to wonder why people dont question drs?

[biddysmama]

i was talking to a woman in my 'due in' groups and she said she didnt want certain tests but had to ... i told her i refused those tests (downs and diabetes tests) and she said she didnt know she was allowed to refuse..

she was shocked when i told her i refused iron tablets (upped my iron in food instead),downs,cervix exams,diabetes test,induction,injection for placenta after labour..

is it not normal to question and/or opt out of things you dont want or really need?

im glad a few people are saying the same as me, i was starting to think i was mad :s

I would hope that pg women would research things properly and choose what is in the best interest of the child, after all you could just refuse to have children, if you decide your going to you should put their health first especially with something as simple as a blood test and drinking some lucozade

I can understand women thinking that they don't need a gtt because they feel well, although this doesnt mean they won't develope gd anyway and women should be informed of this

I don't think many pg women feel that their needs and wants out way the health of their babies,

I would only accept an induction if it was necessary for me/my pregnancy on an individual level, not because it is standard practice to induce everyone at a particular date. The length of pregnancy varies from woman to woman, and many women in my family have had healthy, late babies (one at 43 weeks!).

The increased risk to the baby of going overdue is very small, and monitoring should be made available. And of course there are risks to induction as well.

blood tests arent always that simple tho, i have CRAP veins, even worse when pregnant, coupled with low blood pressure means it is almost impossible for them to get blood out of me, means trip to the hospital and a specialist where it often takes them HOURS to get any blood out of me, bruised arms and a sore hand as they often end up getting it out of the back of my hand or even my feet!

i dont put my health and my needs above my babies, i wouldnt have gone three weeks overdue if i did, as i was very over being pregnant but aware that my baby was just fine and happy where he was and would come out when he was ready!

I'm a doctor and I have trained for 12 years to be able (I hope) to impart some of my knowledge about the human body and help the patient come to a decision about what is the best treatment course for them. That is part of the job of being a doctor. Of course the patient is entitled to question doctors and find out as much information as possible about their condition and if they are not happy then they can refuse further investigations/ treatments.

The fact of the matter is that sometimes patients don't want this and some patients are very keen to be led by the doctor who they see as the specialist, which is fair enough for that particular patient.

Healthcare is a very individual thing - I refused a CVS (which was recommended due to a raised risk of trisomy 18 on my combined screening) because for me the risk of miscarriage was too great. A friend had a very similar risk ratio and went ahead with it. That is a decision that only the individual can make.

What I am trying to say is yes OP support other people in developing their automony in the healthcare system and inform people that they have a right to refuse investigations but remember everyone is different and just because you don't beleive you 'really need' some tests doesn't mean that the person you were talking to doesn't.

ps. Doctors are not suggesting all these tests for their own sick pleasure there is research and evidence that backs up the reasoning for the investigations and they are only suggested as the doctors believe they are in your best interest!

I was given a PV exam one day in ante natal clinic as I was 2 days overdue.

The doctor then started to rake me about inside which was very painful. I objected and told him to stop it, but he just continued. The HCA sitting next to him said that he was stripping my membranes He didn't ask and I wasn't given the chance to consent or refuse.

What he did resulted in a premature rupture of membranes later that evening and my induction failed. I ended up with an emergency c-section and the baby was born with strep B

I absolutely detest doctors and always question what they say. I've met plenty since whom I wouldn't let look after my cat

exactly rita, i was induced with ds1 it took over 3 days and very nearly ended in an emergeancy c section.

they also discovered i am allergic to the prostin they use to induce, so it wasnt really an option with my later pregnancies!

Exactly Mixitnow, it's up to each woman to decide what's best for herself.

OK. One last time.

40-60% of women diagnosed with gestational diabetes have no known risk factor ie they are not overweight, they do not have a family history of it etc

Loads of women don't have any symptoms of gestational diabetes. They feel fine and don't know they're ill

Still support your right to refuse tests, but you should at least read up and understand what you are refusing and the potential risks. In many countries there are tests that are not done as standard that you might research and feel you should

have.

I was induced at 43 plus weeks and nearly died as a result of blood loss due to a very large baby ( probably caused by how long I was left as non of the others have been big) baby got stuck and was distressed so not being induced isn't always the best way either, luckily they don't leave you that long anymore

4madboys, I also had no symptoms, no family history, not overweight etc. - everything you mentioned in your 1st paragraph. I still had GD though.

For example pre pregnancy testing for the presence of the sickle cell gene, which is highly prevelant in certain ethnic groups, is not offered as standard on the NHS. Instead they offer a test during pregnancy when the only choices available on a positive test would be to abort or continue the pregnancy. If you know you carry the gene pre conception you could check the your partner does not (both parents have to be carriers for the child to have sickle cell anaemia).

