . you know that, don't you?" he asked with an assuming
nod.
"A breech? That's ridiculous," argued Laura. Her voice was quivering. "My doctor said everything was perfect. You must be making a mistake. Where is my doctor?" she pleaded in a close-to-hysterical cry.
"Yes, where is he? Please get the doctor," pressured Laura's husband, who had never fully calmed himself.
"Well, I don't know, but we'll have to find him because this is definitely a breech," said the intern.
Laura's husband and the intern had the doctor pagedno response. They called his officeno response. Frantic, they left a desperate message on his service! "We're trying to find your doctor," the intern told Laura as he held her hand. Tears of despair were spilling onto her cheeks when the obstetrician finally arrived in his cashmere coat, white silk scarf, and black dinner jacket. He had left not only the premises, but the neighborhood as well. While Laura's state of alarm had grown impossible for her to contain, he had been miles away, shaking hands at a friend's testimonial dinner.
Laura tried to figure out why he had gone so far from her. Even she knew that a premature birth could be very difficult and risky. She quickly questioned him, but he wasn't cooperating. Without any explanation, she was wheeled into the operating room for a cesarean section. Her world was in rapid motion. She didn't understand how circumstances could change so fast. Why hadn't her own doctor diagnosed the breech right away? Why couldn't she still give birth naturally? He was the same obstetrician who had told her months ago that even in the event of a breech, she would still be able to deliver vaginally. Yet near the moment of birth, the time that every pregnant woman imagines for months, he was hurrying her into surgery. Her doctor didn't acknowledge any of her attempts to get information. She felt ignored, shocked, and eventually, hurt.
Laura's new daughter was a well and happy baby after a few days of intensive care, but Laura herself never recovered emotionally. She felt permanently robbed of her rights as a mother. She and her husband had prepared themselves for natural childbirth and parent bonding, and she saw no reason why they hadn't been allowed to follow through. Even the day after the cesarean, her doctor had avoided any conversation about the breech. It wasn't surprising that before she left the hospital, Laura had decided to shop for another physician, someone who wouldn't break his promises and manipulate her. "I don't trust him anymore," she admitted to her husband.
Through friends, Laura found a new doctor who reviewed her records and told her and her husband how absolutely right her doctor had been in doing the cesarean. Statistics show that the powerful force of natural childbirth is sometimes too much for a premature breech baby to survive unharmed. There's a very high risk that this fragile newborn would have had brain damage if permitted to come into the world naturally. A premature breech has a much better chance of escaping damage if he or she arrives by cesarean section.
Laura's confidence in her doctor had diminished when he had misdiagnosed the breech, but she couldn't forgive him, strongly mistrusted him, for failing to explain the reason for the cesarean. He may have done the right thing for her baby, but he had made her feel pushed around and used. If he had been more sensitive and communicative, she probably would have remained a loyal patient, but he lost her. Laura looked for a different physician, as many women in her situation would have.
Sometimes the "Marriage" Can Be Saved
There is always a doctor with whom you can create a fresh partnership. However, sometimes a woman may not want an instant and forever divorce from her doctor, as Laura did. Another woman may feel that her doctor is basically competent and even though he may have done something to antagonize her, she may decide to try to "save the marriage." Usually there is a point just before trust is completely destroyed, when, if a woman cares to, she can awaken her doctor to his shortcomings and strengthen their relationship.
One woman had believed in her doctor during his early days of practice when he had spent a lot of time consulting with her and explaining everything that he was doing. She had trusted him and praised his manner and skill. After he had cured an infection in her tubes, she had wanted contraception and, like true equals, she and he, together, had decided on an IUD for her.
Years passed. One day she read that IUDs might damage a woman's tubes and she was anxious to talk to him. She was considering the possibility of becoming pregnant and she wanted his advice about her prospects. Were her tubes all right? She arrived for her appointment, but now his practice was flourishing and she felt like a numbered part on an assembly line conveyor. She was whisked into a gown, into the examining room, into his office, and he barely gave her time to think about her questions.
If she hadn't known him very well she would probably have lost faith in him and looked for another doctor, but she considered their relationship a marriage, a fading marriage, but a marriage nonetheless. She made an effort to bring back the communication they once had by doing something that, since the invention of the telephone, many people forget they can do:
Write a Letter. In a letter, she told him that she knew he had a thriving practice now and she didn't mind if she had to wait to see him, but when they were face to face, she wasn't getting the care she deserved. She reminisced about the way he used to talk to her and supply so many facts about her health that she used to feel like she was the doctor by the end of their visits. She explained that his empathy wasn't the same anymore, maybe because he was overworked and frazzled. "Perhaps it's time to reduce your patient load?" she wrote. "You may notice that I used to send my friends to you, but I don't anymore."
Her doctor trusted her integrity and responded to the letter. She had exercised her half of their partnership. She had made her needs known, as every woman who cares about her health should. The doctor telephoned, apologized, and softened his approach with all his patients. Trust was re-established and the marriage weathered the crisis.
It's often difficult to speak your feelings in person. You may love your doctor or be dismayed by him, but either way, you should, since you're his partner, tell him in a letter. So many people have come to consider the telephone as a natural extension of their arms that the quiet art of writing letters which tangibly place friendship and remembrance in one's handsis all but gone. If your doctor has proved he is competent, it's not only fair, it's warm and gracious of you to let your inner feelings flow onto paper. Writing a letter to your doctor is more than appropriateit's impressive.
Of course, if he has lost your trust, as Laura's doctor did, then you must not let your shared history prevent you from finding an easier partnership. With or without the mail, a doctor who loses his patients gets the message that he needs a new style.
Instinct will tell you if your doctor is taking your trust for granted and giving you less-than-thoughtful advice. Then you're faced with holding on or finding someone new. I'll answer questions from women who have found themselves perplexed by whether to get a divorce or save the marriage, figuratively speaking of course. But really, each woman's body ultimately offers the final solutions. If the signs say "go" and not "stay," there are certain essential measures of a new doctor's know-how to look for and find. Without these qualities there can be no trust. Now if you desire an obstetrician, ask your husband to join you in tracking down a doctor's competency quotient. A husband and wife should, together, pick the person who will help them have their son or daughter. That's really where the partnership which characterizes natural childbirth begins.
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Women's Health