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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Is it reasonable or even possible to request this consultant go away?

19 replies

ILikeCrumpetsAndTrumpets · 19/02/2022 23:32

DW is 16w pregnant and very, very sick with hyperemesis. She can't do anything or go anywhere. She throws up absolutely everything, including water, her own saliva and just plain stomach acid. She throws up from the exertion of sitting up, brushing her teeth, even just speaking sometimes. She's not a "weak" person and I have no doubt she's fighting this with every fibre - so please no comments about her needing to make more effort or try harder or that it's "just morning sickness". She can't walk from one room to another, she often crawls or needs my support - and has to stop to be sick. She's really unwell.

She's been admitted to hospital twice (after five trips to A&E getting fluids, anti sickness IV and vitamins/nutrition). On both occasions, she was discharged (in my opinion, before she was ready) by the same doctor. The doctors on the previous shifts weren't even considering sending her home.

The first time she was admitted, he discharged her very suddenly when all previous days doctors had said she'd be in for a while. She wasn't able to keep down food or water at discharge. He discharged her without medication even though she'd been taking medication (ondansetron) for it before going in and still ended up in hospital. She did say at the time she felt like he just didn't listen to what was happening.

The last time she was admitted, her ketones were +3 when he discharged her and he tried to discharge her with no medication, without even speaking to or seeing her. The doctor the day before (and the day before that) had said they intended to put her onto steroids. DW requested to speak to the doctor before being discharged and he told her there's "no point" giving her medication to go away with because morning sickness goes away at this stage of the pregnancy anyway. He also told her she shouldn't come back unless she's completely unable to keep water down because she'll survive on just water until the morning sickness passes. The midwife then got a different doctor (a registrar) to prescribe her medications to go home with (ondansetron on maxed out dosage, prochloperazine and promethazine - ignore bad spelling please). She was also booked in for IV treatments 1-2 times each week. The doctor the day before also wanted her to have an investigation done into severe blood loss and booked that in for the morning but this doctor cancelled it and decided it wasn't necessary.

Today, she went in for an IV treatment but she was only prescribed one bag of fluids and a half dose of ondansetron, which is less than usual. The fluids take two hours. During that time, the doctor came in to see other patients and saw it's the same doctor as above. After that drip was up, and her ketones were still +4 and she was still vomiting, the midwife said she'd need to get more stuff prescribed because she can't go home like this. Six hours later, the midwife still hadn't been able to get hold of the doctor or get him to prescribe anything. She'd been sat with nothing for six hours - the midwife did try to bring her food and water but she can't keep anything down and the midwife can't prescribe anything herself. DW would've had more medication at home (in fact, four times as much ondansetron, plus the others). DW couldn't find out whether she was being admitted or not because the midwife couldn't contact the doctor to find out. There were five women in the room - DW was the first to arrive, three of them were seen by the doctor while DW was on the first drip. The other woman not seen also had hyperemesis. Eventually, DW said she simply couldn't wait any longer (there's a background and other things going on that meant she couldn't wait forever - she needed to either leave or know for sure she's being admitted). The midwife kept encouraging her to stay and wait for the doctor but eventually she said she just had to go. So, she left, more dehydrated and more sick than when she went in. As she was leaving, the doctor turned up, but didn't speak her, just stood in the doorway watching as the midwife removed her cannula - and she left crying. DW feels he wouldn't have admitted her even if she did wait forever for him.

I feel like this doctor simply does not believe in hyperemesis and that every time he touches DW's care, she ends up worse. I don't know if it's even possible to request he not be included in any decisions on her care. All the other doctors we've met have been incredible, and so have all the midwives. In fact, last time DW was admitted, the midwife sat by her side and ranted about this doctor not understanding the situation and not knowing what he's talking about. The midwife said it's a good job they have facemasks now so the doctor doesn't see the faces she's pulling when he makes decisions.

OP posts:
MelCat · 19/02/2022 23:38

Your DW can request not to be treated by any clinician.

I am presuming this doctor is an obstetrician. The only issue you may have is that they may be the only doctor on duty at times and therefore she may have to wait longer to see someone else.

Is there another hospital your wife could have her prenatal care transferred to?

ILikeCrumpetsAndTrumpets · 19/02/2022 23:43

@MelCat

Your DW can request not to be treated by any clinician.

