Beware my vorpal sword!

Today has been one long clash with the medical community.

It started out with a dentist appointment. I haven't been to a dentist in a long time, partly because the last time I had a cleaning, I had a panic attack in the chair (two reasons -- 1. I was certain that the hygienist was going to snap my fragile front teeth in half, and 2. holding my mouth open for too long plays havoc with my TMJ with great anxiety ensuing). But also last winter my job canceled their dental contract with my evil HMO, forcing us to buy more expensive insurance and find new dentists. A week or so ago, one of my fillings began crumbling and I knew it was time. I had asked around at work for a dentist who could handle problem patients, and the referral turned out to be great. I trusted this dentist the instant I saw him. His office staff was very professional and I felt that he immediately understood me, my teeth and my freakish attitude about dentists.

Which is a good thing, since he has prescribed an immediate root canal, then a cleaning, then fillings for 4 cavities, and once we're done with all that, he wants to discuss orthodontia to correct my bite so that my constant tooth grinding doesn't kill all the nerves in my poor fragile front teeth. Whee!

As if that wasn't fun enough, I spent an hour this afternoon with my OB. Yes, that OB. She had scheduled me for a post-m/c follow-up appointment, so why not take advantage of the opportunity to express myself face-to-face? Amazingly enough, it went quite well, except for the fact that I cried the whole time (out of anger mostly).

We spent a few minutes on m/c stuff. Bleeding has been a continuous dribble until yesterday when it finally stopped. Had one last blob of tissue emerge weekend before last but nothing since then. Yes, I'm probably anemic, so let's test my blood. No, I don't think the depression and crying has reached the medication and therapy stage. Etc.

Then I began to speak my mind. She listened carefully to everything that I said and didn't do much in the way of making excuses. She admitted that she had failed me and handled the whole situation badly. She said that my bad experience with her and her staff was unusual, and that it was mostly her fault. She apologized several times. I explained that I wanted a new OB with more experience dealing with patients who have been through IF, and she promised to call several doctors for me this week -- doctors at a facility across town that apparently handles a lot of IF cases (diagnosis and IUIs only; the HMO doesn't have specialists). She said that she would tell them she had failed me and would ask them to provide me special treatment.

I then explained my brochure project and she voluntarily offered to gather all of the standard information that the HMO has prepared about m/c's (none of which she had given me previously), together with the HMO's nursing protocols about counseling m/c patients and send it to me for review. She said that if I have suggestions for improvements in the documents and protocols, she will help me express them to the people who manage such things. I asked her to put me directly in contact with the patient communications folks and she agreed.

We talked some about the conflicting information I received from her and the nurses in her office. This took some time, as she kept insisting that the information they gave me was the standard protocol. I had to keep reminding her that it was only standard for women having m/c's at 6 weeks or so, and that at 11 weeks, the information should have been very different in a variety of ways. She finally agreed.

Another point on which we disagreed was the genetic testing question. She insisted that their standard protocol is to not test unless someone has been through multiple m/c's. I replied, if that is the case, then why the hell had the nurse told me to bring in the "products of conception"? This got her thinking. Apparently it's their standard protocol to do that to make sure that it is not an ectopic pregnancy. Which makes no f-ing sense when the non-ectopic pregnancy has been seen on several occasions by ultrasound! She agreed that they needed to work on that particular issue. I also explained to her that people like me who had not had multiple m/c's might still be interested in genetic testing for other reasons. She said she saw my point, but mumbled something about the HMO not wanting them to do genetic testing on every single m/c because it is expensive and often doesn't tell them anything helpful.

Then -- and this was the funny part -- she asked me if I was sure I wanted to change doctors. Apparently, she likes me, thinks I'm proactive and sensible, really has taken an interest in our struggle to conceive (despite all appearances to the contrary) and, because of her personal respect for me, she assumed that I had more knowledge about what would happen during the m/c than I did and/or thought that I didn't need her to be as doctor-y as she might be for other patients. Weird logic, but I kind of get it. Nevertheless, this means that she put her professionalism aside and treated me differently than she would treat other patients. I told her that she was dead wrong to do so -- that she should always assume patients need all the information up front unless they tell her otherwise, and that if she'd really cared about my struggle, she wouldn't have made it worse by not returning my email or phone calls and by failing to advise me about what to expect during the m/c. She said she understood and she was sorry.

I thanked her for her time (she was incredibly late for her next appointment - ha!). Then I drove to We*ndy's and got a large chocolate milkshake. With whipped cream. And a cherry.

When I got home tonight, the Mister called me a doctor slayer. I suppose that's a compliment? And I guess I feel better having gotten all that off my chest, but that tooth that needs the root canal is causing my TMJ to flare up, which is getting in the way of my righteous triumphant feeling ...

Comments

[Mrs.X]

You go! It is so rare that we get a chance to have a really good chance to talk to those in the medical profession who have not done a good job for us - for whatever reason. Good for you for talking to your doctor. I'm glad that she admitted that she failed you - she did! - and was able to admit it. But, I think you are also wise to find another OB. It's sad to say, but how can you trust her and her office to give you good information when she failed so spectacularly this time?

[Rachel]

Wow. I am very impressed with your work. Good job explaining how the doctor failed you and what she needs to change. Now I wonder how much she's going to bill your HMO for that extra-long appointment?

