The myth of bed-rest efficacy in pregnancy:
Dr. Maloni’s investigations reveal that obstetricians in the United States tend to discount both the side effects of bed rest and to believe in its value in the face of evidence to the contrary . . . Dr. Maloni hypothesizes that fear of lawsuits may also play a part in its widespread prescription. Bed rest convinces patients and doctors alike that everything possible is being done to sustain a difficult pregnancy. And it is, after all, cheap to prescribe.
Dr. Tuteur says that patients should not take this advice lying down:
Bilston illustrates one of the biggest problems in the doctor patient relationship. The same patient who insists that she is a consumer of health care, entitled to all information and to control of medical decisions unconsciously views the doctor patient relationship in parent-child terms and acts accordingly. She’s mad at her doctor as if he were her daddy; he gave her the “wrong” advice and she was forced to follow it. Well, the doctor is not her daddy, and she is not a child. If she didn’t believe or didn’t like the doctor’s medical advice, she was free to ignore it or to seek another medical opinion. She didn’t do either, though, because the one thing she surely wanted to avoid was taking responsibility for own medical care.
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{ 27 comments }
Tuteur is a lunatic–and a dangerous one at that. The Bilston article has every right to be angry–patients have a right to demand accurate, up-to-date information. That’s not a daddy-complex (ahh–the medical profession can never rid itself with its infatuation with shallow Freudianism–perhaps because it gives them such authority). That’s simply the implied contract: consumers give $/you give the most current information.
Ah–and then there’s Dr. Maloni’s hypothesis–the law suits are responsible for OBs irresponsible behavior. Give me a break. Maybe OBs are just lazy bastards who don’t keep up on recent research and just do as they were trained to do>
I thought you people who specialize in broad generalizations believe Negroes are lazy bastards? Or was it Spanish people? I can never keep your prejudices straight.
argument ad PC-em. Hmm. That IS lazy. The question is why do OBs overprescribe bed rest. A reasonable hypothesis: they’re too lazy to keep up with latest info.
Why would you call OBs lazy bastards? When was the last time you woke up at 2 AM to deliver a baby? Have you ever done that?
When is the last time you worked 36 hours straight. Most of the population has never done that and never would, but feel perfectly entitled to have their doctor do that.
b
I have never prescribed complete bedrest. But I don’t throw the baby out with the bathwater.
Multiple gestation, preterm labor, hypertension in pregnancy, all benefit from periods of rest. But not continuous. Intermittent, approx. 40 min at a time, at least three times throughout the day. But here’s the trick, on your side, any side, theoretically left better than right.
Why? Improved blood flow to the placenta. A supine patient with an enlarged uterus tends to compress the vena cava with subsequent reduced preload to the heart. A sitting patient tends to compress the femoral veins.
A comment: Everyone wants evidence based medicine, and it’s become fashionable for medical nay-sayers to use “the lack of evidence based studies” to assume that a practice or technique is somehow illegitimate.
The best compilation of evidence based medicine is “Clinical Evidence” published by the British Medical Journal and accessed at http://www.clinicalevidence.com. I note that in the edition I have on my desk, from summer 2005, evidence based information is available for only 6 conditions of pregnancy.
Let’s ignore Anon 1028. Don’t let him trash this blog. He waits at his computer all day waiting for a response.
I am an OB.
I do prescribe bed rest.
I know that it is counter-productive, I have known that for years.
But I also know:
If one of my bed-ridden girls miscarry in spite of resting in bed, she will (probably) not have my licence yanked, but if she miscarry while ambulant, I’d have to learn how to drive a cab – very soon.
I am not too lazy to keep up with the latest research, I’ll have you know that.
But the lawyers are.
I’m not an Obstetrician. I was thinking that if i were one , I’ll just refer this high risk pregnant patient with oligohydramnios to an OB that practices high risk pregnancy and limit my practice to
what appears to be low risk pregnancy and I should be able to do that because of the shortage of Obstetricians. Now if only there is such a thing as an OB that does high risk pregnancy in every city.
Surely you know someone with some testicles and some confidence in their skills.
“Surely you know someone with some testicles and some confidence in their skills.”
Again, most OB’s are females. And females are traditionally smarter then males, though some seem stupid enough to stay in this sodomite- bullseyed profession.
BTW, I’m a different guy then the one above one of the lawyers says to ignore. There is more then one physician who disagrees with your views on this site, that you need to ignore.
I don’t care who you are. You’re clearly not someone who ought to be treating patients, at least for anything that requires much skill.
“Surely you know someone with some testicles”
Here at Brokeback Mountain, I don’t know nobody with some testicles.
And you are obviously a world renowned medical expert who evaluates the medical skill of a physician by reading what they write on blogs in the middle of a workday when the only people at home are night shift workers, welfare cheats, sodomites, and losers who watch TV all day. Don’t worry, at 3 pm the kids get home from school you can start emailing them at myspace.com)
“Here at Brokeback Mountain, I don’t know nobody with some testicles.”
Wait – I thought EVERYBODY there had testicles.
” by reading what they write on blogs in the middle of a workday when the only people at home are night shift workers, welfare cheats, sodomites, and losers who watch TV all day.”
So which are you? Since you’re reading this and all.
I work nights.
A doctor knows best and most OBs being females they can judge better as to what is best and necessary for a patient.
Maybe OBs are scared of law suits but one thing is also true they do help patients take care of themselves.
“I work nights.”
Is that why you’re so angry at the world? Not enough sunshine?
Anon 1:51..I love how you think you know so much about what all the population might be doing and why at any given time of day.
you are so pathetic…Poor little man who has to jump on the PC to have any type communication in his sorry life!
Anon 151 is at home because he has been advised complete bedrest by his urologist for his atrophied testicles although there is no study or evidence that this will reverse the condition.
ohhhh…..ohhhhh…..let’s all ignore the jackass who hates doctors and when he gets sick he goes running to one like a scared little baby…oooh…oooh….
anon 151 is at home because he never studied when he was in school (because that was for “nerds”) and now he is a loser with a pencil-pushing desk job who is looking back upon his life and sees nothing but futility and failure…
Everyone’s gang banging each other. Very relevant to whether women need bedrest in pregnancy.
Women were having babies for thousands of years while picking fruit, cooking and cleaning the cave without a problem…then we jump forward to the modern day, litigious American female and now we have to prescribe bedrest to coddle them…what a disgusting group.
Anon; 11:01….Yes they were! have that baby in teh field and then get right back to work on the crops. Ah, the good old days. If you remember them then you surely must remember when Docs. made house calls and were paid off with a live chicken! Yes?
Anon 1101: Oh yes, I miss those days when babies can get tetanus neonatorum. Oh, I miss those good old days.
oh–the good ol days, when dirty OBs would kill babies and mothers by spreading puerpurel fever bevause they Were such LAZY BASTARDS they couldn’t be bothered to wash their hands
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