When does a med student learn to do abortions?

[bigfrank]

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K, folks, if the only thing you're contributing to a thread is "I'm not wrong, you're wrong!", take the hint that it's probably time to find another pasture to graze. 😉

K, folks, if the only thing you're contributing to a thread is "please leave," take the hint that it's probably time to find another pasture to graze. 😉

 

[Flea girl]

Well.. now I'm sorry to be a pill.. but "everyone" has a "friend" that has done x or y that defies the norm. You haven't provided any proof either for that matter. But I believe on average.. most men initiate marriages and most women end them. I have read this.. and I will try and find statistics on this and get back to you.

Men will never be on equal footing.. your right.. that is why they are attempting to put forth legistation to give men "some" form of control in the event that they have a lieing woman on their hands. (does happen sometimes) 🙂

I agree with you on the complications of manditory DNA testing.. but I would at least make it a widely available option and let it be more marketed because seriously I think it would prevent a lot of the serious complications of paternity fraud before they become too great.

Seriously, where do you get your stats on this?! I am not stating outside the norm situations. Come on, how many friends do you have that are/were married? I am seriously not trying to be a beast againist all mankind or state clinques but how many married couples with children do you know that the man stays at home with the child/children? I can tell you not many. How do I know this? Because my husband is a stay at home dad(web-designer that can work from home) and from what we've experienced this is a rarity. My husband also got roped in being VP of the PTA this year(mostly woman) and he has come home with many stories about cheating husbands and leaving their families high and dry. Think about, up until recently most woman stayed at home to raise the kids, hence were completely financial dependent on their husbands. So, you are telling me that these woman that have stayed at home with their children are leaving their husbands high and dry with kids in tow? Seriously, I am really not trying to be rude but how old are you? I will state that I do not believe that anyone should lie to the partners about being on BC but like someone else posted, why on earth is it so hard for the man to say "Look NO GLOVE, NO LOVE!" If you want to be on equal footing, then that is one less thing you have to worry about! Another bonus of that action would be preventing stds. From my understanding, if a woman wants to be on welfare b/c of children, social services gets involved(ie finding the father of child/children). At that point, if a man has questions about paternity he can request a DNA test b/f he is forced to pay child support. My best friend and her Mom are both in the SS field. So, I just might have to call her up so that we can get some stats going(with refs). She works mostly with women and children, if anyone would have that data, she would. From their experience, a lot of times that can't find the father much less get them to pay child support.

 

[OzDDS]

1) I am seriously not trying to be a beast againist all mankind or state clinques but how many married couples with children do you know that the man stays at home with the child/children?

2) So, you are telling me that these woman that have stayed at home with their children are leaving their husbands high and dry with kids in tow?

1) Off hand.. 3.

2) Not leaving the man with kids in tow.. many of the women take the children. most of the time even "if" the father wanted the kids.. the courts usually grant the mother custody and give the father "visiting rights". What I ment when I said the women leave the man high and dry.. is that it is usually women that initiate legal precedings and file for divorce more so than men file for divorce. Because they are usually the ones doing the divorce planning.. they think ahead and basically take as much money and assests of theirs/his and put it into her name before she files. Then when she files for divorce she leaves the man "financially" high and dry.. takes the kids and then makes him pay more for child support after she has already taken the cash and assets.. leaving him with nothing.


Again.. when I get a chance.. I'll try to get some stats on divorce.. who begins the process more often.. the husband or the wife. we'll see.

 

[OzDDS]

I will state that I do not believe that anyone should lie to the partners about being on BC but like someone else posted, why on earth is it so hard for the man to say "Look NO GLOVE, NO LOVE!" If you want to be on equal footing, then that is one less thing you have to worry about! Another bonus of that action would be preventing stds.

I agree with you regarding stds.. but look, I've personally been a long term monogamous relationship where my female partner claimed that she did not like using condoms (said they were irritating) and when I mentioned using them… the response was. “But I’m on the birth control pill, we will be ok. What don’t you trust me?”. What are you supposed to say to that? Not only that.. but men don’t like condoms either. And when presented with an offer like that.. Sex without a condom or no sex.. when the other partner promises that everything is ok… kinda hard to refuse. Its not always so black and white.

 

[Febrifuge]

I agree with you regarding stds.. but look, I've personally been a long term monogamous relationship where my female partner claimed that she did not like using condoms (said they were irritating) and when I mentioned using them… the response was. “But I’m on the birth control pill, we will be ok. What don’t you trust me?”. What are you supposed to say to that?

You say, "the pill makes you feel safe. When you say 'we will be ok,' that's what you're saying: you are happy with the pill. Meanwhile, I am happy with the protection condoms offer. Don't you want me to feel as confident as you do?" ...and then you find a different brand that she doesn't find irritating, and you use that.

or you say,

"Of course I trust you. I would feel better with a condom, is all. Why is it a big deal?"

or you say,

"Trust you? Why on earth would you ask about that? Who said anything about trust?" (and then you start a fight, and because it's a stupid fight, it blows over, then you consequently refuse to participate in make-up sex until she assents to the condom.)

