In my family, we commonly celebrate our birthdays and our due dates. It’s not uncommon for me to tell people that my real birthday is Sept. 25 since that was my due date. I made this joke recently to a friend in medicine, who said he’d be celebrating his birthday that day, too. After I told him I was born much earlier than anticipated, he responded, “Yeah, I was born two weeks late. The obstetrician told my mom that I had fallen asleep.”
I raised my eyebrows until I felt they were touching my hairline. As an aspiring obstetrician and gynecologist, I knew that made absolutely no sense. “Nobody sleeps for two weeks, especially not fetuses,” I responded quickly. While fetal sleep cycles vary between fetuses and between different times in development in a single fetus, absolutely no fetus falls asleep for two weeks. And either way, though it is not known what induces labor, we know that an awake fetus is likely not the only thing that pushes the "on button" to start labor.
As a young physician in training, I wondered how many times a similarly inaccurate statement had come out of that obstetrician’s mouth. Given the fact that my friend was born more than 20 years ago, I wondered whether or not doctors at that time believed it was possible for fetuses to sleep for two weeks straight.
However, a quick online search showed me that ultrasound machinery had been around for a while by then and would have been able to provide sufficient information about fetal movement and sleep cycles. Biophysical profiles were also popularized by the 1980s, especially for post-term infants. Given that my friend and I were both born after that point, it’s unlikely that the obstetrician didn’t know about this. This caused me to think more about why the physician said what he did.
As my friend’s mother was a Black Caribbean immigrant, it is possible that the obstetrician viewed her as less educated and thought he could get away with saying something like this. How many times have we clinicians stood in front of patients and simplistically answered their questions because we knew that they might not challenge us? Many of us find ourselves saying things like, “It just happens like that sometimes” or “Honestly, it’s fine” when we don’t know or don’t remember the etiology of a particular disease patients are trying to talk to us about. We might dismiss their comments due to our incompetence, or sometimes, because we just don’t have time for them. We are tired. We are busy. We have given up valuable time sleeping and valuable time with our loved ones to take care of other people. We form exceptionally intimate relationships with patients that often end up being one-sided and leave us feeling uncared for. It’s no wonder that this breeds the perfect storm for us clinicians to speak sarcastically or offer incomplete answers to patients, many of whom wield far less power and privilege.
But is this truly fair to our patients? I’d argue that it isn’t. Under the awkwardness of the medical industrial complex, we are presented with an opportunity either to invite patients to partner with us in their health care or to simply dictate things to them about their bodies, knowing they might believe just about anything we tell them. Whenever we provide patients with information and simply walk out of the room without listening carefully, we don’t know which ones will track us down to tell us they didn’t understand or end up leaving us a bad review. Either way, the services we provide have more of an impact than the typical product or meal; bad service means we may have delayed their return to health and potentially changed their life for the worse.
I’ll never know if the comment made by this obstetrician more than 20 years ago was a cute joke between two people, a smart aleck response due to fatigue or bitterness about his career, or simply a response born out of not knowing what to say. But I do know that a patient walked away understanding less about her health than she should have, and that there was likely a missed opportunity for an important discussion. I know that, for me, hearing this comment has made me think twice about jokes I make to patients without a real explanation of what is going on and will help me to continue taking their care seriously.
How have you approached patient questions when you were busy or did not have the answer at hand? Share your experiences in the comment section.
Micaela Stevenson is a third-year medical student at the University of Michigan planning to go into obstetrics and gynecology to become an infertility specialist. In her free time, she loves to watch love stories, but mostly likes to sneak into work on the weekends and see extra patients.
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