Changing healthcare providers can be stressful at any time, but when the situation is as time-constrained and fraught with emotion as pregnancy it can be even more so. Patients have to undergo a personal analysis to determine why they are unhappy, whether things can change, and what to do (and how quickly to do it) if the situation is no longer acceptable. Recently, Yahoo.com spotlighted an article by Caitlin Brody (written in 2009 for TheBump.com) with suggestions for how to leave your OB.
Normally I would be terribly excited to see such an article. Provider choice! Women taking charge of their own healthcare! Assertiveness! I have a few qualms, though.
1) The explicit comparison to dating, beginning with the title: “When to Break Up With Your OB.” The article continues:
Sometimes, it’s just not working out. It may be awkward to part ways with your doc, but it may be best for you and baby. Here’s how to know when to switch OBs. From awkward first interviews to relying on friends for personal recommendations, finding the right OB is kind of like dating.
Descriptions like this, to be colloquial, kind of creep me out. A relationship with a healthcare provider should be professional, not intimate. There’s no need for “awkward first interviews” (just ask your questions!), just as there is no need for vajzzling or whatever it is the kids are up to these days. I’m as big a fan as any of a provider that is communicative and friendly with a good bedside manner. I don’t think, however, that I’ve ever had - or wanted to have - a “dating-like” relationship with my provider.
Plus, is this really the tone that should be taken with regards to an article about ending a patient-provider relationship? Is this the tone that would be taken in a men’s magazine, or to a mixed group of patients? The theme of treating pregnant women like young girls seems to have been taken to a new level here, even to describing needing to “cut the cord with your doc,” as though the OB is a maternal figure for the pregnant woman.
2) The assumption that all women want OBs. While I understand that most American women (presumably the audience of this article) may use OBs as their primary provider during pregnancy, many don’t and this article would have been much better directed at providers in general. Brody seems to state that you would only “break up” with your OB for another OB. The same concerns and lessons learned would go well towards any patient-provider relationship, however. I don’t know that “when to break up with your endocrinologist” has quite the same ring, though.
3) The idea that all pregnant women are the same and want the same things. Brody says, “it’s not unusual for a doc to see a different patient every 15 minutes. But remember, your 15 minutes are yours.” The indication is that it’s totally fine for a doctor to rush in and rush out - just so long as they don’t look like they are doing that: “One big no-no: hovering by the door, or generally just giving off the vibe she’s ready to jump to the next patient.” What about someone who wants more than 15 minutes? There’s always the quantity v. quality debate, to be sure, but is having both (or at least some of both) not even a possibility?
4) The major concern about the feelings of the OB. “Don’t be angry,” “How to Break It Off (Gently),” and “Start on a positive note” are some of the tips given. While I don’t recommend flying into the office, middle fingers blazing, what if you ARE angry? Brody suggests bringing a friend to help keep things level-headed; I suggest using your anger for good and letting the OB know exactly what your problems are and why you do not think they were fixed. Keep the colorful language to a minimum (this is a professional relationship after all), but there’s nothing wrong with showing emotion when needed and the idea of bringing a partner along to keep you level-headed is almost infuriatingly patronizing, especially when paired with the suggestion to “thank her before you leave.” Mind you, the last sentence does say that “What matters most here is your comfort level,” but that’s lost a little in the rest of the concern about the OB’s feelings.
On the other hand, the article does have some great tips for how to end a relationship with your OB provider, whether we’re talking OB, primary physician, midwife, or doula, and I find the following advice (some explicit in the article, some not) helpful:
-Be direct and as specific as possible when stating concerns with your provider. NB: Keep in mind that “I’m not comfortable” is still a totally valid reason to switch providers.
-Be honest. Talk to your provider, if you can do so. Sometimes, letting them know your thoughts can change the whole relationship. Sometimes not, so be prepared, but you could be surprised.
-You deserve to be heard. I’ll just repeat this: you deserve to be heard. Not to go all “woo” on you, but I think that’s a pretty good mantra for anyone considering a provider switch.
-“You always have permission to call it quits.” I think this is truly important for pregnant woman, who are often concerned with finding the right provider “in time.” I have had acquaintances and friends who changed/fired providers in the last weeks or even in labor; while I don’t necessarily recommend it (as it would drive me particularly neurotic), a patient always has the ability to change providers if the need arises.
Have you ever had to switch providers during a pregnancy? What would make you switch, if you have not? What tips do you have for women looking to switch?