...or you say,

"I'll last longer if we use a condom."


EDIT: Wow, do I really want to wade into a thread of this nature? 😉

My bottom-line point was meant to be, communication is everything, and the reason the whole subject is so complex and maddening is because in the heat of the moment, logic and communication skills go out the window. But there are probably things we could (and should) say.

 

[Med_Leviathan]

This needs to be bumped up a little bit.

I love causing strife and discord.

 

[OzDDS]

You say, "the pill makes you feel safe. When you say 'we will be ok,' that's what you're saying: you are happy with the pill. Meanwhile, I am happy with the protection condoms offer. Don't you want me to feel as confident as you do?" ...and then you find a different brand that she doesn't find irritating, and you use that.

My bottom-line point was meant to be, communication is everything, and the reason the whole subject is so complex and maddening is because in the heat of the moment, logic and communication skills go out the window. But there are probably things we could (and should) say.

Point taken.. and I agree.

She claims that all brands (condoms in general) are irritating and that it is harder for her to get off if her partner is using one.

I’ll just have to force the issue.. no glove no love. I either won’t be having sex with my partner anymore or she will just have to deal.

 

[Llenroc]

Anybody who wants to go out of their way to learn/do abortions is just a sick ****. 👎 Your lining your pockets with money by ending the life of another human being. If you find that satisfying, there is something wrong with you, no matter what your religion is or even if you have no religion. I come from a long line of doctors, and I have many, many relatives who are physicians. I have no respect for any abortion doctors out there. They are the dregs of the medical profession, IMO.

 

[EctopicFetus]

Ahh nothing to fan the flames quite like this. Enjoy....

 

[bananaface]

Anybody who wants to go out of their way to learn/do abortions is just a sick ****. 👎 Your lining your pockets with money by ending the life of another human being. If you find that satisfying, there is something wrong with you, no matter what your religion is or even if you have no religion. I come from a long line of doctors, and I have many, many relatives who are physicians. I have no respect for any abortion doctors out there. They are the dregs of the medical profession, IMO.

You are free to air your personal feelings on abortion in a non-collegial manner in the Everyone forum. However, when you flame any group of medical professionals anywhere in the academic forums, you are in violation of the TOS. This forum is for collegial discussion of topics in healthcare only. Please keep it clean, or take it outside of the academic areas. Thanks.

 

[Llenroc]

Ah I see your point.

There should be some movement to disown these people as licensed medical professionals.

It just makes me sick that an abortion doctor out there who terminates unborn babies will have the same standing as myself, a nice guy whose trying to cure people's illnesses. 👎

The vast majority of doctors out there (even the pro-choice ones) don't do abortions and want nothing to do with them.

 

[mshheaddoc]

Usually abortion doctors do not JUST do abortions. They are women's clinics to help women with women's health in general.

 

[dnw826]

Anybody who wants to go out of their way to learn/do abortions is just a sick ****. 👎 Your lining your pockets with money by ending the life of another human being. If you find that satisfying, there is something wrong with you, no matter what your religion is or even if you have no religion. I come from a long line of doctors, and I have many, many relatives who are physicians. I have no respect for any abortion doctors out there. They are the dregs of the medical profession, IMO.

Wow, guess that goes for the abortions of inbred cases, too, right? 👎

 

[EctopicFetus]

The vast majority of doctors out there (even the pro-choice ones) don't do abortions and want nothing to do with them.

Im not gonna state my opinion on this matter because well i just dont feel like discussing it but you should be aware that the majority of docs dont do it because it is not in their scope of practice. The majority of docs dont do brain surgery it doesnt mean they are all making a value judgement on it.

I assume that many people on here are preclinical or premed. For those of you who are interested, any OB/Gyn has to know how to perform a D&C which is an abortion. There are therapuetic (non-abortive) reasons to learn this procedure. Of course if you are early enough they can just treat you with medications (pills).

 

[bananaface]

Thank you for letting this discussion get back on a collegial track. 🙂

 

[EctopicFetus]

your welcome.. lets see if it lasts.. 🙂

 

[AlanAlan]

I generally dislike abortions and would like to never see them happen, but I am pro-choice. I think that maybe there should be more common ground on the issue.

For one thing, abortions happen regardless of whether they are legal or legal. Some estimates argue that there were more abortions in 1970 before it was legalized and even low-end estimates acknowledge that there were 100,000s of abortions even before roe v wade. When there is social stigma, health risks, and enormous economic burdens placed on women who have children, while the males who impregnated them are often able to skirt their responsibilities, there is going to be abortion one way or another. Perhaps the most perhant step is to try to provide women with the resources, education, options, and social acceptance to have a baby.

