Dismissal from OBGYN

[Anonymous]

Has anyone been dismissed from an OBGYN's office?

I am very upset. Today, on the day I was to receive some results my Dr left a message with me saying that the results were normal, but she wanted to talk about some concerns. I was worried that there was something else wrong with the baby or with me, so I didn't appreciate that type or voice message.

The Dr proceeds to tell me that she feels we are butting heads; I am trying to 'barter' with her about courses of treatment, and that she is the trained expert, not me. She also didn't seem to like some of the c-section questions I asked. In sum, she said I was being dismissed for "trust issues" and that she recommends I go to a small practice that handles more natural births. than they do She was concerned that we might butt heads on delivery day. I didn't have any trust issues, though I was looking for her to say something along the lines of "I know you want a natural birth and we will try to help you, but you need to understand x,y,z."

All of her concerns make sense I guess - though I didn't see things as she did. I am astonished that I was 'dismissed' before there was even a discussion about these concerns. I didn't realize she had these concerns, though I will admit I ask a lot of questions - though they are prepared and thoughtful. I also posted something on this blog about a recent experience at the practice, and they would definately be able to identify me (I think). At the end of the day, it is likely for the best because I don't want a resentful OBGYN operating on me, but I am shocked that this occured. My husband attends all appointments with me. There were no claims of being rude or dismissive or not following their advise, but there are 'trust issues.'

Has this every happened to anyone? I not only feel depressed about this, but I feel like I am a bad person and I don't even know it. Am I supposed to not ask questions or ask if I can handle things certain ways? I am more upset about it, but my husband is outraged and I'm not sure I can control how he reacts to this.

[Anonymous]

It's never happened to me, but I don't ask a lot of questions. Don't worry about it. You're right...it's better to have a doctor that doesn't resent you. And your ex-doctor's probably right about the type of practice you need. Smaller practices seem to take more time with their patients and that type of practice is less likely to be annoyed with lots of questions.

Try not to be depressed. And your husband should chill. Asking questions is not a bad thing. You need a doctor that respects you the way you are.

[Anonymous]

Wow - I'm so sorry.

By any chance, was this Dr. Elizabeth Garreau? I wasn't dismissed from her practice, but I left of my own accord due to getting this type of attitude from her. She is pretty anti-natural birth, too.

For what it's worth, I think you're better off, but her treatment of you is despicable. YOU are not the bad person here, so don't feel bad about it.

[Anonymous]

Thank you. No, it wasn't Dr Garreau. Until I decide how, if, to respond to this I'll probably keep the name confidential. The good thing is that I wasn't fully comfortable there and already had scheduled an appointment with another practice. I had wanted to compare them to another to be able to suss out the vibe.

[Anonymous]

I think your doc may be of the "old school" where the patient listens and is compliant, and the doc makes the decision. Pretty antique view, if you ask me. Docs definitely have expertise, and their knowledge and opinions should be an important part of YOUR decision-making. But it's your pregnancy and your baby. I'm sure there are many docs out there who would be happy to have a patient who is an involved member of her own team. I know for a fact that there are definitely midwives who take that view. I use Birthcare, and have felt free to request or decline any testing, and never felt pressured to do something I felt was unnecessary.

[Anonymous]

Wow- I would be pretty shocked if that happened to me. I'm sure that in time you will see it as a blessing in disguise. I hope you find the right practioner this time. I would get some reccs from others who have achieved a natural birth and DO consider a midwife group- they will likely be much more receptive to factoring in your opinion. My midwives are always hounding me about the details of my birth plan, something that was never even mentioned during my first pregnancy with a large OB-GYN group.

[Anonymous]

I hope you will consider posting the name of the doctor. Normally I would steer clear of smearing a doc on an anomymous forum but if it really went down exactly as you say it did, other women might really benefit from a warning that includes her name. People know how to take things with a grain of salt on this forum -- what one person thinks is shocking another person might think is totally acceptable. (I'm on the shocked end).

FWIW, if you're looking for another practice -- try my doctor, Dr. Malcolm De Souza. He is not only a great doctor, he is just an incredibly nice person. Small practice with one other doc who covers for him one weekend a month (Dr. Footer) who also gets high praise on this board. He seems to like the fact that I ask lots of questions. With other doctors, I have been fairly demanding when I've felt I was getting less than a full or accurate answer but I've never even had to demand anything with Dr. DeSouza because he is great about explaining everything up front. He counsels options but does not push anything. That's not to say that he just tells a mom whatever she wants to hear -- he just does a good job of acknowledging your concerns and input while still guiding you through everything.

I do trust him, but at the same time, he isn't turned off by my questions at all. I could never see him taking the "I'm the trained expert and you're the patient" tone you described from your doctor. A doctor who is threatened by questions sounds imperious, egotistical and, frankly, insecure. I wouldn't want her delivering my baby because I actually would NOT trust someone like that to deal with the questions that might come up in the delivery room. Lets say mom or even a nurse notices something she doesn't during delivery....would she butt heads with you so much that she wouldn't even listen to your question? And would you really want a doctor who would leave a mom-to-be a message saying she had "concerns?" How irresponsible. Doctors surely know that when they say they have "concerns" about something we are going to assume the worst.

