AMA Seeks to Label "Ungrateful" Patients

• 06-13-2009 8:13 AM

  lncooper Joined on 10-09-2004 Geneva, NY Posts 1,682

  AMA Seeks to Label "Ungrateful" Patients Reply Contact http://ican-online.org/news/ican-online AMA Resolution Would Seek to Label “Ungrateful” Patients Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1) The resolution complains: “The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.” “This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN). If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily. Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation. A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less. The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons: • Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients • Use of these labels fails to recognize patients as competent partners with physicians in their own care • Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion • Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research. “The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews. About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery. (1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients” (2) Evidence-Based Maternity Care: What It Is and What It Can Achieve (3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans If you don't like the idea of being officially labeled "non-compliant" or "ungrateful" for questioning your physician, then go to http://www.ama-assn.org/ama/pub/about-ama/our-people/the-federation-medicine/state-medical-society-websites.shtml , click on the link for your state AMA and contact them. Let them know that this proposal is unacceptable. Voting is next week.

• 06-13-2009 8:14 AM

  In reply to

  lncooper Joined on 10-09-2004 Geneva, NY Posts 1,682

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact This is especially of interest to those planning natural births because often, when working for a natural birth, you'll find yourself asking many questions or wanting to do something that the doctor may not agree with (like *gasp* going without an IV, or wanting something to drink, or not wanting to be stuck in bed the whole time). If you read nothing else, read the bullet points & the last paragraph. This is HUGE, & something needs to be done to stop it!

• 06-13-2009 7:32 PM

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  Cookiethief2 Joined on 12-18-2006 #1 5/17/06 #2 6/11/07 #3 12/18/09 Posts 1,157	Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact This is just ridiculous!!! They're trying to take our say in our own healthcare away from us!!!  I'm going for my second VBAC and I'm about to go head to head with my OB/midwives if they don't want to comply with my wishes.

• 06-19-2009 9:59 AM

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  TawniAline Joined on 03-25-2004 Camby, Indiana Posts 699	Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact ugh :P I really detest the medical community sometimes... I wonder where the ANA stands on this.. thanks for the info and the link :) (oh- and nice to see you again! :) )

• 06-25-2009 5:51 PM

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  NoLongerDesolate Joined on 02-23-2005 North Louisiana Posts 527	Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact They keep this up and midwives will be delighted with all the new business! It's also going to cause alot more UC's done on the downlow.

• 06-26-2009 11:11 AM

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  Mom~of~Munchkins Joined on 09-14-2005 Posts 249

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact Haha. That's kind of funny, actually. This is the AMA's way of throwing a formal hissy fit, because their physicians are "unsatisfied." LMAO I think its okay for physicians to have a personal stance on certain issues. Its okay if they feel they want to be in control and to use pitocin when they see fit. However, I really don't understand what's wrong with just referring the patient to another physician if they can't meet the patient's needs? Like if a mom who is low-risk wants an intervention-free delivery and, as a physician, you don't feel you are the best fit to help her achieve that, send her to a CNM! Or to another physician who can meet those needs. Have some damned ethics, for crying out loud. I think we should start a website allowing women do discuss their practitioners and to label THEM as non-compliant, if they feel the physician did not allow them choice.

• 06-26-2009 12:06 PM

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  CrissiLovesDylan Joined on 08-24-2007 Washington Posts 863

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact During my last pregnancy, I was treated so badly by my doctors and nurses, that I threatened to leave their hospital and turn to a midwife. They always seemed to quiet down a little when I said those things, but I still found myself bulled, threatened, and embarrassed by them frequently. I was told the gestational diabetes test done at 28 weeks (where you have to drink 16 ounces of a thick neon orange artificially colored and flavored syrup, and then wait in the wating room with no food or water for over an hour) was not optional, even though I pled with them to not force me to do it, since I don't partake in any chemical or artificial foods during pregnancy, with the safety of my infant in mind. They told me that if I didn't take it, they would have me hospitalized, and treat me lke a diabetic with multiple blood sugar tests throughout the day, every day until I delivered. I was scared shocked, so I gave in and took the test. I became violently ill in the waiting room, and even had to run to the restroom to vomit, which I was afraid to report, that they might tell me to retest another day. Needless to say, I was negative for diabetes, and found out later my insurance didn't even cover the test, it cost me almost $400 dollars out of pocket! When I went past my due date, they threatened me with pitocin induction repeatedly, and when I refused, they made me come in every day for ten days to hook me up to monitors for a fetal non-stress test, even though my baby was very healthy and had never shown any distress of any kind. At the end of it all, I had to have a c-section, because I was told my baby had gone too far past due, and was too big, puttng his life in danger. I'd given up by then, and was too tired to fight, so I allowed the elective section. My baby weighed nine pounds, and was as healthy as a horse. In recovery, they kept coming in when I was alseep to try and vaccinate him against hepatitis, something I'd requested to not have done. They played dumb, as if the new nurse on shift hadn't been informed of my decisions, and I had to physically stop the nurse from giving him the shot 3 times! They also adminstered chldren's tylenol to my newborn for no reason at all! I didn't find out until afterward, and I was furious! Of course the nurses rolled ther eyes and excused me as a paranoid new mother. This pregnancy, I have a new o.b. since I had such a bad experience with my last one, and I have yet to meet him (I will on tuesday the 30th) He's young, and new to the hospital, so I'm going to lay it down immediately, that I won't tolerate being bullied or threatened, and at any time, I can take my "business" elsewhere if I feel the need to. This resolution is sick and disturbing. It insinuates that a pregnant women is incompetant, and has no business wanting to have control of her care, or wanting a positive birth experience. If we're nothing more than "customers" to these medical professionals, shouldn't the old addage, "the customer is alway right" apply here? I'm saddened to think that the abuse of authority goes so far down the rabbit hole, it's enraging that docotrs don't feel like they already have complete and utter control over our labor and delivery process, and that they can't see that so many of us are taken hostage by the medical system, in that we are denied even our basic rights to refuse certain treatments we find unnecessary.

