Considering Family Practice, but Worried about Ethics and Lifestyle

[Miss_TN]

Hello! I am an early college student strongly considering a career in medicine. Since I have such a long road ahead of me, I know I have time to change my mind, but right now, I'm strongly considering family medicine. I love how it seems to be the "jack of all trades." Family medicine seems to be exactly what I've been thinking of when I say I want to become a doctor. However, I have several concerns surrounding the field.
Firstly, I have had family members recommend I avoid family medicine because it does not pay well, and it will be impossible for me to set up my own practice. Is this really the way the healthcare market is headed? I think it would be nice to set up my own practice someday, and it's discouraging to hear people tell me it will be impossible by the time I get through my training; I'd love extra input (of course, I plan to do additional research as well). Also, what is the general pay and lifestyle of a family medicine physician, if there is one? I know lifestyle and pay rely a great deal on what you make them, but if anybody could give me some examples of what it might be like, that would be great. Additionally, could you tell me why family medicine seems to be such an unpopular specialty among medical students? I have heard that it is because the pay makes it difficult to pay of student loans.
Also, and perhaps most importantly, I am concerned about the moral implications of going into family medicine, or really becoming a doctor in general. I am a devout Catholic, and a major inspiration for becoming a doctor is so that I can do my part in pushing the medical world into a better direction. Family medicine is especially attractive to me because the general public seems totally unaware of the difference between abortive medication and contraception. I want to promote natural family planning, and I definitely want absolutely no part in abortions; however, I don't know how realistic that is for me if I want to become a doctor, especially a family medicine physician. I know sometimes kids like me have big dreams that don't match up to real life. If it is not possible for me to go into family medicine without participating in or promoting abortion, I would rather know now. Can you be a family physician who promotes natural family planning and never, ever condones and/or participates in abortions?
Before you tell me that my own morals should not interfere with patient care, I want to point out that I do not consider abortion to be a part of proper patient care. To me, abortion should not even be a part of the medical world because it goes against a doctor's duty to preserve life. I want this awful practice eliminated, and I feel that becoming a medical doctor would give me additional influence in the matter.
Also, please realize that the above stated matters are not my only motivation for going into the medical field. I have always felt called to become a doctor. Medicine fascinates me, and the thought of improving the quality of a life or possibly even saving one inspires me beyond anything else. I've shadowed doctors before, and from what I can tell, I really am in love with the profession. I'm a strong student who is more than willing to endure the hardships of medical school and residency; before I go through all of that, though, I do want to know what impact my personal values would have on a career as a medical doctor.
So, basically: can I remain a Catholic in good standing as a family medicine physician, and what would my lifestyle be like if I chose this profession? Remaining true to my faith is very important to me. If there are any Catholic doctors on this form, I would especially love to hear from them because I have yet to meet one, and I feel like they would be able to provide me with good insight.
Thank you, I'm looking forward to lots of advice, and I am expecting people to disagree; I only ask that those who disagree do so respectfully. Thank you guys for taking the time to read through this long post!

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[JustintheDoctor]

Sorry for not offering any help, but if you posted this in the pre-med forums(arguably the most active forums with college students,med students, faculty, physicians etc) you might get more of a response. There's mostly high school kids in this section.
I would also like to offer my input, but I feel like this wouldn't lead to a good road since I'm pro-choice.

 

[Miss_TN]

Thank you for the tip! This is my first post, and I just assumed I should be in this section since I'm technically still in highschool, and I didn't know if it would be inappropriate to post in other sections. Also, I totally welcome input from pro-choice individuals. I feel like that would help me get a better sense of the overall culture. If I only read comments from other pro-lifers, I'll be in for a rude awakening later on. I will try re-posting in the premedical form.

