It’s The Attitude!

In 1992, in order to encapsulate the central issue in the Presidential election that year, James Carville popularized the statement:  “It’s the economy, stupid.”  I am reminded of this during some of my patient encounters.  I think of a couple  I delivered a few months ago.    This couple had transferred to me, from a local obstetrical group, part way through her pregnancy.  A major reason for transferring, was that they wanted a nonmedicated  vaginal delivery and believed they would be more likely to achieve that under my care than that of the obstetrical group.  Unfortunately, her delivery process turned out nothing like they had planned.  There was an induction, an epidural, vacuum and ultimately a cesarean section of a healthy baby boy.  At the conclusion of this birth, I felt terrible.  This couple had come to me for a specific style of delivery, but I believed I had failed to meet their expectations.  The day after the delivery I went to visit this mom and talked with her about her birth experience.  To my surprise, she was extremely happy with her birth experience.  Obviously, she was thrilled with her new baby,  she was also very happy with the whole experience and happy they had changed doctors, even though the details of the birth had not turned out the way they had planned. 

 

I have been reflecting on the reason for the positive satisfaction, despite the specific unpleasant details and I believe it can be encapsulated in the statement, “it’s the attitude.”  What was the attitude that this couple found appealing?

 

1.      This couple was treated like family.  Since I am the only delivering doctor in this practice,  I get to know them very well and they get to know me.  We not only talk about their pregnancy, but also about both their and my personal lives. They know that, except in a very rare situation, I will be the one shepherding them through their labor and delivering their baby.   I will not be turning them over to another doctor, who might have different ideas, because my shift is now over.  They have my personal cellphone number and can reach me when I am needed.  At the end of all this, the couple has no question as to whether or not my priority is their well being.

 

2.    Throughout the pregnancy all interventions are discussed and a seeking of approval is obtained.  This is even more important during the labor process.  Nurses did not suddenly start doing things because the doctor ordered it.  Rather, the reasons for any intervention are thoroughly reviewed prior to the intervention happening.  The attitude part of this is that they are treated as equals in this process.  While I may have more education and experience, their input is just as important as mine.  This is a collegial process with sincere give and take.   This means they remain in control of what happens, rather than being taken over by a big unresponsive medical system.

 

3.    All options were attempted.  During the labor, she was encouraged to move around and change positions.  Other methods of achieving a vaginal delivery were pursued.  There was no timer running, so she did not feel pressured by the doctor’s fatigue, schedule or arbitrary time line. By the time the decision to do a cesarean section was made, the couple knew there was no other option and were in full agreement with doing the section.

 

Every case is different and rarely there is a true emergency or situation, where the doctor has  to take a more paternalistic approach.  Nevertheless, that should be very uncommon.  

 

Too often, the doctor has the attitude that they are the educated professional and the patient’s views and concerns are irrelevant.  Too many times, doctors will make up rationalizations to justify what they want to do to the patient, rather than admitting it is a doctor preference or the way they do things.   

 

My view is that physicians need to be transparent with their patients.  Agree or disagree with the patient’s viewpoint, a physician needs to be collegial in their approach.  If the doctor disagrees with the patient’s viewpoint, than try to persuade them in a respectful manner.   A doctor should never approach the patient with a condescending attitude.  A doctor should not make things up, to get a patient to agree to a given treatment.  Physicians should treat patients the way they themselves would want to be treated.  It is the attitude!

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9 Comments

  1. Elizabeth

     /  September 10, 2012

    This the same reason that we switched to you at 31.5 weeks. It is all about the attitude and thank you for always having a positive one.

    Reply
  2. Amanda Phillips

     /  September 10, 2012

    Dr. Stafford,
    This is exactly why Chad and I chose you to help me bring Lyla into this world naturally. You are such a kind, caring doctor and it shows in this post! I truly hope your approach to obstetrical care spreads across the Upstate. Thank you for all that you do!

    -Amanda Phillips

    Reply
  3. Although I’m not a current patient of yours, this attitude is what I hoped to find when I started reading your blog. When I am ready to have another child, I’ll be returning to the Upstate, where I was raised, for the birth (I live overseas in a developing country and don’t feel comfortable with the healthcare that’s available here). I heard from a doula in the Upstate that you were her favorite doctor to work with. I’ve been lurking on your blog for a while, and everything I’ve read makes me hope that when the time comes, you’ll agree to take me as a late-pregnancy transfer patient! (Of course I’ll contact you well before I arrive in the States to see what the situation is and if it’s possible to transfer into your care.)

    Reply
  4. Alyse Aiken

     /  September 10, 2012

    Your positive reputation in the natural birth community is why we switched to you at 32 weeks! Feeling like we were discussing things on equal ground always reassured me, and your calm demeanor and supportive words during my labor made all the difference in the world. I can’t wait for baby #2 and another wonderful Dr. S experience. 🙂

    Reply
    • า๹ดวจพ:I experimented with looking at your web site with my iphone and the format does not seem to be correct. Might want to check it out on WAP as well as it seems most cellular phone layouts are not really working with your site.

      Reply
  5. Mark C

     /  September 10, 2012

    Dr. Stafford, I know this is cliche but I literally could not have said that any better myself. What you’ve just written is exactly why we come see you for primary care and why we are happy to call you our family doctor! Blessings to you and your practice 🙂

    Reply
  6. This is the reason that we love you, Dr. Stafford! I’ve had two babies since our family joined your practice and absolutely love the fact that you encouraged me in my desire for a home birth with both of them. I’ve also had the privilege of attending the birth of a friends baby whom you delivered and was just so grateful and appreciative (but not at all surprised!) of the care that you gave them. I have referred so many of my friends to you for their pregnancies as well as for pediatric care and and will continue to do so! After many miserable experience with doctors, it is such a huge relief to have found one who cares about my family. Thank you, Dr. Stafford!

    Reply
  7. Donna

     /  September 11, 2012

    Let me just say that we love you, and are so grateful for the care you give each of your patients. Since our daughter has some health complications, and we live many states away from SC, it is incredibly comforting to know that you deliver our grandchildren, and care for their whole family. You are a gift from God, directly and indirectly, to many people.Thank you.

    Reply
  8. MrsC

     /  March 26, 2013

    We are thankful that you are the Dr. who delivers our kids and sees us for everything else too. We are glad for your wisdom and the graciousness with which you share it.

    Reply

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