It’s The Attitude!

It’s The Attitude!

In 1992, in order to encapsulate the central issue in the Presidential election that year, James Carville popularized the statement:  “It’s the economy, stupid.”  I am reminded of this during some of my patient encounters.  I think of a couple  I delivered a few months ago.    This couple had transferred to me, from a local obstetrical group, part way through her pregnancy.  A major reason for transferring, was that they wanted a nonmedicated  vaginal delivery and believed they would be more likely to achieve that under my care than that of the obstetrical group.  Unfortunately, her delivery process turned out nothing like they had planned.  There was an induction, an epidural, vacuum and ultimately a cesarean section of a healthy baby boy.  At the conclusion of this birth, I felt terrible.  This couple had come to me for a specific style of delivery, but I believed I had failed to meet their expectations.  The day after the delivery I went to visit this mom and talked with her about her birth experience.  To my surprise, she was extremely happy with her birth experience.  Obviously, she was thrilled with her new baby,  she was also very happy with the whole experience and happy they had changed doctors, even though the details of the birth had not turned out the way they had planned. 


I have been reflecting on the reason for the positive satisfaction, despite the specific unpleasant details and I believe it can be encapsulated in the statement, “it’s the attitude.”  What was the attitude that this couple found appealing?


1.      This couple was treated like family.  Since I am the only delivering doctor in this practice,  I get to know them very well and they get to know me.  We not only talk about their pregnancy, but also about both their and my personal lives. They know that, except in a very rare situation, I will be the one shepherding them through their labor and delivering their baby.   I will not be turning them over to another doctor, who might have different ideas, because my shift is now over.  They have my personal cellphone number and can reach me when I am needed.  At the end of all this, the couple has no question as to whether or not my priority is their well being.


2.    Throughout the pregnancy all interventions are discussed and a seeking of approval is obtained.  This is even more important during the labor process.  Nurses did not suddenly start doing things because the doctor ordered it.  Rather, the reasons for any intervention are thoroughly reviewed prior to the intervention happening.  The attitude part of this is that they are treated as equals in this process.  While I may have more education and experience, their input is just as important as mine.  This is a collegial process with sincere give and take.   This means they remain in control of what happens, rather than being taken over by a big unresponsive medical system.


3.    All options were attempted.  During the labor, she was encouraged to move around and change positions.  Other methods of achieving a vaginal delivery were pursued.  There was no timer running, so she did not feel pressured by the doctor’s fatigue, schedule or arbitrary time line. By the time the decision to do a cesarean section was made, the couple knew there was no other option and were in full agreement with doing the section.


Every case is different and rarely there is a true emergency or situation, where the doctor has  to take a more paternalistic approach.  Nevertheless, that should be very uncommon.  


Too often, the doctor has the attitude that they are the educated professional and the patient’s views and concerns are irrelevant.  Too many times, doctors will make up rationalizations to justify what they want to do to the patient, rather than admitting it is a doctor preference or the way they do things.   


My view is that physicians need to be transparent with their patients.  Agree or disagree with the patient’s viewpoint, a physician needs to be collegial in their approach.  If the doctor disagrees with the patient’s viewpoint, than try to persuade them in a respectful manner.   A doctor should never approach the patient with a condescending attitude.  A doctor should not make things up, to get a patient to agree to a given treatment.  Physicians should treat patients the way they themselves would want to be treated.  It is the attitude!

September 10, 2012 Uncategorized