Care
I don't get it.
A mother delivered a 34 week gestation baby this morning. The baby is doing fine. Mother's history is remarkable for chronic high blood pressure and 4 strokes, although it has been hard to find evidence of those strokes on imaging. Also, in a tragic note, the mother lost two children eight years ago in a house fire (an all too common occurence in the poor urban area in which I work.)
Wouldn't you think that a pregnant woman with chronic hypertension would seek prenatal care? Wouldn't you think that a pregnant woman with 4 strokes would get prenatal care? Wouldn't you think that maybe a mother who had two children die in a house fire would consider each child precious and get prenatal care? Wouldn't you think that such a mother might be able to forego her marijuana smoking during pregnancy?
This mother did none of those things. She said she had no health insurance, but in our state any woman who is poor can get Medicaid, and since she was hospitalized for 6 days at about 27 weeks gestation - the extent of her prenatal care - I know a social worker discussed getting Medicaid with her. This mother simply did not follow through, did not do the responsible thing for herself and her baby.
I've always considered myself sort of a bleeding heart liberal, one who tries to see the problems and difficult life of a woman like this and feel pity for her, and try not to blame her for her lack of prenatal care. But I get a little tired of it when I see case after case similar to this. Maybe it isn't as easy for her to get prenatal care as it is for a suburban woman with good health insurance. Maybe it would require her to take a trip to the Medicaid office, or to fill out some forms and mail them in. But that's not a valid excuse; doing the right thing in life takes a little effort sometimes, and this woman simply didn't put out the effort. I'm sick of it.
The Institute for Healthcare Improvement recently surveyed patients and families about what they want and expect from healthcare providers. The first item they wanted was to be listened to, taken seriously, and respected as a care partner. I would love to do all those things for my patients and families. But first they have to respect themselves.
A mother delivered a 34 week gestation baby this morning. The baby is doing fine. Mother's history is remarkable for chronic high blood pressure and 4 strokes, although it has been hard to find evidence of those strokes on imaging. Also, in a tragic note, the mother lost two children eight years ago in a house fire (an all too common occurence in the poor urban area in which I work.)
Wouldn't you think that a pregnant woman with chronic hypertension would seek prenatal care? Wouldn't you think that a pregnant woman with 4 strokes would get prenatal care? Wouldn't you think that maybe a mother who had two children die in a house fire would consider each child precious and get prenatal care? Wouldn't you think that such a mother might be able to forego her marijuana smoking during pregnancy?
This mother did none of those things. She said she had no health insurance, but in our state any woman who is poor can get Medicaid, and since she was hospitalized for 6 days at about 27 weeks gestation - the extent of her prenatal care - I know a social worker discussed getting Medicaid with her. This mother simply did not follow through, did not do the responsible thing for herself and her baby.
I've always considered myself sort of a bleeding heart liberal, one who tries to see the problems and difficult life of a woman like this and feel pity for her, and try not to blame her for her lack of prenatal care. But I get a little tired of it when I see case after case similar to this. Maybe it isn't as easy for her to get prenatal care as it is for a suburban woman with good health insurance. Maybe it would require her to take a trip to the Medicaid office, or to fill out some forms and mail them in. But that's not a valid excuse; doing the right thing in life takes a little effort sometimes, and this woman simply didn't put out the effort. I'm sick of it.
The Institute for Healthcare Improvement recently surveyed patients and families about what they want and expect from healthcare providers. The first item they wanted was to be listened to, taken seriously, and respected as a care partner. I would love to do all those things for my patients and families. But first they have to respect themselves.
posted by neonataldoc at 3:33 PM
9 Comments:
Well done. A+. Excellent post. Thanks!
Thanks!
Do you ever wonder if you're too much of a bleeding heart to be in the practice that you're in?
I am in the process of trying to go to medical school (I'm a non-trad student having spent a year doing investment banking in Europe) and I volunteer as a "cuddler" in my University's hospital.
Inevitably the question arises (from the docs I shadow and from the nurses in the NICU) "Do you want to be a neonatologist?" The first thing I say is that, "I don't know b/c I haven't seen many other practices of medicine" but my first real thought is: "Yes! Yes! Yes! But I think it would break my bleeding-liberal heart".
Good post!
Yes, the parents have to meet you half way-they have to care. Sometimes I wonder, if they don't respect themselves, how is that little baby ever going to grow up with some self esteem and self respect.
Morris the safety tortoise-Go with what you love. You can't control the actions of other people (parents) so you can't worry about that. Your passion and compassion will always make you a better doctor. Sometimes, as a parent of a severly disabled child, life is very hard. Although I never say much to the doc, you can always feel their kindness; every once in a great while there are days when it's especially needed and when it is, their kindness just wraps around you like a great big hug and you can feel the love. On those days, when life has been especially hard, I say a little prayer at night thanking the Lord for such a good doc.
I'm no bleeding heart, neonatal, but there's a perfectly understandable reason for this mom not seeking prenatal care. It's chaos. That's not an excuse, it's an explanation.
This mom is dealing with too much chaos. It's all she can do to get through the day. It doesn't have to make sense, that's just what it is.
best,
Flea
I was reminded of Ken Auletta's book The Underclass as I was reading your post. This woman sounds as if she belongs to the underclass. She has lost hope, and unfortunately, she's the only one who can do anything about it.
Thanks, everyone. Morris, I love being a neonatologist.
I know these people live lives of chaos. I know they were probably raised without teaching or example of how to live properly. I know they might have lost hope, sometimes for good reason. But I still get frustrated sometimes.
And I'm definitely in favor of good access to birth control, education and help for mothers who need it.
That girl: Don't worry, I didn't think you were attacking me. I think I do recognize the burdens of the "have nots", at least as well as any "have" can. I know that life is harder when there is not enough money, family support, etc. But the point I was trying to make was that even though I recognize their burdens - I still get frustrated with them!
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