Thursday, February 16, 2012

When doctors make their patients cry

I was just talking to a patient who was in tears. She had had diabetes for many years and was having a hard time controlling it , but was very sure that she did want to have a baby desperately. Since she was already 38 , we did an IVF cycle for her and she conceived in her very first attempt . We referred her to an obstetrician , who could provide her with the antenatal care she required , since she was a high risk pregnancy . She promptly went to a senior obstetrician, but came back to me in tears. She was extremely agitated, angry and upset and when I asked her what happened, this was her story.

Doctor I'm a grown-up woman and run my own company. I have lived with my diabetes for many years , and I know that I haven't done a very good job controlling it , but that's the reality because I am so busy working . I have spent many years trying to lose weight; control my diet; and get my blood sugar to normal. If you remember , I had come to you 5 years earlier, because I wanted to get pregnant, and you had advised me to control my diabetes, and then get back to you. I did not manage to do so, and finally requested you to do IVF for me, because I am already 38, and my biological clock is ticking away.

I'm pregnant after so many years and I'm extremely excited. I'm looking forward to the fact that I will finally become a mother. I went to the senior doctor you referred me to, so that he would help me manage my diabetes , so that I could have a healthy baby. However, instead of explaining to me what he would do and how we could work together to make sure everything would go well, he started berating me for doing such a bad job at controlling my diabetes - and even went so far as to say that it was irresponsible on my part to do IVF in order to try to get pregnant when I had such uncontrolled diabetes. Not only was he rude, a lot of what he had to say was extremely hurtful and I was very shaken up and upset.

My mother had come with me to the consultation ; and now I'm sure the next eight months of my pregnancy are going to be living hell. Rather than looking forward to an enjoyable pregnancy and a healthy baby in my hands at the end of it , I will be worrying about the possibility of this baby having birth defects. I had much higher hopes from such a senior doctor. I know that he told me off for my own good , but there are better ways of criticizing a patient.

I had to spend about 15 minutes consoling her , explaining to her that the doctor didn't really intend any harm, and perhaps he was saying things in order to motivate her to be more careful about managing her diabetes. I also told her that sometimes patients tend to over interpret the doctor’s expressions or his statements , when he really doesn't mean to be critical.

She refused to be consoled, and insisted on going to a second doctor . I did refer her to a second one , with whom she was happy, but I think this story has important lessons for all of us.
Doctors sometimes forget the power of their words and expressions when talking to patients. Patients are extremely vulnerable , and hang onto every facial expression or word. I know doctors can’t be on their guard all the time , but they need to understand that how they frame a particular sentence makes a world of difference to the patient. They need to learn to be positive and to understand the patient's anxieties. After all , managing the patient doesn't just consist of controlling her blood sugars. It also consists of managing the patient's peace of mind and building confidence in the patient - both in her own abilities to manage her problem , as well as the doctor’s ability to be able to care for. Unfortunately, this doctor , even though he was very senior , failed on all counts.

I think part of the problem is that when patients are upset with doctors , they just walk away and go to another doctor. Because they never provide any feedback to doctors about these negative encounters , doctors don't even understand that they're making mistakes ; and they merrily continue making them all the time. I'm sure I'm guilty of the same error, even though I do try my best to be as responsive and alert to my patient’s signals.

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  1. The one thing I hope her doctor does, inbetween yelling at her (so, productive, not!), is to get her Vitamin D levels monitored and kept in a good range throughout her pregnancy, given all its links to gestational diabetes.

    If he has not bought it up yet, then its her turn to yell at him. That'd be fun :)

  2. Anonymous11:00 AM

    Dear Dr,

    A humane doctors placebo effect is much, much stronger than that of the most potent medicine :). I wish every doctor keeps this in mind when they interact with their patients!
    Have a wonderful day!

  3. Anonymous8:20 PM

    Dear Dr,

    I am curious to know what kind of diabetic meds your patient is using to control her blood sugar? Is it just metformin? Did she respond well to stimulation? How will her diabetes be managed during pregnancy? With metformin alone? Sorry, if it is not a topic related to this post but would be happy if you could let me know the details.

    I am really sorry that she has to face some situation like this which reduces her confidence. I wish her a very happy and healthy pregnancy!

  4. Anonymous1:20 AM

    Jay :)))) I love the way you advocate Vitamin D!!!

    GD for a woman with diabetes ;)!

    Dr, will you please answer my question regarding your patient's diabetes meds? Nice to see you again, wondering where were you? :)

  5. Thank you for this post (and everything else you share with us). Love your blog! Please, write some more!


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