As a Maternal-Fetal Medicine specialist, I care for women with high-risk pregnancies. Many times, they have pre-existing medical conditions that make them high-risk; other times they develop a complication during pregnancy that warrants the care of a high-risk obstetrician like myself. As a result, I routinely prescribe medications to treat a variety of medical conditions that a woman may have while she is pregnant.
In my roles as a physician and researcher it is my job to know which medications are safe to take in pregnancy, weigh the risks and benefits before prescribing a medication, and make certain I am prescribing the best medication for the specific medical condition. I always have to keep in mind that I have not one, but two patients to consider -- the pregnant woman and her baby.
More recently, I have found that pregnant patients are asking more questions about their care, their specific medical condition(s), and the medications prescribed to them. I believe this is in part due to more information being available on the Internet and pregnant women connecting with each other through social media and online support groups. They are more informed and willing to ask me questions when they have a concern. Overall, they are taking a more active role in their pregnancy care.
I must admit, though, that if a patient starts asking questions about the medications I prescribe during pregnancy, I sometimes find myself thinking, "Do you think I would prescribe a medication to you that will hurt you or your baby?"
I suppose a part of me assumes the patient should just trust me. She should know that I have the best interest of her and her baby in mind. She should know I am not prescribing a medication that she doesn't need. She should know that my training and roles as a clinician and researcher have qualified me to care for and prescribe medications to pregnant women. She should know that I carefully weigh the risks and benefits before I prescribe any medication during pregnancy.
My thought processes completely changed, though, when I became pregnant. After two years of trying to conceive and multiple infertility treatments, I became pregnant with twins. Now the high-risk physician was the high-risk pregnant patient, and suddenly everything I knew about pregnancy with all of my training and years of practice went out the door. I had question after question, and even though I knew the answers I would have given to my own patients with the exact same questions, I still questioned everything!
My professional role as a physician and personal role as an expectant mother finally collided at 13 weeks of pregnancy when I became sick with a terrible upper respiratory infection.
I had not been that sick in years, and I knew I needed treatment. I still tried, however, to treat myself conservatively because I didn't want to expose my babies to anything, especially early in pregnancy. I was determined to tough it out until I got better on my own.
After about 10 days of severe coughing and overall worsening illness, I finally started medications. I researched every drug that I was prescribed even though I already knew the safety data on each in pregnancy. The physician part of my brain knew that I needed treatment, but the expectant mother part of my brain had taken over. I had gone without proper treatment for way too long and a simple upper respiratory infection turned into three weeks of misery. Ultimately, I was forced to acknowledge the fact that a healthy mom is necessary for a healthy pregnancy -- something that I have told my own patients in similar situations countless times over the years.
When I became pregnant, I had this idea that I wouldn't take any medications during my pregnancy unless absolutely necessary. But even when I knew I needed treatment, I was too stubborn to admit it. I can understand now, though, why many of my patients are hesitant to take any medications during pregnancy even when needed and prescribed by a physician like myself. If I was second-guessing myself despite all of my medical knowledge and years of treating high-risk pregnant women, how could I expect my patients not to second-guess and question me as a physician?
Once I was on the other side of the physician-patient relationship, I finally understood -- the protectiveness of a mother over her baby will always come first.
My experience has changed the way I interact with my patients. First, I now understand that I should not expect my patients to inherently trust me because of my title or degrees, especially when a baby is part of the equation. If I need to take a step back and answer a few, or even many, questions, so be it; it is my job and duty. Secondly, there are times when treatment with medication(s) is necessary. As an expectant mother who happens to be a high-risk obstetrician, I am no different than anyone else. I can ask questions and do research to put myself at ease before taking something prescribed to me. It is OK if my role as an expectant mother comes before my role as a physician.
The most important lesson I have learned, though, is that I am still learning--both as a woman and as a physician. I am about to embark on a journey as a first-time mother that will teach me things I never knew. Because of this, I will have a better understanding of what my patients are going through and how they feel. As a physician, I realize that I still have a lot to learn that will allow me to better care for my patients. This is perhaps the most valuable lesson of all.
I owe my patients an apology.
I didn't quite understand why I was questioned as a physician, but now I get it... and I am a better physician now for accepting this lesson.