Apgardian was created to expand labor education and increase engagement between patients and healthcare providers. In my experience, these two aspects of care, education and engagement, are what set the stage for the best patient outcomes.
“I discovered after many, many labor experiences that what a patient knows and understands is most important to meaningful dialogue. Meaningful dialogue helps focus everyone on the goal…healthy mom and healthy baby.”
Apgardian provides a path to engagement through education.
How Apgardian Began
My first job is to observe. Do I deliver and intervene and talk? Yes, all the time in fact, but my main role is to observe. That might seem at odds with the MD part, but actually they work together for me quite well.
I spend much of my 12 hour labor and delivery shift watching and listening. I listen to patients who have never seen me before, on one of the most important days of their lives, tell me their greatest concerns and fears. This is the one day out of all their days that everything must go well. They are often vulnerable, emotionally and physically, and I listen. Some come in with a plan, others not so much, but in either case I listen. I am a great listener and then I ask questions.
I listen to the hospital staff greet, triage and assess patients. I listen as patients, nurses and doctors discuss a plan of care. I listen as doctors explain to patients why a natural process honed by nature may, at times, need intervention and then I ask questions. Sometimes I ask questions because I want to learn how a patient processes information and how much they understand. Sometimes I ask questions that a patient is probably thinking but is not asking. I ask questions to expand (strengthen) the dialogue.
It was in those moments of listening and participating in those discussions that the idea for Apgardian was born.
You may wonder what kind of doctor is roaming around observing and listening 12 hours a day. I am an obstetric hospitalist or ob hospitalist. My particular specialty is patient safety. Generally, my job is to care for patients whose doctor is not available. I monitor and stand by, until their doctor arrives. Sometimes that means delivering babies but more often it means I am part of the hour-to-hour labor experience. And I have learned a lot.
When I had a private practice I often sat with my patients to monitor them directly. I wanted to know firsthand how they were doing. So when I became an ob hospitalist in 2009, I was no stranger to the hour-to-hour labor experience. The difference was I now participated in multiple experiences in one shift. A typical shift might find me being a part of two or three different labor experiences. Toss in a delivery and an emergency here or there and my knowledge of labor and patients expanded exponentially.
Here is what I have learned so far: labor is physically exhausting. I must admit I did already know that, but the added emotional stress plays a major part in keeping dialogue open to making progress. The hours spent laboring are some of the most important to the health and well being of the mother and baby. The decisions made during this time are also some of the most important and can have lifelong consequences.
The group I call the expectants: partners, parents, family and friends, have a wealth of information as does the internet. Some of that information may be accurate and relevant for the current situation and some of it may not.
I realized that as the labor progressed, mom and her expectants grew more tired and anxious yet the stakes increased. At the time when understanding was most important, meaningful dialogue and clear understanding were in jeopardy.
Apgardian took shape in my mind first as a source of timely and medically accurate information on labor and delivery. That information could then serve as a path to meaningful dialogue at critical moments. I realized that was the role I often found myself in. I was regularly coaching, educating and asking the questions that kept the dialogue meaningful and focused on the goal…healthy mom and healthy baby.
And so Apgardian began.
Arthur Townsend IV, MD, MBA, FACOG