"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

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

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.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Thursday, December 10, 2009

Visit to Washington DC

Returned late last night from a 20 hour turn-around trip to Washington DC advocating for patient focused care. The trip was organized by Docs4patientcare.org which is a grass roots organization formed as an alternative to the AMA. Like most of my colleagues, I don't know any doctors that belong to the AMA or think that it represents practicing doctors and the interest of their patients. Unfortunately, the AMA still has name recognition and its endorsement of the Health Care Bill has been used by the Obama administration as a sign that doctors support his plan. Nothing could be further from the truth.

We have a Hypocratic oath that in effect states we are to serve our patients. The current legislation would be so cumbersome and overbearing that serving our patients best interests would become impossible. A group of doctors gathered from several states at the Heritage Foundation. We met with some leaders from the Heritage Foundation who explained a little bit about the process of lawmaking. I am still scratching my head. Apparently, the current bill is purposely designed to be vague. The supporters have not read it, don't need to and never intend to. This is common practice in lawmaking which the rest of us might find curious. Its supporters just want to pass anything, claim victory and then spend the next 3-4 years trying to figure out how to pay for it and create the micromanaging details and definitions. It is a set-up for rationing, legal disputes and chaos. I am still shaking my head.

I visited with Senator Feinstein's office and had a very cordial conversation with her aide, Kristin Wikelius. She initialized the conversation by saying she only had a few moments to spend with us and reiterated standard reasons Senator Feinstein supports the bill. However, she listened and dialogued with us for nearly 40 minutes. I stressed the importance of patient decision making, non interference in doc-pt relationship and my belief that the Senate bill would most certainly lead to rationing and be a massive hindrance to good medical care which takes place in exam room, not boardroom. Also, I discussed the inevitable future shortage of doctors and why I felt few good people would choose that as a profession and many my age would quit if this bill passes. I cannot possibly state here all that is wrong with the current bill. I would suggest going to the Heritage Foundation website and reading some of their analysis of the bill and what the Congrssional Budget Office has to say.

I then met with Cecelia Daly, aide to Congressman Elton Gallegly from my district here in Westlake, California. Again, a very cordial conversation but with the difference being that the congressman is opposed to much of the bill. In both offices, we did discuss some things I thought would be helpful. Taking small steps and correcting those things first rather than a massive government overhaul/takeover. But it is clear that the goal of this administration is a takeover of 1/6th of the American economy for ideological reasons. I would suggest that we all look closely at supporters or endorsers of this bill. They either do not understand how the true delivery of care to patients takes place or don't care because they are idealogues of socialism or they have a vested financial interest in a government takeover and stand to gain enormous sums of money from the bill's passage. This is, sadly, the feeling I got from talking to so many people yesterday. Let's be clear that this bill is not about health care. The doctor and the patient are at the bottom of the list on the agenda.

One suggestion proposed by a doctor from New York was interesting. It will never come to pass because it would actually work and mean smaller government and less control. He suggested that doctor's be given a tax deduction for providing free care to those in need. This would eliminate a huge waste of bureaucratic administration and the need for any expansion of Medicaid and all the expense, waste and fraud that goes along with it. Another doctor from Georgia told me this metaphorical story. A child asks his father why the cost of bread has only risen 4 times in the last 20 years but the cost of health care has risen 20 times during that time. The father responds by saying that is because people pay for the bread.

Lastly, I did not get to meet with Senator Boxer or her staff because they could only offer a 7PM appointment and I had to leave for the airport at 4. But just some thoughts about the Senator's postion. Some of my midwife colleagues are happy because Senator Boxer sponsored the birth center-medicaid bill. But her support of the overall health care bill will likely end up killing out of hospital birthing by midwives. My logic is that licensed midwifery in many states has to have backup doctors. With the passage of this bill, without tort reform and with the crushing of the spirit of the private doctor there will be no incentive to back up midwives and birthing center births. I hope I am wrong but I know I am not. The birth center bill is an example of a small good thing. But all the small good things that could possibly work will be crushed by the massive health care bill. I urge all of you to contact your elected officials and express your concerns about more government intervention in our profession. And do it now for tomorrow will be too late. My experience from yesterday tells me they will listen and our voices can make a difference.

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