Saturday, February 4, 2017

My baby's doctor is not a pediatrician

"Who is your baby's pediatrician?"

I was first asked this question 12 weeks into my pregnancy by my OB's intake nurse. I have since been asked it countless times - when I arrived at the hospital for my delivery, as we were leaving the hospital with our new baby, and then every time we have taken her to specialist appointments and hospital admissions over the last few months.

My response has been the same every time: "Our family doctor is..."

I don't think any of the people asking me this question intended any offense. I know that, for many people, "pediatrician" = "doctor who cares for children." And, yes, pediatricians are doctors who care for children.* But family doctors care for children, too. The automatic assumption that my baby's doctor is a pediatrician is part of the image problem that Family Medicine still has. It seems that most of the lay public - and, frankly, much of the larger medical community as well - still doesn't know who we are and what we are qualified to do as family physicians.

I've written about this issue before, but nothing has changed regarding our national specialty organizations' efforts in the last four years. Certainly there are many articulate and inspiring family physicians active on social media, but that channel reaches only a relatively small segment of both the medical community and the lay public.

The US will not achieve an accessible, high-functioning healthcare system that delivers equitable, high-quality care without Family Medicine as its foundation. If people don't know who we are and what we have to offer as a specialty, if people don't know that family physicians' patients live longer and better at less cost, how can we possibly be a part of the national conversation about healthcare?

Maybe each of us, as family physicians, needs to launch our own mini-public-relations campaign. First and foremost, our patients must know that we are family doctors (not just a "general practitioner" or a "PCP"). We need to get involved in local medical organizations and make sure primary care's voice is heard there. We need to share our passion for our specialty with anyone who will listen.

I will start by affirming that my baby has a family doctor.

* Pediatrics is a specialty with board certification and its own rigorous training. I suspect many pediatricians would take some offense at the assumption that any doctor who cares for children is automatically a pediatrician. For the record, I have nothing but the utmost respect for pediatricians.

Monday, January 23, 2017

Pregnancy after infertility and loss

I just about stopped writing while I was pregnant last year. Sure, I kept writing professionally. But this blog, and the fiction I had been working on - nothing. Nothing for 9 months. I didn't mention my pregnancy on the blog, and I barely did so on other social media channels.

When I think back to why that might have been, I remember that writing requires recognizing the truths within yourself. There was a truth within me that I did not want to face during my pregnancy; I was terrified that I would lose my baby. I am a board-certified family physician and intellectually knew better, especially once we passed the first trimester. But I did not trust my body to care for my baby. I kept waiting, day after day, for something bad to happen. Once it was obvious I was pregnant, family, co-workers, and even patients gushed with happiness for me. I tried to match their jubilant tone, but it was always fake. I had trouble bonding with my unborn baby and resented the discomforts of pregnancy.

I can't blame you for thinking that the above paragraph sounds impossibly irrational. Looking at it typed there, it sounds impossibly irrational to me. To be honest, I'm ashamed of those fears. I feel guilty for not enjoying my pregnancy the way I was "supposed" to. After all, pregnancy after years of infertility should be cause for a grand celebration, right?

When I reflect on the five years of reproductive failure that preceded my pregnancy, though, the irrationality begins to make some sense to me. Cycle after cycle, year after year, our hope eroded away. When we did achieve pregnancy, miscarriage followed. I was conditioned to expect failure.

Pregnancy does not cure infertility. I still had to wrestle with feeling defective as a woman; I still had to reconcile those years of disappointment and heartbreak with the reality that a healthy, viable baby was growing within me. It was only when my OB laid my newborn child on my chest that I felt joy and hope again. (And, please know, I did feel and am still feeling a lot of joy now!)

I debated whether to share this post after I wrote it. But I'm certainly not the only person who's experienced these feelings during pregnancy, and it would have helped me to see stories like mine. I also hope that we, as physicians and healthcare providers, will allow our patients the space to experience their pregnancies authentically regardless of our personal feelings or society's expectations.*

I feel a complicated web of emotion around motherhood and how I got here. But I keep telling myself that here is a pretty fantastic place to be, all things considered. Our baby is a miracle and every day with her is a gift.

And that's more than enough for me right now.

* This hyperlink is to a post that contains explicit language. It is a raw and honest piece that includes f-bombs and frank anatomical references. If that won't offend you, please give it a read.