 

[JustintheDoctor]

@On Eagle's Wings might be able to help you more, they're also strong to their faith and in medical school

 

[Miss_TN]

Hello! I am an early college student strongly considering a career in medicine. Since I have such a long road ahead of me, I know I have time to change my mind, but right now, I'm strongly considering family medicine. I love how it seems to be the "jack of all trades." Family medicine seems to be exactly what I've been thinking of when I say I want to become a doctor. However, I have several concerns surrounding the field.
Firstly, I have had family members recommend I avoid family medicine because it does not pay well, and it will be impossible for me to set up my own practice. Is this really the way the healthcare market is headed? I think it would be nice to set up my own practice someday, and it's discouraging to hear people tell me it will be impossible by the time I get through my training; I'd love extra input (of course, I plan to do additional research as well). Also, what is the general pay and lifestyle of a family medicine physician, if there is one? I know lifestyle and pay rely a great deal on what you make them, but if anybody could give me some examples of what it might be like, that would be great. Additionally, could you tell me why family medicine seems to be such an unpopular specialty among medical students? I have heard that it is because the pay makes it difficult to pay of student loans.
Also, and perhaps most importantly, I am concerned about the moral implications of going into family medicine, or really becoming a doctor in general. I am a devout Catholic, and a major inspiration for becoming a doctor is so that I can do my part in pushing the medical world into a better direction. Family medicine is especially attractive to me because the general public seems totally unaware of the difference between abortive medication and contraception. I want to promote natural family planning, and I definitely want absolutely no part in abortions; however, I don't know how realistic that is for me if I want to become a doctor, especially a family medicine physician. I know sometimes kids like me have big dreams that don't match up to real life. If it is not possible for me to go into family medicine without participating in or promoting abortion, I would rather know now. Can you be a family physician who promotes natural family planning and never, ever condones and/or participates in abortions?
Before you tell me that my own morals should not interfere with patient care, I want to point out that I do not consider abortion to be a part of proper patient care. To me, abortion should not even be a part of the medical world because it goes against a doctor's duty to preserve life. I want this awful practice eliminated, and I feel that becoming a medical doctor would give me additional influence in the matter.
Also, please realize that the above stated matters are not my only motivation for going into the medical field. I have always felt called to become a doctor. Medicine fascinates me, and the thought of improving the quality of a life or possibly even saving one inspires me beyond anything else. I've shadowed doctors before, and from what I can tell, I really am in love with the profession. I'm a strong student who is more than willing to endure the hardships of medical school and residency; before I go through all of that, though, I do want to know what impact my personal values would have on a career as a medical doctor.
So, basically: can I remain a Catholic in good standing as a family medicine physician, and what would my lifestyle be like if I chose this profession? Remaining true to my faith is very important to me. If there are any Catholic doctors on this form, I would especially love to hear from them because I have yet to meet one, and I feel like they would be able to provide me with good insight.
Thank you, I'm looking forward to lots of advice, and I am expecting people to disagree; I only ask that those who disagree do so respectfully. In fact, as long as you're respectful, I really welcome disagreement, because I want to get a feel for what I'm in for. Thank you guys for taking the time to read through this long post!

P.S.: I re-posted this from the highschool section because I was advised that I would get better responses in this area. If this is against the rules, please let me know. Also, if I'm still in the wrong section, don't hesitate to tell me. I'm new to this website, so I don't really know what I'm doing quite yet. Thank you again!

 

[Medical Bear]

I am also a Catholic, but I'm not a doctor. I just wanted to say that your conviction was very motivating and that I share in it completely. Abortion is murder and has no place in medicine. I hope you never lose that conviction and get the answers you are searching for!

 

[whitemagic]

HOLD UP LEMME GET THE POPCORN

 

[efle]

Sorry kid, medicine isn't for you. At the end of the white coat ceremony they make you stab a baby.

 

[Dral]

Well I think there is good news and bad news for you. The good news is that if you manage to set up your practice, you can run it the way you choose.

However, if a pt comes to you requesting abortion information, you can attempt to manage it the way you feel fit, but if they are insistent, your only choice will be to refer them to someone who can SAFELY (as in a medical care professional who is trained to safely perform, opposed to some back alley operation or bad physician that/who puts the woman's health in danger) offer what the patient wants.

If you are ok with that, then by all means...

You may have considered this already, but I'm sure you realize that women will always find a way to get an abortion if they want it. Pay special attention to the 'methods' section.

https://en.m.wikipedia.org/wiki/Unsafe_abortion

 

[raindropx]

ugh not another pro choice/life debate

If you don't like abortion, then DON'T HAVE ONE. If someone else does, then leave them the f*ck alone

 

[Noomm]

ugh not another pro choice/life debate

If you don't like abortion, then DON'T HAVE ONE. If someone else does, then leave them the f*ck alone

What an infantile argument.

