This month, parenting educator and Piper+ Enza contributor Giselle Baumet shares her personal journey to self-advocacy for her family’s medical care, and shares ways that you can insist on and ensure a patient-centered experience for your children (and for you!).
I knew not to ask too many questions. It wasn’t that it was explicitly told to me, as it was indirectly expressed.
It was my first pregnancy, and I chose an OBGYN that some of my friends gave as a recommendation. She was covered by my insurance, female (that mattered to me), and a short drive away. In the reviews, other mothers seemed to like her.
The first time I handed her my autonomy was when I spoke to her about my birth plan, and she responded that she doesn’t do birth plans, that her goal was for a healthy baby and mother, and she would do what she needs to do to make that happen.
With words like that, who was I to speak up for what would appear to be the opposite?
The doctor wanted the best for my baby and me, so if I pushed for the birth plan, I felt I would go against what was best for my baby and me.
I didn’t realize, at the time, the manipulation of her words and that they were being used to keep her in the position as the decision-maker for my birth.
When the day of labor came, I followed along and complied with the nurses without asking any questions. Questions would’ve been disruptive to their rhythm, which felt confirming as I noticed the speed with which the nurses came in and out of the delivery room.
Under the influence of my epidural, I became slightly aware that it was time to start pushing. I was in the final stages of labor.
It was then that the OBGYN appeared, and said calmly to me, “I have contractors coming at 11 am. I’d love for you to have this baby vaginally, but if not, we’ll need to do a cesarean.”
Without questioning what she told me, I pushed as hard as possible so my baby could be born vaginally. She was born shortly before 11 am.
Years later, I wondered why I didn’t feel that I could ask questions. Why did I accept such sub-par medical care? And why did so many other mothers review this doctor so well?
Why is self-advocacy so challenging for patients?
The truth is that historically, the healthcare industry emerged as a paternalistic model that is a physician-driven, physician-led approach.
The physician is seen as the expert, knowing things you do not know, so you are to listen and do as you are told.
However, in the last 20 years, there’s been a shift toward a patient-centered approach.
Much of this change has happened with access to more data and information now available to patients in our digital age. However, there needs to be more clarity between how doctors are trained and the increasing desire by patients to be a part of their healthcare decisions.
Many people are becoming aware that they have more of a say in their medical decisions—yet medical schools still mostly train doctors in the paternalistic model of care.
What does this mean for those who want to participate in the decision-making process, together with the doctors responsible for their care?
It means empowering yourself with the language, resources, and advocacy needed for your care.
This can be a scary concept, primarily if you were raised not to question doctors, not to mention may not be fully aware that you have the right to consent (or not).
Recently, in one of my childbirth education classes, a couple of Latinx descent said, “I can do that?” after I told them that they could refuse a particular common medication used in labor management if they disagreed that was in their best interest.
Their reaction is typical. It is much more common for me to hear this from couples who had not, up to that point, realized their free will with regard to patient consent and advocacy.
Advocating for yourself in a hospital setting often means questioning those we deem as the authority. It means asking detailed questions to better understand your risks and benefits and being willing to say no if you disagree with your doctor’s care plan.
The risk of not agreeing could include manipulative wording (to change your mind), disgruntled care, and even harsher risks, like having governing bodies called in, such as Child Protective Services (CPS).
In the 10+ plus years since my experience, and in teaching numerous classes to patients and nurses, I can share the top three suggestions that can empower you to switch from physician-centered medical care to patient-centered care.
How do I advocate for myself at the hospital?
1) Choose your doctor wisely.
The best place to begin a search for a care provider is by asking like-minded peers for recommendations. This suggestion is an essential distinction from choosing a well-reviewed doctor from Yelp or other review platforms.
The reviews on places such as Yelp may be from patients who may still need to be made aware of their ability to advocate for themselves and reclaim their autonomy in a hospital setting.
It’s far more trustworthy to consider recommendations from those who value and practice advocacy and autonomy.
Once you have a few recommendations, you can schedule an appointment to discuss your preferences in care and gauge if the doctor practices patient-centered or physician-led care.
Our current pediatrician is a beautiful representation of what choosing a doctor well can mean for you as a parent receiving patient-focused medical care.
At each visit with our pediatrician, he will give us an overview and a detailed analysis of the child. When making a medical care recommendation, he will present it as a recommendation, not a mandate, and he will kindly answer each of our questions.
There have been times I’ve asked for evidence-based research on a medical recommendation, and he has always provided it.
Our pediatrician made it clear from the first visit that he is not the expert on our child but that we, as the parents, are the experts. And he has referred to us often as the final decision-makers for any medical recommendation.
When we declined a medical recommendation and chose another plan, he continued to provide us with his services and supported our decision to be the final decision-makers.
For this reason, we have been with our pediatrician for over ten years. He’s skilled in his medical profession while empowering us as parents to be active in our child’s medical care decisions.
2) Be bold and ask questions.
During your appointment, the doctor may have suggestions for your care. Remember that these are suggestions, and you have the final say in decision-making.
Learn how to ask open-ended questions that give you the clarity you need to make an informed decision on the suggested care plan.
These questions can include the following:
- What are the risks?
- What are the benefits?
- What are my other options?
- Can you show me the research that backs up this recommendation?
3) Be willing and ready to speak up.
Self-advocacy in a medical setting means being willing to speak up for your desires, complain when you’re not getting the care you need, and be ready to ask for another doctor.
Recently, I took my 17-year-old daughter to an OBGYN for PMS symptoms. My daughter is not sexually active, yet the only recommendation that the OBGYN gave was a prescription for birth control pills.
When I asked for other options, the OBGYN had none. She had no answers for why a teen’s hormones might be off balance, nor other suggestions for what else my teen could do to improve the symptoms besides birth control pills.
I asked further questions, and the seemingly-annoyed OBGYN answered, “If you’re looking for more holistic care for her, I have nothing. All I have to offer is birth control pills and everyone takes them.”
Then, I told her we would not continue receiving care from her, and we left.
In cases where you are hospitalized, you have the right to ask for another doctor to care for you, and you have the right to file a complaint about the type of care you’re receiving.
While I can empathize that questioning authority may be something new to you in a hospital setting, it is your key to receiving care that is focused on your needs more than on the convenience or preferences of the doctor.
You matter most when it comes to your healthcare. You matter more than a doctor’s preference or usual method of practice, and you matter more than the potential frustration or annoyance the medical care team may have over you advocating for yourself.
While historically, medical care has been physician-led, today, more and more patients are advocating for patient-centered and patient-led care, where they take an active role in their medical care decision-making process.
Practice self-advocacy by increasing your ability to communicate with your doctor and others who are part of the caregiving team. Be willing to choose your doctor wisely, ask questions, and speak up for your needs. The more you learn to do this, the better your care will be, making it all worth it.
Giselle Baumet is a Certified Life Coach, positive parenting educator, herbalist, aromatherapist, hypnotherapist, mental health educator, and more. She is also a Piper + Enza expert contributor. Learn more about her work at gisellebaumet.com.