Over three pregnancies/babies I have seen

• an ob/gyn consultant try to move DS's EDD forward by 4 weeks because he was measuring large for dates. I pointed out that I'd had a scan at 6 weeks that had shown him bang on for dates and she said "well, scans aren't precise for dating at that stage". I further pointed out that it wasn't a case of being precise about dating, but that for her suggested dates to be right a 10 week foetus (over 3cm long with arms and legs) would have had to be mistaken for a 6 week embryo (about 3mm long, so a tenth of the size, and a tiny little smear on the screen with a minute flickering heartbeat). She said "Oh, yes" and left the EDD at its original point.

• an ob/gyn SHO (? I think -- could have been a registrar) who managed to misread my scan report in my next pregnancy to take the "estimated weight now" as the "estimated weight at EDD". He was rushed off his feet, poor thing, as several other doctors were off sick, but still.

• a paediatrician who did DD2's postnatal checks, when specifically asked about her preauricular pits, said "no, no, they are just cosmetic and absolutely nothing to worry about". Eight weeks later, after she was diagnosed with a hearing loss, the ENT consultant said "yes, those are very often associated with hearing loss".

• a midwife who insisted that being 2 ounces over birthweight at 10 days was "not putting on enough weight", that "not putting on enough weight" was probably my fault for not breastfeeding properly, and that perfectly normal baby acne was a worrying rash.

• several GPs who told me that there was nothing wrong with 2-week-old DS and that I shouldn't worry about his severe cough or vomiting up entire feeds (on one occasion I actually said, in so many words "I know this is my first baby, but I do know babies, I know they posset, but this really isn't just posseting, it's much worse than that"; I've seen the doctor's notes on that visit on the screen at subsequent appointments and they say "Posseting."). He actually had whooping cough and wound up in hospital on oxygen support.

and I'm sure there have been others.

I think there is some legitimate question and ongoing discussion over where the limits are drawn on GD testing, and whether insulin resistance is confused with diabetes. Personally I've been happy to be tested, though (in fact, couldn't understand why they wouldn't test me with large-for-dates DS; they kept just ordering random blood draws instead, which I always aced).

I agree with the principle of not accepting drs opinions if you feel they are wrong (nearly killed myself doing this back in my twenties) but I think you are wrong in that in terms of tests/help/info around babies I'm all for everything.

In my view it's only common sense to take on board the advice of professionals, however, it can be irresponsible to do so without question. Surely it's only sensible to understand our own bodies and how any clinical intervention will affect them. 2 years ago my midwife tested me to see if my baby was in high risk category for downs. I had no idea of the implications if this came back as high and this test was presented to me as routine. I was at high risk and the stress this caused me and my family was horrendous. We chose to have amnio carried out just to alleviate our worry but this also carries it's own risk. The dr who carried out the amnio was horrified that this hadn't been fully explained and that I hadn't been given the opportunity to make a well thought out and educated decision. I'm glad I had the amnio done and everything was fine but I dont think I would have had the downs test done if I had been given all the information beforehand. I've learnt since then to question any medical professional if I feel I need more information before allowing tests or treatment to be carried out.

Ive seen so many babies die and miscarriages due to diabetes I cant understand why anyone would refuse such a non invasive test.

Of course doctors are sometimes wrong, just like every other professional opinion is sometimes wrong. Part of the problem is that it seems to be so adversarial. Many doctors IME react badly to being questioned (perhaps I don't do it in the right way). Also, I suspect that many doctors suffer from being aggressively questioned and therefore tend to feel defensive. It would be nice to have the doctor - patient relationship set on better footing, with more explanations and questioning as the norm. But this would require more time and be more expensive, so perhaps that's why it doesn't happen on the NHS. I've found that when I've seen doctors privately, there's a lot more room for questions and explanations.

Clearly not every doctor has this attitude, but the ones I know (best friend, husband, two of husband's friends: three qualified GPs and one trainee) genuinely like patients asking questions. They say it's a great way to ascertain a) whether the patient's understood what they've been told, b) whether any important points were missed out / not clear enough and c) what the patient feels about the possible courses of action. That seems to me to be common sense . Moreover, DH bends over backwards to emphasise patient choice precisely because he doesn't want to push patients into procedures they don't want (inadequate consent is a really big source of litigation).

DH does say that it is harder to promote a model of shared decision-making with older patients, in general, because they have been used to a more rigid and unquestioning medical model in their past.

I'd say the only questions that really get DH's goat involve either a sweeping dismissal of the entire profession as quacks or a blind denial of the science (e.g. links between high blood pressure and morbidity).

In my experience doctors welcome questions when they are well informed, less so when someone has found info from a dodgy 'medical' website or google. Maybe I've just been lucky though!

As a HCP I also actively encourage the people I work with to ask questions and refuse certain treatments once they have all the information - the difference if that I'm in Mental Health so many time the decisions are, legally, removed from people (when detained under the MHA) - that said, I still think (luckily work with fantastic psychiatrist who also agrees) that people can make an informed choice about the type of intervention or medication, in the majority of cases - for example, someone who is a watch maker by profession will not be able to tolerate slight tremor but might accept weight gain as a side effect, so can make an informed choice about type of antipsychotic).

