In the Hospital, a Degrading Shift From Person to Patient

[Kire]

In the Hospital, a Degrading Shift From Person to Patient

By BENEDICT CAREY
Published: August 16, 2005

Mary Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room.

Without a word, one of them - a man - leaned over Ms. Duffy, pulled back her blanket, and stripped her nightgown from her shoulders.

Weak from the surgery, Ms. Duffy, 55, still managed to exclaim, "Well, good morning," a quiver of sarcasm in her voice.

But the doctor ignored her. He talked about carcinomas and circled her bed like a presenter at a lawnmower trade show, while his audience, a half-dozen medical students in their 20's, stared at Ms. Duffy's naked body with detached curiosity, she said.

After what seemed an eternity, the doctor abruptly turned to face her.

"Have you passed gas yet?" he asked.

"Those are his first words to me, in front of everyone," said Ms. Duffy, who runs a food service business near San Jose, Calif.

"I tell him, 'No, I don't do that until the third date,' " she said. "And he looks at me like he's offended, like I'm not holding up my end of the bargain."

More: http://www.nytimes.com/2005/08/16/health/16dignity.html?th=&emc=th&pagewanted=print

[quiet.american]

1. I happened across this article, too, this morning --

-- and my first thought was, this woman has an incredible sense of humor. I would have been outraged to be treated like that.

How is it that people going into medicine these days seem to have the least sense of humanity amongst us?

Can this doctor not tell the difference between a cadaver and a live human being who has the capacity to feel humiliation and who has a need for decency and consideration?

There should be some legislation put into place to prevent this kind of hospital practice. I've got some letter writing to do.

[lilymidnite]

2. I was treated in similar manner ...

I was recently in the hospital for a few days. I was never once addressed by my name, and those 'have you passed gas yet?' questions were the constant mantra.

[no_hypocrisy]

3. There's a generation of doctors from which my father emerged.

He was a healer of the first rank. He spent time talking to all his patients.

The patients were allotted 15 minutes of time for their visit but my father would ask them about their diet, their family, their job, their recreation, their pets, etc. to get the best perspective of their health, not just their immediate problem. With this information he would render a diagnosis that was short and long-term with the appropriate treatment.

My father gave out drug samples to help with prescription expenses. He often didn't collect on past due bills. A majority of his practice centered around geriatric patients (read, Medicare payments) and instead of being revulsed by their age, he treated them as if each were a surrogate parent, with extreme care and gentleness.

My father's legacy won't be his McMansion or his garage of vintage luxury cars. It will be those patients who lived until their late 90s when they were told by other doctors they wouldn't make it past 65.

P.S. He also made housecalls or went to the hospital at the drop of a hat -- at 4:30 in the morning more often than not.

I have not seen any doctor close to my father and don't expect I ever will. Medicine is now a business.

[quiet.american]

5. What a good man. God bless him. n/t

[KoKo]

4. Yes...that's what it's like these days. Particularly bad in the

University Hospitals. If you are in a non-university hospital you can count on few knowing your name, and checking for "vital signs" or "medication time" is the only encounter you will have with any hospital personnel.

Budget cut backs, lack of staff, and improper training. But, mostly it seems a disconnect with the patients and a general decline in compassion
which is pretty common out there in the general population these days with the rise of IMUS type dialog and Faux/Limbaugh views of people :-(

[HuckleB]

6. This is a repeat story.

That's hard to verify.

At any rate, any honest look at this issue would show actual improvement in recent years, yet that doesn't get headlines.

[WildClarySage]

7. This is very typical in maternity care. Women are treated as passive

and ignorant when it comes to obstetrical care by many doctors. While there are some women who don't want to be involved in making health care choices during prenatal and labor care, most are simply either discouraged from being active in the process or are ignored when they speak up for themselves.

[MountainLaurel]

8. Right now I'm reading

Jessica Mitford's "The American Way of Birth" and "Lying In: A History of Childbirth in America." Both are eye-opening. Did you know that the doctor who discovered that the main cause of death among women who had given birth -- childbed fever -- was doctors poking around a woman's vagina and cervix with hands contaminated by other sick patients and autopsies, he was run out of the medical profession? The line was that doctors were gentlemen, and a gentleman's hands were never soiled.

:grr:

[WildClarySage]

9. That is interesting!

I've been readng a lot on holistic birthing lately (for good reason!) A lot of recommended interventions haven't done much to alter maternal or infant death rates in this country, such as our 26-29% c-section rates & 33% episiotomy rates in some areas, and yet with all these other things we do, the biggest reduction came after the recommendation of hand-washing.

[Southpaw Bookworm]

10. The whole thing is fascinating

I've become really interested in the topic because (a) I'm of childbearing age and (b) a good friend had a homebirth back in February.

