NYTimes makes OB recommendations

March 24, 2006 1:00 PM

NYTimes makes OB recommendations - I'm not sure what this is doing on the Times op-ed page. It purports to criticize obstetricians for recommending bed rest. It is more enlightening as a window into the doctor patient relationship. The doctor shared his doubts with the patient and she's still angry.
posted by DrAmy (35 comments total)

I'm not sure what single-link 1000-word Op-Eds from a well-known registration-required website are doing on MeFi.
posted by Kwantsar at 1:13 PM on March 24, 2006

Op-ed, as in, opposite the editorials and signed by someone not on the editorial board of the paper.

I take the author's point to be that if there is no medical evidence for the benefit of the rest cure, it shouldn't be as widely prescribed as it is.
posted by bardic at 1:16 PM on March 24, 2006

Ditto. The piece is [kind of] stupid. Here's an idea, let's suggest normal activity to women in pre-term labor, because no one sues their OB when things don't go according to plan. Fetal monitoring is also not shown to prevent bad outcomes. What a fucking surprise.
posted by docpops at 1:18 PM on March 24, 2006

Why is this piece "stupid?" Is she right? If so she had a very good point. Bed rest is an extreme imposition and it certainly is used with great regularity.

I guess you can not blame a doctor for being conservative until their is evidence to the contrary. OBs have terrible problems with malpractice suits, many of them unfair. If they don't prescribe bed rest and the child is born early with complications will they get sued? Often enough to be conservative. Who will do the study to prove the contrary? Will they get sued by the non-bed rest mothers who deliver early, despite informed consent disclosures?
posted by caddis at 1:31 PM on March 24, 2006

It's stupid beyond the valid point that bedrest deconditions a person. It's stupid to expect a person needs "therapy" to recondition, beyond her own routine activity. She didn't just return from three months in space. It's stupid to use depression and bedrest in the same essay as preterm labor or other OB issue, as the former simply reinforces old notions of patriarchal physician stereotypes and bedrest for OB issues stems from an entirely different paradigm.
posted by docpops at 1:37 PM on March 24, 2006

She didn't just return from three months in space. I think you ought to try three months of isolation and confinement to bed, with a 30 lb weight strapped to your belly for good measure. Get a clue doc.
posted by caddis at 1:45 PM on March 24, 2006

docpops, honestly, I don't understand what you're trying to say. Perhaps you could clarify?
posted by lodurr at 1:48 PM on March 24, 2006

The main reason I posted this is because it illustrates one of the biggest problems in the doctor patient relationship: the disconnect between what patients say they want and what they unconsciously expect.

I imagine that Bilston considers herself a "consumer" of health care entitled to complete information and control over decision making. Nonetheless, she acts like a child who believes in old style medical paternalism.

Bilston says her doctor "placed" her on bed rest. No one placed her, she chose to follow her doctor's recommendation. The doctor told her about the lack of evidence for bedrest in this situation. She could have ignored or modified his recommendation or she could have sought a second opinion.

She sounds like a teenager whining that daddy was wrong and he made her take to her bed. The doctor is not daddy and Bilston is not a child. She had a number of options available to her, but she did not make a choice. She did not want to take responsibility for her own care.
posted by DrAmy at 1:48 PM on March 24, 2006

So you're saying that when it comes to health, we'd be better off cutting the MD out of the picture and taking responsibility for ourselves?

Interesting. The Republican healthcare plan is starting to make sense to me.
posted by bardic at 1:51 PM on March 24, 2006

I think you ought to try three months of isolation and confinement to bed, with a 30 lb weight strapped to your belly for good measure. Get a clue doc.

You first. In the meantime I'll stick with the three or four dozen cases from residency that mentioned every detail of their life, every kick, every BM, etc., and never needed or mentioned aggressive rehab for their re-conditioning. I'm not saying it's a non-issue. I'm stating the essay is a classic case of a non-issue in search of a soapbox, and is boring, and irrelevant.

On preview, Dr. Amy says it better.
posted by docpops at 1:52 PM on March 24, 2006

Wow, it's like everyone is talking past eachother here.

So you're saying that when it comes to health, we'd be better off cutting the MD out of the picture and taking responsibility for ourselves?

No she's not. Can you read?
posted by delmoi at 1:58 PM on March 24, 2006 [1 favorite]

Allow me to chime in here, because my wife was put on bedrest during a portion of her pregnancy with twins.

She had great difficulty walking, because of a fairly common medical condition during pregnancy that increased the flexibiliity between the two halves of the public bone -- it made even the most simple movements incredibly painful.

