So, met with the chief of staff, current and future as well as the head of the OB committee today. Bottom line is the OB committee does not want me to even offer the option of elective VBAC or vaginal breech delivery to women at either campus. If I were to agree to this then they seemed to suggest the disciplinary action might just go away. This is going to be a dilemma for me. An intolerable situation facing many private practice physicians today. Compromise your values to pay your overhead or compromise your practice to keep your values. In the meantime they are supposed to reinstate the midwives but I suspect it will not happen until early next week.
One thing was made clear to me today. The hospital believes the OB committee is the final arbiter of standards in this community and since none of them would offer a breech delivery then for me to do so is beneath the standard. Good outcomes and innovation are not relevant. They also essentially said that skewing your informed consent process is OK because allowing patients the option of VBAC affects other personnel such as anesthesia, peds and nursing and puts them at risk. While I do see their point, they did not want to hear that the patient has rights and is the one we are supposed to serve. There was no place for discussion of the risks of repeated c/sections or evidence supporting our midwifery model today. That was my take anyway. Will keep you posted.
"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.
"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine
"The welfare of humanity is always the alibi of tyrants." Albert Camus
"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977
"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine
"The welfare of humanity is always the alibi of tyrants." Albert Camus
"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair
Explaining the Cause
Summary of what is happening now.
I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.
I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.
This scenario is happening all over the country. Small practices with small voices are being coerced. The purpose of this blog is to reach out for support and to gather together as one loud, unshakable voice. To do this will require a coordinated effort and I will need your help. Please ask questions of your local hospitals, write letters to support or protest what they are doing, write your legislators, contact the media and send me your ideas. A grass roots effort against large forces will require a united effort. I believe the health of the future mothers in our country is worth it. Thank you, Dr. F
I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.
I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.
This scenario is happening all over the country. Small practices with small voices are being coerced. The purpose of this blog is to reach out for support and to gather together as one loud, unshakable voice. To do this will require a coordinated effort and I will need your help. Please ask questions of your local hospitals, write letters to support or protest what they are doing, write your legislators, contact the media and send me your ideas. A grass roots effort against large forces will require a united effort. I believe the health of the future mothers in our country is worth it. Thank you, Dr. F
Friday, August 21, 2009
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Dr. Fischbein,
ReplyDeleteI'm so sorry this is happening. I've made a contribution to your legal defense fund. The women of Southern California need OBs like you!
Warmly,
Jen from vbacfacts.com
Hi Dr. Fischbein,
ReplyDeleteThanks for all you're doing. I've highlighted ths post on the ICAN blog's weekly feature "Best of the Birth Blogs" for this week (ending 8/23): http://ican-online.org/community/users/ican-blog/blog/best-birth-blogs-week-ending-august-23rd
Best,
Sarah
blog@ican-online.org