8 Tips for Success With Your New Doctor

Health insurance often changes with the new year and many patients find themselves searching for a new doctor. Here are some tips for making your first visit a success.

1- Come in for a reason. While it may seem courteous to want to meet your new doctor before you are ill or in need, these “getting to know you visits” aren’t always popular with doctors. Insurance companies require a diagnosis to bill and “establishing care” doesn’t count. If you want to become known by your doctor, schedule a visit for an annual wellness visit.

2- Don't come with too many reasons. There can be a lot of paperwork during the first viait and a lot of data to be entered. If you have more than 2 issues to address, ask for a longer appointment or be willing to come back for an additional visit.

3- Write out your health history in advance. Ask if the office has forms. Take the time to gather important data such as immunization history and dates of important screening tests such as colon cancer screens and mammograms. It really helps.

4- Bring a complete list of medications you are taking or better yet, bring the bottles themselves.

5- Know your insurance coverage. There are a lot of changes each year and it is impossible for office staff to keep up. They may have hundreds of different insurance plans to deal with, you have one.  Know what you need to pay each visit and be prepared to pay it when you arrive.

6- If you doctor offers the ability to communicate online, take advantage of it. I love it when patients who were unclear about my instructions gave me the chance to clarify later. 

7- Find out about office policies for someday visits and after hours calls. If your health plan requires you to use certain hospital facilities or urgent care centers it pays to know this in advance.

8- If you are unhappy, say something! If you have an unpleasant experience, let the doctor know before deciding to switch providers. Some of my greatest improvements were patient suggested. If you receive exceptional service share that too. Even doctors need an occasional “good job!”

- Bart

Thanks for reading. More thanks to those who take the time to click a share button and let know others know about the blog. It is the only way word spreads and it is a huge encouragement to me! Comments and questions are always welcome.

14 year-old mom survives a delivery room emergency- An Amazing Childbirth Story

The young mother was not at all prepared for what was about to happen to her. Unfortunately, neither were her doctors.

It was my first time in the delivery room at the University Hospital. The doctor “training” me was an intern with 3 weeks experience. Our combined knowledge and experience would have filled a page and a half in a medical textbook. But there we were, attending the delivery of a 14 year old girl. That is not a typo. The mom had gotten pregnant as an 8th grader. She was from Mexico and spoke no English at all.

The birth of the baby was routine, and the intern performed the delivery of the baby without any difficulty. The umbilical cord was quickly cut and clamped and the baby handed off to the nurse.

The intern then turned to me, “Want to deliver the placenta?” It wasn't a hugely difficult medical procedure, but third year medical students take what they can get.

“Sure!”

I switched positions with the intern and grabbed hold of the clamped umbilical cord. I gently pulled downward. Nothing happened. I continued to pull for a few minutes. Seeing no progress, the intern instructed, “Pull harder.” So I did. Still no progress. The intern repeated the instruction. A few minutes more, still no progress. I thought I as pulling pretty hard, but according to the intern I wasn't as she instructed me to increase the downward traction even more.

Finally the amount of visible cord began to lengthen, indicating the placenta was on its way out. But what appeared between the mother's legs did not look to me like a placenta at all. It was big and round and purple, with lots of veins. It looked like a martian head. (If martian heads actually existed and came out in delivery rooms!)

“Oh my God! What is that?” exclaimed the intern who was watching me. As she verbalized the question the answer came to me, the words came out of my mouth simultaneously with the realization of what it was-

“It's the whole d--- uterus!”, I said as quietly as I could.

I had pulled the cord so hard that the girl's uterus had turned inside out and come out with the placenta still attached. The uterus was now located outside of her body. I lacked experience, but I was pretty sure that this was NOT a good thing. (I later learned how bad it actually was. If the placenta detached while the uterus was out, the uterus could not contract down to stop the bleeding and the mother could bleed to death. If the uterus contracted with the placenta still attached, it would take a lot of medication and skill to safely put it back. It was a race against time.)

“What do we do now?” I whispered.

“I don't know!” was the intern's non- reassuring reply.

