Thursday, April 12, 2012

Oh Where, Oh Where Did My Informed Consent Go?

Did you just sing that? Because I totally did. It's been running in my head all day long and I have been waiting and waiting for that time of day when I can actually plop down and get some me-time to work on a post. Which, as any mother knows, translates to after the kids are in bed and I catch up on a few things around the house and online.

So here I sit, thinking back to the way I used to treat medical decisions. You know, before I made INFORMED medical decisions. I would go to the doctor, they would tell me the course of treatment we were going to take, and I would not question their standard policies and procedures. Why would I? They went to MEDICAL school. They have MEDICAL degrees. I'm just a lowly person with no medical training, why should I question what they want to do in regards to my health?

I have always had low iron levels and was on iron supplements for 2 of my pregnancies. With Sassy and Diva, I took the iron supplements I was prescribed with no question. The extent of my conversation with my OB went like this:
OB: Nicole, your prenatal screening bloodwork came back and shows that you are slightly anemic. I'm going to give you a prescription for some iron supplements.
Me: Ok.
Now, if I had to make a list of my LEAST favorite memories from my pregnancy with Sassy, do you want to know what would be near the very top? Being so constipated that I missed a class and was *thisclose* to going to the college's health clinic. Definitely not a shining moment for me.

Granted, it is common knowledge that iron supplements can cause constipation. It is listed with the possible side effects on the information printout from the pharmacy. The majority of my friends and family that had already had children at that point had complained about taking iron supplements during pregnancy and feeling crappy because of it.

But, long story short, I took the iron supplements daily. I tried to eat a fibrous diet to curb the constipation. And I was still constipated most of the time thanks to those damn pills.

Before my first OB appointment during my pregnancy with Monkey, I decided to eat a lot of iron-rich foods in the hopes that my lab results would show levels high enough to avoid taking those damn pills again. I ate lots of spinach salads. Had steak a few times over a two week period. Had chili with lots of beans. Ate chickpeas, broccoli, eggs (for the yolks), and baked potatoes. And then my prenatal bloodwork came back in the normal range.

But as the pregnancy progressed, I realized something. Adding iron-rich foods to my diet helped ensure that my iron levels stayed high enough that I was able to avoid those constipating iron supplements.

Let me say that again more concisely:

Eating a healthy diet allowed me to not need supplements.

WOAH! That is quite a mind-blowing concept. And it raises a ton of questions:

Why didn't my OB ask about my diet in my other pregnancies? Why didn't he suggest adding more iron-rich foods into my diet to raise my "slightly" low iron levels back into the range that is considered normal? Why did he only present one treatment option without any explanation?

Because true Informed Consent is MIA.

Don't believe me?
When was the last time that your doctor asked if you were interested in a flu shot and then gave you a detailed description of the possible risks? What about your pediatrician? Do they sit down with you and go over the risks of every immunization, antibiotic, or other prescription medicine they prescribe for your child? During a pregnancy, did your provider go over all your pain management options for childbirth with a detailed list of the benefits, risks, and standard policies that are followed for each?

What? Your doctor does not spend time doing that at appointments?
Then your doctor does not provide Informed Consent.

Now, medical professionals should provide all information necessary for the patient to make an informed medical decision regarding their health. The issue with the typical medical establishment in our country is that most medical professionals do not "have" time to do this. So instead of the doctor taking the time to have a detailed conversation, he or she will only give the patient the "cliff notes" version that decreases their liability and is their standard of care.

The problem with this is that options as simple as a small diet change are passed over as a possible treatment and patients are given supplements and medications instead. Now, my example is just for slightly low iron levels. Can you imagine how much information is left out for more complex health issues and concerns?

And today's medical professionals are busy people. Their schedules are typically jammed with patients that they spend no more than 10-15 minutes with per appointment. It is difficult to provide detailed treatment options for a minor health concern in that time frame after the provider does the standard once-over check-up.

So what is to be done? I don't see any major changes in the typical medical establishment in the near future that will allow most professionals the time to give all their patients a full range of treatment options with detailed discussion.

So the burden rests on the patient.

This can be intimidating. After all, your doctor or medical provider usually has degrees, years of education, and years of experience. Who are YOU to question them?

But this is YOUR health. YOUR body. YOUR decision. Not your doctor's. How many times do you hear people say "get a second opinion." So if you are not satisified with what one doctor offers for treatment options, you should go see another doctor to see if they have a different opinion. If this is ok, why is it not ok to educate yourself as much as possible and engage in a discussion with your doctor? Why can YOU not have an opinion?

One of the best things I learned during my pregnancy with Monkey is to use my BRAIN:
For each medical procedure, treatment option, etc, you run down this list. What are the possible benefits? What are the possible risks? What are the alternatives? What is YOUR intuition telling you about YOUR body? What will happen if we do nothing?

Now, back to my example from my own medical history of slightly low iron levels during pregnancy. Here is how that discussion SHOULD have happened with my OB.
Benefits- The benefits of iron supplements is that it will raise my slightly low iron levels to the normal range.
Risks- Nausea, vomiting, constipation, diarrhea, dark colored stools, and/or abdominal distress. (see here)
Alternatives- Monitor my diet and add more iron-rich foods. This option has minimal side effects (maybe just excess gas from the iron-rich foods haha) and another blood test will confirm if it raises my iron levels to the normal range or if I need additional supplementation.
Intuiton- Um, maybe I should pick the easy treatment option that won't make me contemplate going to the doctor to beg for something to make me poop.
Nothing- There are serious concerns for low iron levels (see link above with risks), but my levels were only slightly lower. The low levels might have resolved on their own as my diet naturally changed during the pregnancy. Doing nothing may have meant that I was slightly fatigued at different points in my pregnancy or it may have progressed to the point that it was obvious that I needed supplementation or other treatment.

So there you have it. If I had fully discussed all the treatment options, I probably could have avoided all of the crappy (pun intended) side effects of the iron supplements and made a medical decision regarding a treatment option that I felt was the best option for ME instead of fitting into the cookie-cutter treatment protocol that my provider uses as a standard.

Now, can you imagine what decisions you might make differently if you know the full range of options? For me personally, I would have made different decisions about birth control, pain management during birth, invasive tests that are "standard" when I exhibited no symptoms and had no medical history, etc.

So have you realized that your Informed Consent is missing from your relationship with your doctor? Or have you worked actively to make sure that you maintain it? Does your provider take the time to fully discuss your options? Or only present the benefits of their standard treatment protocol without discussing risks and alternatives? Do you think that Informed Consent is MIA in the traditional medical environment in our country? What are your thoughts and experiences?

1 comment:

  1. Great post! My doctor did the same thing with my iron being low never once mentioned diet. I remember telling people I worked with that my iron was low so they mentioned that I should just eat more food with iron so I did and I haven't taken any iron pills lately. But thanks for all the information!