Imagine a different scenario... "If you don't like the Holocaust, then DON'T KILL JEWS. If someone else does, then leave them the f*ck alone"

At the very least, I hope you realize that the issue isn't as cut and dried as you think it is.

 

[raindropx]

Please go on

 

[CaliforniaDreamer]

These people think they are doing the right thing. I mean, can you imagine if there was some mass holocaust of baby murders going on, you would be motivated to stop it. Unfortunately they are a bit blinded to the objective realities by their religious beliefs. Not something uncommon when logic goes in the face of the beliefs you have held since childhood.

 

[raindropx]

These people think they are doing the right thing. I mean, can you imagine if there was some mass holocaust of baby murders going on, you would be motivated to stop it. Unfortunately they are a bit blinded to the objective realities by their religious beliefs. Not something uncommon when logic goes in the face of the beliefs you have held since childhood.

I can understand this, having grown up in a religious home. It's extremely difficult to shake off values you have been taught since childhood and as an adult you blindly defend these values against all reason.

 

[JustintheDoctor]

Guess I should have expected this... Lol

 

[AsianPersuasion]

You're not there to make decisions for them. You're there to provide facts and choices THEY have to make regarding their own care.

It's that simple. Where do you see in the Hippocratic oath that you need to impose your religion on others? And if you can't separate the two, I think you need to look into other career paths.

 

[hopefulERdoc251]

why are there parallels being drawn between the holocaust and abortion...like you guys decided to pick two huge extremes lol.

 

[Yojimbo_OGT]

As a physician, it's your responsibility and obligation to remain a medium of pure medical objectivism. You can choose to turn a patient away without any referral or medical advice and instead impart your religious beliefs, but like an atheist physician who hears of a terminal patient praying to a god for grace proceeding to tell that patient "there's no point in prayer," you aren't benefiting the patient. If you see an abortion as less of a health risk for your patient than birthing the child (which may have very high risks for both mother and child), then you cannot deceive the patient into thinking otherwise for your own moral satisfaction. Refer that patient to a physician who has the capacity for objectivity.

The patient > you.

Now, apart from my crude religious argument, the money aspect of private practice lies solely on your business practices. Will you be an entrepreneur and expand your business? Or will you sublease a section of a building and only see ~20 patients/week and wonder when the money will start pouring in? And then there's malpractice insurance for PCPs (yikes I'm not opening that can of worms)...

 

[hopefulERdoc251]

As for the OP's post on abortion. You guys do realize that he can practice 99.9% of specialities and not have to ever even consider the pros/cons of an abortion right lol? Like as a Family Practice Physician, he is def not performing an abortion. He's going to counsel a patient regarding one but the patient has every option to get a second opinion if she thinks he's a quack for his beliefs.

 

[rocklobstr]

What an infantile argument.

Imagine a different scenario... "If you don't like the Holocaust, then DON'T KILL JEWS. If someone else does, then leave them the f*ck alone"

At the very least, I hope you realize that the issue isn't as cut and dried as you think it is.

TIL: Abortions are like the holocaust.

 

[raindropx]

TIL: Abortions are like the holocaust.

don't waste your time lol

If OP feels a need to force her religious beliefs on patients, then medicine is not right. I don't think you yourself need to do the abortion, but you are not allowed to tell them how wrong it is or blabla because that is your belief, not necessarily theirs. You would be required to refer them to someone who can do it.

 

[ChillDawg]

These people think they are doing the right thing. I mean, can you imagine if there was some mass holocaust of baby murders going on, you would be motivated to stop it. Unfortunately they are a bit blinded to the objective realities by their religious beliefs. Not something uncommon when logic goes in the face of the beliefs you have held since childhood.

One can be against abortion for entirely nonreligious reasons.

 

[hopefulERdoc251]

What I will chime in is that OP says:

"Before you tell me that my own morals should not interfere with patient care, I want to point out that I do not consider abortion to be a part of proper patient care. To me, abortion should not even be a part of the medical world because it goes against a doctor's duty to preserve life. I want this awful practice eliminated, and I feel that becoming a medical doctor would give me additional influence in the matter."

