A veteran OB-Gyn physician recounts this story of an incident that happened during his residency.
While he was on rotation in a high-risk OB clinic, a patient presented at 20 weeks with elevated blood pressure. This was her second pregnancy, and the first had resulted in a tragic outcome for the baby due to complications with preeclampsia. As the resident contemplated the case, the attending physician breezed in and announced, in front of the patient: “It’s already too late for her.”
The patient was devastated—but so was the young resident. This jarring early introduction to patient communication remained with him through decades of private practice in Colorado. It taught him that an OB-Gyn had a critical duty to manage not only a patient’s medical condition, but her emotional one as well.
Today, high-risk OBs know very well the correlation between a patient’s physical and emotional well-being, with the March of Dimes noting that prolonged stress increases the risks of prematurity and low birth weight.
The following strategies simply offer a quick reminder to help OBs stay attuned to the best ways to coach and support their high-risk moms-to-be. Here’s what members of the medical community recommend.
Focus on the Future
In “Care of the High-Risk Mother,” a paper published in the Global Library of Women’s Medicine, Richard Depp MD addressed the significance of anxiety during the initial consultation with a high-risk obstetrician. If a patient has been referred to a high-risk OB, he noted, most likely they’ve already experienced a traumatic pregnancy.“
The clinician must consciously attempt to avoid appearing astounded by the care rendered by the prior or referring physician,” he wrote. “Such behavior is not professional, absolutely unnecessary, and often quite disturbing to the patient.”
Instead of providing an after-the-fact second opinion, Dr. Depp recommended focusing on the many steps that can be taken now to ensure that the current pregnancy will be different. In his practice, clinicians collect a detailed history and use the information to create a Problem Plan, which outlines actions to address each problem. The process assures patients that “no stone will be left unturned.” It also facilitates communication and coordination with the patient’s other caregivers, which Dr. Depp cited as essential for easing fears and helping patients feel secure and confident in their care.
Millennial patients “do healthcare their own way,” noted a recent Forbes article. Six out of 10 millennials expect to utilize telemedicine technology for video chats with their physicians, and even more want digital access for booking appointments and viewing their records.
Further, millennials seek information from multiple sources. They are more likely than baby boomers to research healthcare online, and only 41 percent of them say they trust their physicians as the best source of health information.To effectively coach the millennial high-risk mom, physicians will need to leverage the newest technology tools to communicate with patients and coordinate care. A robust EHR platform will bundle all the technology services millennial high-risk patients expect—video chat capabilities, secure texting for check-ins and questions, access to medical records, and even a library of resources for patient education.
In the case of the high-risk patient, tech-assisted care coordination is not simply a matter of patient convenience. It’s a critical component of remaining accessible to the patient and easing her anxiety.
High-risk OBs face a delicate balance: Their patients must be informed about their complicated medical conditions so they can make educated decisions on tests and treatments. However, the information must be measured to avoid terrifying patients with descriptions of high risks and small odds.
Physicians offer these suggestions:
Don’t Eliminate Hope -Realism is important, says the Colorado OB-Gyn, but so is hope. In fact, he personally learned the value of preserving hope years later when his own wife was being treated for cancer. He and the family were encouraged early on by a 50% reduction in a marker related to the tumor. The oncologist didn’t let on at the time that the care team was expecting a 100% reduction. Years later, in a follow-up discussion after the wife had passed away, the oncologist revealed the true prognosis. The OB-Gyn says now that, even as a member of the medical profession, he would have been devastated to learn the truth at the time.
Build Time for Planning – High-risk patients often have other children and family responsibilities to plan for. If bedrest is a possibility, raise the issue long before it becomes a certainty. “Planning for such alterations may require considerable lag time, which cannot be accomplished once the pregnancy has advanced significantly,” Dr. Depp advised.
Speak in Plain English – Writing for KevinMD.com, Michelle M. Kittleson MD offered this advice to new physicians. “It’s easy, after you’ve taken all the time and trouble to learn the foreign language of medicine, to use words like afebrile and renal failure when you talk to patients,” she wrote. “But if you wouldn’t use those words with your (non-medical) friend, parent, or spouse, don’t use them with the patient.”
The Medgen EHR platform includes numerous communication and education features to help physicians coach their high-risk OB patients.