I had three pregnancy losses: an unexplained stillbirth, a miscarriage and an ectopic pregnancy. I was on my third ob/gyn and was finally happy and confident that I had good medical care and emotional support when my doctor announced that she was "retiring." She, herself, had two young children and wanted to spend more time with them. Who could argue with that? I respected her greatly both as a doctor and a friend. But, nonetheless, the question remained: what was I going to do???!!! I did not like any of the other doctors in her clinic.
After two months of agonizing, I finally admitted that I had a bad experience when I first switched doctors and decided to avoid the same mistake again.
My husband, Bob, and I devised a "system" to help us "flush out" good doctors and it worked; we have a great ob/gyn now. I thought I'd share my "system" with you in the hopes that it might help if you decide you need to look for a new careprovider.
First, the preliminary steps taken:
1. I called the American College of Obstetricians and Gynecologists (ACOG) and explained my history briefly. I then asked for a list of high-risk specialists in my area. They sent me a worldwide list of doctors who are board-certified by ACOG as maternal-fetal health specialists (aka perinatologists). You can contact ACOG by email, by phone (202-863-2518 9-5 Eastern Time), by fax (202-484-1595), or by mail (ACOG Resource Center, 409 12th St. SW, Washington DC 20024).
2. I started a list of doctors beginning with those specialists in my immediate area.
3. I then contacted numerous other parents in my local bereavement support group and collected names of "good" doctors.
4. I looked through the telephone book. Sound strange? Well, I was very interested in finding a good woman doctor because my only good experience was with a woman ob/gyn. Although my list up until now had a mix of men and women, I completed it by getting the names of all the other women ob/gyns in my area who were listed in the phone book.
My completed list of doctors now consisted of both "specialists" and non-specialists (male and female), about 12 - 14 total.
5. I requested a personal copy of all of my ob/gyn records from my previous doctors. In one case, I had to pay a small fee. I learned from a nurse-midwife friend that it is my right as a patient to get a copy of those records (if a fee is charged, it may only be a minimal fee for copying services). No doctor can refuse to give you those records, and they should be complete.
I reviewed all records and highlighted those items which I thought were questionable or confusing.
6. I wrote up my own summary of my medical and ob/gyn history. I created two versions: first a one-page summary, extremely brief with just month/year dates and 2 to 3 word descriptions of each event. The second version contained more detailed descriptions of each event (including all medical procedures, tests, etc.) that I considered even slightly pertinent to my current problems. This detailed summary required approximately 8 pages. I used the one-page summary as a cover sheet to the more detailed summary.
7. My husband and I sat down and prepared a list of questions and concerns that we wished to discuss with each doctor. We decided that all meetings with all doctors would include both of us because we felt it was critical to see how each doctor treated Bob as well as me.
These questions included things like: what they thought my chances were of a successful subsequent pregnancy would be, their opinions on "older" mothers (I had just turned 40), how they would manage a subsequent pregnancy for emergencies, etc.
8. I prepared a little "speech": I quickly explained that I was a high-risk patient with three previous losses and quickly listed each loss. I then explained that I was looking for a new ob/gyn and wanted to set up an appointment for a consultation with the doctor. This speech would be my "intro" when I called each doctor's office.
Now I was ready to start contacting the doctors on my list. I started calling the "list." Some doctors were immediately eliminated because:
- their staff was cold or rude or sounded incompetent on the phone, or
- the doctors "couldn't find time" (or in one case, didn't do consultations), or
- there would be a very long wait to get in for a consultation, or
- the doctor didn't/couldn't accept high-risk patients at this time, or
- they would not accept my medical insurance
I set up a collection of consultation appointments over a space of 4 to 6 weeks. For each appointment, I prepared the following items:
- 3 copies of my medical summary: one copy for me, one for Bob, and one for the doctor (to keep if they wished)
- one copy of all medical records (if the doctor wanted to see them - they could not keep these records)
- 2 copies of the list of questions (one each for Bob and myself). We only used these in the early visits - we knew them by heart after just a few consultations.
While waiting to see the doctor, we observed the following:
- how many other patients were waiting and how long each seemed to be in with the doctor
- I looked at each woman's face as she left the office to see if I could detect the presence/absence of satisfaction with her visit.
- was the doctor consistently late for each appointment (including ours)? If the doctor was late, how did the patients (and staff) react?
- how pleasant was the waiting room and the reception staff? Was the conversation of the reception staff (on and off the phone) pleasant?
For each consultation, we started the visit by handing the doctor their copy of my medical summary (in a few situations, we gave it to the nurse/receptionist prior to meeting the doctor). We carefully watched the doctor's reaction as they read my history. In some cases, the doctors were visibly disturbed by the information and became quite uncomfortable (and often very defensive and cautious) for the remainder of the meeting. Some doctors drove the discussion and we did not get our questions asked (or answered). Others let us drive the conversation and ensured we asked all our questions (and got answers). Some doctors saw us in their comfortable offices or conference rooms, whereas others ushered us into examining rooms and talked to us there. This was important, but not crucial to our final decision. Some doctors ignored me and focused on Bob, while others ignored Bob and focused on me. Others talked to us both equally as a couple and a "team."
After each visit, Bob and I took time to analyze the experience. We noted our initial "yes or no" reaction to the doctor and made a note of it.
Finally, we made our decision. I am now seeing a (woman) ob/gyn with whom we are both quite happy. She is very supportive of me in every respect of my care. She is, for the record, not a perinatologist and we are comfortable with that.
I hope this information can be of help to you in your search. It is a difficult decision and a very hard task to accomplish. I urge you to go through with it though. You will feel so much more confident and comfortable with your new doctor if you do so. Good luck!
Copyright Ada Lai. All rights reserved. Used with permission.
Ada Lai lost her first three babies through unexplained stillbirth, miscarriage and an ectopic pregnancy. Her fourth pregnancy resulted in the birth of her daughter, Alexandra, 8 days overdue and very healthy. The Lais were very happy with their ob/gyn and felt their hard work in finding her was well worth the effort.