Without her doctor telling her officially to go on bedrest, she would not have been able to take disability time off of work, which means she would have had to drive back and forth and run around the office floor (something crucial to her job) with twins and an incredible amount of pain. While bedrest doesn't necessary cure anything by itself, it did mean she didn't have the intense pain all day long, and didn't have the associated stress -- and I am sure there's a study out there showing that reduction in pain and stress IS beneficial.

So we're talking about prescribing a lack of activity in order to prevent other things from negatively impacting the pregnancy. Here's who I think would object to this:

1. The companies that have to pay disability;
2. The insurance companies who prefer to pay for direct treatment rather than preventative treatment;
3. The people who pay payroll/other taxes that fund state-sponsored disability.

So who do you suppose wrote this op-ed?
posted by davejay at 2:11 PM on March 24, 2006 [1 favorite]

No delmoi, I can't. I need geniuses like you to explain your wisdom to me, dipshit.

I wasn't blown away by this piece, but I'm sympathetic to the author, and the general gist that doctors (and many other science professionals) are woefully lacking in the ability to criticize their own "objective" practices. Sure, getting a second opinion is generally a good idea, but many can't afford it, and many are so enthralled by the rhetoric of "I'm a doctor/genius" that they're cowed into thinking that they shouldn't question the care they're getting. I heartily agree that "the doctor is not daddy," but having dealt with many (usually male) MD's, this is a myth that they themselves promulgate, often.

I'll readily admit this has a lot to do with the care received by some loved ones that was, after the fact, quite awful. No law suits occurred, but maybe they should have. As for me, I thankfully haven't needed to see one for over a decade, but it has something to do with the fact that a sports injury was diagnosed as a sprain, when in fact it was a total ACL that led to me dislocating my left knee and screaming for help on the tiles of a dormitory shower.

Heal thyself, yadda yadda. Maybe the thrust of the author's piece is a bit misguided, but dealing with doctors and/or the medical regime in America is frustrating on all levels. Peole have a right to complain, even if they risk being dubbed "hysterical."
posted by bardic at 2:15 PM on March 24, 2006 [1 favorite]

*people*
posted by bardic at 2:17 PM on March 24, 2006

Ah, lest that we should starve from lack of NYT inanity.
posted by birdie birdington at 2:19 PM on March 24, 2006

Davejay:
...the two halves of the public bone...

Well, um, it's a VERY public bone, now.

--------------

I'm more with the poster above who questioned why a single-link post to a mainstream news op-ed piece is FPP material. Docs have long debated the need for bedrest, and no two seem to agree on it.
posted by OhPuhLeez at 2:45 PM on March 24, 2006

I found this interesting but could've used more background on the topic since I too am a consumer and not a doctor.

Just doing a google search I found these articles on bedrest:

About.com Bedrest article, Dr. Spock Bedrest Article, Multiple Pregnancies and bedrest

In case you're also interested in the topic or have someone in your life who's pregnant or with multiples!
posted by cell divide at 2:54 PM on March 24, 2006

...the two halves of the public bone...

Well, um, it's a VERY public bone, now.

Oops. You have exposed my error. And I have exposed your pubic bone (details) to the public.

for those too lazy to look it up: we're married
posted by davejay at 3:01 PM on March 24, 2006

She did not want to take responsibility for her own care.

Pretty harsh. She did what her doctor recommended, then she did her research, and she's letting other women know there are more options. Good grief, pregnancy only happens to some of us, and then only once in a very great while. It's hard to become an expert pregnant woman. If something was happening to me for the first time and my doctor told me something, I'd do it, and if I had enough time I'd find out whether it was the right thing on my own -- but it sounds like there was a certain event which took place that cut short the opportunity for her to do so.
posted by dhartung at 3:31 PM on March 24, 2006

for those too lazy to look it up: we're married

I think I speak for us all when I say:

GET.

A.

ROOM.

