Friday, January 24, 2014

An Annoying Trip to the Pharmacy

After meeting my doctor, and getting prescribed prenatal vitamins, I set off to the pharmacy (there is only one in my town) to pick up my prescription.  One of the few things my doctor had explained to me was the way the vitamins work.  There is an AM one and a PM one.  The AM one has iron, folic acid and a bunch of vitamins, the PM one has calcium and a bunch of different vitamins.

When I got up to the counter, I handed over my prescription to a lady who looked at it, and after a minute said, "Oh, you can just get these over the counter."

I thought it was a bit weird that I'd been prescribed over the counter meds, but with all the other weirdness with my doctor, I thought it was pretty much par for the course.  I picked up the only prenatal vitamins in the area the pharmacist had directed me to, and headed for the checkout, reading the label as I went.

Thinking it was a bit odd that the package made no mention of there being two separate pills, I looked a bit closer and realized that the name of the product I had been given was different than the one I'd been prescribed.  I figured they were the same, and that it just came down to branding, but I wanted to double check.

After being ignored for a while at the pharmacy counter, the same pharmacist came over, and I explained to her about the two different pills and asked if what she'd recommended to me was actually the same.  She called over another pharmacist, and told her that I wanted to know how often I needed to take the pills.  The other pharmacist came over, and I explained it all to her, since clearly the first one had told her the wrong thing.  She took my prescription paper, looked at it for a minute and said, "Oh, this means she wants you to take it twice a day.  She'll probably reduce it later."

Rather than trying to explain a third time that there should be two different kinds of pills for me to take, I pointed out that it's a different product and that I thought the over the counter one was the wrong thing.  She checked again, and then said that they would have to order it in, but she did admit that it was probably better if I actually got what had been prescribed to me.

I don't know what happens to mothers who ingest twice as many prenatal vitamins as they're supposed to, but I would hazard a guess that it can't be good.  I assume that by and large, prenatal vitamins are similar enough that I probably would have been OK with the over the counter ones... but the fact that the pharmacists were so dismissive, so inconvenienced by me and so unabashedly lazy, that they would have happily sent me away to take two of the wrong things a day rather than take the time to listen to me (or, you know, read the prescription), scares the hell out of me.  It kind of makes you wonder how many other people they've done that to, and with what kind of more serious medication.

I didn't go back the next day to fill my prescription as planned because my first serious morning sickness hit, and I spent that day sleeping on my bathroom floor and vomiting intermittently.

When I did go back to the pharmacy, there was a different pharmacist there, who explained more specifically when the best time to take each pill was, why these were the best times, and possible side effects (none of which the doctor had mentioned), including constipation and dark stool.  He didn't congratulate me on my pregnancy (which I didn't expect), but did give me a fond, knowing smile, which suggested that he'd like to congratulate me, but didn't want to overstep - which I thought was very nice.  So far, he's the only professional that I've been impressed with.  I hope that changes, and I find some more people to have confidence in.

Wednesday, January 22, 2014

My Incompetent Doctor (Part 1)

Pretty much the first thing I did after taking the at home test was go to my local clinic and ask for an appointment to see a doctor.  They got me one for the next day, which I was happy enough about, though in my excitement, I'm sure I would have been happier to see someone that minute.

As I sat in the waiting room, a woman who I assumed was an assistant of some kind, came out holding a clip board and calling "Anal?  Anal?"  She walked right up to me and asked, "Anal?" and I told her no - and took a moment to feel sorry for whoever this poor person was, with a name that could be misread in that way. The woman looked confused and went back into one of the exam rooms, then came back out a few minutes later, and asked for me by my first name.  My name does start with an A, and it does have an N in it.  It's also 3 syllables, and has no L, so I'm not sure how she came got Anal from it, but whatever.

I followed her back to an exam room, where I realized that this woman, in jeans and ballet flats, was my doctor.  Shortly thereafter, she let me know she's in her residency.  I generally prefer a younger doctor, I find, on a whole, they're happier to consult with their colleagues and they're not afraid of appearing inexperienced by looking things up when they aren't sure about them.  I thought a doctor in her residency would be great, because she'd be super-focused on making sure everything she does is thorough and correct and done properly.

Yeah, not so much.

A woman who actually was a medical assistant had had me pee in a cup on my arrival to the clinic, and gone off to do her own test, to confirm what the at home one I'd taken said.  So when the doctor asked if I'd done a test, I assumed she meant that one, so I told her I had, but they had not told me the results.

"But you did one at home, right?"
"Yeah.  It was positive."
"Good.  That's what I meant.  Because some people freak out."  At no point did she say the test they had done was positive.

Then she asked if the pregnancy was planned, to which I replied, more or less.  Before I could explain what I meant, the doctor asked, rather incredulously.  I explained that while we wanted and were doing nothing to prevent the pregnancy, we were also not trying in the sense of tracking my ovulation, or having any more sex than we normally would, or seeking out ways to increase fertility.  Our thinking was that if it happened, it happened, but we weren't going to stress ourselves out trying to make it happen.

With the same incredulity, the doctor asked, "Well, were you on contraception?"  I explained again that we hadn't been using any.  She congratulated me with a completely impassive face, and without even a hint that she was aware that this might be an important milestone in my life.

Then she said that was basically all they were doing today, and that I would have to book a prenatal exam and do some blood work.  The prenatal exam is when they would take my medical history (I hadn't filled out any paperwork or been asked any questions about my lifestyle, at all).

She said she would prescribe me prenatal vitamins - which I really should have been on already.  Right, because, even though I'm not a doctor or a nutritionist, let me just fill up my body with prescription supplements, which I may or may not need, and assume that they'll help my baby rather than hurt it.  Never mind how I was supposed to get a non-existent prescription filled.

She explained I would need to be tested for chlamydia,  gonorrhea, HIV and a bunch of other, non-sexually transmitted diseases, and have my thyroid tested, etc.  I told her the thyroid test was very important to me because my mother has a thyroid disorder and I have had tests which suggest my levels are quite low in the past.  I mention this, because it came up again on my next visit, which will be a whole other post.

The entire meeting lasted about 15 minutes, and the final part of it was her telling me about the various tests for Downs Syndrome, which, rather than explaining to me, she advised me to google.  She did tell me briefly about the Nuchal translucency test, which she actually explained incorrectly, as counting the folds in the fetus' neck.  For lack of another option, I did take her advice and google it, and found that what it in fact is is measuring the fluid build up under the skin in the folds of the baby's neck, as more fluid suggests a higher risk of Downs.  I can think of two possibilities for why she explained it the way she did.  Either she actually doesn't understand how the test works, or she's assuming, that as a layman, I couldn't possibly comprehend things like fluid build up.  Neither of these bode well, and both make me nervous.  And though I would rather have an arrogant doctor than an ignorant one, how can I trust someone who isn't going to give me the necessary information to make informed decisions about my body and my baby?

She also told me about the various places I would need to travel to (from my very small town) to get different tests and ultrasounds done, asking me "Are you from here?" when I was surprised that I can't give birth in the hospital here (I later asked my sister, who also lives in this small town and had her kidlet a year and a bit ago - and the doctor got the location of every test wrong).

I got the feeling from the encounter that I was, at best, a mild inconvenience to her, an interruption in an otherwise acceptable day.

I was thrilled when I found out that my prenatal exam (which comes oddly close to the end of my first trimester) will be with someone else.  I was less thrilled to hear back from her a couple of weeks after my initial visit - but that's another post.