Doctors’ Appointment Update:

13 Mar

I finally get to confirm that we are indeed expecting a little girl!

Oh no! Bring on the pink! (I spent the entire afternoon working on my registry – ugh!)

The appointments I had Thursday went as expected.

I was at the MFM office Thursday morning for my ultrasound and “download” (they use a program to grab the numbers off my glucose meter and analyze the averages, lows and highs since the last visit).  No change in insulin dose and the Salty!Baby is growing well.  My husband was great support.

I’m glad to see that I don’t normally wait very long at the MFM, but the entire staff, including Dr. McMFM, needs to work on their bedside manner.  I asked about the lights in the room during the ultrasound and the answer I got still seemed “odd” (if you can’t read the screen in the light, why not get non-glare screens and increase the contrast slightly?), but I think the nurse I was asking was understanding.  When I was shown my ultrasound room Cindy and the tech were both there ready for me.  I never did get the technician’s name.  I asked Cindy, who I assume must be the lead nurse on diabetes cases, if she could ask me questions about my “numbers” separately (with the lights on) from the part of the exam where I’d be getting the ultrasound, and she said, “oh I’m just here to get you comfortable,” at which point I rolled my eyes because my husband was with me and I’m not so pregnant that I can’t get on a table and roll down my own pregnancy jeans.  So I hopped up, try to let it pass that they continually “tuck” towels into my underwear’s waistline without so much as a warning, and Cindy left.  5 minutes later, as the tech is doing the scan, Cindy comes back in, without so much as knocking or announcing herself and proceeds to ask me questions about my numbers.  Seriously?  *sigh*  That’s why it’s going on my birth intentions page – I don’t like it when people just barge in without respecting that I’ve got other things going on, like trying to see images of the kid I’m gestating.

When the technician was done, I asked, “would you be able to tell me the sex of the baby?”  Her response was a slightly indignant, “you don’t already know?”  and I had to explain that no, not even Dr. McMFM was able to confirm last time.  Without much difficulty she was able to go back towards that area of the baby and show us that affirming “line” in between the baby’s legs.  That was cool, but I was a little put-off that she seemed inconvenienced by it and no one had notated that it wasn’t “confirmed” last time.

She left and Dr. McMFM came in to do the secondary run-through and at the end, the good doc asked if I had any questions.  I told her that I was going to see Dr. V in the afternoon and that I was going to show her my birth intentions.  Dr. McMFM made it clear at the last visit that she’s just there for the pre-natals – Dr. V is the person who attends the delivery, so she can’t answer too many questions about my labor and delivery.  Well, I figured that because she’s my Maternal-Fetal Specialist, she might know of some resources on what to expect for my hospital labor as a type II diabetic.  She said no, which I was fine with, because again, she’s there to make sure baby’s doing okay while baby is still inside me.

My husband and I went to an early lunch, after which, he went to work.  My doula, Pat, met with me for my OB appointment in the afternoon.  There was no wait this time, which was GREAT and my blood pressure and weight are on track and I was feeling more excited than apprehensive about showing Dr. V. my birth intentions.  We were able to go through, line by line, and she agreed to just about everything, or had a rational explanation for why it may not work in my situation.  The only things we shot down completely were eating (I knew that’d happen) and line about managing my BG levels.  She and I even found understanding on the clothing issue: she would rather that I wear something with shoulder snaps and back access, so I’m going to purchase 2 “fashion” hospital gowns online, so that they feel more like my own clothing.

The one thing we got to on the draft that bugged me was the drinking/hydration part.  According to Dr. V, Dr. McMFM wrote the “diabetic fluid protocol” that the hospital I will be delivering at uses.  Dr. McMFM knows where I intend to birth because, 1) it’s in my chart, 2) Dr. V only attends deliveries at two hospitals and even told me she’s trying to keep it to only the one that I’m delivering at, 3) Dr. McMFM’s office is in the hospital where I’ll be delivering, which is why Dr. V’s office prefers to refer patients to her office.  *sigh*  I feel that when I mentioned that I expressed that I was curious about what to expect during labor at the hospital as a diabetic (and I’m pretty sure that I used the word protocol), that Dr. McMFM could have mentioned this.  So now I have to call over there and ask for it to be explained or a hand-out faxed to me.  I kinda question why Dr. V wouldn’t just ask the nurse to send it to me (I can understand it’s not ‘her’ protocol, but it still feels a little weird), but I’m still mostly upset that it’s not something that Dr. McMFM would mention.  I thought that I’ve been trying to present myself as a curious, concerned, and active participant in this pregnancy and I feel that she hasn’t seen this or doesn’t appreciate it.  Maybe it’s because I’m neurotic?

The point is, I’m really starting to understand that I prefer “patient-centered/medical home“-style care.  The medical-home model is a relatively new idea – there’s still a lot of research being done on how it works and what aspects are most effective – but basically when I talk about medical home-style care, I’m thinking about a practice that includes the front-line doctors and/or the specialists, the lab, the educators, the nursing staff, and counselors/case managers all in one spot, with lots of  communication between these people, with the intent of decreasing costs and improving patient well-being by making the patient feel a like part of his or her care.

For example: When I was first diagnosed with Type II Diabetes as a teen, my doc immediately referred me to a program in the endocrinology department at the pediatric hospital.  My mom and I participated in a comprehensive “class” that met once a week, that included dietary education, fitness evaluation, in-depth tests to show us our body fat percentage and oxygen output and other related measurements, etc.  They even encouraged us to share our feelings and experiences.  It was a total experience.  Everyone there was a “brand-new”, young Type-II-er.  It was really motivating and everyone involved was highly knowledgeable professional in their field: we met with nutritionists and pediatricians who specialized in endocrinology/diabetes (or maybe they were technically endocrinologists who specialized in pediatrics?).  They were always careful to explain what would happen next and what to expect, and to encourage us to avoid pitfalls that could make our diabetes self-management suffer.  After the class was over, I continued to follow-up on my diabetes with the same doc in the endocrinology department for two years.  Looking back, I can see that the expected outcome was that we would learn to manage our “adult” disease with maturity if they gave us the tools.  And they made sure we had the tools, and then they gave us self-confidence and and a network of other people our age going through the exact same thing.

Did my diabetes self-management take a nose-dive after that?  Yes, but it wasn’t because I didn’t know how to self-manage.  Part of why I slipped was because after I aged out of the clinic’s program and left for college in another town my medical-home fell apart.  I wasn’t seeing the doctor as often, and I wasn’t good about asking my mom to make sure I was current on prescriptions and she didn’t bother to ask me.    And when the fiscal responsibility became my own, I failed to take up the slack and eventually I convinced myself I “couldn’t” afford to take care of myself.  But that’s me

In a medical home, no one assumes that the patient is passive.  Every contact with the patient is an act that asks the patient to be an ACTIVE participant.  I wish my OB care and interaction with MFM was more like that.  :-\  You hear about places where moms take their own vitals when they arrive and practices that include certified nurse-midwives and doulas.  I hope those programs expand as the medical home model catches on.

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3 Responses to “Doctors’ Appointment Update:”

  1. nicole March 14, 2011 at 1:10 am #

    I ran across this while searching for a birth/doula shirt. It might be a better/cheaper option for you than hospital gowns, designer or no? I’m sure if you ask she could also make it back-accessible

    http://sanantonio.craigslist.org/clo/2219259477.html

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