Comments on: “Have We Met?”

By: Henry Dorn MD

Henry Dorn MD — Mon, 08 Mar 2010 18:30:07 +0000

Write your local representative and tell them why you feel we need more caregivers such as midwives in the system, and to move towards legalization where they are not recognized.
Check out our website http://www.ncdocsformidwives.org for more info about this issue in NC.

By: Wendy

Wendy — Mon, 08 Mar 2010 14:07:12 +0000

And another thought!! (Ahem, sorry!) Am I the only one who sees a slippery slope here? If the doctor can’t know or even take the time to learn a woman’s name, how is s/he going to know all of the critical information required to oversee her birth? Charts aren’t just there to teach people names, you know.

By: Laura

Laura — Sun, 07 Mar 2010 18:00:28 +0000

SO MUCH WORD. Seriously. This is one of the reasons we CANNOT shut up about midwifery!

By: Wendy

Wendy — Sun, 07 Mar 2010 16:50:39 +0000

Another thought: Marsden Wagner, a former WHO physician, addresses the problem of obstetricians, surgical specialists, attending normal, every-day births. They perform complex surgery, and then rush back to the office to counsel “a healthy pregnant woman on her sex life” (to quote him). If they’re this over-extended, so much so that they forget the names of their clients–or don’t even have time to read their charts–it only makes sense to have them scale back on their tasks and do what they’re trained to do: high-risk, specialized cases.

By: Wendy

Wendy — Sun, 07 Mar 2010 16:46:41 +0000

Thank you for this, Dr. Dorn.

By: Wendy

Wendy — Sun, 07 Mar 2010 16:45:57 +0000

This submission represents something much grander than the problem of OBs not reading charts. It proves that modern obstetric practice as a whole has gotten out of hand. Giant practices, on-call and rotating physicians, doctors who only see clients long enough to catch their babies, women processed on assembly lines…. and to top it all off with a cherry, we pay a high cost with our bodies and our wallets. With all of these factors contributing to de-personalized maternity “care,” no wonder midwives are the wave of the future!

By: Krista

Krista — Sun, 07 Mar 2010 08:45:37 +0000

Dr. Dorn – Thank you for the insight and I have to say, it always makes me smile when a doctor says he supports midwives. Doctors are vital to saving lives, but midwives are better for normal birth. Each plays an important role and I would like to see both sides working harmoniously to make birth more enjoyable and safer.

I don’t think that the doctor should have to remember every patient, but taking the time to skim over the details goes a long way toward building trust. My first was born at a birth center and the whole idea sent my mom into a panic. She talked to her OB about it and he offered to talk to me to see if I wanted to use him instead (even though I was 7 1/2 months). I told him how much I appreciate what he was doing for my mom but I was extremely happy with my midwife so I respectfully declined. He was supportive of my decision and told me that if I needed a transfer, changed my mind, or wanted to have an OB with a subsequent pregnancy, he’d be happy to do so. Needless to say, 2 years later when my insurance refused to cover a midwife, I went back to him. When I came in for my first prenatal, he “knew” who I was. I’m sure he just read my chart, but it meant a lot. I still laugh about the fact that when he started doing my pap he actally said “so how’s your mom?”. Lol! We talked about her for a few minutes and he even said he was worried because she never showed up for her 6 week postartum visit (yes, she had a baby after me). I had to kindly defer that to his office staff since they illegally refused her care and had forged her name on some paperwork and she had a lawsuit against them, but that’s a whole other story. It bothered me that he didn’t know, but I’m quite sure he got all the details afterward because the problematic office staff member was fired shortly after and the lawsuit settled out of court. Anyway, he even asked how everything had gone with my first birth and we talked about how to make this one as similar as possible. It turned out very different, but anyone can see why I agreed to augment my labor so that he could be the one to deliver my son! A little forethought and compassion goes such a long way in the medical field.

BTW, I live in a city of 150,000 and he’s quite the busy man!

By: Henry Dorn MD

Henry Dorn MD — Sat, 06 Mar 2010 14:03:24 +0000

I agree that it is vital for good relationships to review the chart before walking in a room, but often we do not have that luxury, especially outside the office.
I work in a small town, and run into women constantly who know me, but though I usually recognize their face, I am often unsure whether I delivered their baby, cared for their dying mother, attended their miscarriage, or diagnosed their STD.
We see hundreds of women every week and I deliver hundreds of babies every year, and the uncomplicated ones often blur together. An experience that for the woman may be one of the top 10 most memorable ones of her life, may be one of a thousand for us, especially if everything goes as planned.
Now, there are some folks who have really amazing memories and they are often very popular as a result, but sadly I am not one of them, which is why I rely on my charts, textbooks, notes, etc to fill in the gaps.
I know its hard for patients to understand, and we often wish we had time to develop deeper relationships with them, but the realities of practicing in the US today often precludes this.
This is one of the reasons why I think midwives do such a great job for healthy women. They are able to spend more time with each individual and address the psychosocial needs better than most MDs.
So please understand that we don’t mean to be so rude, but we’re often doing the best we can!

By: Erin

Erin — Sat, 06 Mar 2010 13:07:52 +0000

GranolaRN brought up a good point. It doesn’t say that this was her OB from the previous pregnancy, just that he attended the birth. So if she was a new patient at his practice, it may not say in the chart who did the c/s.

Now if this was her OB from the previous pregnancy, do I expect him to recognize her at the store? No. But he should at least read the chart before he goes in the room.

By: Jena

Jena — Sat, 06 Mar 2010 08:04:13 +0000

I think that’s a good point. It’s VERY easy in a clincal setting to just grab the chart, glance at the name, and go in because you’re on a schedule. That’s largely a function of patient volume and insurance company pay out regulations. You only have so much time to be in there. It’s sad. I’m certain a lot of OBs would rather be able to spend more time than a medical slam-bam-thank you ma’am.