I have preexisitng diabetes and welcomed every single extra scan, blood test and intervention, including (unlimately failed!) induction at 38 weeks, because when I researched the papers that informed the NICE guidelines on diabetes in pregnancy the risk of stillbirth after this point was too high a chance for me, personally, to take.

No idea WHY anyone would take a chance with diabetes given it is very high risk in pregnancy, and is a simple test - but defend to the death people's right to choose not to have that test. Or any other test. Provided they have been given ALL the information and then accept any and all negative consequences wholly and completely themselves.

I agree with Wolfhound. If doctors didn't get so angry when questioned, patients would feel able to have a dialogue with them.

OP - "im glad a few people are saying the same as me, i was starting to think i was mad" - watch out, you will be sectioned, and then you will have no say about what is done to your body whatsoever.

Likemotherlikeson

Pretty big generalisation there about how doctors react to being questioned.

Being sectioned does not mean that you have 'no say about what is done to your body whatsoever'.

narkypuffin, i was and am aware of that statistic, i still chose not to have the test following discussions with a midwife and two consultants, one who thought i should have it because i had a big baby.

the other who looked at me and MY medical history and following thorough exam and discussion stated that i was just lucky to have big healthy babies and to have a pelvis that could birth them and who had seen firsthand HOW difficult it was for them to get blood out of me agreed that it was unnecessary and if need be they would test the babies blood sugar levels once it was born, which is wasnt.

i will question drs when necessary, whoever said they wouldnt when it came to pregnancy/babies as if i had not i would have suffered.

ds1 i had severe spd, so much so that i could hardly walk, couldnt move from flat to upright, couldnt use a bath, couldnt walk up and down stairs, was in excruciating pain, so much so that at a routine ante natal my midwife thought i was actually in labour so admitted me to hospital, saw a dr who said to me 'you are pregnant you are supposed to be uncomfortable'!! i wasnt just uncomfortable i was in agony and the three day labour i then had with ds1 was a walk in the park compared to the spd pain i suffered! i saw a different dr who spoke to me, listened, examined me and immediately realised that my symphis pubis joint had seperated and to a huge degree, hence the pain and the cracking/grinding noise my pelvis made when i tried to move! had i just listened to the first dr i would have just gone home thinking i was making a fuss!

i was offered a section because of the spd, but luckily had seen a specialist who knew that natural birth in an upright postion such a kneeling could actually HELP my pelvis to realign, despite this and the huge red notes saying no stirrups, to be upright etc i still had another dr try to put me flat on my back and in stirrups so 'he could get a better view'!!

when i was ill after having ds4 i went to see gp and was told that it was normal, to feel like i couldnt cope, that i wasnt sleeping and hallucinating, that the self harm and feeling like i may hurt myself and my kids was just because i was tired which was to be expected with four kids!! ummm NOPE i had post natal pyschosis, thankgod my partner dragged me back and insisted we saw a diff dr who immediately called in the crisis mental health team and i was then admitted to psych.

then when preg with baby no 5 i was taking 10mg citalopram, this was done under the supervision of mh and a consultant obstertrician and paed who all decided that that level was not a risk to the baby and would be better to make sure I stayed well rather than risk a relapse to my mh. but then i saw a locum gp who did his nut that i was talking it, told me i was putting my baby at risk and was basically tried to terrify me into not taking it, at which point i told him to phone my psych and they would explain why it was fine, he refused their advice and told me i should write a letter explaining that i had gone against his advice so it could be filed with my notes!

then with no 5, i saw a consultant as the pnp made me high risk, only when i walked in he looked at me (petite 5 2 and then at dp 6ft) and said 'oh you will need to be booked in for a section as you are likely to have a 9lb baby and are obviously too small to deliver naturaly) i then pointed out that HAD he read my notes he could see that all four of my previous babies were over 9lb and that 10lb 13oz ds4 had been born in a birth pool! all were delivered naturally with no intervention, he then told me i had been 'lucky' and that i probably wouldnt be lucky this time and would need a section as in his opinion the baby was going to be at least 9lb.

i told him the baby wasnt big as i knew she didnt feel as big, she was 8lb and delivered naturally. i did point out to the consultant that i wasnt there because of how i would deliver or the size of my baby but because of my previous history of pnp, he then glanced at my notes and said well i dont know why you are here, thats not my business!

so yes i question drs and i get all the information i can from trained proffesionals and reliable resources (helps having a mum who is a nurse and can look up meds etc and access studies) and THEN i make a decision.

Er yes it does. If you are sectioned you cannot refuse anything at all. Or do anything without permission.

well i was sectioned and still they discussed with me which medications i should take and they took my views into account etc and found one without side effects such as huge weight gain. i am sure they WILL force treatment if necessary but if you show you are reasonably competent and willing to engage with them and that you do want treatment they will or did in my case still talk to me and discuss treatment options.