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india7

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This was in the NY times this week and was brought up for discussion at my med school.....what are some thoughts regarding this here on SDN, as a slice of the population of doctors/medstudents/etc?

http://www.nytimes.com/2007/02/13/opinion/13tue3.html?_r=1&oref=slogin

Doctors Who Fail Their Patients

Published: February 13, 2007

It was bad enough when pharmacists who call themselves pro-life refused to fill prescriptions for morning-after pills and an emergency medical technician refused to help drive a woman to an abortion clinic. Now a new survey has revealed that a disturbing number of doctors, at the presumed pinnacle of the health professions, feel no responsibility to inform patients of treatments that they deem immoral or to refer them to other doctors for care. Although the close-mouthed doctors claim a right to follow their consciences, they are grievously failing their patients and seem to have forgotten the age-old admonition to “do no harm.”

The survey, by researchers at the University of Chicago, was published last week in The New England Journal of Medicine. The researchers mailed questionnaires to some 2,000 doctors asking whether they had religious or moral objections to three controversial practices. Of the 1,144 who responded, only 17 percent objected to “terminal sedation” to render dying patients unconscious, but 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception.

The encouraging news is that substantial majorities thought that doctors who objected to a practice nevertheless had an obligation to present all options and refer patients to someone who did not object. But that left 8 percent who felt no obligation to present all options and an alarming 18 percent who felt no obligation to refer patients to other doctors. Tens of millions of Americans probably have such doctors and are unaware of their attitudes.

The researchers put the burden on patients to question their doctors upfront to learn where they stand before a crisis develops. But that lets doctors off the hook. Physicians have a right to shun practices they judge immoral, but they have no right to withhold important information from their patients. Any doctors who cannot talk to patients about legally permitted care because it conflicts with their values should give up the practice of medicine.
 

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This was in the NY times this week and was brought up for discussion at my med school.....what are some thoughts regarding this here on SDN, as a slice of the population of doctors/medstudents/etc?

http://www.nytimes.com/2007/02/13/opinion/13tue3.html?_r=1&oref=slogin

Doctors Who Fail Their Patients

Published: February 13, 2007

It was bad enough when pharmacists who call themselves pro-life refused to fill prescriptions for morning-after pills and an emergency medical technician refused to help drive a woman to an abortion clinic. Now a new survey has revealed that a disturbing number of doctors, at the presumed pinnacle of the health professions, feel no responsibility to inform patients of treatments that they deem immoral or to refer them to other doctors for care. Although the close-mouthed doctors claim a right to follow their consciences, they are grievously failing their patients and seem to have forgotten the age-old admonition to "do no harm."

The survey, by researchers at the University of Chicago, was published last week in The New England Journal of Medicine. The researchers mailed questionnaires to some 2,000 doctors asking whether they had religious or moral objections to three controversial practices. Of the 1,144 who responded, only 17 percent objected to "terminal sedation" to render dying patients unconscious, but 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception.

The encouraging news is that substantial majorities thought that doctors who objected to a practice nevertheless had an obligation to present all options and refer patients to someone who did not object. But that left 8 percent who felt no obligation to present all options and an alarming 18 percent who felt no obligation to refer patients to other doctors. Tens of millions of Americans probably have such doctors and are unaware of their attitudes.

The researchers put the burden on patients to question their doctors upfront to learn where they stand before a crisis develops. But that lets doctors off the hook. Physicians have a right to shun practices they judge immoral, but they have no right to withhold important information from their patients. Any doctors who cannot talk to patients about legally permitted care because it conflicts with their values should give up the practice of medicine.

This clown presents these numbers as if they accurately reflect how ALL doctors feel about these controversial practices. I don't see how you can derive any meaningful data from a questionaire in which only little more than half of those polled even responded. Any study like this has an inherent bias in that only those who have an extreme viewpoint one way or the other would be inclined to respond. Most doctors are moderate and nuanced on these issues, and recognize that nothing is black and white in medicine. Most doctors would be unlikely to respond to this poll, since they know their views can not accurately be laid out in a tidy little questionaire. The authors of this study clearly had an agenda and a preconcieved notion of what they wanted the results of the study to show.

Of course, no need to ask an academic what he or she thinks of the study design, since on the surface it seems to make a point that the New York Times inherently wants to believe. To ask an academic would be to jeopardize the Times own smug sense of moral superiority.

Besides, who in their right mind expects anyone to believe that a woman in this day and age does not know that abortion is an option for failed contraception? To what ridiculous extent do we have to free somebody from personal responsibility? Should we force sterilization? After all we can't expect everyone to know how to responsibly use contraception. :rolleyes:
 
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Faebinder

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For heaven's sake.... this is 2007... they come in with their own opinion premade for them and ask you to confirm it.

As a doctor.. you are an advisor + a skilled waiter.

