Questioning Motivations

Saturday, 5 June 2010

A delicate flower from the garden which Andrea picked for me.

At the follow-up visit to his assigned paediatrician (let's call him Dr A) at Pantai hospital last week, Reuben was found to have a high level of bilirubin in his blood at a reading of 301--i.e. he is considered to be very jaundiced. Dr A called both me and Wu Han while we were on our way home from the hospital, sounding very concerned, asking us to turn back and have Reuben admitted for intensive phototherapy treatment right away.

Our answer was no. I already knew he was going to call with that recommendation. Our initial decision was based on these premises:

  • Reuben is breastfed. From what I understand, breastfed babies tend to display signs of jaundice more than formula-fed ones, and can still be healthy despite this.
  • Reuben was feeding regularly, every 2-3 hours. He had begun to stay awake for about 10-15 minutes after some feeds, then going back to napping.
  • He was wetting his diapers about 4-6 times a day.
  • Prior to his visit to the doctor's, he hadn't pooed for two days--this could have led to a possible build-up of bilirubin in his blood which would have otherwise been excreted.
  • He showed no signs of lethargy, fever or weakness.

I asked the doctor whether we could have a few more days to observe him at home before committing to any treatment, as he seemed quite normal and healthy apart from they yellowish tinge to his overall ruddy-red skin. Dr A persisted with his recommendation, saying that Reuben ran the risk of getting into complications like hearing loss, brain damage etc if his bilirubin levels continued to climb.

Let's backtrack a little. When we finally made it into Dr A's office after being made to wait in the hallway for almost 2 hours, all he did was to whip out his stethoscope to listen to Reuben's heartbeat and breathing, and pronounce that he looked quite jaundiced after prodding him like a wet market fish. "We'll have a blood test done, just to be sure," he said. "In the meantime, have a look at this leaflet," handing me a brochure about home phototherapy treatment rental. "It's something for you to consider if your son needs treatment."

Dr A's lines seemed so well-rehearsed, mechanical--and very familiar. So I asked him whether newborn babies' bilirubin levels normally peaked at the time that his blood test was taken (that was 6 days after he was born). He said yes. "But that doesn't mean that they'll necessarily come down in all babies," he quickly added. "It's best to start treatment as soon as possible to avoid problems down the road. I'll give you a ring when the blood test results are back."

With that, we were ushered out of his office in 5 minutes flat.

Now, I totally understand why doctors would want to play it safe and recommend treatment as soon as possible. But with jaundice, I get the feeling that some doctors are taking advantage parents' concern for their children (especially first-time parents) by recommending phototherapy for pretty much any case of jaundice, which happens in most babies anyway.

What irked me about Dr A's response wasn't from the immediate replies he gave to my telling him of our decision to opt out of phototherapy for Reuben, which included things like,

"I have to make sure you're aware of what the possible complications are,"

"...I have discharged my duties as his doctor to recommend the appropriate treatment,"

"...the decision is ultimately yours and I will bear no responsibility of the outcome of you not bringing him in..."

blah blah blah. That's all well and fine. I've heard pretty much the exact same lines before with Brandon and Andrea.

That Dr A didn't ask for us to come back for a follow-up blood test to monitor Reuben's bilirubin levels, now THAT bothered me. If he was so convinced that Reuben was truly in possible danger, wouldn't it be logical for him to 'persuade' the parents to at least allow for that?

That didn't feel right. In fact, my trust in the doctor evaporated almost immediately. I'm almost certain that all he wanted to do was to make a quick buck out of us, all the while acting in a very justifiable, and still professional, manner.

Am I being way too judgmental about Dr A's actions? Were we too suspicious of the corruptive role that money can play in this scenario?

Whatever the conclusion you draw from this, let me just state gently that all the players involved are human. We make mistakes. I'm not a doctor. And Dr A is not Reuben's father.

For now, we'll continue placing Reuben in the morning sun that fills our bedroom, and give him his Guinness baths. We'll observe his skin colour and behaviour. Then I'll take him to our usual paediatrician in SS2 for a general checkup and a second opinion about his jaundice this coming week. Fingers crossed till then, that our parental instincts are right.

For some light reading on jaundice in babies, click here.


#1Gravatar imageDenis says:

Nice article. It’s one of the problems in dealing with doctors – that there is so much information asymmetry. You have to believe that there is a basis for their recommendations – because generally you don’t have enough expert knowledge to question them well.
That said there was an interesting study done in the US that demonstrated that most people make the decision to sue a doctor for malpractice if things go wrong within the first few seconds of meeting him (or her).
Nothing to do with his professional skill – just on whether he treats you like a pay check, or a friend.

#2Gravatar imagechristine says:

michelle, i totally agree with your decision. i would consider 2nd opinion in most circumstances unless i know my doctor well enough to trust him/her. and i think it’s this same practice in most pediatricians that we see so many babies admitted for high bilirubin levels and after that being slap with bills amounting to 4 digit numbers.

Leave a Comment:

required asterisk denotes compulsory fields. Off-topic or inappropriate comments will be edited or deleted. Your email address will never be published. This site makes use of Akismet and Gravatar services.

About this post

This post is filed under Elucidations, Reuben. You can follow any comments to this entry through the RSS 2.0 feed.

The previous post in this category was .

The next post in this category is .

You can leave a comment, or trackback from your own site.