What does a grown man wearing a baby-doll dress have to do with your healthcare? by Michal Klau-Stevens

A few years ago, a critic said something that stuck with me which led me, recently, to an unusual experience. Back when I was president of a national nonprofit organization working to reform maternity care practices, a critic of natural childbirth accused leaders of the reform movement of being insular. She claimed we always heard from the same experts who touted the same studies, and our tunnel vision kept us from viewing the “big picture.” At the time I considered whether she had a point. After all, there was a fairly small pool of experts – the “usual suspects” who published books, appeared in documentaries, and spoke at conferences. Were we operating in a bubble? That critique made me aware of the importance of seeking out other sources of information as a kind of reality check. So earlier this year, when I received an email about The Tenth Annual Transgender Lives: The Intersection of Health and Law Conference being held at the University of Connecticut in April, and saw there were presentations on healthcare advocacy, I was inspired to attend. I was curious what experts who specialize in issues that affect another, very different, population would have to say about healthcare delivery.

I was excited about the prospect of hearing from a whole new group of people who would expand my horizons. For weeks leading up to the conference, I envisioned myself soaking up new information and being re-energized by learning cutting-edge research and ideas. In my mind I pictured myself being totally focused on the speakers in rapt attention.

On the day of the conference I was thrown out of my comfort zone in the parking lot, before I even walked into the building. As I got out of my car, one of the first conference attendees that I saw was a grown man, about 30 years old, wearing a baby-doll dress with a lace bib collar, white eyelet knee socks, mary-jane shoes, with his hair in pigtails. He was carrying a purse over his shoulder. I thought to myself, “Whoa – I guess I’m not in Kansas anymore…” You see, while I envisioned myself at the conference, I had not envisioned anyone else who would be at the conference. I’d been looking forward to learning about healthcare from a new perspective, but didn’t fully anticipate that the perspective would be that of transgender people, who in case you don’t already know, are a bit different from the pregnant women, midwives, and doulas I usually attend conferences with.

Once I got inside the building, I saw that the baby-doll dress was the most radical outfit in the place. Most of the attendees were much more low-key, although the energy of the environment was different from a birth-related conference, and the culture was different too. When I was given a name tag to fill out, I was asked to put my name and which pronouns I prefer to be called on it. I learned that pronouns are a very big deal in the LGBTQ community. The vendor gallery was filled with organizations that offered STD testing, HIV testing and support, mental health services, and legal support. Bright colored condoms were given out along with the usual pens and water bottles. The bathrooms were non-gendered, and frankly, it was sometimes hard to tell who was a man and who was a woman anyway. Once the stall doors closed, it didn't matter. Everyone was very polite and respectful, though. I did overhear more than one person say that this conference was one of the few places they felt safe using a public bathroom, but that’s another blog post.

While so much of the environment felt different to me, when it came to discussions about healthcare, much was similar to what we discuss about maternity care, and about healthcare in general. While technology and surgical techniques have made incredible advances, they are not foolproof, and there is still much more that remains unknown. It is vital to your well-being and your safety to have someone at your bedside to help advocate for you while you are in the hospital. Access to certain kinds of care is challenging and costly. Sometimes doctors and other caregivers are heroic and champion our needs, and other times care is paternalistic, disrespectful, and traumatic. Being able to use your voice, express your preferences, and have them be respected is an important component of good health outcomes. Minority people, people of color, and other oppressed populations do not get the same quality care that upper-class white cisgender men get. The advocacy skills necessary for getting good care are basically the same, whether you are going into the hospital to have gender-confirming surgery, to have a baby, or because of some other health reason, like cancer, heart disease, or other illness.

I learned a number of new things that day, and also confirmed some things I already knew. Hearing from experts outside the field of maternity care assured me that I’m not being insular or looking at healthcare with tunnel vision. There are serious issues with the way healthcare is delivered in this country, and they affect people in similar ways, regardless of the different reasons why people seek care.  Attending that conference was an unusual experience, which expanded my horizons. It reminded me of the value of moving outside my comfort zone and seeking out other people and places to gain valuable perspective.