What about for cases where there was rape or an unplanned sexual encounter? Condoms break, birth control doesn't always work, mistakes happen. Indirectly, your desire to eradicate abortion simply based off your personal belief is a very judgemental statement because you're basically judging people based off their decisions and saying because of their decisions, they deserve to face the consequences regardless of the medical care available. You also realize that you're disregarding the future of the infant right? If a 21 year old becomes pregnant after a stupid mistake, or because a condom broke while she was in a monogamous relationship with her significant other, that person might not have the capacity (finances, maturity ect) to care for a child. She didn't make a stupid mistake, she made a perfectly rationale decision (have safe sex w/ their s/o), why should she have to pay the consequences of an accident? Even if it wasn't an accident, people make stupid choices. I don't think an infant should have to suffer and grow up in that family that might not be capable of caring for them.

 

[rocklobstr]

don't waste your time lol

If OP feels a need to force her religious beliefs on patients, then medicine is not right. I don't think you yourself need to do the abortion, but you are not allowed to tell them how wrong it is or blabla because that is your belief, not necessarily theirs. You would be required to refer them to someone who can do it.

Definitely. Also, do family med doctors really have anything to do with abortions anyways? I imagine you could just refer them to someone and say it's out of your scope of practice.

 

[hopefulERdoc251]

Definitely. Also, do family med doctors really have anything to do with abortions anyways? I imagine you could just refer them to someone and say it's out of your scope of practice.

Yeah, usually OBGYN's do abortions.

 

[Yojimbo_OGT]

OP, what about ectopic pregnancy? Just let it run its course?

 

[hopefulERdoc251]

OP, what about ectopic pregnancy? Just let it run its course?

well another extreme here haha. Ectopic pregnancies can cause death. A normal uterine pregnancy will probably not cause death unless the mother begins suffering from preeclampsia.

EDIT: or another complication during birth

 

[rocklobstr]

OP, what about ectopic pregnancy? Just let it run its course?

 

[rocklobstr]

You guys are helping me prep for CASPer tomorrow

 

[hopefulERdoc251]

ya'll are helping me prepare for my interview monday...I should be sleeping but I have anxieties about flying -__- #Ineedativan

 

[allantois]

Mother Teresa who is concerned about her lifestyle above all else.

Seems like LUCOM fanatics are taking over pre-allo.

 

[raindropx]

OP's quote:" I feel that becoming a medical doctor would give me additional influence in the matter."

real motive for going into medicine? not gonna happen kid

 

[rocklobstr]

So, OP, my advice is, if you want to do medicine, stay away from OB-GYN, and you will likely be fine. There are a good amount of religious schools and hospitals with religious physicians who do just fine with these religious obstacles.

 

[raindropx]

she should practice in texas

 

[rocklobstr]

OP's quote:" I feel that becoming a medical doctor would give me additional influence in the matter."

real motive for going into medicine? not gonna happen kid

You mean I can't single-handedly end abortion?

 

[Womb Raider]

Hi Miss_TN, welcome to the forums.

To answer your first question - yes, you can absolutely become a physician without participating in or promoting abortion. However, it won't be particularly easy. Medicine (and science fields in general) are generally less religious than other walks of life. Most physicians are not Catholic and don't believe there is some universal moral imperative to avoid abortion. There are lots of moral arguments and methods of reasoning that favor abortion in certain situations (as I'm sure you're aware) so, IMO, be familiar with these and acknowledge them - don't simply shrug them off - you will not earn the respect of your colleagues this way.

For all of people screaming "doctors shouldn't force their beliefs on others!!! at OP. This is not about the physician forcing religious beliefs on patients - this is about the patients forcing the physician to perform actions that violate core, fundamental moral principles that she (the physician/OP) lives by. Patients don't have (and shouldn't think they have) free reign to control their physician to do whatever they want. Physicians are people too - sometimes with values that don't always align with common medical practices. Most modern bioethicists agree that physicians do not have a moral obligation to perform actions that violate their own ethical code. (Go read Beauchamp & Childress: Principles of Biomedical Ethics if you want to learn more, OP).

However, if your patient is adequately informed about his/her options, and decides to have an abortion, the question then becomes do you have a moral obligation to direct your patient to someone who can help him/her. This is not as black and white as the previous question, and there is no clear consensus within the medical community (there's not even a clear consensus within the Catholic church) - I strongly suggest consulting with your priest and some catholic physicians to get their opinions. However, I personally would suggest carefully considering what might happen if you don't direct your patient to a safe alternative when you will not help them. Remember why you became a physician in the first place.

