comprehensive reproductive health education?

[sparky5]

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Obviously, if you want you can learn it, doctors are being trained in it but I would caution you not to be too enthusiastic about it.

Thanks but no thanks on your advice. I am 100% pro-choice on this one. If it is a procedure that I can perform and my patient wants it done I am going to do the procedure. That said, there are some things that I might not be as willing to help with, like treating a convicted felon, or a sexual abuser or a chain smoker who refuses to think or talk about quitting. Yes that's right I grouped all those together, I hate smokers with a vengeance. All of those are against my morales and really I have little desire to spend my time trying to help people who I don't see hope for.

 

[Hurricane]

That said, there are some things that I might not be as willing to help with, like treating a convicted felon

Wha? If Martha Stewart walked into your office, you wouldn't treat her? Or are you just talking about some stereotype of "convicted felons" you have in your head? First of all, convicted felons aren't all raving homicidal maniacs. Chances are you probably know someone who has been convicted of a crime and you don't even know it. And second, a person who has committed a crime and paid their debt to society is no less worthy of medical treatment than any other person. As physicians, it is not our job to decide if our patients pass some moral test before we treat them. A physician who refuses to treat a person because he has a problem with something the patient did in the past is just as bad as those pharmacists who refuse to fill Plan B scripts because they have a moral objection, or people who say abortion should be allowed for rape but not unplanned pregnancy, etc.

 

[aphistis]

A physician who refuses to treat a person because he has a problem with something the patient did in the past is just as bad as those pharmacists who refuse to fill Plan B scripts because they have a moral objection, or people who say abortion should be allowed for rape but not unplanned pregnancy, etc.

Erm, will you remind me when, and by whom, these supposed benchmarks of moral turpitude were established?

 

[yellowcat322]

Obviously, if you want you can learn it, doctors are being trained in it but I would caution you not to be too enthusiastic about it.

\

I am having a hard time understanding why you keep equating someone wanting to learn a medical procedure (albeit controversial one) with some kind of maicious intent to see more women get abortions. Like someone pointed out before, if you go into pediatric oncology does that mean you LOVE seeing kids with cancer??? Whether you're performing abortions or cutting out tumors you are providing medical care. PERIOD. I think the enthusiasm that you are referring to is coming from the ability to provide an essential medical procedure at times when obtaining a safe one is becoming a scarcity. It the enthusiasm of being able to prevent countless women (many of them teenagers) from getting lethal infections and mutilation of reproductive system due to botched abortions. There is nothing wrong with being enthusiastic about that.

 

[NEATOMD]

Thanks but no thanks on your advice. I am 100% pro-choice on this one. If it is a procedure that I can perform and my patient wants it done I am going to do the procedure. That said, there are some things that I might not be as willing to help with, like treating a convicted felon, or a sexual abuser or a chain smoker who refuses to think or talk about quitting. Yes that's right I grouped all those together, I hate smokers with a vengeance. All of those are against my morales and really I have little desire to spend my time trying to help people who I don't see hope for.

Interesting...are you a medical student? I've serious doubts that you are.

 

[sparky5]

Interesting...are you a medical student? I've serious doubts that you are.

As my sig says I am a MS2 at NYMC. And yes I did think about what I wrote (in case that is your next question). My thought is that anyone who says they will treat everyone, who wants their help, equally just isn't being honest. We all have our own baggage, and those past experiences might not let you provide as high a standard of care as you (or others) feel you should provide, in those cases it is in my opinion (and those in my ethics class) a ethical imperative to terminate your care of that patient and transfer them to someone else's care who will be able to provide better care for the patient.

What about my statements all mighty neato md make you not think I am a med student? And just for a frame of reference what is your medical background/training?

 

[NEATOMD]

What about my statements all mighty neato md make you not think I am a med student? And just for a frame of reference what is your medical background/training?

Its pretty naive to believe that you can pick and choose who and what illness you are going to treat and when. I know you probably realize its not that easy. And, it is true that it is slightly easier is some fields to send a patient elsewhere for care when needed. Still, aside from legal and ethical problems you'll encounter if you attempt to practice the way you said you will, you definately won't get any respect from your colleagues (and trust me it matters). Further, you won't be liked by your community and that means you won't even get the patients that you do want. Also, if you don't own your practice (and fewer do these days), then you'll really be looking at trouble because you'll have even less control over who you see.