You advise them... and when they decide and order you do what they want. Some like to order against advise and some don't even want to hear your advise. Move along, nothing to see here.
 

india7

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I'm confused. Why would an EMT drive a woman to get an abortion?


I wasn't quite sure about that one either...i couldn't figure out the scenario in my head.
i do agree that it is patient responsibility to find out where their physician stands on issues that are impt to them if they are concerned they may come up during their care. that is in the ideal sense of course, most people just don't really think about it until things come up.
and of course we can assume the majority of people know their legal options with unplanned pregnancies. however many people go to their personal doctors first with medical problems. since abortions are not available in the majority of US counties (80 some percent now don't have providers?) they justifiably look towards their doctors for assitance. so the concern is doctors in the majority of counties that don't have providers who are unwilling to provide their patients with information.
 

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I wasn't quite sure about that one either...i couldn't figure out the scenario in my head.
i do agree that it is patient responsibility to find out where their physician stands on issues that are impt to them if they are concerned they may come up during their care. that is in the ideal sense of course, most people just don't really think about it until things come up.
and of course we can assume the majority of people know their legal options with unplanned pregnancies. however many people go to their personal doctors first with medical problems. since abortions are not available in the majority of US counties (80 some percent now don't have providers?) they justifiably look towards their doctors for assitance. so the concern is doctors in the majority of counties that don't have providers who are unwilling to provide their patients with information.

I just don't see why we should expect doctors to check their own sense of morality and ethics at the door once they graduate from medical school. And doctors are not the sole proprieters of information about where and how to get an abortion. I live in a community that is teeming with religious conservatism, yet even here there are at least five phone numbers listed in the yellow pages under "Abortion".

Again, I don't think one can draw any meaningful conclusions from this study, for the reasons I've stated earlier. I think any discussion needs to address the flaws in the study before anyone jumps to conclusions about how doctors practice. But I think its a worthwhile debate to talk about whether or not physicians must present all options to a patient, even when it goes against their own morals and ethics. Personally, I don't think a physician should feel compelled to violate his own beliefs. (Within reason, of course. This sentiment would not apply to a Christian Scientist physician who prescribes only prayer for instance). And I am pro-choice in certain circumstances.
 

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I think it is important that physicians present standard of care alternatives regardless of their personal beliefs (i.e surgery for ruptured appendix, antibitoics for bacterial infection, birth control pills for painful and irregular menstrual bleeding). I also think physicians should be required to provide the standard of care whenver failing to provide it immediately will cause harm to the patient. A physician may have a moral objection to transfusions of blood products, but I don't think they should be able to refuse to provide one to someone bleeding out. When action isn't required immediately, I think the obligation to present the standard of care options should stand, but the physician should be allowed to state that for personal reasons he/she is unwilling to provide that option. I don't know if I believe they should be forced to come up with a name of someone who will provide that option, or if the patient should be responsible for finding an alternate provider. However, I'm not sure it is a good idea to allow providers to fail to inform patients of all the options that are considered standard of care. The question arises about what is considered standard of care though. Also the question is how much information is really required from the physician, and how much is really common knowledge. I don't need a physician to explain to me that if I am pregnant that I can keep the baby, give it up for adoption, or abort it. But then again, maybe I am giving people too much credit. There is a great deal of naivete and ignorance in the world, so maybe there are people out there who truly don't know their options in this and other scenarios. I don't know the full answer.
 

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I'm confused. Why would an EMT drive a woman to get an abortion?

Here is a bit more information on the case: http://www.merginet.com/index.cfm?pg=human&fn=discriminationlawsuit

Thing is she is now suing the ambulance company because they fired her when she refused. I used to work for that ambulance company. It is almost exclusively non-emergency runs between health facilities. Makes me laugh when the EMT claims that she "became an EMT to save lives" - what?!? Since when is transporting grandpa from the nursing home to the podiatrist saving lives? And I've seen people fired from the company for MUCH less than refusing a call!

- H
 

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I guess I just don't understand why someone in severe abdominal pain would be transported to get an abortion instead of evaluated for her pain. And if she wasn't in pain, why would she not just take a cab. I am either very dense or there is some piece of info missing (or it was just a ridiculous situation).
 

FoughtFyr

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I guess I just don't understand why someone in severe abdominal pain would be transported to get an abortion instead of evaluated for her pain. And if she wasn't in pain, why would she not just take a cab. I am either very dense or there is some piece of info missing (or it was just a ridiculous situation).


The hospital in question doesn't do elective abortions. I could imagine that if a person who was inpatient, being evaluated for abdominal pain with no source yet identified, was to undergo an elective abortion as a "therapuetic trial" (that is she would return to the hospital to see if the abdominal pain subsided after the pregnancy was terminated), an ambulance transfer would be necessary. That is a pretty convuluted set of circumstances but could happen...

- H
 
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