Please do try Dr. De Souza. In fact, just call and ask to talk to him. He will actually call you back. Unlike MANY other OB's in this town, he doesn't think it is insulting or shocking that a woman might want to talk to him before her first appointment. Even if you do go ahead and schedule an appointment, he will call you a few days ahead of time to ask you if you have questions. I should stop praising him so much -- I never have any problems getting appointments and don't want to crowd myself out!

Anyway, sorry you had such a bad experience. It's never pleasant being dumped by someone YOU should have dumped first...

[Anonymous]

You know, as nasty as it was of this doc to do it this way, she probably did you a huge favor. It sounds like she was not the least bit interested in dealing with an expectant woman who had educated herself or trusted herself enough or had enough self confidence to ask questions that she had.

Educate yourself and ask questions? How DARE you?

Please don't take this experience as anythign other than a positive reflection of you. Seriously. Do not let this lady make you feel bad about yourself.

This is a really long winded way of saying, "fuck her," I guess.

[Anonymous]

I think you're right to be a bit offended but I wouldn't get too worked up over it. Some doctors just aren't interested in being part of "team" decisions. Good luck finding a new doc. I hear Dr. DeSouza is fantastic. I would give you the name of my OB but I've found recently that he's a little more anti-natural birth than I took him for.

[Anonymous]

You are better off without the doctor in question but yes you have a right to be upset as does your husband. That being said what happens sounds like a reflection on the doctor's skill not you. Obviously the doctor wasin't doing their job very well caring for you the patient and the easy way out was to send you along to someone else. With each pregnancy we have I have found that some doctors get intimidated by the fact that I know what is going on with my own body. The good doctors use that knowledge to give even better treatment. The other doctors respond like they are insulted and I'm stepping on their toes.

You first step is to find a new doctor that is willing to work with you, not on you. After that you should consider speaking to the management practice at your old doctor's office, or the patient advocacy group at the hospital the doctor is affiliated with. Bad doctors will continue to give bad service if know one steps up to complain.

Good luck

[Anonymous]

I don't think that a doctor can dismiss you for trust issues. Seriously, she very well may have violated ethics rules, you should contact the AMA and report her. A doctor is not a personal trainer, a beauty advisor, an accountant or someone else offering a basic business service where they can simply terminate the arrangement. The rule is an important one to protect the patient and provide continuity of care. Imagine this happening in a rural area with only one or two doctors. Imagine a doctor who wants to stop taking insurance and charge higher rates who knows a certain group of patients could not pay. Could that doctor abruptly end treatment and the relationship harming the patient? Since you are pregnant and prenatal care involves regular appointments this rule may be even more important.

It would have been good for her to have the discussion about her feelings and perspective but there are two big problems in what you reported.

Informed consent is a cornerstone of medical ethics and your license depends on it. The doctor is required to inform the patient and the patient then provides informed consent. The patient ALWAYS has the right to turn down a treatment option or procedure whether it is wise or unwise for the patient to do it. As the patient you are well within your rights to ask questions and alternative treatments but you may be charged extra for consultation and you can not force the doctor to recommend, perform, or prescribe a form of treatment that they do not support. This applies to an action rather than an inaction. For example, you could not force a doctor to perform an elective c-section, but you could refuse an elective c-section. You doctor can not refuse any and all treatment because you decide not to consent to one of the other treatments. Her approach was basically intimidation that with her you can be informed but you do not have the ability with her to say no. This violates the informed consent rule.

The second problem is that she informed you that she was dismissing you from her practice. This action alone is a problem but coupled with the underlying reason that you would not yield informed consent, I would think she is in significant hot water with her license on this. I think you should pursue it as you were harmed and this behavior is unethical. You would not necessarily be seeking reinstatement as you should go somewhere else but she should be penalized by the board and taught not to do this again to others.

[Anonymous]

Yes, please post the name of the Dr! I think MANY of us would benefit from that. Or, if you don't want to post the name of the Dr., posting the name of the practice. I am sure most OB's in the same practice share a similar philosophy.

[Anonymous]

PP here I would not recommend filing your complaint with her practice. The doctors in a practice are business partners. While another doctor in the practice may be sympathetic, they would not necessarily be in a position or even inclined to take any affirmative action. There is no way the practice would report her to the AMA. You want to file a complaint directly and also contact patient advocacy groups. I would find a group that is not directly affiliated with the hospital. Remember hospital patient advocacy groups are there to mediate disputes between patients and the hospitals. They can do a lot of good for basic complaints to resolve them within the system but again they do not file with the AMA and are a unit within the hospital business corporation.

[Anonymous]

Just playing devil's advocate here since there are always two sides to a story and everyone seems to be ganging up on the doctor:

Perhaps the OP should reflect on the kinds of questions she was asking and whether her tone or response to the doctor's answers had anything to do with her dismissal -- and perhaps the OP should try to make sure she isn't perceived as being a combative or difficult patient the next time around. The bottom line is that doctors don't have to deal with difficult patients if they don't want too.

Done playing DA.

Try to find a doctor who is open to whatever it is you want or expect -- but be sure to be open minded when talking to a doctor b/c he or she is the expert (regardless of how much research you have done -- your google MD does not trump a doctor's real-world experience).

[Anonymous]

Since you had already been thinking about seeing another doctor, it sounds like you weren't comfortable with her either. The feeling was mutual. You can't get along with everyone in your life, some personalities just clash and there is nothing you can do about it. Just forget about it and go see another doctor that better suits you.