I'd like to end by making sure you fully understand your stance on abortion. Catholic "law" does not forbid abortion absolutely. As I'm sure you're aware, the principle of double effect morally allows certain "bad" actions to be performed in certain situations (abortion included). Are you willing to perform abortions in these situations? If not, why? Things to think about.

I hope this was helpful, let me know if you have any more questions.

You're not there to make decisions for them. You're there to provide facts and choices THEY have to make regarding their own care.

It's that simple. Where do you see in the Hippocratic oath that you need to impose your religion on others? And if you can't separate the two, I think you need to look into other career paths.

See above. Abortions are usually not emergency situations that will determine the life or death of the patient. Thus, physicians that have personal values that forbid performing abortions are not morally obligated to perform them simply because their patient feels like it. Furthermore, solely providing facts and choices does not comprise the full scope of a physician's role. If you informed your patient about their condition and they chose to do something radical - like chop off a perfectly functioning limb - would you acquiesce? That's what I thought. Think before commenting next time.

 

[raindropx]

Hi Miss_TN, welcome to the forums.

To answer your first question - yes, you can absolutely become a physician without participating in or promoting abortion. However, it won't be particularly easy. Medicine (and science fields in general) are generally less religious than other walks of life. Most physicians are not Catholic and don't believe there is some universal moral imperative to avoid abortion. There are lots of moral arguments and methods of reasoning that favor abortion in certain situations (as I'm sure you're aware) so, IMO, be familiar with these and acknowledge them - don't simply shrug them off - you will not earn the respect of your colleagues this way.

For all of people screaming "doctors shouldn't force their beliefs on others!!! at OP. This is not about the physician forcing religious beliefs on patients - this is about the patients forcing the physician to perform actions that violate core, fundamental moral principles that she (the physician/OP) lives by. Patients don't have (and shouldn't think they have) free reign to control their physician to do whatever they want. Physicians are people too - sometimes with values that don't always align with common medical practices. Most modern bioethicists agree that physicians do not have a moral obligation to perform actions that violate their own ethical code. (Go read Beauchamp & Childress: Principles of Biomedical Ethics if you want to learn more, OP).

However, if your patient is adequately informed about his/her options, and decides to have an abortion, the question then becomes do you have a moral obligation to direct your patient to someone who can help him/her. This is not as black and white as the previous question, and there is no clear consensus within the medical community (there's not even a clear consensus within the Catholic church) - I strongly suggest consulting with your priest and some catholic physicians to get their opinions. However, I personally would suggest carefully considering what might happen if you don't direct your patient to a safe alternative when you will not help them. Remember why you became a physician in the first place.

I'd like to end by making sure you fully understand your stance on abortion. Catholic "law" does not forbid abortion absolutely. As I'm sure you're aware, the principle of double effect morally allows certain "bad" actions to be performed in certain situations (abortion included). Are you willing to perform abortions in these situations? If not, why? Things to think about.

I hope this was helpful, let me know if you have any more questions.



See above. Abortions are usually not emergency situations that will determine the life or death of the patient. Thus, physicians that have personal values that forbid performing abortions are not morally obligated to perform them simply because their patient feels like it. Furthermore, solely providing facts and choices does not comprise the full scope of a physician's role. If you informed your patient about their condition and they chose to do something radical - like chop off a perfectly functioning limb - would you acquiesce? That's what I thought. Think before commenting next time.

No. Your job as a physician is to help patients. They pay a large sum of money so you can help them. They shouldn't have to give a **** if they are violating your beliefs because your job is to serve them and get compensated in return. And if you cannot serve them, then refer them to someone who can. It is absolutely NOT okay to force your opinions on patients, but yes it is okay the other way around, regardless of how unfair it sounds. If you choose a medical career, commit to serving patients, not yourself.

 

[hopefulERdoc251]

Completely unrelated to anything thread related...I think the handle WombRaider is awesome lmao

 

[hopefulERdoc251]

No. Your job as a physician is to help patients. They pay a large sum of money so you can help them. They shouldn't have to give a **** if they are violating your beliefs because your job is to serve them and get compensated in return. And if you cannot serve them, then refer them to someone who can. It is absolutely NOT okay to force your opinions on patients, but yes it is okay the other way around, regardless of how unfair it sounds. If you choose a medical career, commit to serving patients, not yourself.

