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When you shouldn't tell your doctor?

6 answers
I am 34 weeks and a High Risk pregnancy. I have Systemic Lupus. For a long list of reasons (and a long story) I travel out of town to a larger city to see my Rheumatologist. I love the fact that it's a teaching facility and have always received excellent care. For my OB needs, I do stay in town and see a local doctor. I discussed with my OB's about a month ago that I was considering having my baby out of town at the other hospital. (With Lupus, I run the risk of complications and flare up after the baby is born) They seemed offended at the idea. One even said that if I was delivering there, he would no longer see me for prenatal care. "Too many cooks in one broth". Without telling them, I set up a high risk appointment anyway and went. I love the staff and they answered questions even my OB struggled with as far as Lupus and effects after I give birth. They said I would see my local doctors until I was to be induced in my 39th week (Keeping me from having to travel 3 hours while in labor) at that hospital. I told them my OB's reaction and that he wouldn't see me anymore. I can't imagine driving for regular appointments out of town, causing my husband to have to take off from work so much and the fact that it's just uncomfortable as it is to do so. As much as he hated to admit it, he said I could always just... not tell them. I guess ethically I struggle with that idea. Should I really keep it from them? Are there ever times where it's OK to withhold things from your doctor?

answers (6)

I can understand why you are struggling with this. It's definitely a difficult situation. My opinion is that as you get closer to delivery, you should see the doctors who will be delivering your child. They are the ones who need to be monitoring your progress, especially since they are so much more knowledgeable about your condition. And while it may seem a little rude, I can understand your current ob's reaction and decision to not see you. You are essentially wasting his time by continuing to see him even though you don't plan to have him deliver your baby.
I'd have to disagree with V. Chances are, the doctor you are seeing is associate with a certain hospital or group of other physicians. As far as I can tell, the only reason for your induction is travel. If you go into labor naturally and go to the hospital, they won't call your specific doctor. They'll call whatever doctor is on call for the hospital or whichever is on call that day for his physicians group. There's a decent chance he won't deliver the baby. Even so, the only reason I can imagine a doctor being defensive about delivering is that they would get to bill the insurance for it. I do agree that the other doctors should be kept in the loop. That's just a matter of keeping in touch. You as the patient have a right to release your records from one doctor to another. Ask for a medical release form and have them send those to your out of town OB and keep in contact if something goes wrong or the situation changes. My grandmother suffers from autoimmune disease as well, Rheumatiod Arthritis. Her doctors far and wide have never had issue communicating with each other for her safety. That's what it should be about. Patient rights, choice, and health. Not who's getting the insurance check.
I apologize for not fully addressing your question: In short-No, you are not obligated to inform your doctors, but at some point you may want to. It'll be harder to explain at a later date, like after you've been induced. If they reject the idea, find a different doctor for care. You, the Patient, have a right to be treated fairly, without discimination and have the right to make choices about your health. Doctors should never be anything less than supportive. It would benefit you to find a doctor that you are comfortable with for your care now into the future. 
You wouldn't have pre-op appointments with one surgeon if you were planning on having another surgeon perform the operation. Why would you see an ob you aren't planning on having deliver your baby? It doesn't really matter that you might have one of your ob's partners delivering your baby. Doctors out a lot of effort into forming a relationship with their patients, especially ob's. they are caring for both you and your baby. It's kind of a big deal.  And really, if there are doctors who are more knowledgable and better able to care for you, why would you want to see someone else?
You obviously misread her question. This isn't about a more experienced OB. She is wanting to have her baby at the hospital where her Rheumotologists reside. Women with autoimmune run a risk of flare up and complications after giving birth. Even if she stayed in town for the sake of appeasing her OB if they even delivered the baby, should she have complications afterwards, she would be treated by Rheumotologists that have no idea of her history. Let's say at most, she's about to give birth and is around 9 months right now. That's 9 months of prenatal care (less since she's already had her initial appointment) for a doctor to overview and catch up on versus what could be years and years of Lupus information for a local Rheumotologists to learn to treat her.As far as your surgeon example, in most cases when you require surgery, you'll be refered by a doctor (primary or otherwise) to have the surgery done, you typically have one or two appointments with them before, they do the surgery and then you follow up with your original doctor. If you want to hard compare, she's had her pre op appointment already so she's fine to have the baby out of town. It's also an issue of her husband having to miss work and for her being a high risk to travel so much back and forth, just for short check up appointments.If OB's cared That much about the sentiment of deliver a patients baby, they would schedule to deliver them. Not leave it to chance by saying 'Well if I'm on call I'll do it, otherwise someone else will'. I don't see her not trusting her OB's at all. If she went into labor early or was unable to travel, she may be fine with them delivering, but this is about her Lupus and her care as well. I think she's weighed her options fairly well. Again, it's a patients right to choose.  It's a hard decision to balance, but no womens pregnancy is like anothers, and she's doing the best with what options she has. 
I did read her question, which is why I unrstood the part where she saw a high risk on who was able to answer her questions. They were the ones who told her she could keep seeing her current doctor until 39 weeks. Obviously, her current ob has problems with her switching doctors that late in pregnancy. Most doctors won't take on new patients after they are 37 weeks along. A high risk ob is a little different, but clearly, her current ob isn't comfortable with the situation. Whatever the reason, it doesn't matter. A patient should never lie to a doctor, and if a doctor doesn't want to continue seeing a patient, the patient should respect that. And really, if she's so comfortable and happy with the high risk ob and that office, why wouldn't she continue seeing that doctor?having worked for surgeons, I can tell you that there are more than just one or two appointments before surgery, and there are a few post-op appointments as well. Follow up is not handled by a person's primary care doctor. Even emergency surgical procedures are followed up with the surgeon who performed the procedure.

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