And that man in the baby-doll dress? They (yes, that’s the right pronoun) are advocating to make healthcare better for you.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Wash Your Hands Please!

By Michal Klau-Stevens


Would you have the nerve to tell your doctor to wash his or her hands?

We all know that germs travel from one surface to another, often carried by human hands. For people with healthy immune systems, contact with many types of common germs does not always lead to illness; in fact, it’s often not a problem. For people with compromised immune systems though, contact with common germs can lead to illness. Even worse, in a medical setting such as a hospital or surgical center, the types of germs that can be transferred from patient to patient can cause serious illness, and even death. We expect doctors, nurses, and other healthcare workers to be conscientious about washing their hands, but you might be surprised to hear that in some hospitals the hand washing rate of caregivers can be 50% or lower. What can you, as a patient, do to reduce the risk of having germs transferred to you?

During the mid-1800’s a doctor named Ignaz Semmelweis discovered that when doctors in his Austrian maternity hospital washed their hands after doing autopsies before examining women in labor, fewer women and babies died from childbed fever. He implemented a hand washing protocol on the labor ward, and demanded that all the doctors and nurses wash their hands in a caustic solution when they arrived on the ward and before they touched any patients. Death rates from puerperal fever plummeted in his hospital, and thousands of women and babies survived their hospital confinements because of the hygiene measures in his institution.  This took place in the very early days of microscope development, and before germs were viewed by human eyes. Sadly, because Semmelwies was never able to isolate the cause of transfer of illness between people, the other doctors of the time refused to believe him when he said their unwashed hands could be the cause of people dying. He was reviled by the medical community and died an unhappy death in an insane asylum.

Decades later, after microscopy was more advanced, germs were discovered and germ theory was created. Doctors finally understood that indeed, their unwashed hands were the travel mechanism for microscopic organisms that transferred illness from patient to patient.

These discoveries happened in the late 1800’s, so we’ve had well over 100 years to make hand washing the norm in our healthcare institutions and as part of medical training. Yet, a recent study showed that while some hospitals have excellent hygiene practices and compliance, others have compliance below 47.5%. According to the World Health Organization, caregivers are supposed to wash their hands:

• Before touching a patient,
• Before performing a clean/aseptic procedure
• After body fluid exposure risk
• After touching a patient
• After touching patient surroundings

There are a number of reasons why caregivers might not wash their hands, including lack of understanding about the importance of hand washing, a hospital culture that places it at a low priority, lack of time from being overloaded with patients, too few hand washing or hand hygiene stations, and skin irritation from frequent washing.

Even though caregivers know that washing their hands is an effective way of limiting the spread of infectious diseases, it’s not always top-of-mind for them. Since they can’t see the germs, it can be difficult, if not impossible, to connect an illness with a handshake that occurred days before. The importance of hand hygiene can fall by the wayside if the administration and peers within the workplace do not strictly maintain it.

You, as a patient, are the person who will be most seriously affected if hand hygiene is not practiced in the healthcare facility where you’re receiving care. You are the one who will become sick. Therefore, it’s to your benefit to make sure that no one touches you before they wash their hands. Take a few minutes before checking in to familiarize yourself with hand hygiene protocols, so you’ll know when and how it should be done, and when it’s appropriate to be touched with gloves and without. When someone enters your room, watch to see that they take the time for hand hygiene before making skin-to-skin contact with you. If they don’t – ask him or her to do it.

Some people feel uncomfortable taking that stance and making a demand of their doctor or nurse, but it’s your right as a patient to do so. Don’t let embarrassment, discomfort, or over-politeness stand in the way of your health. With the super-bugs floating around in hospitals these days, it’s too big a risk to take. Just a little soap and water or some hand sanitizer could prevent serious illness or even save your life! Be an empowered patient and demand good hand hygiene, because there may be a 50% chance that your caregiver isn’t taking care of that for you.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

The Changing Relationship Between Doctors and Patients

The Changing Relationship Between Doctors and Patients

By Michal Klau-Stevens

“What does the doctor say?”

