To complete the miscarriage at home: A lack of discharge instructions

Rene's story:
Years ago I was diagnosed by more than one fertility specialist as being infertile because I had only one fallopian tube that was totally blocked. I lost my other fallopian tube in 1990 when I had a tubal pregnancy. To add to the odds stacking up against us, my husband Arthur had a low sperm count. We were told our only alternative was in vitro fertilization (IVF) which was not affordable. Unfortunately most insurance companies don't pay for this procedure, so we didn't worry about it. God had blessed me with two daughters before I got married that Arthur legally adopted at a young age. Our daughters were all grown up and out of the house. We were living life to the fullest without the responsibility of being tied down to children, when suddenly after seventeen years of marriage and not using a contraceptive I became pregnant with our son, who was conceived on February 15, 2008, just one day after our seventeen year wedding anniversary. What an anniversary gift! The doctors still can't explain how we conceived our love baby.

I had prenatal care early in the pregnancy. Then in my second trimester, my water bag broke, and I went to the hospital here in Louisiana. I was sent home to complete my miscarriage with no discharge instructions. I was told I would be going home to pass tissue the size of a bar of soap. We left the E.R. at 5 am, on Arthur's birthday, and delivered our son at home 45 minutes later in the toilet. Arthur grabbed baby Trey who was still alive, breathing and gasping for air. Within minutes Trey stopped breathing and went limp in Arthur's hands. Our love baby was gone, we would have never left the E.R. if we were told it was a possibility our baby would be still alive.

It was a nightmare! They hadn't told me that could happen. There's no way they can make me believe that was normal. But that's what they said at the medical review panel, and that it was not preventable.

At the deposition, the E.R. doctor had tears in his eyes, and said, "I didn't realize this would happen," even though his lawyer was trying to tell him to shut up. But my Ob Gyn doctor could care less! She just sat there, twirling the ice in her glass, looking at me with such bitterness. If she'd said, "Rene, I'm sorry, I made a mistake," it would be different. But to pretend that I'm the one who has a problem, really irritated me. I went to this doctor because I trusted her, she was the best. She said she would take care of me and she didn't. There should be a law to prevent hospitals from discharging people without instructions when they most need them!

Rene's Advice: All week long my body was telling me something. Everybody knows their own body. If something's not right, it's not right. If you feel uncomfortable about a procedure, ask questions. Realize that the doctor is a man and not God, and ask questions about what they're doing, and why. If your body is giving you warning signs, if the doctor can't see you, get a second opinion.

Thanks to Rene McCoy for sharing her story.

Read another story on a premature birth.

Parents are often concerned: Dr. Hartman's patient communication

As a father with 19 years of parenting experience, I sometimes have to decide whether to bring my child to the pediatrician. If it will help, of course, I'll bring in my son or daughter, but if not, I'd rather not spend the time. So I call the doctor's office, and either talk to the receptionist or the nurse, and decide with them whether my kid's complaint is worth a doctor's visit. It’s helpful to have guidance from the doctor's office.

Some pediatricians are starting to think more systematically about how to partner with their patients in this decision. Dr. Lester Hartman of Westwood Pediatrics, outside of Boston, has innovated in several ways.

In Dr. Hartman's office, staff routinely collect the email addresses of their young patients' parents of their patients. He sends an e-newsletter to teach them when to come in for a sore throat, what croup looks like, and so forth. "One Saturday while being on call," he says, "the nurse practitioner and I must have seen 30 children with influenza. It is the same old story – the child has a cough and complains of a sore throat and achiness. The parent focuses on the sore throat, worrying about strep or pneumonia. We sent out an e-mail that evening stating to parents: 'We often realize when parents bring their child into the office during flu season, parents are often concerned about pneumonia or strep throat. Interestingly, most children who complain of sore throats say it is a minor symptom compared to their headaches and body aches. If your child says this when you ask then it is unlikely to be strep. Coughs and high fevers are very common in flu season and do not represent pneumonias. Call if your child has the following symptoms….Remember your child can have a fever for 5-7 full days.' The next day we saw two-thirds fewer children with the flu.”

At the end of the newsletter you can state that no emails sent back will be responded to.

Dr. Hartman was able to tell most of the parents – i.e., the vast majority who had email – what to watch for, and how to respond.

Advice to parents: Get a pediatrician like Lester for your kids.

Disclosure: I'm proud to have Lester as a close friend. We've had many backyard discussions on these topics over the years.