LOL woah this went off the deep end. What if a patient came to the ER for chest pains, his EKG was abnromal, he had elevated troponin's, he wants to leave. You're obligation is to help them but they want to leave...what do you do? What if you had a patient who was a chronic narcotic drug user? He comest to your ER for the same old same abdominal pain of unknown cause or the same old same lower back pain that isn't reproducible on palpation with no new injury. Are you going to give him pain medication? Opioid withdrawal is a bitch, you get hyperalgesia. Your patient is in distress due to her addiction, are you going to feed it to help and serve them?

 

[efle]

Where do you see in the Hippocratic oath that you need to impose your religion on others?

Not sure if you're aware of this, but the Hippocratic oath actually specifically forbids abortion:

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

Just a fun fact.

One can be against abortion for entirely nonreligious reasons.

Important point here guys. No reason to focus on OP's particular motivations. Whether they oppose abortion because God personally called them up and told them to, or because they believe it is murder and would oppose it even if they were atheist, isn't really relevant.

To OP, as others have said, you would have a responsibility to provide good information to patients inquiring, but would never have to personally perform the operation if you did not wish to.

 

[raindropx]

LOL woah this went off the deep end. What if a patient came to the ER for chest pains, his EKG was abnromal, he had elevated troponin's, he wants to leave. You're obligation is to help them but they want to leave...what do you do? What if you had a patient who was a chronic narcotic drug user? He comest to your ER for the same old same abdominal pain of unknown cause or the same old same lower back pain that isn't reproducible on palpation with no new injury. Are you going to give him pain medication? Opioid withdrawal is a bitch, you get hyperalgesia. Your patient is in distress due to her addiction, are you going to feed it to help and serve them?

I think you need to remind yourself of what serving others means. You help them meet their needs/desires, and if that is to leave, then you help them do just that. It's not too complicated to understand really.

 

[Womb Raider]

No. Your job as a physician is to help patients. They pay a large sum of money so you can help them. They shouldn't have to give a **** if they are violating your beliefs because your job is to serve them and get compensated in return. And if you cannot serve them, then refer them to someone who can. It is absolutely NOT okay to force your opinions on patients, but yes it is okay the other way around, regardless of how unfair it sounds. If you choose a medical career, commit to serving patients, not yourself.

A) You're not forcing your beliefs on anyone by abstaining from action.
B) Some would argue that the problem with referring is you are being complicit in a morally unacceptable action. There are those who believe being an accomplice or helping someone perform a bad action is as bad as performing the act yourself.
C) Of course it's OK to force your opinion on patients. The entire reason patients seek physicians is to get their opinion... If they didn't need this why do we have physicians?
D) Again, put yourself in the limb-amputation scenario I described above. Would you chop off a patient's arm just because they asked you too? Would you prescribe them heavy pain meds because they think that's what they need? I could go on and on. But If you answer no to any of these, why? You're letting your own morality affect how you treat your patients.
E) Your option is naive. Go shadow more and actually experience these scenarios in the real world.

 

[efle]

C) You can advise patients without forcing them to do what you advise
D) Very faulty. The mental illness and addiction seen in scenarios like what you describe make what the patient claims to want no longer a factor. Same reason you can tackle a patient to the ground and forcefully stop them from killing themselves. Different case from when the patient is sane/rational.
E) Tone down the condescension. I've shadowed, and would describe the physicians I've seen as serving their patients much more than forcing anything on them

 

[Womb Raider]

Another fun fact: the original Hippocratic oath is obsolete - no one (MAYBE 1 school) still uses it.

 

[efle]

Another fun fact: the original Hippocratic oath is obsolete - no one (MAYBE 1 school) still uses it.

lol, obviously. It forbids all surgery.

 

[Womb Raider]

C) You can advise patients without forcing them to do what you advise
D) Very faulty. The mental illness and addiction seen in scenarios like what you describe make what the patient claims to want no longer a factor. Same reason you can tackle a patient to the ground and forcefully stop them from killing themselves. Different case from when the patient is sane/rational.
E) Tone down the condescension. I've shadowed, and would describe the physicians I've seen as serving their patients much more than forcing anything on them

C) I said force your opinion on the patient, not force them to do what you advise. I used exactly the same words that he did.
D) I don't even understand what you're arguing for here. Oh and how do you define sane/rational? Furthermore, how do you determine / test for this?
E) Forcing opinions is equivalent to simply telling them your opinion, which is all a physician's diagnosis is.