Consider this: Who goes to the doctor in the first place? Well, the majority of office visits are going to be people who are experiencing health problems. Now, let's just use smoking as an example: It's not a coincidence that people who smoke are often less healthy than those who don't. So, when combined with the total population that smokes and their increased health risks, smokers make up an extremely high number of most doctors' patients. And that's not all, we all know that smokers aren't the only ones at risk, but countless people (especially children) are subjected to second hand smoke from their family members. And you'll have even less control over those people. So, if you refuse care to all these people, you won't have much a patient base to work with.

Meanwhile, though you might have sat in some ethics discussion and come to the ideal you mentioned above, the truth of the matter is that if you spend your time worried about your patients character flaws and the such, you'll have a miserable practice. Honestly, there are some patients that no one is going to WANT to treat. Trust me on that one. For instance, ever heard of noncompliance? So, at some point, if you plan on being successful, you'll just have to get over all that crap and treat everyone to the best of your ability. As a final note, you might find that helping those tough patients will bring you more satisfaction in the end that you would have thought.

 

[Hurricane]

A physician who refuses to treat a person because he has a problem with something the patient did in the past is just as bad as those pharmacists who refuse to fill Plan B scripts because they have a moral objection, or people who say abortion should be allowed for rape but not unplanned pregnancy, etc.

Erm, will you remind me when, and by whom, these supposed benchmarks of moral turpitude were established?

Perhaps I should have used "no different" rather than "just as bad." But it's a fact that this kind of thing is going on. Most recently, a Target pharmacist made the news for refusing to fill a Plan B script, and Target is fine with that. Sorry, but I do not agree with health care providers picking-and-choosing who they're going to help based on some self-imposed worthiness scale. Especially something as time sensitive as emergency contraception. Every hour of delay decreases its effectiveness.

We all have our own baggage, and those past experiences might not let you provide as high a standard of care as you (or others) feel you should provide, in those cases it is in my opinion (and those in my ethics class) a ethical imperative to terminate your care of that patient and transfer them to someone else's care who will be able to provide better care for the patient.

Yes, that baggage is called countertransference. In my chosen field (psych), the physician makes an effort to recognize it, explore it, and hopefully use it to help treat the patient. Perhaps that is why your post angered me so - I read your statement to mean that you had decided not to make any effort to overcome your baggage and treat patients of whom you disapprove. And if we want to talk about my baggage, I have a couple of family members who have been convicted of a felony in the past, and if you met them now, you'd never know it unless they told you (esp the white collar one). So based on my experience, I think your sweeping generalization about the moral status of "convicted felons" is naive. Oftentimes a felony conviction results more from stupidity, bad judgement, or bad luck than moral baseness. And I think that they are no less deserving of medical care than myself. Although I see your point and would rather them go to a physician who does not hold them in such contempt, if given the choice.

And FWIW, I agree with NeatoMD that it's rather naive to think you can go through med school, residency, and even your own practice without having to treat smokers and people who have been convicted of crimes. I hope you are not going into ER.

 

[sparky5]

okay boys and girls this thread has been hijacked enough back to the op and the topics at hand.

 

[evade]

I absolutely think that comprehensive reproductive health education should be offered in medical school, and I absolutely think that medical students should have the opportunity to learn about abortion. During medical school, we have the opportunity to learn about any number of other procedures, why should abortion be any different?

Now, don't misinterpret this to mean that I want to perform abortions. I don't want women to suffer unwanted and unintended pregnancy. That is, as some people have mentioned, akin to oncologists wanting people do develop cancer, or pediatric neurologists hoping that kids develop intractable seizures. Abortion should be the last line of treatment when birth control has failed. . .and it is my job first and foremost to make sure that my patients (a) have access to birth control that works for them, (b) that they know how to use it, and (c) that if they ever feel that the method they chose isn't working for them, they know that they can try a different method. I want to help women prevent unwanted pregnancies so that they never have to go through such an invasive and unpleasant procedure.