That’s the question we often ask when a loved one has a health concern. We place great trust in doctors, because of their training and expertise. Yet, the doctor-patient relationship has changed over the past few decades in ways that have a direct effect on your care. Here are some things about the doctor-patient relationship that are different from how they were, even twenty years ago.

It used to be that you had a family doctor or internist who saw your care through from beginning to end. Today, there are many large medical practices, and while you may see “your” doctor for much of your care, it’s also likely that you will see other doctors in the practice, or get referred to a specialist. Medical care has become more compartmentalized, and specialists focus on certain body systems or illnesses. You may need to coordinate your own care while managing orders from several different doctors who may not see the overall health picture. If you need surgical or hospital-based care, you must be prepared to work with care providers who are strangers to you, and who don’t know your individual needs.

Also, the average medical appointment today is 7 to 15 minutes in length, where previously appointments were over 30 minutes. The teaching, conversation, and relationship building that used to happen in the exam room do not happen with the same depth as they used to. The interactions between doctors and patients today leave little time for developing a true relationship in which your physical, mental, and emotional needs are understood as deeply as they were in the past. The discussion time, and therefore the opportunity to develop personal connection, simply doesn’t exist today.

Another aspect of the doctor-patient relationship that is different from previous generations is the access to “special” information. It used to be that doctors’ training taught them information that was not available to patients, which made them authorities whose word was not to be questioned. Today, patients have access to vast amounts of medical information through the Internet, and can access far more data than was ever possible in the past. While most patients don’t achieve the level of medical learning that doctors have, they are able to engage in conversation about their care on a much higher level now than before. This patient access to specialized medical information changes the relationship from one of authority to one of partnership.

In addition to Western, or allopathic, medical information, patients also have access to information about a wide variety of natural, herbal, Eastern, and alternative healing modalities. Most doctors who are trained in the United States are not trained in these other types of care. Many doctors are skeptical about them because they differ so greatly from their “traditional” medical training and some modalities have little peer-reviewed scientific research to support their claims, even though they have been used in other parts of the world for hundreds of years. Patients who wish to use alternative therapies may find their doctor does not support their use, and conflicts will arise.

Medical schools don’t offer a lot of training for doctors on how to manage their relationships with their patients, and the landscape is changing faster than school programs can catch up with anyway. Patients vary in their knowledge levels, and the quality of information they are learning ranges from top-notch science to quackery, depending on its source. Since this shift is still happening, with some patients taking an active role in their care, and others still relying on doctors to take the lead, it’s not always clear to doctors or patients how to manage the changing relationship expectations.

Put together, these changes to the doctor-patient relationship have deeply affected levels of trust on both sides. When patients feel they can’t trust their doctors because they haven’t developed strong relationships with them, they may not feel secure in following their advice, which can cause serious problems. When doctors feel they haven’t developed a strong relationship with their patients, they can’t care for them as well and may be more likely to practice defensive medicine.

What does all this mean for you as a patient today?

This means the demands on you to advocate for your needs are stronger, because you may not be able to rely on a relationship with a trusted caregiver to guide your care. You must be more outspoken about what you need and want throughout your care, and you must develop skills to help you communicate effectively with unfamiliar caregivers.

In order to do that, you must be proactive in learning about your health needs or illnesses from trustworthy outside sources. You can’t assume your doctor will tell you everything you need to know because there is not enough time in typical medical appointments to give you all the information you will need to make truly informed choices.

Be prepared for your appointments by doing research in advance, and having a list of questions prepared with the most important questions at the top of your list.

Finally, you must seek out doctors and medical practices that match your care philosophy and approach to medical care from the outset. Each practice has its own work and medical care culture, and it’s up to you to explore all the options available to find which will be the best fit.

As frustrating as it can be to both patients and their doctors, the days of “just do as your doctor says” and “letting them take care of you in the hospital” are over. The changing doctor-patient relationship makes getting good individualized healthcare different now than it used to be. The times, they are a’changin’.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Healthcare is about YOUR health.