The nurse, who actually had experience, reacted quickly and called for the senior doctor on the OB unit. The doctor arrived quickly, and surprised me by rapidly pushing the intern aside. She then used her balled fist to forcefully shove the uterus back inside. I vividly remember repeatedly seeing the outline of the doctor's fist through the mother's abdomen as the doctor worked to make certain that the entire uterus had completely returned to its correct position, and would stay there.

I also remember wondering- what is this young mother thinking? She was alone. There were no family members with her in the room. She was in a foreign place surrounded by doctors and students she did not know, speaking a language she did not understand. She had to have felt significant pain given the pounding pressure of the doctor's hand inside her body, and she did not even know why. Things happened so quickly no one had taken the time to explain. And- she was only 14 years old.

14 years old... about the same age that Mary was when she gave birth to Jesus. We have sanitized the Christmas story and ignored the pain of childbirth, the bleeding after the placenta released, the cramping that came as she nursed her baby, and the vulnerability of that young family. Mary was in an unfamiliar city, alone except for Joseph, her young husband. Shortly after the birth shepherds arrived, strangers intruding on her first moments with her son, relating an incredible story of an angelic announcement. What was Mary thinking?

The story of the young girl in the delivery room reminds me that Mary's experience was not all halos and choirs. Childbirth, especially to a young woman in a strange place, can be a frightening experience!

- Bart

This is the 4th of Six Amazing childbirth stories. you can read the previous ones in our archives, and subscribe to the blog to have coming posts delivered straight to your inbox. 

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The Baby is Healthy, but the Doctor Needs Surgery- An Amazing Childbirth Story

Moments before delivery, the concerned mom paused to ask the doctor, "Are you okay?"

Very few woman choose natural childbirth, mostly because it hurts really bad and epidural pain relief is safe and effective. This patient was the exception. She was determined to deliver her baby naturally, no medications at all. As a result during labor she could move and position herself as she pleased.

When it came time to begin pushing, she asked the nurse if she could squat at the end of the bed so she could push more effectively. The nurse and I found a "squat bar," attached it to the bed and helped her position herself for the final stages of labor.

Between contractions she rested, and then with each labor pain she lowered herself into a deep squat, hung on to the bar and pushed, her lower half a few feet off of the floor. While this was an effective pushing position it made it difficult for me to monitor her progress! I needed to kneel to perform an exam. When I thought the moment of birth was near, I again squatted down to check the baby's head position as she pushed.

As I settled into the squat, I suddenly felt searing pain as the reconstructed anterior cruciate ligament in my left knee exploded, my leg buckled and gave way beneath me. I felt myself falling and, almost in slow motion, I stumbled forward. In a panic I reached out my hand and grabbed the delivery table to catch myself, stopping my face mere inches from experiencing an embarrassing head on collision with the baby. (Not sure how I would have explained that to the dad!). The baby's head was "crowning" meaning the top the head was just emerging and delivery was moments away!

I gathered myself, balancing on my good leg. Pain had drained color from my face and I felt droplets of cold sweat appear on my forehead. The contraction ended and the mother looked at me with a concerned look on her face and asked, "Doctor, are you okay?" I wasn't, but it didn't matter. It was time.

I turned to the nurse, "Can you check and see if there are any other doctors on the floor?" I was not sure I could complete the delivery. The nurse picked up the phone and called the nurse's station. She turned back to me, shaking her head, "No one is here but you."

I took a deep breath and replied, "I think I am going to need a stool!"

The nurse wheeled a stool over and lowered the bed so I could be seated while the baby was born. Within a few minutes the baby arrived, fortunately without any difficulty or complications. Once I was sure mom and baby were fine, I hobbled out of the room. Leaving behind a happy family and a memorable story!

I was not at my best, but I was the only doctor available. There were no other options. It was an “Apollo 13” moment, failure was not an option!

I wonder if maybe Mary's husband Joseph didn't feel similarly incapable the night Jesus was born. Young, inexperienced and alone, there were no other options available. A teen-aged mother and a young man had no choice but to trust God and do their best.

Isn't that life in a nutshell? So many times we find ourselves in challenging circumstances, overwhelmed and seemingly alone. In those moments trusting God is so crucial. We must do the best we can, knowing that the God who "delivers" will "deliver" us again.