(unless you guys are, like, gonna have sex right here on the blue, in which case we, by which I mean dios, promise not to watch. Or film. Or sell it on the intarwe...hey, waitaminute.)
posted by scrump at 3:32 PM on March 24, 2006

Humans, particularly industrious Americans, are the only animals that will ignore the natural instincts telling us, "Hey, you're tired. You're achey. Maybe you should rest a little more," and instead drag ourselves out of bed at 5 am after a 6 hour night of sleep, fuel ourselves on caffeine, and go to work for 8 or 9 or 10 hours, only to repeat the cycle the next day, even with a bun in the oven. With patients more and more frequently erring on the side of overactivity, doctors will err on the side of underactivity - too much stress is far, far more likely to put a pregnancy at risk than too much rest.
posted by Feral at 4:20 PM on March 24, 2006

I also find it ridiculous that she compares her time in bed with the mindnumbing boredom that it would have been in 1877. She probably had access to a tv, a radio, books, I daresay she wasn't even banned from playing cards or checkers! The only way her complaints would sound valid to me is if she was forbidden to move or sit up for several months. I doubt that that is the case.
posted by jacalata at 5:38 PM on March 24, 2006

Thanks for the context links, cell divide. DrAmy, posting just an op-ed piece from a mainstream newspaper is generally frowned upon by the site owner; framing it with supporting links generally makes for a richer post.
posted by mediareport at 5:46 PM on March 24, 2006

Here's who I think would object to this:

1. The companies that have to pay disability;
2. The insurance companies who prefer to pay for direct treatment rather than preventative treatment;
3. The people who pay payroll/other taxes that fund state-sponsored disability.

Maybe also the woman who once had a full, vibrant life and now has to lie in bed for three months?
posted by transona5 at 6:29 PM on March 24, 2006

Not saying I agree with the tone or the point of the article (whatever that was), but I definitely sympathize. And for all of you out there saying, "Oh, big deal-" Really. Try it. For months. Sit your ass on a couch/bed and stay there. Feel free to try different positions, if you like. Watch TV, stare at a computer screen, do crosswords, and be completely dependent on somebody else for everything. It is a profoundly powerless and frustrating experience. I would never have understood, personally, until experiencing it for myself.

What I see is a woman who may have been frustrated with a lack of understanding from her doctor about the effects of long-term bed rest, and a desperate desire to believe that there must be something else that could be done, something other than complete inaction and waiting. It's an uninformed and loose piece of writing, mostly complaint, but I do understand the reactive sentiment.

That said, I don't think it is irresponsible or unreasonable in the least to recommend bed rest when it is an advisable option. Feral has a good point. Sometimes down time is the best thing we can do for the body.

Patients expect doctors to make it better. Period. Makes for a lot of friction in an imperfect reality. You couldn't pay me enough to be an MD.
posted by moira at 8:42 PM on March 24, 2006

No delmoi, I can't. I need geniuses like you to explain your wisdom to me, dipshit.

My wisdom? What on earth are you talking about? I'm just wondering why you thought DrAmy said anything like "So you're saying that when it comes to health, we'd be better off cutting the MD out of the picture and taking responsibility for ourselves?", because she clearly didn't.
posted by delmoi at 11:14 PM on March 24, 2006

Maybe also the woman who once had a full, vibrant life and now has to lie in bed for three months?
transona5 - if the woman is that concerned about her own social life she shouldn't be procreating in the first place. Most women are pregnant once in the entire lives. That's nine months out of 60-80 years. I think you can hold off on the beer, bad foods, and too much strenuous activity for just that wee while - it'll affect the childs entire lifespan after all. Put it in perspective.
posted by dabitch at 12:31 AM on March 25, 2006 [1 favorite]

I read the op-ed as being a complaint that bed rest may be a traditional cure, but it is not an example of evidence-based medicine, it has many negative side-effects, and there is actually some evidence that overall it is harmful.

The essay is hurt by the fact that she's an English professor and probably studied as an undergraduate at Mount Holyoke or Smith and so she couches the whole situation as an echo of Victorian fears of hysterical women. But if you can get through that, it seems like she has a point.

I'm sorry, Dr. Amy, that you think she sounds like a whiner. Sure, it's good for people to double-check their doctor's recommendations against Google. But it's not too much to ask the medical community to continue to engage in research to find out whether traditionally accepted practices are actually beneficial or harmful. Just look at the whole slew of studies over the last year or two that have shown that accepted medical practices were not beneficial --- from hormone replacement therapy to dietary advice around fats --- and you'll see that there is a lot of progress to be made.
posted by alms at 8:09 AM on March 25, 2006

Dabitch, who here was talking about social life, beer, bad foods, and strenuous activity? We're talking about a sick person confined to bed for months. There are physical and emotional repercussions. If it helps, take the pregnancy out of the equation.

Alms, well put. It seems every issue I've had during my pregnancy is hormone-related: hyperemesis, pubic symphysis dysfunction, gestational diabetes... Makes me wonder if there won't be some way to help moderate this in the future without harming the baby and the process. It doesn't help, though, that researchers' hands are pretty much tied when it comes to pregnant women.
posted by moira at 9:54 AM on March 25, 2006

This type of patient is the nightmare of every compassionate doctor. You take the time to explain your recommendation, your reasoning behind it, the evidence that may or may not support it, trying to give the patient all the tools she needs to be an informed "consumer" of health care. Nonethless, Bilston insists that the doctor somehow forced her to go on bedrest even though he secretly knew that it wouldn't help.

