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Scare Tactics

Posted Oct 10 2012 10:29am
My brother Steve loved to scare the daylights out of me when I was a kid. He hid under my bed, in my closet, in the boiler room in our basement, in the hall closet or in the garage just waiting for me to pass by before jumping out and trying to give me a heart attack.

Just look at this picture of the two of us in the backyard of my house in Milton. Is there any way that I was not going to end up in therapy after being tormented incessantly? Actually, I have avoided therapy so far but interestingly enough many of my nightmares take place in the house where I grew up....I wonder why?

Sometimes it is the job of a physician to counsel patients about the scary things that can happen during fertility treatment or in pregnancy itself. Clearly there is a fine line between full disclosure and doing the healthcare equivalent of jumping out from under the bed with a latex mask covering your head causing your younger brother to scream like a little girl...

A few weeks ago there was a story in the news about a 61 year old who successfully carried a pregnancy for her daughter who was unable to be pregnant herself. Here is the link to the story for those who are interested. That week I received several phone calls from local news media asking if we had ever had a patient carry a baby who was that old and if we did could they please speak to someone who had a horrible complication of such a pregnancy such as death of the baby or the gestational carrier... Well, at least they didn't beat around the bush in regards to the story that they were after....

I am a very risk adverse physician. It gives me chest pain to contemplate someone over 60 years old carrying a pregnancy because the risk seems excessive to me. Of course, I am not the one carrying the pregnancy, nor a family member involved in the decision so the issue becomes one of informed consent and patient autonomy. Last year I was accused by a patient of being horribly insensitive when I recommended that she use a gestational carrier because of a profound uterine issue that I believed put her and her unborn child at excessive risk. She posted a very negative review of my handling of the situation and put me in the category of a fear monger (along with older brothers who wear latex masks and torture their angelic younger brothers). I felt terrible (unlike my Brother Steve) and reached out to her to clarify my position and apologize for how my advice was delivered. She thanked me for taking the time to discuss the issue with her and accepted my apology (but never revised her online rant..oh well). However, I remain convinced that my advice was sound. Ultimately, patients vote with their feet and at least here in Washington there is no shortage of REs to provide a 2nd or 3rd or 4th opinion. Walking that fine line between scare tactics and good advice is tricky.

As a 3rd generation physician I believe that medicine is a calling not just an occupation. So as a physician I need to look in the mirror every morning and believe that I have done my very best and that I am truly giving the best advice that I can to my patients...and I need to be sure that there is not an idiot in a latex mask hiding in my shower....
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