Building Trust in a Defensive Environment
By Jill Arnold and Henry Dorn, MD
In an era in which fear of litigation often dictates the treatment a patient receives, is it possible to build trust in the patient-provider relationship?
In addition to wanting basic patient rights, informed if not enthusiastic consent and fair, non-discriminatory care, here is a list of what pregnant and laboring women need their care providers to know.
Please convey risk to me in a realistic manner. Have percentages on-hand so I can make an educated decision, or follow up to make sure I have the information. “It’s dangerous” or “it’s safe” means nothing.
Ask me first. Always. Don’t assume you have my consent. I know it might slow down your system but no harm can come from giving a calm, general explanation of things you are doing.
Accept that I might read books and access information on the internet in an attempt to understand what you are saying. If I refer to this information in an appointment, I’m not trying to insult you.
If I express a preference for a vaginal birth after cesarean, vaginal birth or elective primary cesarean early on in pregnancy, please let me know right away if I should find a new care provider. You can save us both a lot of headaches in the last few weeks of pregnancy if you are honest up front.
Childbirth has always been and will always be a high-stakes event to be taken seriously. Ultimately, we all share the goal of healthy baby, healthy mother. I understand that even with the best technology, diagnostics, training and skills (or by not employing certain technology with the same goal of minimizing harm or risk) there is a chance that something can go wrong and I or my baby could end up injured or dead.
Trust goes both ways. I want to trust that you’re doing everything for a reason and that the reason is moves us toward the goal of healthy mother, healthy baby.
As the other half of this relationship, your provider has their own set of things they would like you to know.
Patients should understand that doctors (and midwives) are balancing many concerns, including significant medico-legal ones, which this series of posts has demonstrated. Expressing your understanding of this to your caregiver goes a long way towards opening up communication.
Financial incentives are actually pretty low on our list of reasons to do a c-section, despite many people’s perception. Fear of the uncontrollable ranks highest for most OBs.
Patients need to find a caregiver that they can communicate with and advocate for themselves. Use local networks and ask others for recommendations of good providers, and find out why they recommend a provider.
Natural childbirth advocates need to realize that medical interventions do have their role and save lives, when used appropriately and judiciously. It is appropriate to question their use, particularly if invasive, but be willing to accept their value in certain situations.
Be a constituent and let your representative know what you want, not just how you feel about current legislation. We will not get true reform unless there is a perceived mandate from the voting public to make changes.
Keep an open mind. If you want to make “Mother Nature” laugh, make a plan.
Patient advocacy rhetoric is historically insensitive to the burden borne by the physician, with physicians demonized as overtreating, overtesting, trying to impose their will on the patient, or in many cases, withholding needed or wanted tests from patients. These suspicions originate from a single seed—the feeling of not being heard and of not working together.
Although heavily marketed throughout the 20th century, the paternalistic model of medical care is no longer as prevalent, falling by the wayside as a result of various social movements which emphasized the rights and autonomy of the patient or consumer. The internet has made previously hard-to-find information accessible to the non-practitioner, opening up new opportunities for personal responsibility, accountability and informed decision-making.
The Participatory Medicine movement has emerged as a recent example of democratized health care in which the role of the patient shifts from that of “mere passenger” to “responsible driver” of their own health, according to the Society for Participatory Medicine’s web site.
Medical recommendations are not made in a vacuum and will always reflect the dominant culture’s values, such as risk aversion, valuation of technology and social hierarchy. At the end of the day, the two most important stakeholders in our health care system—the patient and the care provider—will benefit from understanding their shared responsibility in defining what they would like the system to accomplish.
Jill Arnold is an activist, aspiring public health researcher and founder of TheUnnecesarean.com
Henry Dorn, MD, is an OB-GYN who currently practices in High Point, NC. www.drdorn.com