I have had the benefit of communicating to physicians who like to teach on the internet, not just in the real world. DoctorJen was really helpful with my KALI questionnaire. I have communicated with Dr. Fogelson of Academic Ob/Gyn, whose blog has inspired a reply turned post of its own.
Dr. Onyeije, a Maternal Fetal Medicine specialist, is also communicating with me about ethics, risk presentation and paternalistic (or not) obstetrics.
Here was his comment on reply turned post, Academic thought on VBAC style.
Just wanted to chime in and echo your comments regarding how risk is communicated and how it is received. What I’ve found is that there are multiple different ways to communicate risk and (perhaps just as many ways) to receive such information. It’s a two way street and problems can occur when the recipient and communicator are not on the same wavelength.
I certainly see this when counseling patients regarding all types of screening tests.
I’ll be interested to read your thoughts on risk perception.
I have thoughts! I wrote a little bit about it here, but that is just the tip of the iceberg. Prenatal screening can be really problematic. High false positives in some screening tests can be emotionally devastating to a patient, especially if the physician and staff communicate risk poorly.
I know of a couple who called off their baby shower and told everyone they were getting a 20 wk termination over a “positive” quad screen – a high AFP level. And this was AFTER I personally warned them about the poor specificity of the test. Then, this couple who had told me they weren’t going to get amnio (prior to the quad screen) got an amnio, and of course, the amnio results were within normal range.
I have heard of a woman passing out at work and hitting her head on the desk because someone from her OB office called and told her her fetus has tested positive for Down’s syndrome. Not only was this incorrect, it was, again, just a quad screen result, not a diagnostic result, but they hadn’t even told the patient what the test was screening for until they called with the results. Every subsequent pregnancy she got the same low AFP, and then a “normal” amnio. Every pregnancy she got the amnio anyway.
Same thing with gestational diabetes screening. UpToDate is currently full of information about how unreproducible the results are for the initial challenge test screening and the GTT, and how there aren’t universally adopted thresholds. But, how many women have been bumped up to “high risk” by a GTT test, and then possibly even sectioned due to possible fetal macrosomia? I don’t even want a baby getting unnecessary heel sticks after every feeding, which is protocol in some places if the mother had GD. Especially if it subtly tells a new mother that her child will be hurt every time she attempts breastfeeding. It’s not worth it if it’s due to an imprecise diagnosis. I have another set of friends, the mother is a medical student, and the father has a PhD in psychology. She got a positive challenge test screen, and had a “freak out” (their words, not mine).
These are anecdotal studies, but I have read research about the anxiety these screening tests cause women.