"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.

Saturday, March 6, 2010

Where will future doctors come from?

Thomas Sowell wrote on this today. It is good to see this question asked in the mainstream media. It is a question I have asked and written about before on this site and a discussion I have had with many of you in person. Last year I attended a meeting to review a new product. About 30 of my Ob/Gyn colleagues sat through several hours of powerpoint presentations and discussions. The last lecture was by a lawyer working for the company sponsoring the event. There is no medicine without lawyers anymore. Actually, there is just about nothing without lawyers anymore but I digress. The conversation was interesting and eventually he asked how many of us in the room had parents who were doctors. About 40-50% of the hands went up. Then he asked the obvious next question. "How many of us would want our children to become doctors?" Not one hand went up. It was one of those indelible moments of reality and sadness to all attending of what our once noble profession was becoming.

I know many of my colleagues would agree with Dr. Sowell while some do see it differently. However, I would add this bit of thought. When you are sick or scared or need health advice would you prefer a shepherd or a sheep? For my part, I want someone who is a take charge person. One who exudes confidence, will go to bat for me with those that would obstruct my care and go the extra mile to make me and my family feel safe. I call those type of physicians shepherds. Shepherds do not want to go through 8 years of postgraduate education, 4-6 years of residency and fellowship training, costing them hundreds of thousands of dollars and leaving them in substantial debt ,spending the entire decade of their 20's in labs and libraries and lost hours and screwing up a normal social life.....Only to discover upon completion of their training that they will now have their salary, their decisions, their ability to plan their schedules and prescibe medicines all determined by an employer, an insurer, a government, a hospital and their lawyers. To be told what you can and cannot do confirms they are and will only ever be sheep. So, as the reality of what the future will be like reaches those eager premed students, the shepherd personality, the capable decison maker, the person who would take responsibility for their decisions, will not choose medicine.

Medicine will no longer be a profession but might still be a good "job". It will not be cost effective or individualized as it will be left in the hands of those incapable of taking charge. Natural selection and a training environment that emasculates decision making will lead to doctors incapable of making even a simple decision without consultations, extensive use of testing modalities and one size fits all protocols. (Ah, protocols....sound familiar?). This is where we are already and the future does not look brighter if trends in Washington continue. As Dennis Prager likes to say, "The bigger the government, the smaller the citizen." Anyway, I encourage you to read Dr. Sowell's piece linked below. Thanks, Dr.F


1 comment:

  1. so very true....i started off as pre-med, but now am completely turned off of medicine. I do not even think I want to go the nurse practitioner/midwife route that I switched to either. I'm even becoming turned off by certified professional midwives because I can see that with every "licensing" and "regulation" that they gain, there are more and more rules imposed to suppress their knowledge and abilities. I'm not saying we should have a free-for-all or that the amount of training that direct-entry and nurse midwives receive is on par with OB/GYN's. Obviously they do not spend 10+ years just getting through the credentialing. However, when I learn something, I really learn it. I take it, analyze it, take it apart, put it back again, build on it, tweak it and perfect it. I may be your version of the "shepherd", I don't tend to stand around waiting for someone else to fix it. But, I don't know if I can deal with being required to follow practices that I can find no sound logical or scientific basis for and that clash so loudly with my personal ethics. No one should lose the right to exercise their choice. Maybe I'll move to Canada or another English country where midwives are treated with much more respect in a true collaborative meeting of medical minds, and the rights of pregnant women aren't thrown by the wayside by legal opportunists and money-hungry medical administrators/hospitals and insurers.