 

[efle]

Please. Opinion is what is advised. "second opinion" = "see if another doctor advises the same". "expert medical opinion". etc. Semantics.

This is established by ethics boards. Do you really not get why consent is taken out of the picture when someone is mentally ill or addicted? I'm not saying there aren't better analogies you could use that do support your point. Just pointing out these ones are faulty.

 

[CaliforniaDreamer]

D) I don't even understand what you're arguing for here. Oh and how do you define sane/rational? Furthermore, how do you determine / test for this?

You have different obligations if a patient is not competent to make decisions for themselves. Your examples are making it seem like you are comparing mothers who want abortions to mentally incompetent people.

 

[Dral]

LOL woah this went off the deep end. What if a patient came to the ER for chest pains, his EKG was abnromal, he had elevated troponin's, he wants to leave. You're obligation is to help them but they want to leave...what do you do? What if you had a patient who was a chronic narcotic drug user? He comest to your ER for the same old same abdominal pain of unknown cause or the same old same lower back pain that isn't reproducible on palpation with no new injury. Are you going to give him pain medication? Opioid withdrawal is a bitch, you get hyperalgesia. Your patient is in distress due to her addiction, are you going to feed it to help and serve them?

I see where you are going with those examples, but I don't think they are the best comparisons in this case. We are talking about a physician with a moral dilemma giving or 'witholding' care from a patient based on physician beliefs. Since we've sorta established for the benefit of the thread that we are discussing non-emergent abortions it seems most of us agree that the physician is within their right and obligations to not provide an abortion if it is against their value system. The way I understand it, it is a physicians ethical obligation to provide that patient with a referral to a competent physician who can provide the care. This is what happens when a physician has to 'divorce' a patient. Not all people get along, we need ways to have a patient we don't see eye to eye with get the care they need if the physician/patient relationship is causing a block to providing that care in the best way possible.

Flat out refusing care to a patient without providing a proper referral I guess would be within the physicians rights. I believe it violates ethical practice though. I'm not totally sure if it's entirely within rights for current medicolegal purposes though.

Now on to those examples...the first one is pretty cut and dry imo. If a patient comes in having an MI and they then want to leave....well, if they are alert and mentally competent, you have to let them leave. You try to explain and convince them to stay, but in the end, if the patient wants to leave (refuses care), you have to let them leave. You have to do what the patient wants. You try to explain they will benefit more for staying with care, you explain what you would do to help them, you explain what the alternatives are if they decide to not stay and what could happen...I mean, that's just basic informed consent. If the patient wants to leave, you try to get them to at least sign a waiver stating they are refusing care and leaving AMA, but in the end, you have to do what the pt wants. You can get in big trouble if you don't do it that way...that's day one intern year stuff.

The second example is tougher. The patient wants the meds but you don't feel you should give them to the patient. If you feel the patient is truly in withdrawal, the physician should probably do what they can to help the patient. However, if you don't give that patient what they want, they are off to the patient care rep and you could potentially face problems (sucks, but it's modern medicine...I wish we had physician care reps, lol). Anyway, in this example, it's more about evaluating the patient at the time. If they are not in withdrawal by your assessment, you try your hardest to not give them the meds that will fuel their addiction. It's hard to really assess pain perception sometimes, of course. If they are in withdrawal, you help them the best you can. Either way, you should then go through the steps to get them to a place that can help them with their problem (even if you've done it 30 times before).

If you don't give them meds, you carefully document evidence that supports your medical decision...again, can be difficult. Hmm, something like "pt stated in exquisite pain and any touch or movement caused pain. Upon jarring patient bed accidentally, patient did not react to indicate they were experiencing pain as they previously described".

In that second example, I could see the physician not necessarily giving in and giving the patient what they want. So I see your point there.

Either way, these examples are based on medical choices (and protocol) and don't have a preface of the physician necessarily interjecting their moral beliefs into the situation...maybe a bit in the second one if a physician feels strongly about not doing drugs or abusing substances. But again, the physician should stabilize the patient and then work on getting the patient to someone who can care for them properly if the current treating physician is not able to do so for whatever reason.

Is there a right or correct answer for some of this stuff? I'm not sure there is.

 

[IlDestriero]

There was more than one question in the OPs mission statement.
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