"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.

Friday, September 30, 2011

More thoughts on the "Affordable" Heathcare Act

Last April I gave a speech at a tax day rally here in Thousand Oaks, CA expressing my opinions on some of the chilling effects of the government getting into the healthcare business. The text of that speech can be found in the April 2011 archives on this blog. On October 12th I will be a member of a panel speaking on this same subject at a dinner in North Ranch, CA. I will post the details here as the date draws closer for anyone locally who would like to attend.

One of my biggest criticisms of the health care bill is the intrusion of immense government into the realm of the very personal issues of healthcare and the expansion of the administrative state well beyond its scope granted by the U.S. Constitution. Taking a closer look at what this legislation is about reveals it has almost nothing to do with the distribution of medical care and is simply about control and bean-counting of our lives and enrichment of some favored groups.

Writing in the September 2011 publication, "Imprimus", of Hillsdale College, author Edward J. Erler has this to say:
"The administrative state, of course, always seeks to extend its reach and power. This is an intrinsic feature of a system where administration and regulation replace politics as the ordinary means of making policy....This is tantamount to denying that legitimate government derives from the consent of the governed...(taken from The Declaration of Independence). Obamacare certainly fits the description of the activities denounced in the Declaration. The number of regulations and the horde of administrators (not to mention lawyers) necessary to execute the scheme are staggering. We have only to think here of the Independent Payment Advisory Board. It is commission of 15 members appointed by the President, charged with the task of reducing Medicare spending. This commission has rule-making power which carries the force of law. The Senate, it is true, will have the power to override its decisions--but only with a three-fifths majority. There are no procedures that allow citizens or doctors to appeal the Board's decision. The administrative state--here in the guise of providing health care for all--will surely reduce the people under a kind of tyranny that will insinuate itself into all aspects of American life, destroying liberty by stages until liberty itself becomes only a distant memory."

As a concrete example it has been announced that diagnosis coding, required by Medicare and all insurance companies, will be changed in 2013. Currently, ICD-9 coding has about 12,000 diagnoses. The new ICD-10 coding to go along with the mandated electronic medical records provision of the bill will have 140,000 diagnosis codes. Is this for the betterment of health care or will it be used for micromanaging and regulation and eventual rationing of health care resources? What do you think? You know what I think! Dr. F

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