Friday, March 24, 2006

Bed rest

What is going on over at the NYTimes? There is an article on today’s op-ed page about bed rest for obstetrical complications. I can only hope that it was published because the author is related to someone at the Times, because it certainly doesn’t belong there. It isn’t news and it is a hit below the belt to obstetricians who try their best to help patients make decisions.

Bilston whines that her doctor recommended bed rest despite the lack of evidence for its effectiveness. That bed rest is not proven to be helpful is hardly a newsflash to obstetricians. The author unwittingly demonstrates why the doctor was afraid not to recommend bed rest; in the patient’s mind, the doctor was damned if he did and damned if he didn’t. Bilston is mad at the doctor because he recommended bed rest, but had he not recommended it, and something went wrong, she would have been the first person to blame him (and sue him) for not recommending it.

Bilston’s language is revealing: “I was placed on bed rest”. No, no one placed her on bedrest; she chose to accept a recommendation for bed rest. Bilston acts like the doctor tied her into bed, that once the doctor mentioned bed rest, she had no choice but to embrace it. That is absurd. The doctor himself told Bilston that he doubted it would be helpful and that there is no scientific evidence that it would work. On that basis alone, the patient could have chosen to forgo or modify the recommendation. She wouldn’t, though, because she didn’t want to miss even a tiny chance that bed rest might be helpful. Even so, she condemns the doctor for following precisely the same course. He recommended bed rest because he didn’t want to miss even the tiny chance that bed rest might be helpful.

Furthermore, Bilston easily could have gotten a second opinion. She could have consulted another obstetrician or, better yet, a perinatologist. Then she could have weighed the additional information in making her choice about bed rest. She didn’t want to make a choice; she wanted to blindly follow the recommendation of the doctor and condemn the recommendation at the very same time.

Bilston illustrates one of the biggest problems in the doctor patient relationship. The same patient who insists that she is a consumer of health care, entitled to all information and to control of medical decisions unconsciously views the doctor patient relationship in parent-child terms and acts accordingly. She’s mad at her doctor as if he were her daddy; he gave her the “wrong” advice and she was forced to follow it. Well, the doctor is not her daddy, and she is not a child. If she didn’t believe or didn’t like the doctor’s medical advice, she was free to ignore it or to seek another medical opinion. She didn’t do either, though, because the one thing she surely wanted to avoid was taking responsibility for own medical care.


Blogger Jo said...

This comment has been removed by a blog administrator.

6:55 PM  
Blogger Fat Doctor said...

If, for example, a woman comes to me with a first trimester threatened abortion, I recommend bedrest. What I tell her is, it probably won't stop you from losing the pregnancy if that is happening, but many women like to feel they are "doing something."

This post reminds me of my patient who got a bad disease probably secondary to smoking. He came to me, accusing that I had not been emphatic enough at every visit when I counseled him that he should stop smoking for his health. I said it (and thankfully documented it), but I wasn't a good enough salesperson to convince him, and therefore his lung cancer was my fault.

Damned if you do, damned if you don't is right. It's our daily dilemma as physicians.

11:46 AM  
Blogger diary of a premmy mum said...

Well when I was having massive bleeds during my pregnancy around 17 weeks. My uk ob gyn said I could do what I liked, that there was no evidence either way to suggest bed rest helped. 'well why are all the u.s pregnant woman on bed rest then?' I ask..
'because their doctors paid to say that' came the response.
I chose to bed rest until exactly 24 weeks, I got up and my waters went.

6:27 PM  

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