• 06-26-2009 6:00 PM

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  angela~2DS Joined on 04-04-2005 VA Posts 1,794

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact I could have swarn that I responded to this post a few days ago! But anyways, this whole thing just sickens me! It's our body! NOT the drs. Why should we be trying to make THEM happy when we are the ones PAYING them! It makes no sense. I wish I could say this could help out in some way. It just makes me so mad that they even think they can do this to us. Exp when the drs are using drugs(pit and cytotec) that aren't even approved by the FDA for use on pregnant women. Shouldn't they just only have the option of intervention is something is actually seriously wrong?! If everything is going perfect, just do whatever the woman wants. It's not like they do much but catch the baby anyways! I have so many things I would like to do, but due to our insurance(which is good) I can't do. Like a homebirth. I've thought about doing it totally unassisted but DH would be very upset with me if he missed it. SO....at least we can hope this is the turn the to midwifery in our country again. We have to be 31st for mortality and morbitity for something! Maybe they'll realise what it is now!

• 06-30-2009 2:54 PM

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  Mom~of~Munchkins Joined on 09-14-2005 Posts 249

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact Actually, according to the 2009 estimates, we're 45th in infant mortality. Behind Cuba, actually. LOL Way to go US! You know, most midwives will work REALLY well with people who want a homebirth but can't afford it. Mostly, because they are in it for the mother not the money, which none of us are really used to!!!!  LOL I've been told at two separate OB offices already in the last 2 yrs that they wouldn't even tend the birth unless my part of the delivery was pre-paid before I went into labor. My homebirth midwife hasn't even sent me a bill yet and I gave birth on the 12th. I think my insurance pays for 90% of nurse midwifery care in a hospital...but if I tell them it was a homebirth, they'll drop it to only 50%. Isn't that a bag of sh**?

• 06-30-2009 2:57 PM

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  Mom~of~Munchkins Joined on 09-14-2005 Posts 249

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact BTW: Crissy...your story makes me want to cry. Its so common. I fought to tears for my third birth. I was in labor naturally (progressing slowly, but met the 1cm per hour requirement) and my physician argued for an HOUR with me over pitocin. I gave in...then subsequently gave in to the epidural. Gave birth to a totally healthy baby girl, thank goodness. I fought like wildfire to go into labor naturally so I didn't need pit...and he stole it from me anyways. I didn't even go back for my 6 wk checkup, because I was sure I'd strangle him with his stethoscope if I did.

• 07-07-2009 12:36 PM

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  TawniAline Joined on 03-25-2004 Camby, Indiana Posts 699

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact Mom~of~Munchkins: BTW: Crissy...your story makes me want to cry. Its so common. I fought to tears for my third birth. I was in labor naturally (progressing slowly, but met the 1cm per hour requirement) and my physician argued for an HOUR with me over pitocin. I gave in...then subsequently gave in to the epidural. Gave birth to a totally healthy baby girl, thank goodness. I fought like wildfire to go into labor naturally so I didn't need pit...and he stole it from me anyways. I didn't even go back for my 6 wk checkup, because I was sure I'd strangle him with his stethoscope if I did. whoa?? what 1cm/hr requirement??? if I had been limited to that I never would have given birth vaginally to my first son- took me 24.5 hours and I was at 4cm when I got there... they damn well better not have changed it since then.. if they start trying to push me onto pitocin b/c of that that early on i'm gonna freak out on someone..

• 07-07-2009 2:58 PM

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  Mom~of~Munchkins Joined on 09-14-2005 Posts 249

  Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact It was something that the particular hospital I delivered at and the physician kept talking about. It wasn't a requirement per say (just like a hep lock isn't a requirement, right?), but for multiparas a "reasonable" labor progresses at least 1 cm per hour. If your labor is "unreasonable' they try to augment either by AROM (which I probably would have consented to over pitocin, given I was at 5cm with intact membranes) or pitocin. Although I consider walking an even better way to augment a labor, but they wouldn't let me do that. They wanted constant fetal monitoring because I was GBS positive. I know. Any little quirk that isn't "textbook" and they want constant fetal monitoring. I understand why, though. I think intermittent fetal monitoring is great, but, in a hospital, an RN tending several moms at a time, paperwork, prepping new patients, etc doesn't have the time or the memory to come in to each mom's room for intermittent monitoring. Its easier for them to just check the computer screen at the nurses station every once in a while and staple a page to the chart.

• 07-16-2009 10:08 AM

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  angela~2DS Joined on 04-04-2005 VA Posts 1,794	Re: AMA Seeks to Label "Ungrateful" Patients Reply Contact You have got to be kidding me! 45th?! That's rediculous! Shouldn't they realise what they are doing to us here by being so greedy, to earn money and get kick backs, and not allow us to labor the way we were made to. It's just stupid!