[luna]

I'm so glad you had that 1:1 time with her. hope it was satisfying, for what its worth. and good of her to admit her shortcomings. I'm impressed. also good that you find a new ob though, since you've lost confidence in them. I know I can't go back to my old ob either...

and I hate going to the dentist too.

[Wishing4One]

Man, can you imagine her talk with her husand or whoever that night at home? Can you imagine her thoughts driving home ending the day? Shit, I bet her whole day was consumed by thoughts of her conversation with you.... and you know what AWESOME. Maybe just maybe you have awoken her to ome very important patient issues. I am so super duper proud of you. You my friend are the "man".

[BrooklynGirl]

You rock, seriously.

I always have been bothered about the differing standards of care for repeated miscarriers (defined, I believe, as 3 or more) versus that for women who have "only" had one or two. Had I known that there was a series of blood tests for recurrent pregnancy loss, for example, I would have done it after my first loss, found my clotting issue, and saved 2 years (and 2 more losses).

It's one thing for insurance companies to play the odds and refuse to cover the tests after "only" one loss (I'm not saying it's right--just understandable), but had I known the tests existed, I certainly would have paid out of pocket for them--or started arguing with my insurance company there and then.

If there's anything I can do to help with your brochure, let me know.

[Shelli]

I think it's great that you had the time to hash it out with her.

I had my annual a couple of weeks ago at my OB/GYN, and had a lengthy conversation about their protocol... I had two m/c with them before they even THOUGHT of referring me for testing, and I wasted SO MUCH TIME I couldn't get back. I was already 38 at that point, and I asked the OB why they wouldn't refer anyone over age 35 with a m/c right away... she was stumped and thought... hmmmmm, that's an idea. I hadn't stepped foot into an RE's office until my 3rd m/c.

Gosh, if I could do it all over again....

Let me know if you need anything for your project. Having had 5 m/c's... I feel like I've seen everything.

[Sherry]

You continue to amaze me. I give you so much credit for sitting down with her and being so frank and direct.

I've had a couple of experiences that I wish I had done something similar with - if for nothing else, than to possibly prevent it happening to another poor woman who came after me. Unfortunately, in my post-m/c situations, I was always so emotionally compromised that the idea of doing such a thing seemed an impossible mountain to climb.

You're my hero!

[Melanie]

Sounds to me like you handled it perfectly, like an intelligent, articulate adult. Well done. I'm afraid I would have handled it like a screeching hyena. Your dental experience made me smile (not the root canal, et al). The last time I went to an HMO dentist, the office was in a trailer, two cats wandered into the waiting room and the receptionist was smoking a cigarette on the front step. I left.

Otherwise, hope all is well with you!

[Shinejil]

What an amazingly productive conversation, one where it sounds like your perspective was heard and respected by the OB. I'd bet that's due to your articulateness, which is quite a feat, after your recent experiences.

After not seeing a dentist in 7 years (grad students don't deserve dental insurance, you know), I had a hellish list of stuff to do (still working through it). I'm glad you found someone you can work with; it makes a huge difference. I've got the hippy dentist, who's all about relaxation.

[Shinejil]

What an amazingly productive conversation, one where it sounds like your perspective was heard and respected by the OB. I'd bet that's due to your articulateness, which is quite a feat, after your recent experiences.

After not seeing a dentist in 7 years (grad students don't deserve dental insurance, you know), I had a hellish list of stuff to do (still working through it). I'm glad you found someone you can work with; it makes a huge difference. I've got the hippy dentist, who's all about relaxation.

[Rebecca]

I give you a lot of credit for being honest with the doctor...it sounds like that's what she needed to hear to make some really important changes around her office and within herself. Good for you and good luck with your dental stuff...it's always such a pain in the ass when things change in coverage!

[docgrumbles]

I was upset when after my second m/c my OB told me I'd need to have one more to warrant any testing ... it was so frustrating - why not check now?

[eggedout]

Well done with your doctor. In the end, I'm sure she will appreciate your openness so she can improve her practice. And I hate the dentist, too, and haven't been in 7-8 years and probably won't go until I need a zillion things done which will just make me hate the dentist even more.

You're great.

[Fiddle1]

Outstanding! I hope that tooth pain diminshes or you find a quick way to make it go away. Ugh. I left you a pink rose at my blog this morning. Just wanted you to know I am thinking about you.

[noswimmers]

Wow--good for you! I could never do that. I'm sure she'll think next time she deals with an IFer. Or anyone, for that matter. Sometimes docs need a reality check.

You go, doctor slayer!

[The Babychaser]

Nicely done. I'm really impressed. Not sure I could have stood up to a doc who had hurt me so badly, at least on a face-to-face (I write good letters, though). I'm sure that was at least somewhat cathartic, no?

So sorry about the teeth. Sounds painful and expensive. I grind too, and wear a mouthguard to sleep.

And I'm glad that your m/c has made its way out of your system. I really hope that, with the bleeding behind you and your hormones returning to normal, you can start feeling more like yourself again. It's been a rough summer, I know.

[Lifeslurper]

So sorry to hear of your loss. However, it is wonderful to hear of an OB admitting to errors and apologizing for wrong doings. They can do that?! Wow! I believe we have to be happy with these people who are supposed to be caring for us through this whole thing...that is the reason I am now with my third fertility specialist, oh and wow, what a difference having a doctor we trust and like has made. Best wishes!