I am presuming this doctor is an obstetrician. The only issue you may have is that they may be the only doctor on duty at times and therefore she may have to wait longer to see someone else.

Is there another hospital your wife could have her prenatal care transferred to?

Thank you - this was our concern. I have no idea how many doctors are usually there, is that something it would be reasonable to ask?

We adore this hospital. It's not our local but we know it well, it's incredible and has an outstanding CQC rating. Every single other person working there is flawless - every midwife is amazingly friendly, everyone is knowledgable, the doctors are all amazing (except this one). The hospital could not be more perfect except this one doctor. Every time she gets sub-standard care or a poor attitude or bad communication, it's this one doctor. The facilities and expertise for hyperemesis are just unparalleled - except this one doctor. And, based on the conversation with the midwife last time my wife was discharged and the frustration of the midwife today, I get the impression that other staff there know he's not understanding of hyperemesis (the first midwife said as much). I don't want one bad apple to make us abandon the orchard we're comfortable in.

OP posts:
Kidsaregrim · 19/02/2022 23:50

You need to request an appointment with the consultant midwife, the sooner the better!

As the previous poster said your wife can refuse care by the doctor and if he is a consultant you can ask to be seen by another or for the on call consultant to be called. You are always entitled to a second opinion.

WallaceinAnderland · 19/02/2022 23:52

The midwife said it's a good job they have facemasks now so the doctor doesn't see the faces she's pulling when he makes decisions.

That's incredibly unprofessional and inappropriate. If she really thinks that he is lacking in his duty of care she should report via the NHS very clear process.

ILikeCrumpetsAndTrumpets · 19/02/2022 23:55

@Kidsaregrim

You need to request an appointment with the consultant midwife, the sooner the better!

As the previous poster said your wife can refuse care by the doctor and if he is a consultant you can ask to be seen by another or for the on call consultant to be called. You are always entitled to a second opinion.

Thank you. DW is consultant led, but hasn't seen her allocated consultant yet this pregnancy (but had her in her last pregnancy). I think this doctor is the on call consultant (but not 100% sure what the term means), he's not linked to her at all, he's treating everyone on the ward for that shift. So, it's pure chance which consultant is in charge when we go to the hospital. After she's been admitted for a week, he'll undoubtedly see her - but he'd discharge her if he saw her on day 2 or day 4 or day 7.

What is a consultant midwife? Sorry, not clued up on medical staff terms. How would we go about booking to see them?

OP posts:
DropYourSword · 19/02/2022 23:56

Contact PALS or equivalent in your hospital. Your DW has awful hyperemesis gravidarum and the doctor is being inexplicably unhelpful. There is absolutely no reason or explanation to this level of poor care.

Embracelife · 19/02/2022 23:58

Speak to PALS at the hospital
Change hospital

cdba88 · 20/02/2022 00:08

Yes she can refuse care from him.

She really shouldn't discharge herself next time.

UniversalAunt · 20/02/2022 00:34

I third directly contacting the PALs unit as soon as possible. You & DW might leave a brief message/email over the weekend requesting a call back & follow up promptly on Monday morning. Then share the detail.

Your DW’s care is not to standard, her health & wellbeing is at risk.

If the PALs unit ask you what is the outcome you want, it is that your DW sees her allocated consultant who knows her at the earliest opportunity so that you are both assured of optimal care.

thaegumathteth · 20/02/2022 00:44

Ugh I feel for your wife - I was exactly like this with my first pregnancy and it was horrific. I ended up asking for one midwife to not be allowed to treat me as she shouted at me that I should abort the baby because clearly I wasn't very good at being pregnant.

I don't know about if it was a consultant due to staffing ratios but I didn't want to read and run.

Scuttlingherbert · 20/02/2022 00:47

I had hyperemesis and felt so angry reading this! So glad all the medics I saw were brilliant.
It improved at 18 weeks for me. I took Xonvea (after 3 others) and it was a game changer.
I hope your wife feels better soon.
You or she could contact the charity Pregnancy Sickness Support. They matched me up with a 'buddy' - a volunteer who had been through it - we only had text contact but it got me through dark times.

Justilou1 · 20/02/2022 00:58

Absolutely contact PALS with all the details including ketone levels and make sure you mention your DW’s distress on leaving. Hyperemesis is dangerous.

