The Loneliest Career
To paraphrase Voltaire, it is dangerous to be right when those in power are wrong. Certainly the vaccination vendettas have demonstrated this. In my many years of practice I often embraced new and unpopular causes when I thought the new thought was ethically, morally, and scientifically superior. We know from experience that there is some danger in thinking outside the box and it would appear in some cases danger in thinking at all.
Too often the arrogance of metropolitan physicians regarding the validity of a rural doctor’s opinion is obvious. Unfortunately, the patients are the ones to suffer from this disconnect.
I endorsed prenatal RhoGam before it was popular in this country. I also endorsed management of group B before ACOG or the CDC recognized that Group B was dangerous, and I developed a plan to treat it. I recognized Group B strep was responsible for all too many avoidable neonatal deaths. Prior to the official ACOG program to address Strep B in pregnancy, I developed my own Group B program. It worked well for the 40 years that I used it.
ACOG did not consider Group B an ascending infection. For those of you who are not doctors, an ascending infection is one which travels upward from the vulva to the vagina, the cervix, the uterus, the amniotic fluid, and to the baby. Furthermore, because ACOG is so fixated on being physicians of only women, male spouses had been ignored. I’m not even aware of any standard thought that even discusses whether Group B is found in men. There is the popular dogma that claims you can’t eradicate Group B. I have always thought of Group B as an STD which can be passed back and forth between a man and a woman.
I treated many women with infertility and recurrent pregnancy loss for ureaplasma, mycoplasma and Group B. I had a very successful practice turning pregnancy loss and infertility into pregnancy success and normal newborns.
I also befriended midwives because I came to understand their level of commitment had much to do with their success. Having spent most of my career in independent practice, I know the importance of establishing good rapport with my patients. I was committed to seeing every patient every time and to be present for their births.
Over the course of four and a half decades, I came to know and appreciate several lay midwives, and to work with them closely when they needed help. Most recently, I had the opportunity to meet a midwife in another rural area. She has delivered 959 home births over 41 years. We talked a little bit about the responsibility, the awesome responsibility, of being the person in charge of a woman’s delivery.
Having been in independent, solo practice, I know what it is like to have the buck stop here. There is generally a time during any labor process when providers feel the weight of the world on their shoulders, and the feeling of 100 percent responsibility. I experienced this feeling as one of extreme loneliness, which is exceeded only by the euphoria which follows a normal healthy birth with a normal healthy baby, a normal healthy postpartum, and a normal healthy family life.
In our conversation, I asked this midwife whether she ever felt lonely. She looked at me, and to my amazement, began to weep. She explained that she would probably not have used the word loneliness, but she had experienced that feeling, and now she had a name to identify how she had felt. It is the feeling of being the only person responsible for the best possible outcome and not being able to call anybody.
We talked a little more about being the person in charge of the best outcome. That means seeing our patients personally every visit, being there ourselves for the delivery, and having a relationship that the mom and dad can trust.
We discussed the importance of having a good relationship built upon trust is important for good outcomes, and in particular, important for avoiding the new major cause of maternal mortality now called behavior problems. These includes suicide, homicide, and drug-overdose. I asked her whether she had had any patients with postpartum depression. She said that her patients did not have postpartum depression. We agreed that a good patient relationship has disappeared from the care of women in modern obstetrics.
We’ve seen many changes in obstetrics in the last several decades. Most of the changes have been for the benefit of the doctors, the nurses, the hospitals, clinics, medical malpractice, and all payers. But these changes have not been beneficial to the patients or to the patient-provider relationship. That relationship has virtually disappeared from modern obstetrics. Hans Duvefelt writes often about the loss of the patient-doctor relationship in medicine today.
Today, obstetricians are often part of a seven- or eight- member group. The patients cycle through the providers on prenatal visits so a woman gets to see all of the doctors who might be present at her delivery. But seeing multiple providers does not form the basis of a good patient-provider relationship.
The revolving door of physicians does not serve in providing security and success for deliveries. The good patient-provider relationship is a casualty of modern obstetrics and we don’t see any option to repair that relationship in the near future, largely because the eroding patient-provider relationship isn’t recognized as a problem.
What can the average couple do to bring back the valuable but rapidly-becoming-obsolete portion of obstetrics, the good patient-provider relationship? They can look for a midwife. They can also look for an obstetrician in private practice, and they can look for an obstetrician in a group practice who is willing to own responsibility for their care during the prenatal course, birth and postpartum.
Good Luck!