Guilt Among Obstetricians

I wonder how many of these .. sad .. obstetricians are actually ..
obstetricians .. at .. all ..

"Up to 17 percent are not board certified"

------------------
University of Michigan Health System

Newswise — Nearly one in 10 obstetricians in a new study has
considered giving up obstetric practice because of the emotional toll
of stillbirths and infant deaths.

Three-quarters of the 804 obstetricians who responded to a survey by
researchers at the University of Michigan Health System reported that
the experience took a large emotional toll on them personally.

“Our survey reveals that perinatal death has a profound effect on
obstetricians, and 8 percent had considered giving up obstetrics
because of the emotional difficulty of caring for patients with
perinatal death,” says lead author Katherine Gold, M.D., MSW, of U-M’s
Department of Family Medicine and Department of Obstetrics and
Gynecology.

“We know that stillbirth and infant death are traumatic events for
families; this study suggests that they are also traumatic for the
physician.”

The study appears in the July issue of the journal Obstetrics &
Gynecology.

Approximately 15 percent of pregnancies end in early losses (before 20
weeks gestation). In the United States, 1.3 percent of pregnancies end
in either stillbirth (losses after 20 weeks but before delivery) or
infant death (deaths in the first year of life, most of which occur in
the first week). On average, the typical obstetrician performing 140
deliveries a year could encounter nearly two dozen women with a
miscarriage and one to two with stillbirth or infant death, the study
says.

“Obstetricians want to see a healthy baby. When a fetus or baby dies,
the loss can be devastating for the physician,” Gold notes. “Half of
the time, the medical cause of a stillbirth is unknown, but physicians
still may struggle with feelings of guilt or self-blame.

“When a fetus or baby dies, we focus on the family's needs, but
obstetricians are often struggling with their own emotions too.”

The threat of lawsuits also weighs heavily on physicians. Stillbirths
are the number two reason for lawsuits against obstetricians in the
United States, preceded only by allegations involving births with
adverse neurologic outcomes. In the study, 43 percent of obstetricians
who responded said they had worried about disciplinary or legal action
due to a perinatal death with no identified cause.

Improved physician training would help obstetricians, according to a
majority of the study’s respondents. Physicians who said they’d had
adequate bereavement training were less likely to report that they had
considered giving up obstetric practice because of the emotional
difficulty of perinatal death, the study notes. Physicians who
perceived their own training as adequate were less likely to worry
about disciplinary or legal action when cause of death was unknown.

“As physicians, we get a lot of training in medicine but little in
death and bereavement. Sudden and unexpected losses can be terribly
difficult both for families and for the physicians involved in caring
for the family,” Gold says. “This study shows that stillbirths and
infant deaths can have profound and persistent effects on
obstetricians. We need to find ways to help both families and
physicians cope with these devastating events.”

Two-thirds of physicians supported training by formal presentations or
seminars, and nearly half recommended informal gatherings for
physicians to discuss difficult experiences. Many respondents
suggested that a meeting with bereaved parents could serve as a useful
training strategy as well as a way of helping physicians cope with
their own feelings about the loss.

Methodology: A total of 1,500 randomly selected U.S. obstetricians
were mailed a self-administered survey with 51 questions about their
experiences and attitudes in dealing with perinatal death. Eight
hundred four physicians (54 percent) completed the entire survey.

Authors: In addition to Gold, authors were Rodney Hayward, M.D., of
the Department of Internal Medicine and the School of Public Health,
and Angela L. Kuznia, MPH, of the Department of Obstetrics and
Gynecology and School of Public Health.

Funding: The research was supported by the Robert Wood Johnson
Clinical Scholars Program and the U-M Department of Obstetrics and
Gynecology.

Reference: Obstetrics & Gynecology, “How physicians cope when a baby
dies: a national survey of obstetricians,” Vol. 112, issue 1, pages
29-34.

For more information:

Pregnancy complications http://www.womenshealth.gov/pregnancy/complications/complicationssp.cfm

Information about stillbirth from the March of Dimes
http://www.marchofdimes.com/professionals/14332_1198.asp

Dr. Katherine Gold
http://www2.med.umich.edu/pcdv2/provider/dsp_provprofile.cfm?individual_id=93928&um_department=Family%20Medicine

--------------------------------------------------------------------------------
<<snip>>
self-declare their areas of expertise
<<snip>>

Public release date: 30-May-2007

Contact: Krista Hopson
khop...@umich.edu
734-764-2220
University of Michigan Health System

Study: Who claims to be a pediatrician?
Up to 17 percent of physicians who claim to be pediatricians are not
board certified by ABP
Ann Arbor, Mich. - How well do you know your child's pediatrician" Is
he or she board certified in pediatrics, or has he or she ever
completed specialty training in the field"

Findings from a new study from the University of Michigan C.S. Mott
Children's Hospital's Child Health Evaluation and Research (CHEAR)
Unit may prompt parents to find out if their child's physician really
is who he claims to be - a board-certified and specialty-trained
pediatrician.

