Being Dad, not Doc. How a doctor tried (and failed) to keep his mouth shut: Part 1.
From the ob/gyn’s office to the delivery room, I found it challenging to suppress my medical opinions: A three-part series.
Last week, Kate and I welcomed our second daughter to the world. Everyone is doing well!
Being an ER doctor means knowing a little bit about a lot of things, including obstetrics and gynecology. I want to share with you what this entire process was like for me, as a physician but also as the non-birthing parent.
In this first installment, I’ll describe what I remember from my experience as a doctor and dad-to-be in the months leading up to the birth of my first daughter (Maya). In the second, I’ll take you to the delivery room of our first daughter, where I really had to keep my mouth shut. In the last installment, I’ll talk about how things were different this time around with our second daughter (Sarah).
During Kate’s first pregnancy, I found myself gently questioning some of the relatively low-stakes choices made by the excellent ob/gyns we saw. I had not meant to do this. But, also, have you met me? By the time we were expecting our first daughter, I had made something of a name for myself writing about medicine and being a stalwart for basing our practice on data-driven research, rather than received wisdom and old habits. Naturally, this tends to set me up to disagree with some of my colleagues on some day-to-day decisions. When I’m at work as an ER doctor, it’s one thing. I’m teaching my residents and students. I can guide them toward better practices by citing medical literature. But when I’m the spouse of a pregnant woman, it’s a little different. I knew that. I knew I was supposed to keep my opinions to myself. And yet…
It started when Kate was prescribed a thyroid hormone. Why? Because her blood tests indicated that she “nearly” had an abnormally underactive thyroid. “Nearly?” I contested. What’s the point of having a range of normal levels if the clinicians just move the goalposts and regard the lower end of the normal range as abnormal? If anywhere between 4 and 10 units is “normal,” and doctors start treating 5 as abnormal, then they have, effectively, redefined the normal threshold to 6, not 4! If the same game happens on the upper end of the spectrum, they might start treating “overactive” thyroid disease in patients with a level of 8 or 9. Pretty soon, most patients with normal thyroids get treated as though they have a problem that they don’t have! In reality, the normal ranges are quite “liberal” to begin with, meaning that even slightly abnormal results are likely to also just reflect normal thyroid function. From a risk perspective, this makes sense. Doctors don’t want to miss anything, and so back when these tests were developed, doctors and scientists selected the upper and lower thresholds of normal quite generously. This means that slightly abnormal blood test results are likely false positives (i.e., not genuinely indicative of a true medical abnormality). Taking this approach means fewer false negatives (i.e., failing to detect a problem that really exists), which is what would occur if the so-called normal ranges were set more narrowly. And yet, Kate, with her “lower range of normal” thyroid function, was prescribed supplemental thyroid hormone!
Deep breaths, Jeremy. Deep breaths. I told Kate I thought this was kind of ridiculous, but I did not let this on to the ob/gyn at the next appointment I attended.
Another such episode centered around the ob/gyn’s decision to prescribe some prophylactic antibiotic for some reason or another at some point during the pregnancy. This time, I spoke up. I wondered, out loud, how many infections this practice actually prevented and how many complications it might cause, both now, and in the future, when the overuse of the said antibiotic might have led to it being rendered completely resistant to all relevant bacteria, and therefore useless. Again, I gently prodded, but I did not push back too much, nor come anywhere close to overriding the doctor’s medical judgment by advising Kate to reject the doctor’s plan.
At this point, I don’t think the ob/gyn liked me very much. Despite my sincere, if mild, protestation, I relented quickly. I did not stand in the way of the doctor making the decisions; I was not going to override an expert. But I’ll admit I wasn’t thrilled that the experts seem to have never heard of the ills of overtreatment. There is such a thing as “doing too much.” I think the doctor picked up on me being, perhaps, a bit “judgy.”
The whole question of what kind of genetic testing to do came up. (We had to do some, as Kate and I are considered “old” for parents, by virtue of being in our mid-to-late 30s the first time around, and our early 40s this time.) There was simply no good information on this. Should we do amniocentesis? Cell-free DNA screening? How many conditions should we check for? Even my friends who are experts in maternal fetal medicine had no strong feelings. At this point, I literally do not remember exactly which tests we ended up doing (although we did do the cell-free DNA testing instead of amniocentesis), but I do remember wondering if we were spending money unnecessarily. I think we went for a bit more testing than the doctor recommended routinely, but nothing that was literally off their menu of options. All of this made me think that parents need a good resource for this choice that reflects today’s technology. I could not find one.
Overall, I think I managed to navigate things reasonably well. Sure, I did a few things that most dads don’t do—like doing an ultrasound on my wife right before the doctor came into the room, just to get a sneak peek. But I did nothing to prevent our doctors from practicing within their usual customs.
Nevertheless, I probably managed to alienate our ob/gyn a bit. Fortunately, Kate is pretty easy as a patient, and that’s what matters. What can I say? I found it hard to switch off the doctor part of my brain and just be a dad. I guess that’s how I show that I care.
In Part 2, we’ll go to the delivery room of my first daughter, where my ability to keep quiet would be put to the ultimate test.
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