But if all that caution fails, abortion must be safe and available. Were I standing in a room with another person of my same blood type who was hemorrhaging to death, and were I holding transfusion equipment, I would not be required under any law to give that person my blood, even if I was the only person who could save them. You are never required to use your body to sustain the life of another entity against your will. Even if you believe an embryo or fetus is a person, this still holds true.

Oh, and though I know it's not the majority of pregnancy terminations, I've seen a good number of terminations done for women who were carrying badly deformed, nonviable fetuses. There is nothing sadder than watching a woman (and often, her partner) who has conceived a deeply wanted baby and has discovered that there is something terribly wrong with it, walk out the door of her obstetrician's office with tears in her eyes and a referral in her hand. Abortions will always have to be performed for one reason or another, and there's got to be someone who knows how to do them safely and effectively.

 

[sportsman]

I totally agree about absolutely having education on women's reproductive healthcare for all and abortion education available for those who want it....as well as the total need for birth control available, without judgement. And I would say not just available but work with patients to figure out why some people may not use it (cost? bc can be a finanicial burden on limited incomes..method not working right? and on and on)
I just wanted to say though, please be careful saying that abortion is an invasive and unpleasant procedure. A first trimester abn takes 3-5 minutes and has less risk than carrying to term. A second tri abn takes longer, but typically under 15 min. And contrary to what anti-choicers like to say, it is a minority of women that have any psychological trauma afterwards. Not to minimize that at all, but to say that the vast majority of women are OK with their decision. They know why they chose this route and are grateful that THEY could choose it, not someone they don't even know and who doesn't know their situation mandating what they need to do based on their opinions. against abortion? fine, don't have one. but don't tell others what they can and can't do and push all women back to untrained people in scary situations.

 

[evade]

I totally agree about absolutely having education on women's reproductive healthcare and abortion education available for those who want it....as well as the total need for birth control available, without judgement. And I would say not just available but work with patients to figure out why some people may not use it (cost? bc can be a finanicial burden on limited incomes..method not working right? and on and on)
I just wanted to say though, please b/c careful saying that abortion is an invasive and unpleasant procedure. A first trimester abn takes 3-5 minutes and has less risk than carrying to term. A second tri abn takes longer, but typically under 15 min. And contrary to what anti-choicers like to say, it is a minority of women that have any psychological trauma afterwards. Not to minimize that at all, but to say that the vast majority of women are OK with their decision. They know why they chose this route and are grateful that THEY could choose it, not someone they don't even know and who doesn't know their situation mandating what they need to do based on their opinions. against abortion? fine, don't have one. but don't tell others what they can and can't do and push all women back to untrained people in scary situations.

Firstly, I agree with your comment about finding out what the barriers are for women in terms of procuring birth control. I considered spelling this out in my post, but in my mind it's included with "access." Still, though, it's crucial to find out, if patients aren't using birth control, WHY they aren't. Some have financial issues, some believe misinformation they've heard from friends or read on the internet, and some have partners that don't want to use it. These are all issues that need to be explored.

Secondly, I think you misinterpreted my comment about abortion being unpleasant and invasive. I'm as pro-choice as they come! You are absolutely right about the safety and efficiency of the procedure. You are even more right about the feelings of most women after they've had an abortion; most are okay with their decision and the majority feel "relief" as their primary emotion after the procedure. What I was trying to say was that preventing unwanted pregnancies is the most important thing, because no woman *wants* to have an abortion. There are plenty of medical procedures in this world that are safe and necessary, but are at the same time invasive and unpleasant. Consider having a tooth drilled to have a cavity filled. Is it unpleasant? Yup. Is it invasive? Yes, you're having a hole drilled in your tooth! But is it safe? Sure is, and is it necessary? Of course. When it comes to abortion, of course, a woman has this huge and very personal decision to make on top of all that. My point wasn't that the procedure is so awful that no one should have one. It was that if you can provide proper birth control options and education to your patients, they are much less likely to have to worry about abortion at all.