Tabbacous · 20/02/2022 01:10

@WallaceinAnderland

The midwife said it's a good job they have facemasks now so the doctor doesn't see the faces she's pulling when he makes decisions.

That's incredibly unprofessional and inappropriate. If she really thinks that he is lacking in his duty of care she should report via the NHS very clear process.

Well quite. It doesn't sound like a great hospital if this doctor is let loose putting pregnant women's health at unnecessary risk.
UserWithNoUserName · 20/02/2022 01:56

Yes, she can ask not to be treated by that doctor, but there may not be another one available at that time.

In fact, last time DW was admitted, the midwife sat by her side and ranted about this doctor not understanding the situation and not knowing what he's talking about. The midwife said it's a good job they have facemasks now so the doctor doesn't see the faces she's pulling when he makes decisions

---> This sounds massively unprofessional. Shocked by the midwifes behaviour!

ButtercupOfFlorin · 20/02/2022 02:00

Your poor, poor wife! How awful - and she needs to get onto PALS and be readmitted. There is a little talked about but well researched gap in women’s healthcare where - especially in maternity healthcare - women are ignored, not listened to, not believed, dismissed and even have procedures against their consent. You need to fight this, the consultant is absolutely wrong. Continue to be a good advocate for your DW and don’t be afraid to demand a second opinion - she won’t have the strength to do it so it will be up to you to fight for her. Good luck to you both!

Rainbowqueeen · 20/02/2022 02:06

I had it in my notes that I would not be cared for by one particular doctor. Just ask and outline your concerns

ILikeCrumpetsAndTrumpets · 20/02/2022 10:02

Thanks everyone - we'll contact
PALS. I agree the Midwife's comment probably wasn't professional - I also think it was completely fair based on everything we've encountered with this doctor. I can't imagine I'd be a paragon of professionalism if I had to deal with the situations she does because of this doctor.
DW has also just reminded me that when she first arrived yesterday, the medication prescribed to her by the doctor initially was a medication she's allergic to (it's all over her file) and the midwife had to get it changed. So, he actually could've done some really serious damage right then and there if DW hadn't explicitly checked which anti sickness she was being given. Given that medications are given throughout the night by IV when she's admitted, I feel really anxious about her being under his care again - I can't expect her to request to know exactly what medication she's being given when she's literally asleep.

OP posts:
UniversalAunt · 20/02/2022 17:25

Hi @ILikeCrumpetsAndTrumpets, I posted last early hours this morning so now firing on all cylinders. I’d like to clarify what I said. The jist is consistent, & I’d like you to help you minimise the effort in the coming days to get the best outcome for DW.

Firstly, it has been good to read your summary, salient & detailed enough. However, I would not lay out so much up front for the PALS team as it is rather detailed for a first read.

Often the PALs team are tightly stretched & may have a part-time front desk so that they can manage the workload. So pitching up in person may be frustrating as the office door will be closed. However, PALs are a hive of activity behind the scenes, so you may need to use email & phone until, if required, a 1:1 appt can be made.

Each NHS Trust determines how ‘concerns’ & formal complaints are managed by the PALs team, so please pay attention to what is on offer.

The PALs team will seek resolution about concerns raised through informal means to achieve an outcome that the patient wants or needs.

So for your DW, the outcome may be an immediate improvement in her care & case management by reviewing/removing said consultant from her case AND getting the earliest appt for a review with the designated consultant who also knows her case (& who you both trust). This is a two step outcome & PALs have the leverage to do this.

At this time, this matter should be informally resolved.

PALs also cover formal complaints & this may be mentioned as part of the conversation as information to let you know this is possible. Please bear in mind that should you raise a formal complaint at this time, it is a different process which is fast tracked to the senior management team (per Trust processes) & this has formal governance/takes time, so may not get the change that your DW needs straight away. That said, should a formal complaint is required in due course, then go ahead with that as a separate matter.

I suggest that you both leave a brief message & drop a brief email to the PALs team tonight so that is picked up first thing tomorrow - keep the message brief so that they don’t get bogged down in detail. Then make a follow up call tomorrow morning. What you want is to speak with someone, get them engaged, then share the detail/timeline & what you’d like the outcome to be.

Apologies if I am teaching you to suck eggs, just suggestions to save you time, effort & angst as you are spinning plates & have enough to do.

FlowersHope your DW feels a bit better today.

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