On the whole, Daniel Landers, M.D., has a rewarding job. A maternal-fetal medicine specialist, or perinatologist, Landers sees many patients go from heartbreaking loss to healing and joy.
“Most people who have a bad outcome with a pregnancy are able to have a good outcome in the future,” says Landers, who is also a professor and vice chair of the Department of Obstetrics, Gynecology, and Women’s Health. “Even after losing three consecutive pregnancies, the chance that they’ll eventually have a successful pregnancy is still in the 50 to 70 percent [range].”
And sometimes, the most grateful patients are those who haven’t experienced a happy ending—at least not yet. They’re women who simply appreciate a health-care provider who is unafraid to look them in the eye, listen, and allow them to grieve.
“We have people who’ve gotten devastating news, and nobody really wants to deal with them,” Landers says. “Some doctors are just not comfortable with those things. Sometimes we can’t fix the problem, but [we can give] support in managing the devastating outcome.” That support can include information, additional testing, referrals to subspecialists, and simple human empathy.
“They need someone who’ll support them in their decision-making process, rather than inflict their own choices onto them,” he says. “Sometimes you have to put aside your personal preferences and figure out what’s best for the patient—what do they want to do?
“There are all of these options in the mix, but there’s not necessarily one right answer,” Landers continues. “Part of it is sharing your experience with the patient, but I always tell the patient that my job is to present you with all the options that I know of, figure out what’s going to work the best for you, and then support you in your decision.”
That can take time. Landers gives patients a few days to process a difficult diagnosis before moving forward. “You give them some time to cry, to conjure up all of the possibilities. You say, ‘You need some time to digest this.’ Other than ‘Something’s wrong,’ patients don’t hear more than a third of what you say.
“I’ll say, ‘I know you didn’t hear most of what I said, but you’re going to have a lot of questions in a couple of days and you’re going to want the opportunity to come back and talk some more.’”
Landers keeps a box at home filled with some 200 cards and letters from patients, many of whom eventually had healthy children. He’s philosophical about the fact that while expert care is a big factor in many cases, so too is luck and perseverance. “What most people who’ve had a bad outcome mainly need to heal is a good outcome,” he says. “Sometimes it’s just persistence.”