Posted by My OB said WHAT?!?.
Apr
19
Posted by My OB said WHAT?!?.
Thoughtful Thursday! “Would You Like Me To Run The Basic Blood-work To Make Sure There’s Nothing Else…Going On.”
“I’m not concerned that you’re not getting pregnant yet, or that your cycle hasn’t returned regularly, given he’s still nursing so much. But you obviously are, so would you like me to run the basic blood-work to make sure there’s nothing else obvious going on?” – OB to mother who was worried about secondary infertility.
Dislike these words.
There are 18 comments to this post.
Terrific on two counts.
1) The doctor did not discount the mother’s concerns as unnecessary or paranoia, did not say “Oh, you already have one lovely baby so everything will be fine” OR “For Pete’s sake, why would you want another baby?”
2) The doctor ordered a low-risk, low-cost test that would provide data they could use to make decisions in the future. At the very least, the mother now has baseline numbers for comparison later.
This is good doctoring. 
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Rachel Reply:
April 19th, 2012 at 1:27 pm (Quote)
I would also add that the dr seems supportive of breastfeeding! Understands that breastfeeding impacts fertility and, though we don’t know how old the nursling is, i would guess somewhere around older baby or toddler and no mention of needing to wean!
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Sure, it’s fine to offer this, but if it’s not medically necessary, and it’s low-cost, the patient should pay for this out-of-pocket.
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Jessica Reply:
April 19th, 2012 at 9:07 am (Quote)
That’s kind of random. Where does it say anything about who pays for it? I paid for every single test procedure etc out of pocket for my first birth, including the 9 months of care from the midwife and the hospital transfer and everything they did at the hospital. Why are you assuming this patient won’t pay for her care?
And why is it okay with you if it’s not medically necessary but it costs a lot, for her to NOT pay it? You did say if it’s necessary AND low cost.
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Jane Reply:
April 19th, 2012 at 10:16 am (Quote)
The woman should pay a couple hundred for her blood tests on the same day the doctors stop billing insurance for an ultrasound at every single visit, a full panel of blood work on every pregnant woman “just ‘cuz,” and all the other “unnecessary” medical procedures and tests they run on every healthy low-risk pregnant mom.
How does that sound?
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Cara Reply:
April 19th, 2012 at 12:29 pm (Quote)
And we won’t know for sure if it’s not medically necessary until we get the test results back…
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Rachel Reply:
April 19th, 2012 at 1:05 pm (Quote)
This line of thinking makes me uncomfortable. “medically necessary” and “not medically necessary” are not black and white things. There’s plenty of gray and I’m not sure everyone can agree where “not medically necessary” ends and “medically necessary” begins. Sure, cant argue that its not strictly necessary for one’s health to be able to get pregnant. But the blood panel could catch something out of the ordinary, even if it doesn’t strictly refer to fertility. This could be considered good, common sense preventive medicine. If I go to the dr and request blood work to test for things like iron, cholesterol, vit d levels, etc when I am feeling well, should I be required to pay for that when I have insurance since its not “medically necessary”? Generally, low cost preventive things like simple blood work keep costs down for everyone by catching little problems before they become big, medically
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Laura Reply:
April 20th, 2012 at 6:13 am (Quote)
Hmmm. So, first, who defines “low cost”? Second, was it medically necessary?
My son was then 20 months old and I had not had a period since he was born. We wanted a little brother for him. Also, if the nursing (and he was still nursing a fair bit for that age, 3-4 times a day!) was not the cause, then it could be a sign of a deeper problem.
So, if I’m nervous and she’s not, was it necessary?
The tests were done (and my insurance paid for them). They found a substantial vitamin D deficiency, which she didn’t think was likely involved (though it could be, I think she said) but which needed to be treated. Now was it medically necessary?
After attempts to treat the deficiency with over the counter supplementation failed (but, during that time my numbers did rise), I was put on a mega-dose for two months. So, does it make a difference that my cycles returned while I was on the lower supplementation, and that I had to stop the mega-dose after two months because I got pregnant? My toddler had also reduced his nursing substantially during that time. Now was the blood-work medically necessary?
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Laura Reply:
April 20th, 2012 at 6:30 am (Quote)
And to clarify, “substantial” is not at the rickets level but it is in the deficient range. I think it was around 22, where under 15 is severely deficient and 32-100 is optimal.
Vitamin D is not implicated in fertility that I know. But it is implicated in a host of other problems including cancer and heart disease, and possibly (research is ongoing) may be relevant to diabetes, high blood pressure, and glucose intolerance.
After I had my second child, we tested and I was still low, so we’re back to trying to bring it up – but so far avoiding megadoses since I’m nursing a fairly young baby. So I’ve had this blood panel about five times now and will have it at least one more (probably more) as we try to sort this out….
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Ahhh, Thankful Thursday…how I’ve missed you!
This doctor is on the ball. Those are the exact words I would want to hear if I was concerned about something – “it’s probably not an issue but we’ll check it out anyway.” I’m glad there are great doctors out there.
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This is perfect. It shows respect. Imagine that treating an adult like an adult.
Plus, if mom wants to take that script home with her and think about it for another month or two she can do that too. Maybe it will be her lucky charm and she will get pregnant before she even gets around to testing!
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Rach had this to say,
Apr 20, 2012 @ 5:17 am (Quote)
All your talk of costs and insurance makes me so thankful for our wonderful NHS. It’s not perfect I’ll grant you that, but when you are looking at health care and best treatment options it’s good to know that it’s usually based on evidence rather than prices.
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Why should the woman pay if it’s not medically necessary? Because if she doesn’t pay, she’s basically asking everyone else to pay for her care via higher insurance premium rates or higher taxes. We all pay when someone requests a test that isn’t medically indicated, whether that someone is a patient or a physician.
Jessica: to clarify, it simply shouldn’t be a big deal for a woman to pay out-of-pocket for low-cost tests that aren’t medically indicated – and it sure doesn’t sound like this bloodwork was, given more information – but certainly, more expensive tests that aren’t medically indicated (like, say, CT scans for simple concussion, annual pap smears, etc. just to name two) also should be paid for out-of-pocket.
Cara: whether a test was medically indicated is not determined by the result of the test, but by the reason the test was ordered. Yours is a common misconception.
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icon downloads had this to say,
Oct 7, 2012 @ 8:37 pm (Quote)
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How considerate and professional. Hooray for Thursdays!
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