Friday, April 06, 2007

The Sorry State of American Health Care, or Why I Don't Like My New OB

(Warning: this is a loooong one.)

Back in good old Philadelphia, I had a doctor who assisted me in the removing of Sam from my nether parts. I trusted him. He was a bit old school, but in a good way. He never pulled any punches, and he was always honest and up front with me. When I would freak out over something fairly mundane, he would gently put me in my place. He explained the necessity of every test and procedure and the frivolity of others. When he suggested an episiotomy in lieu of the possibility of a nasty tear, I said go for it. Is there any better way to say 'I trust you' than letting someone cut your vagina? With scissors?

Now it's the second time around. I've been to see two different doctors, and I'm not sure that either one has instilled in me the same level of confidence.

My issue? Both doctors have strongly recommended that I undergo supplemental testing for genetic abnormalities. Even though I'm young, healthy, and have no family history of any heredity diseases. The first doctor I went to see tried to sell me on an additional ultrasound, the results of which would be evaluated in conjunction with some blood work to determine the likelihood of my baby having down syndrome. This test would be performed at 12 weeks, only slightly earlier than the triple screen or quad screen. Oh and this additional ultrasound? It isn't covered by most insurance companies, so you have to pay cash. I politely declined, and if that had been the end, I would have no problems with this guy. But no, he decided to get all George Bush on me by starting in on the scare tactics. When I still declined (a little less politely) he tried to appeal to my soft side by pointing out that at 12 weeks the baby would be much more developed and wouldn't I just love to take an extra peek at my growing little boy or girl? At that point I was sick of being manipulated and I was done being polite. I simply said a very firm 'No thank you' and changed the subject.

Now I am seeing a new doctor. There was some sort of insurance snafu which, had it remained un-noticed, would have made us 100% responsible financially for my hospital stay. I saw the bill from Sam's delivery. It was large enough to scare me silly. While I wasn't thrilled to be changing hospitals, getting a new doctor didn't seem all that bad. SOB got a recommendation from a fellow fellow and I made an appointment.

During my first visit the guy seemed nice. Down here, people are much more into scheduling their deliveries, so the doctor's willingness to do just that was mentioned to me about 724 times. I made it pretty clear that I was not interested, and we moved on. At this point I was fairly content with my care.

Yesterday I went in for my detailed anatomy ultrasound, which for most people is a fun and exciting day. While I was in with the tech, she started telling me a story about a woman who freaked out because there was a teeny detail in her baby's heart that she couldn't see clearly. Because of that the doctor wanted her to see a perinatologist, which sent her into a tizzy. I though it was a little odd, because she kind of told me this story out of nowhere, but whatever. She probably scans dozens of women a day, so I'm sure she has an arsenal of small talk. Then I went to see the doctor.

Guess what he told me?

He said that because the images of one section of our baby girl's heart weren't too clear, he's worried that there might be something there indicating a 1 in 3,900 chance of association with a genetic abnormality. Even though my quad screen results, which we had just discussed, were completely normal. He then proceeded to start flinging a bunch of technical terms around before suggesting that I go see a perinatologist for an additional scan. I stopped him and asked him to spell out every single term that had just spewed from his mouth. He got all fatherly on me and suggested that I avoid looking these things up online as it will probably just scare me. I tried to maintain my composure as I explained to him that the main reason I wanted to get all the details is because my husband is a physician and would be interested in the specifics, so would he just spell the damn words, please.

Throughout all of this, he kept repeating that I shouldn't be worried because he was sure there was nothing wrong. Finally, I asked him why, then, should I even bother to get the 'emergency' scan he was recommending? I couldn't get a straight answer from him. Just more gentle bullying and the information that he said he sends 10% to 15% of his patients to this doctor for follow up scans. He did make a point, however, of informing me that my 'diagnosis' would ensure that everything would be covered by my insurance.

I got a call later in the afternoon informing me of the time and date of my 'emergency' scan. This whole thing feels wrong and dirty to me, and pisses me off for so many reasons. First of all, there are a lot of people who don't have the resource of a doctor in the family. By the time SOB came home last night he had already read several journal articles on this very subject, all of which essentially said there is no true correlation between what they may or may not have been able to see and any genetic conditions. Without this information, I'm sure I would be a total wreck, as would many people I know. It is shitty beyond compare this man would put his patients in a state of hyper-anxiety over something insignificant. If you've been following what Liz over at Mom-101 has been going through during her pregnancy, then you have a glimpse into how harrowing things like this can be.

Secondly, it seems like either this doctor is doing everything he can to cover his own ass, or he's in bed with this perinatologist. Either way, I blame the system as much as I blame the doctors. Obstetricians can be sued up to 18 years after performing a delivery, a law which was written by lawyers, not doctors. I'm sure that this leads many docs to order non-essential tests for their own protection. Also, insurance reimbursement rates are lower than they've ever been. Coupled with skyrocketing malpractice premiums, most OBs are finding it tough on their bottom line. An extra test here and there equals a little more in their pockets at the end of the month.

I wish I could say, after all of this, that I told them where to shove their 'emergency' scan, but I can't. I'm having it done next Thursday. SOB pointed out to me that if we are the 1 out of 3,900, we would want to know so that at the time of delivery the hospital can be adequately prepared. Which is true. I just feel so manipulated and worried that I'm not going to be able to trust this guy when it does come time for me to squeeze this baby out.

Whew. That was a head/heart/mouth full. Let me leave you with some sweets to cleanse your palate, in honor of the final day of Snap Happy week from Picture This!

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Mom101 said...

Oh geez, I'm sorry to hear about all the added stresses. Like pregnancy isn't a mental burden enough as it is. If I can say one thing it's that my OB rocks the house in every sense. I am so totally at ease with her and her whole practice - I feel very very very fortunate.

Of course I'm paying through the nose for that luxury. Indeed it is a luxury. I haven't forgotten it.

natalie said...

I'm married to a health care professional, so I can totally agree with your perspective of "thank goodness I have someone who will give me the straight shot and help me keep my head on straight." I also COMPLETELY agree with your take on why all these additional tests are "necessary." Health insurance is getting too expensive for the private citizen (hence I have to work instead of being a stay-at-home mother), but it's not covering enough of our health care needs. And it's not paying my husband enough, so he's struggling to keep his healthcare business open independently (I'm being cryptic here so there is no repercussion). The healthcare industry needs a major overhaul so it will continue to work.

Now on to the issue you dealt with today. I am SO sorry for you. It's hard work growing babies in our wombs. I feel so frustrated for you. I hate that you have to worry about the baby you are carrying and I hate that you have so much stress.

Good luck...I'll check back for the result.

I love your "sweet" picture!

super des said...

I hate switching doctors. And I hate doing it because you're not sure your dr can be trusted.

Hope it gets better for you.

Amy Jo said...

Thanks for all the niceness. I know that come thursday everything is going to be fine. I just wish I didn't require three different people telling me so.

susan said...

Wow and wow. The whole "better safe than sorry" has kinda turned into "damned if you don't, damned if you do", hasn't it. If you had chosen to not go along with the additional tests/whatever, you would have to deal with that niggle of doubt that you hadn't done everything in your power to give your little one the best beginning you possibly could. But, now, if all the stress turns out to be for naught, you're stuck with the frustration of having undergone unnecessary tests/stress/whatever. Yuck.

Oh, and wow to the pic as well -- I love ribbon candy!!!