This letter is to inform you that I will be no longer be attending your clinic for care during my pregnancy.

After attending four appointments with the doctors at the clinic, I remain disappointed with the service I have received and it culminated with my appointment on Friday, April 7th, 2006.

Although this was my fourth appointment, it was only my second appointment with you. Rather than introduce yourself, you simply walked into the room and began speaking to me. Considering the fact that patients are rotated through the three doctors, I would imagine that it would be prudent with new patients to introduce yourself for the first few times you see them so that they remember you and are comfortable with you rather than to assume that they know which doctor they are meeting.

The appointments I have had were disappointing for the following reasons:

• Each appointment was less than five minutes long. Doctor walks in. Says hi. Takes blood pressure. Writes notes. Checks baby with Doppler. Asks, “any questions?” End of appointment.
  Information given to one doctor was not given to all doctors or if it was noted in my chart, was not passed on or read prior to subsequent appointments
• Questions regarding my care do not appear to have been given careful, respectful consideration.
• During all four of my visits I mentioned that I did not want to take the Glucose Tolerance (GT) test unless it was medically indicated. My reasons were given four separate times. On the fourth time I was told by you that you “did not change the way you managed pregnancies” because I believed a test was unnecessary.

With all due respect, you are not “managing my pregnancy” you are providing health care to a pregnant woman. There is a difference. I am curious as to why, at the three previous appointments, my declaration that I did not want the GT test unless medically indicated were met with no concerns. When I attempted to explain my reasons today, I was not met with any concern for my informed consent, but rather grilled for names of research papers I had read, specific studies I could cite or reputable research to back up my opinion. I was also told that it sounded like I was basing my opinion on anecdotal information.

During the appointment on Friday April 7th, I was unable to reference research material to your satisfaction. Again, with all due respect, while I am pregnant I have to think a little bit harder to tell you my correct age. I do not have the propensity to remember specific book titles or research papers that I have previously read. However, as I mentioned, all information was garnered through respectable institutions such as Douglas College in New Westminster, BC and the International Childbirth Educators Association. At this time I offer one of many sources I consulted.

From ‘Third Edition: A Guide to Effective Care in Pregnancy and Childbirth’ published by the Oxford University Press and written by Enkin, Keirse, Neilson, Crowther, Duley, Hodnett and Hofmeyr in 2000:

“This test is not reproducible at least 50-70% of the time, and the increased risk of perinatal mortality and morbidity said to be associated with this condition has been considerably overemphasized. As no clear improvement in perinatal mortality has been demonstrated with insulin treatment for gestational diabetes, screening of all pregnant women with glucose-tolerance testing is unlikely to make a significant impact on perinatal mortality and morbidity. An abnormal glucose-tolerance test is associated with a two- or threefold increase in the incidence of macrosomia, but the majority of macrosomic infants will be born to mothers with a normal glucose-tolerance test.”

I interpret this to mean that the test is of limited value. I have other references to state, but do not believe my time should be spent seeking validation from someone who is no longer my health care provider.

With my previous pregnancy, I also declined to take the GT test and my doctor discussed my decision with me in a respectful way that reassured both of us that I was in fact informed enough to consent to decline the test.

During my appointment I felt attacked, belittled and dismissed. I felt as though you thought perhaps I thought I was an expert in pregnancy care because I had taken my CBE certification. Your suggestion that I might also want to decline the Group B Strep test was peculiar, however seemed to indicate that you perceived me as someone who might be inclined to decline this test as well. In fact I am not, I do believe that it is impossible for me to discern for myself whether or not I would test positive for Group B Strep, and therefore would be more than willing to have this test administered. I am not an expert in pregnancy; I am an expert in my own body.

I have stated that the dates on my chart for my baby’s due date are more likely to be August 2nd and that I carried small with my first pregnancy – my son was 6lbs 11 oz at birth and was overdue (he had dry skin, long fingernails and there was mecconium in the waters despite the fact that he was under no stress - all indicators of a late term baby). My current pregnancy was planned. I know when I conceived. I know when I had sex and when I did not have sex. Unless you are telling me that my husband’s sperm have somehow managed to quadruple their life span, then I am pretty sure that I am due on August 2nd – making me 23 weeks pregnant.

When I asked if the GT test was in fact medically indicated (as I believed my baby was not measuring large) you indicated that you felt that I was measuring large: 23 cm.

You had already discredited my assertion that I was 23 weeks rather than 21 weeks, therefore the measurements could not possibly indicate that I was actually correct in my dates could it? On the contrary, the information was used to indicate a large baby rather than to confirm the due dates I believe to be accurate.

According to the Canadian Diabetes Association, risk factors for developing Gestational Diabetes are as follows:
· a previous diagnosis of GDM
· age over 35 years
· obesity
· a history of polycystic ovary syndrome
· hirsutism (excessive body and facial hair)
· acanthosis nigricans (a skin disorder characterized by the appearance of darkened patches of skin)
· being a member of a population considered to be at high risk for diabetes, including women of Aboriginal, Hispanic, South Asian, Asian or African descent.

I have none of these risk factors, nor am I showing any signs or symptoms of gestational diabetes. When I mentioned to you that I did not have any symptoms of gestational diabetes, you told me that you have women who are (5”11 and small) not supposed to be at risk of developing GD, but do show that they are borderline diabetic after taking the test. (Actually you stated that you even see "Asian women" who are "not generally at risk"... it seems that the Canadian Diabetes Association disagrees with you on this point.) I am not sure, but that sounds like anecdotal evidence to me. Are anecdotal reasons for an opinion only allowed on the doctor’s side of an argument?

The anecdotal evidence I presented was of a co-worker whose hypoglycemic wife was instructed to take the GT test and began spotting a mere 10 hours later. She went on to give birth to their premature son. You stated that you “had not heard anything like that in 15 years”. That is interesting. They were patients at your clinic during that time.

My trust with your clinic has been irreparably damaged and the result is that I am choosing to seek care elsewhere.

Please forward copies of my medical records to the following address, pursuant to the Health Information Act of Alberta, (Section 7(1)).