But I'm finding that it explains a whole hell of a lot. Like the decline of breastfeeding among middle- and upper-class women in the 50s and 60s: With the hallucination-inducing twilight anesthesia used during childbirth (when the woman was literally strapped onto her back onto a bed and was unconscious throughout the birth and the infant delivered with forceps), the newborn would often sleep for the first two DAYS.

[WildClarySage]

11. That decline can also be in part from the explosion of c-sections

there's a direct correlation between inability to breastfeed and the c-section birth that doctors don't usually discuss when talking about risks of surgical birth. They should- I would not have 'given in' so easily and agreed to the surgery with my first if I'd known that the section would result in my son being unable to nurse. Now I'm determined that this pregnancy is going to end in an unmedicated VBAC.

[Southpaw Bookworm]

12. Awesome

And in turn, the explosion of c-sections can apparently be attributed to the slippery slope of other hospital interventions. Make a laboring mother wear a fetal monitor and an IV so that she can't move around -- Not moving around slows down labor -- Labor isn't progressing according to "standard" so the doctors administer pitocin or something else -- Pitocin makes contractions more intense so that the mother is worn out more quickly and in more pain -- Pain medications affect the fetus's heart rate -- Heart rate issues will have the fetus categorized as being in distress, thus "requiring" a c-section.

[WildClarySage]

13. Exactly right! And unfortunately, the rise in these interventions has

done nothing to decrease infant and maternal death rates. It's really sad, because so many women think otherwise- that natural births are less safe, though the opposite is true! Doctors are not doing anything to encourage us to be more involved in our own medical care. This is an issue for women, that our participation is discouraged and ignored by the medical community, as if our brains decrease in ability as our tummies increase in girth!

[Southpaw Bookworm]

14. A little secret

Many doctors don't want you to be involved in your own health care: takes too much time and effort for them, and takes away from the aura of omniscience. ESPECIALLY if you're a woman. And heaven help you if you're poor. I'd say many long for the days when physicians weren't questioned about treatment, could get away with gross malpractice, and were considered gods in their own right.

[WildClarySage]

15. Takes away from their sense of omniscience and they can charge

more from insurance companies if women are having episiotomies, epidurals, c-sections, etc. than if women give birth at home or in birthing centers with midwives. You can always count on those dollar signs when it comes to health care trends. I don't think they are necessarily adding it up in their heads when they make the suggestions like "lets strip your membranes and see if that speeds things up" but they are thinking "I don't get paid enough to wait around here all day for her to get those last five centimeters dialated."

[Southpaw Bookworm]

16. Another point mentioned in these books

Is the huge discrepancy in c-section rates according to a hospital's primary users. If a hospital mainly gets poor women or minorities, they'll have a c-s rate of like 7 percent (which is counterintuitive, because these groups tend to have worse prenatal care and more co-occuring problems like diabetes, which makes the fetus and them more likely to require heavy interventions). Meanwhile, a private hospital in a rich suburb is more likely to have a rate of 35 percent or more. As you say, the doctor's time is another issue: Some hospitals' c-section rate will go as high as 75 percent right around a holiday. Same for births near shift changes. I'm sure that's not just a coincidence.

But unfortunately, it's not just the docs any more. There was an article in the Washington Post last year that told the story of a woman who scheduled her c-section so that she could attend a business meeting out of town. :grr:

[WildClarySage]

17. I'm running into the problem here that hospitals don't want you to try

a VBAC without emergency staff on 'stand-by' and doctors don't want to be hanging around the hospital waiting for you to get to 10 centimeters so you can start pushing, so rather than make the decision to be present so a woman's child can have the best start they really pressure the patient to have a repeat c-section. I swear, my OBGYN acts like I'm the first patient of his to ever tell him "No, that's not what I want for this baby." I'm doctor shopping now to find someone who will support my efforts to have a peaceful natural birth, and if I can't find someone, I'm tempted to just stay home and DIY- the way my grandmothers did.

[Southpaw Bookworm]

18. Not sure if you're familiar with this resource

But Mothering.com's discussion forums might be a good place to ask about doctors in your area who do VBACs. They also list a lot of books and Web sites that might also provide info.

Good luck!

[WildClarySage]

19. Thanks!

I do have some good resources here locally, but my options are limited here. I've got two great doulas and a wonderfully supportive spouse on my side, and I have all the confidence in the world in body's ability to give birth safely.

[bemildred]

20. You don't suppose this sort of thing could be bad for your health, do you?

:banghead: :banghead:

[FM Arouet666]

21. Not a typical occurrence

Yes, I am a doctor and surgeon, and spent quite a bit of time as a medical student and resident. I have never seen such callous behavior, but I know that it does exist in the medical field. I have heard the horror stories from a number of patients, over the years, but they do constitute a minority.

I cannot imagine treating a patient with such indifference, like a piece of meat. Disgusting. Undoubtedly, someone will post that they had similar experiences, I do not deny this. However, I would not brand an entire profession for the boorish behavior of a few.