The doctor did eveything a good doctor is supposed to do and now he's reading about himself in a whiny op-ed in the NYTimes.

The short version of the story is this: the doctor recommended bed rest because he felt that medico-legally he had no other choice (remember defensive medicine?). However, he told the patient about other options and the fact that his recommendation was not supported by evidence. He left the decision up to her. The bottom line is that the patient REFUSED to make the decision. This so called "consumer" of medical care will not take responsibility for her medical care.

It was and always is the patient's decision. It is the doctor's fault if he or she does not provide all the information that might be helpful. It is not the doctor's fault if the patient refuses to accept the recommendation for what it is: a recommendation, not an order by some paternalistic, all knowing, all caring being.
posted by DrAmy at 10:11 AM on March 25, 2006 [2 favorites]

if the woman is that concerned about her own social life she shouldn't be procreating in the first place.

What a rotten argument! Especially considering the political atmosphere surrounding the issue of choice and access to contraception.

* Women have in many cases been denied access to their contraceptives (both regular oral contraceptives and emergency contraceptives) by pharmacists who think that their personal beliefs are more important and valid than the woman's.

* Access to abortion services is becoming more and more limited.

And yet if a woman is put on three months of bedrest during er pregnancy and complains about it, it becomes, "if the woman is that concerned about her own social life she shouldn't be procreating in the first place."

Now granted, this woman seems to have been pregnant by choice, but that "logic" you used above could be extended to women who did not want to become pregnant (who may also be put on bedrest). I guess we all just better cross our legs, and then shut up and let other people decide what is best for us, heh?
posted by kayjay at 10:14 AM on March 25, 2006 [1 favorite]

I think the Victorian comparisons make it hard to take the piece seriously, especially because her own argument, as best I can tell, is not "modern doctors are prescribing bed rest because they think all women are hysterical womb-hosts" but "modern doctors are prescribing bed rest because not enough research has been done about it." And the other thing I think causes some problems is the emotional component. I spent nearly a month on bed rest for a condition that, I later learned when I returned to the US, does not actually require bed rest. I'm still not angry about it, because I believe that my doctor cared about me and was doing what he thought was best. If I didn't believe that, I would undoubtedly be furious right now, because bed rest was really not fun. The emotional component in situations like these is really strong, which I think it makes it harder to have a rational conversation about them.

It's possible that bed rest is overprescribed, but I think a lot of people (me included) have a tendency to tune out when that argument is packaged with Victorian examples and a strong implication of My Doctor Didn't Listen To Me And That's Not Fair. It's not, and he should have, but sometimes they don't, and the Doctors Need To Listen More argument should be kept separate from the Bed Rest Is Overprescribed argument.
posted by posadnitsa at 10:15 AM on March 25, 2006

moira - transona5 seemed to be talking about social life. I threw in the beer and bad foods as a perk.
posted by dabitch at 4:05 PM on March 25, 2006

kayjay, please - you are putting words in my mouth. That is not what I said and you are seriously barking up the wrong tree there. When pregnant, don't you think that your own health and the babies health is just a wee bit more important than your social life? Just a tad? No?
posted by dabitch at 4:18 PM on March 25, 2006

This type of patient is the nightmare of every compassionate doctor. You take the time to explain your recommendation, your reasoning behind it, the evidence that may or may not support it, trying to give the patient all the tools she needs to be an informed "consumer" of health care.

DrAmy, how do you know her doctor did this? It doesn't say that in the article. It just says that he prescribed bed rest an mentions that her doctors (plural) "openly admitted that they were not sure bed rest would increase my amniotic fluid levels."

The doctor did eveything a good doctor is supposed to do and now he's reading about himself in a whiny op-ed in the NYTimes.

Where is she whining about her doctor? She says, "My own doctors, who were undoubtedly acting in good faith..."

It doesn't sound to me like she's doing any of the things you describe. Did you read the piece? Her complaint is about the state of medical knowledge about bed rest and about the fact that it is standard practice. She's trying to educate women about this and nudge the medical profession as a whole to investigate it more.

Do you have some first-hand knowledge of this case, something that wasn't in the op-ed piece?
posted by alms at 12:59 PM on March 26, 2006 [1 favorite]