Posted by: notdeaddinosaur | August 6, 2010

It’s Called “Preventive Care”

From the comments on an earlier post about suggesting that patients in late pregnancy refrain from wearing stiletto heels:

Is that accepted medical practice, to comment on patients clothing and shoe choices? At what stage of pregancy does the AMA recommend pregnant patients replace their footware (or is the barefoot and pregnant stereotype preferred?)

I’m not really on board, it sounds meddelsome and irrelevant to me, and not medically related… You can also twist your ankle just walking down the street. Shall we all live at home in bubble wrap to avoid it?

I am surprised to hear this coming from you, when you have railed against other stupid medical directives; ear cleaning, was it?

Why is it acceptable for me to comment on patients’ shoes? For the very same reason it is acceptable — even encouraged — for me to comment on other “meddlesome and irrelevant” things like patients’ food choices, activity level, sexual practices, alcohol consumption, whether or not they wear seat belts, and if their intimate relationships include violence. Each of those and many other so-called “lifestyle choices” were once viewed as “non-medical”.

“Why should the doctor care what I eat, drink, or who I sleep with? I should be able to do what I want. It’s his job to take care of me, whatever happens. After all, you don’t have to be obese to get diabetes. It can happen to anyone.” Not that bubble wrap would prevent it, but you get the gist.

When did it become my job to notice and say something about dangerous footwear? The moment “Injury Prevention” became part of medical care. We can actually have a legitimate discussion about whether or not that should be the case. But as long as I’m responsible for providing advice and recommendations about lifestyle issues such as diet, smoking, sexual practices, bike helmets, and yes, even shoes — anything with the potential to cause harm to an individual, pregnant or not, that he or she can do something about —  I am sure as hell going to take notice, and make comment.

(By the way, the ear cleaning stuff was about guidelines promulgated by doctors for other doctors, and had nothing to do with patient choices.)


  1. My former sister-in-law fell during her late pregnancy, and wound up delivering early because of it. I’d say that a kindly caution about wearing wobbly stilettos is entirely appropriate…

  2. Love your blog Dr! Just thought I’d add that my OB did comment to me when I was pregnant that she was glad that I wasn’t wearing high heels. She said she sees a lot of her pregnant patients fall on them. She also said that during the summer her patients are all tripping over their flip-flops. She has that method down of commenting to make a point rather than lecturing–more effective I believe. Of course I still managed to trip down a couple stairs while pregnant with my sensible shoes on…fortunately no harm to the baby just a banged-up shin and knee along with a twisted ankle!

  3. Just last week I told a client to change from flip-flops to closed-toe shoes so the horse she was restraining for the veterinarian (me) wouldn’t smash or sever her toes. I also regularly advise clients to wear helmets, especially since a USET dressage rider is currently recovering from a brain injury sustained when her horse tripped (she went off head-first and spent a few weeks in a coma).

    I guess I’m even more meddlesome than you are, considering the humans aren’t even my patients, though I also dispense plenty of advice re: horse safety.

  4. It’s “accepted medical practice to comment”on ANYTHING which might adversely affect a patient’s health and safety. It’s what we’re supposed to do. I suppose it’s “meddlesome and irrelavent” for me to advise somebody to stop smoking or wear a bicycle helment, too, but it would certainly be remiss of me not to do so. Good grief.

  5. Outrider: We had a tech in the clinic who wore Crocs. The large animal clinic. Where we routinely did laryngeal tiebacks on draft horses. Super smart.

    Personally I wore Dansko clogs all through my last pregnancy. Even at the end when I had to stuff those sausages into their very tight casings. Those damn things cost $200. I wasn’t buying a new pair for a few months! But I’ll tell you what – the first time I put them on after my son was born I was amazed at how rooooooomy they were. 🙂

  6. If people had more common sense, maybe then doctors wouldn’t have to state the obvious (Seriously? Stilettos when pregnant?!) and McDonald’s woudn’t have to warn customers that their coffee is HOT.

    Somebody has to save us from ourselves.

  7. New DVM: My clients who own big (>2300lb) drafts put the horses in stocks before I do anything. I’m below the horses’ sight line and it really doesn’t matter what I’m wearing on my feet when they’re shod with pulling shoes with cleats.

    A horse steps on me probably twice a month and I’m always thankful to be wearing boots when that happens. If it’s a direct hit I bruise right through those boots, though.

  8. I’m glad to live in a part of the world where most lifestyle choices are still considered non-medical and where it’s still pretty much unacceptable to lecture people on how they should live their lives. I hope it stays that way, because I think that everybody should have the right to make their own choices, even if it means to find out the hard way that the choice was bad …

  9. I never mind people giving me gentle friendly advice. It’s up to me whether I take it or not. But amazingly, sometimes other people have more knowledge about things, especially medical details, than I do, not having been to med school and spent time practicing, you know. While I may have lived in this body for nearly forty years, I tend to trust my care providers about a lot of things. That’s why they and not someone else are my care providers.

  10. Love this post (as well as the one suggesting the pregnant woman not wear heals) AND all the comments!

  11. My cousin is an ob-gyn, and she routinely checks the weight of the purses and handbags carried by her patients. She simply steps to the chair where they have placed their bag and attempts to lift it. Her point is that a lot of neck, shoulder, and back pain is caused by women carrying bags that are too heavy.

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