When you acquire your medical records
The Midwife I Like in my practice was the midwife I saw at my last appointment, and when I told her we were going to Florida in a little bit to visit Jen's parents, she suggested I take a copy of my medical records "just in case." She said that lots of times ERs and stuff freak about pregnant people and are afraid to treat things, so having the records is a kind of insurance. So, okay, I hoofed up there to pick up the records (and to get more blood drawn from some missing prenatal tests, whatever).
Now before seeing TMIL last time, I had two visits with The Midwife I Do NOT Like. And oh, I do not like her. She's very snappy and it comes off as judgmental, and well, I just don't like it. I told her once (because umm, if you can't tell your midwife your pregnancy worries, whom can you tell?) that I was concerned that everyone was telling me I was really small, and that I looked really small compared to some of my due date peers. She snapped, "Stop looking at the internet." I was cheesed. That was the first visit.
The second visit with TMIDNL was the same day as our Big Ultrasound, so Jen was with me. We'd had a particularly rocky night the night before due to some misunderstanding and also a lot of sad feelings about our lost baby, and we're also pretty hung up on ultrasounds (as we've had a million and also have to see our lost baby at every single one), AND we ended up "not getting clear pictures" and being told we'd need ANOTHER ultrasound, so... yeah. Not the best day. I was really emotional in the office that day, and Jen was too, and at some point she asked if we were "having problems." I felt like crap that day, hadn't slept, and well, I'm protective of my relationship. I don't like people making snappy judgments about it.
So... the records. I shouldn't have done it but it was like a train wreck. I /had/ to immediately go to the page with those two visits on it, because the whole ride home from that awful visit that day I was hysterically crying that this woman was going to write awful things in my record. And there it was:
"strained relationship"
"recommended couples counseling" (which she definitely did not)
"seems to distrust the medical system"
"pt worries that we will think she is crazy"
OH. MY. GOD. This is in my FILE, the same file that will probably go to my new PCP, the same file that may be picked up again if I ever have another baby, my FILE. I am MORTIFIED. This is ON PAPER. What the hell do I do, besides spit nails?
Jen wants to file a complaint against TMIDNL. Or she wants me to talk to TMIL at my next appointment. She wants to go On Record saying that this sort of thing is inappropriate, etc. But all I can think about is how anything On Record is ALSO going to be a part of my file, and do I need MORE crap in my file about how I have issues? Honestly, I want to complain to someone too but I feel like I'm in this weird Catch-22 where expressing my displeasure (and also the lack of ethics involved) Proves Their Point. Augh.
This may not seem like a big deal, but when I have a like four-page record TOPS, and one whole page is full of disparaging remarks about me, it makes me twitchy. Especially because I don't like her. Especially because she made me feel stupid for asking questions about my pregnancy concerns. Especially because this woman could very possibly deliver our baby.
I don't even know what to do.
posted by Jude @ 12:09 PM
4 Comments:
Jude,
I am speechless. She sounds pretty awful. I think if I were in your shoes I would bring it up to the MW you like. Hell, I told my MW that I didn't want space cadet MW doing my IUIs because she was so slow and sloppy. Her response, "yeah that's not her specialty." So you may be one of many voices that need to be collectively heard at the practice.
Sorry.
xoxoxo
Hi,
I stumbled on your blog here during a bout of insomnia, but just wanted to say that you should definately say something to either 1) the midwife you like, 2) The office manager or administrator, 3) Directly to TMIDNL. I'm a nurse and if I were you, I would focus my complaint on your observation that something was documented in the medical record that is not true (ie- that she documented that she recommended couples therapy if she did not recommend couples therapy.)
If I were having this conversation with someone, it would be hard for me to remain calm and "seemingly" rational because I would be so outraged, but if you can limit your complaints about TMIDNL to very objective obervations of her "inappropriateness," you will come off as seeming very rational...
For example, tell whoever you end up meeting with that obviously this midwife is very perceptive and has good assessment skills b/c she picked up on your stress level and/or noticed that you were uncomfortable that day, but if she had been more direct in her questioning she would have discovered that the stress was very closely connected to the two of you having lost a child before- a more than resonable source of strain...
I would tell whoever that you have felt uncomfortable seeing this provider, but now are more concerned after seeing the chart because she DOCUMENTED IN THE CHART something that DID NOT HAPPEN in the visit. You requested these records on the recommendation of your other provider, and you feel worried that TMIDNL has been non-therapeutic in her interactions and clinical documentation.
If possible, stay away from adjectives and feelings and use specific examples of quotes she has said or things that she has done. [She asked if I had concerns, I began to talk about my concerns, she said, "stop looking at the internet."] See, you don't have to say, "I felt like she was judgemental" or "She made me feel like I shouldn't have expressed my concern." The examples stands on it's own as a (judgemental, stupid, annoying, infuriating) inappropriate thing to say to a pregnant woman whom you have just asked, 'do you have any concerns?'.
You have a right to choose not to see a provider. If this is a small practice where not wanting to see this provider will be a problem, serously consider changing practices. OR, if you are up to the challange, take your complaints right to the source (better to ask to see TMIDNL and an office administrator together and address your concerns directly to the provider.) If TMIDNL gets defensive or angry- it will be a sure sign that your instincts about her are correct, but she may respond positively to the feedback, it may empower you, even the scales, and repair or smooth the relationship considerably.
My last bit of advice is to try to ignore what you read- it is not personal... it was never intended for you to read. From my point of view, it is an example of not-great clinical documentation. If I read that in a chart I would wonder why there were no assesments of your (supposed) behaviors documented. What assessments of the clinician led to her perceptions and generalizations... She probably wrote the note quickly and it is her perception of the interaction at a specific moment in time (which is appropriate to document in a clincial chart) It should not and will not brand you for life. Medical documentation is not warm and fuzzy, it is utility- that's why we in healthcare can be so squeemish about releasing them- people are often offended by the terseness and the shorthand... Don't let it scar you- Most rational people (GLBT especially) do not trust the medical system, and everyone worries that their providers think they are crazy, and that day your relationship was a little strained- These things are all normal and healthy. Be proud of your rational self!
Oh My God!!!
I'm totally speechless too - so I'll back up everything Tracy and e says
Thanks, guys.
Tracy, as a therapist, I am most appalled by the inappropriateness of the paperwork, as in, documenting things that were not said or did not happen. It's not just the counseling thing, although that is the biggest sticking point (why write something down you never suggested?) - I also know that I never mentioned any sort of distrust of the medical system. I am critical of the Western medical system as much as I think anyone should be, but I also know that I wouldn't be pregnant right now without medical people.
It's probably the better thing to do to bring this directly to TMIDNL, but to be perfectly honest, I don't think I can do it. I /am/ overly emotional these days, where any perceived threat to my family or my baby make me cry, and I don't know that coming into a situation like this and crying is going to do anything but give her some sort of self-satisfaction.
I will probably mention it to TMIL at our next visit, and ask if there is a way I can avoid working with the other woman if that is at all possible. (It may not be.) Changing clinics isn't really an option for me because I'm driving 45 minutes north to a remoter area because I love the birth center there, and this clinic is pretty much the one. And I do love TMIL. And one OB that I met there once.
It's hard not to take things personally when someone mentions my relationship. I am ridiculously protective of my relationship, and I don't know if I feel MORE inclined to do so because we're a queer couple and therefore feel like society EXPECTS us to have a faulty relationship... but I know that to imply that our relationship is "strained" because we're mourning a loss seems awfully counter-intuitive. I don't know.
I just hate the whole thing.
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