Read about a very different kind of communication about children's medical care.

Get an Ix with your Rx: Patient education by physicians

Joshua Seidman’s Advice: Research shows that 40%-80% of everything a doctor tells a patient in the office is forgotten, so taking along a patient advocate is a great strategy. Unfortunately, it is not always an option or sufficient. In order to ensure effective communication, every patient should leave the doctor's office with an information prescription (Ix). This after-visit summary reinforces what transpired in the clinic and outlines the person's next steps for self-management and interaction with the delivery system.

Providers that have implemented after-visit summaries — both in print form and available through a secure Web portal — have found that patients love them. The summaries provide something tangible to take home, guidance that is practical, and a bridge to the next visit or to a referral to another clinician.

Non-profit and government organizations such as the Center for Information Therapy, American College of Physicians and National Library of Medicine have been advocating information prescriptions for years.

Next time you go to the doctor, make sure to get an Ix with your Rx.

Read a story about model provider-patient communication, or read more atJoshua’s web site.

My dog has a better medical record than you do: Electronic medical record

My dog Jackson had a well-dog checkup recently with his veterinarian.

A month earlier, we had received a postcard reminding us that he needed certain vaccinations and was due for a yearly checkup. (Does your doctor’s office remind you?) When I phoned the office to make an appointment, they asked me my last name, and looked up his record on the computer so they could verify for me which shots he would need, and what the purpose of the visit would be. (Would your doctor’s office do that?) Knowing he’d need a fecal test, they suggested I bring in a (poop) sample, and gave the necessary instructions. They entered the information into their computer scheduling program.

At the visit, much of the equipment was not much better than that of a doctor’s office: a stethoscope to listen to his heart, a thermometer to measure his body temperature, a digital scale built into the floor, a pair of highly trained hands and eyes for the physical exam.

At the end of the visit, the vet handed me an individualized, four-page, neatly formatted and typed summary of what he had found, for each bodily system, with his advice on diet, exercise, and hygiene, a thumbnail photo of Jackson, lab test results and their interpretation, and target dates and types of future vaccinations. (Does your doctor routinely do that?) At check-out, I also received a receipt and itemized bill, which clearly named on an 8.5 x 11 inch sheet each shot and service Jackson had received, and showed the name of the receptionist, phone number, and future vaccine and exam dates, to keep for our records. (Does your doctor do that?)

They even advised on the preferred flavor of the toothpaste for daily brushing: poultry. The care was Mmm-Mmmmmm good!

Advice for people searching for a doctor: Find a doctor who uses an Electronic Medical Record to educate patients and themselves about the care you need.

Read another story about an electronic medical record.

Her Internet research said it could help: Patient education

Susan Arazy has multiple sclerosis. In January, she emailed her physician, Dr. Moore, wanting his opinion on whether early intervention with Avonex would slow her disease's progression. Her Internet research said it could help.

During the appointment, her doctor read information on several web sites, confirming what Susan had found. He deemed it worth asking a specialist, and arranged an appointment with a neuro-opthalmologist.

Susan had educated herself and asked her doctor's opinion. Her doctor had considered it thoughtfully with her and promptly supplemented his own knowledge with the most up-to-date information.

Advice to patients: Educate yourself. And get a physician like Dr. Moore.

Read another MS story, or read another example from the Wall St. Journal source article.

No more “diagnose and adios” for “Laverne and Shirley” star: MS patient education

David Lander acted as Andrew “Squiggy” Squiggman in the 1970s sitcom “Laverene and Shirley.” He’s still laughing, even 23 years after being diagnosed with multiple sclerosis. In those days, there was nothing doctors could do about MS, so doctors’ treatment was “diagnose and adios.” Now, many treatments are available.

“My doctor had painted a fairly bleak picture of the disease, even going so far as to say I probably wouldn’t walk again,” he said. Now he walks slower—and is a scout for the Seattle Mariners baseball team—and for the handicap accessibility of ballparks.

Speaking to MS patients is one of his greatest joys. He adds, “There’s a great strength that we derive from each other. Support groups offer MS patients an invaluable resource.”

“Wherever the chips may fall, if I fall with them, I will do so gracefully, laughing.”

Advice to friends and families of patients with MS: Take ‘em out to the ballgame—but check first for the ballpark’s accessibility for handicapped people.

Read another story about a celebrity spokesperson , or read Linda Childers’ article, “Fall Down Laughing,” in Neurology Now’s Jan./Feb. issue.