- Bart

This post was originally published 2 years ago, I share it again this Christmas in the hope that it will give perspective as we approach again the season of the year in which the Savior was born. Feel free to share it with others, or offer comments below.

A lot of Blood, a little needle, and a life saved-An Amazing Childbirth Story

In a near death story of a mom and a baby we find a reminder that little things can make a big difference-

She had been hospitalized for a month, placed on bed rest for complete placenta previa. Instead of implanting higher up in the uterus, the placenta was low, completely covering the opening of the cervix. This was a potentially deadly situation for both mom and baby. Once labor started and the cervix began to open massive bleeding would occur.

Once the condition was diagnosed at 24 weeks of pregnancy the waiting began. She was placed on bed rest to stave off any contractions and cervical dilation and was to remain in the hospital until she either reached 36 weeks of pregnancy or the bleeding started. Either way the baby would be delivered by c-section, as a vaginal delivery was impossible.

I was the intern on the OB floor, responsible for rounding on each patient every day, performing deliveries and assisting on c-sections when needed. I came to know her well, as would be expected when a doctor sees a patient every day for a month. The first month had been uneventful, with no bleeding at all. We we all optimistic that things would go well. She had made it to 28 weeks, and each day that passed brought another day of maturity for the baby and an increased chance at survival.

Everything change in a moment. It was just after lunch. I had just changed from surgical scrubs into shirt and tie for my outpatient clinic that afternoon when I heard a nurse call out from the patient's room, "Dr. Barrett, she's bleeding!"

I hurried into the room. The patient lay on her back, a bedpan filled with blood between her legs. Unsure of how much blood there was, I grabbed the water pitcher from the bedside, dumped it out in the sink and poured in the contents of the bed pan. 500 cc of blood, a half of a liter. In less than 2 minutes she had lost over a unit of blood. I turned back to the patient, and watched as blood began spurting out between her legs. It was even worse than I feared. She was going to bleed to death in a matter of minutes.

I had one nurse place an urgent call for the obstetrician and another nurse call for the anesthesiologist. What else could I do? I surveyed the room and saw her single IV line. I remembered from somewhere in my training that when treating a patient in shock it was important to have at least two IV lines inserted so fluids could be rapidly administered. I turned back to the nurse, "I need a second IV, large needle, NOW!" The nurse got to work and a second line was quickly in place and fluid poured in. Moments later the anesthesiologist arrived and took over the case. I watched helplessly as they wheeled her away, the combination of my inexperience and clinic responsibilities excluding me from the operating room. I paused to whisper a prayer and went to the clinic, fearful for mom and baby. Things did not look good.

As soon as my clinic shift was over I hurried back to the hospital to check on her status. The anesthesiologist was at the nurse's station completing paperwork when I arrived. "Hey, Bart! She made it! 16 units of blood, 10 packs of platelets, but she made it, and so did the baby." I let out a sigh of relief.

She went on, "Oh, and great job getting that second IV started. She went downhill so fast that without it we would have lost her. It made all the difference."

Her words caught me off guard. I had a hard time believing that something so simple could be so important. Yet, according to her, a single needle was instrumental in saving her life.

A little thing made a big difference. I didn't think I had done much but when the time came to save her life, and the life of her child, everyone, including me, had played a part. Nurses, surgeons, anesthesiologists, lab technicians, blood bank employees, and me, a green intern, all had contributed.

It is easy to overlook bit players, but they can be important, including the bit players in the Greatest Childbirth Story ever. This Christmas, as you read the Christmas story, take some time to consider all of those who had a part in the story. Shepherds, angels, Mary, Joseph and the wise men, all had a role in the story of the amazing birth of the Savior.

A final note- Nine years ago I received an email from name I did not recognize. It read, "you do not know me, but 15 years ago, you saved the life of my sister and my mother. I just wanted to say thank you and let you know that we have not forgotten what you did for our family."

All because of a needle.