The study, published in the June issue of the Journal of Pediatrics,
found that as many as 17 percent of physicians in a single state who
claim to be pediatricians on state licensure files have never been
board certified as a pediatrician by the American Board of Pediatrics
(ABP). And another 12 percent of physicians who report to be
pediatricians did not complete a medical residency training program
in
pediatrics.

"Residency training in pediatrics and board certification by the
American Board of Pediatrics distinguish the physician as having the
level of expertise and knowledge to provide the best possible care
for
your child," says study lead author Gary L. Freed, M.D., MPH, chief
of
the Division of General Pediatrics and director of the CHEAR Unit at
Mott.

He continues, "Our finding that up to 17 percent of those reporting
to
be pediatricians in a given state are not board certified by the ABP
should encourage more parents to find out if their child's physician
really has been board certified as a pediatrician, and that he or she
has maintained that certification status. Recertification is equally
important because medicine is constantly changing, and it is a means
to keep physicians up-to-date on the latest medical developments."

So why are some physicians able to claim to be pediatricians without
the proper training and certification" Freed says many state
licensing
boards allow physicians to self-declare their areas of expertise
without verifying the information.

To study the accuracy of such self-reporting systems, the CHEAR Unit
team gathered state licensure data for all active physicians in two
randomly selected states in each region of the United States - Ohio
and Wisconsin, Texas and Mississippi, Massachusetts and Maryland, and
Oregon and Arizona. The state data were then matched with the ABP's
listing of all pediatricians who have ever received board
certification, regardless of their medical training history.

The proportion of "unmatched" physicians ranged from 6.9 percent in
Massachusetts to 16.8 percent in Maryland, with the researchers
finding, on average, 11 percent of physicians who claim to be
pediatricians on the state licensure files were not listed by ABP as
having as ever been board certified in pediatrics.

The researchers then sent a survey to nearly 400 active physicians in
all eight states who appear as pediatricians on state licensure
files,
but had no certification record with the ABP. Of the 255 physicians
who responded to the survey, 61 percent say they had completed
residency training in pediatrics. Nearly half reported they had some
current board certification, and of these, 53 percent say they were
certified by a board other than the ABP. Freed also notes that 12
percent of physicians who report to be pediatricians did not complete
a pediatric residency training program.

"This is a reminder to parents that just because physicians claim to
be pediatricians, it doesn't necessarily mean that they are board
certified by the ABP or have ever been certified, or even received
the
appropriate training to be designated as a specialist in the field of
pediatric medicine," warns Freed, the Percy and Mary Murphy Professor
of Pediatrics and Child Health Delivery at the U-M Medical School and
professor of health management and policy at the U-M School of Public
Health.

"Parents have the right to have high expectations for the physicians
they have entrusted with their child's care. They should feel
empowered to ask physicians if they are board certified in their
field
of expertise," he says. Parents also can go online to check a
pediatrician's board certification status via the ABP: www.abp.org.

Finding a pediatrician that's right for you and your child

While parents often opt to have a pediatrician to provide care to
their child, many will instead choose a family medicine practitioner
to handle their child's - and even the entire family's - medical
needs. Freed says physicians who specialize in family medicine are
trained and very capable of caring for children. If a family,
however,
decides to have a pediatrician care for their child, Freed offers the
follow six tips to help guide parents in selecting a pediatrician:

1. Board certification and specialty training. Board certification
demonstrates that the physician has the knowledge, skill and
experience to offer the highest quality of care in the field, and
pediatricians are required to undergo recertification through the
American Board of Pediatrics every seven years. To check on a
pediatrician's board certification status, visit the ABP at www.abp.org.

2. Office hours. Does the pediatrician hold office hours that will
work with your family's busy schedule" Is the pediatrician available
to handle patient care needs after regular business hours" The
pediatrician's schedule needs to be a good fit for your family's
schedule in order for the relationship to be a success, Freed says.

3. Ability to care for children with chronic diseases. Is the
pediatrician experienced in caring for children with chronic diseases
such as asthma or diabetes" The American Lung Association estimates
that 6.2 million children under age 18 currently have asthma, so
having a pediatrician who is able to provide your child with the
necessary care for such chronic diseases can be important.

4. Association with major medical center. Pediatricians who are
associated with a major medical center, such as U-M C.S. Mott
Children's Hospital, are able to easily refer patients for specialty
medical care services - rheumatology, cardiology, oncology and
neurology - when needed.

5. Health care philosophy. Does the pediatrician share your views on
health care for your child? It's important that parents find a
pediatrician who agrees with their views on what keeps a child
healthy, disease prevention, and treatment options.

6. Gender. As children grow from infants to an adolescents, they may
feel less comfortable discussing their changing bodies with a
physician of the opposite sex. While adolescence may be years away,
Freed encourages parents to plan ahead, and select a pediatrician
with
whom their children will feel most comfortable as they grow.

###
In addition to Freed, co-authors from the CHEAR Unit in the Division
of General Pediatrics are Rebecca L. Uren, MHSA, Ericka J. Hudson,
MHSA, and Indu Lakhani, MBA, MS; and the Research Advisory Committee
of the American Board of Pediatrics.

The study was funded by the American board of Pediatrics Foundation.
Reference: Journal of Pediatrics, Vol. 150, Issue 6.

--------------------------------------------------------------------------------

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