- Bart

This is part 2 of 6 of the Christmas series "Amazing Childbirth Stories". It was first posted to years ago. I am sharing it again this Christmas season. Subscribe to the blog to have the future posts delivered to your inbox! Enjoy the stories? Please share with your friends on Facebook or other social media by clicking one of the share buttons. Comments and questions are always welcome.

6 amazing childbirth stories

Reflecting back on amazing birth stories seems appropriate as we approach the day we celebrate the most amazing birth ever. Here is the first of 6 of these stories-

It was 1991. I had been a doctor for 15 months, only 3 months of which I had spent delivering babies. I had delivered about 50 babies and been involved in 30 or so C-sections. Not exactly a long and glowing resume.

Nevertheless, I was the resident physician covering the labor and delivery unit. There were experienced Obstetricians on call who were less than 30 minutes away and occasionally in the hospital, but if and when an emergency happened I was the designated first responder.

Although I was inexperienced, I had worked hard learning protocols for emergencies in childbirth. I was determined- If there ever was a bad outcome, it would not be because I wasn't ready.

It was mid afternoon when the call came from the emergency room. The charge nurse answered the call, her face quickly turning serious.

“Bart,” she said, “We have a 27 weeker coming in by ambulance with a prolapsed cord.”

I headed for the elevator that would take me to the emergency room on the first floor. In the 3 minutes it took me to descend I reviewed what I knew. A cord prolapse meant that the amniotic membrane (Bag of waters) had ruptured, and that as the fluid flowed out it had carried the umbilical cord with it outside of the vagina. If the head descended (as it does in labor) the cord would be pinched and the blood supply cut off. The baby could die. The woman was also 27 weeks pregnant, 3 months early, only a few weeks past the age of development where babies can survive outside the womb. If we could save the baby, it would have a difficult road ahead of it.

The elevator door opened and I hurried into the ER, past the nurses station and into Trauma Room 1, where an ER doctor, several nurses and EMTs scurried around the patient, measuring vital signs. The ER doctor saw me come in, “I didn't feel a pulse in the umbilical cord,” he said, implying that the baby may already be gone. (Only later did I consider how frightening those words must have been to the mother).

I was the youngest and least experienced person in the room, but I called to a nurse- “Get me a doppler!” (the ultrasound device for listening to a baby's heart beat.) The nurse applied the device to the mother's abdomen, and the rapid sounds of a heart beat were audible above the commotion.

“Heart rate 140!” the nurse called in my direction. I barked out another order, “What is the mom's pulse?” I wanted to make sure it was not 140 as it would be a grave error to perform an emergency C-section only to discover that the baby was gone and the pulse we heard was the mother's.

“Mom's pulse is 90!” replied the nurse.

“Let's go- now!” I said and grabbed the rail on the gurney. The ER doctor watched as I took over, more than a little surprised at me taking charge. A few nurses joined me and we headed for the elevator to the OB floor. When we arrived on the floor the charge nurse was waiting for us. She had grabbed an OB as he was walking by the nurse's station and then called for an anesthesiologist. They were standing at the door of the operating room, ready. We wheeled the mom straight into the OR and started the C-section in minutes. The baby was delivered just 17 minutes from the time the mother had first arrived in the emergency room. The neonatologist (high risk baby doctor) was on the scene and the baby was stabilized. Both mom and baby were okay.

Two days later the mom was visited by the director of my Family Practice residency program. He learned that she worked at UCLA Medical Center in a specialty department and did not have a high regard for Family doctors, for one of her first questions was, “How did a second year Family Practice resident know what to do like that?”

In her mind, experts in handling OB emergencies had to have a certain pedigree and experience. She knew what their resumes looked like, and they didn't look like mine. She could not believe that the doctor who had acted quickly to save her baby was a mere family practice resident. 

This episode reminds me of the greatest birth story ever- so many people had decided in their minds that the Messiah would come in a certain way, with fanfare and glory. They didn't expect a poor young virgin to give birth in a stable, and as a result they missed it. Isn't that how God works? In unexpected ways and through unexpected people?

-Bart

If you like this story- share it! If you don't want to miss any of these stories, you can subscribe to the blog and get them all in your inbox. Just check the link on the right of the home page, or at the bottom of your mobile screen.  This post was previously posted in 2013.