Second, this issue must involve a conflict in interest if you oppose abortion. Childbirth can be deadly (statistics indicate it is more dangerous than aortion), physically unhealthy, and mentally damaging - and it varies depending on each individual and the dangers are often not clear until after consimation. While the baby might have rights, surely the mother has some rights to control her own life and health as well (eugenics anyone?). Im sure some will argue that the life of the fetus can't be compared in magnitude to any other right, but these rights are indeed contradictory. In just these sticky moral issues where every case may differ and people might legitimately weigh these values differently, why don't we leave it up to the individual to decide?

 

[OzDDS]

In just these sticky moral issues where every case may differ and people might legitimately weigh these values differently, why don't we leave it up to the individual to decide?

I agree!

I'm pro equal rights. and I'm pro choice.

I think both people who contributed to the creation of the baby should have a say in what its ultimate fate is. Mother AND Father. 👍

 

[f_w]

I was under the impression that a good number of the 'abortion docs' that work out of dedicated abortion clinics are NOT OB/Gyns but rather GPs whose surgical scope of practice is limited to this one procedure. Some of them hold licenses in several states and travel multiple clinics on a irregular itinerary (to avoid the militant pro-life fraction that believes in 38s and dynamite as their preeminent ways of political expression).

As for when a medical student gets exposed to D/C as a procedure. Most would have an opportunity to see it during their OB/Gyn rotation. As for 'learning' the procedure it is pretty much limited to OB/Gyn residents. (the 'medical' abortion using RU486 can probably be performed by anyone familiar with its use. For incomplete cases it will still be necessary to hava a provider available who can perform a D/C).

 

[Shredder]

I hope this wasn't addressed already, but how much money do docs make per abortion? Can docs be selective about performing them? What about sterilizations--money and selectivity again

Have you read the book Freakonomics? Very interesting about how legalizing abortion can be linked (in the study) to the decrease in crime. Makes you think...Maybe abortion can be a good thing, right? If it's available, think of all the advantages (and I'm a liberal).

This is the crux of it. Abortion is inextricably tied to population genetics

 

[EctopicFetus]

For you pre meds.... any doc can refuse to perform a procedure if they have an objection to it. the exceptions are basically emergent things but an abortion doesnt count. any Ob knows how to do them but most choose not to for various reasons.

 

[Shredder]

Bump--I'm still really curious about $ per abortion and sterilization. Is there anywhere to find stats like these?

 

[Cinnameg]

You don't have many friends, do you? I mean, other than the people you know through your vice-presidency of the Pre-Med club at your school.

At least I haven't reached 5000 posts on SDN.

 

[Cinnameg]

And we also know that, whether or not we are willing to admit or accept it, women die when abortions are legal.

Carrying a fetus to term carries many more risks than does abortion. I'm not saying that's a strong argument in favor of abortion, but I AM saying that your argument that "women die anyway" does not lead to the conclusion that abortions should be illegal.

 

[Cinnameg]

Ouch, from either side?

Actually I consider bodily autonomy to be a fairly strong argument, but it isn't even my main reason for being pro-choice. As Panda correctly pointed out, I don't believe that a fetus is a person or that it has a right to life. (If a fetus has a right to life, I would argue that a dog or a cow has an even greater right to life as they can feel pain, have some level of awareness, and can live without using humans' bodies to do so.) The bodily autonomy argument is icing on the cake, i.e. even if a fetus does have a right to life it has no legal right to use any part of your body against your will in order to survive. If I did believe a fetus was a person, I would still be pro-choice (for the above reason) although I would probably judge women who choose abortion quite harshly (in the moral sense) and would not do abortions.

This thread is fairly drained of meaning at this point, I admit. I didn't think my earlier posts were hard to understand (except for the "reactionary" stuff on this page, which is complex and far less heartfelt). Certainly they spoke to a few people, unless they were all lying to me. There is relatively high turnaround on SDN (and I suspect that once my news comes back on Monday, I'll find another hobby and/or my anxiety levels will drop so I won't peruse med school forums anymore). This thread, and I, will vanish into obscurity fairly soon. I hope the OP learned something about how to get trained in abortion provision, and I hope that my stories and perspective have meant something.

Your posts HAVE meant something. I have very much appreciated reading your perspective, and appreciated the persistance of your arguments. I agree with you about almost all of it, too.

 

[LADoc00]

What do you guys think about the recent stink over Berlusconi in Italy stating that babies were used as fertilizer in Communist China??

Actually, they were aborted fetuses, ground up with manure and mulch and was a fairly well documented Communist practice until the mad cow scare threaten rice exports....crazy huh??

Next time you eat imported rice, think Yum aborted baby sticky rice!!

Go go Communism!

 

[LADoc00]

Bump--I'm still really curious about $ per abortion and sterilization. Is there anywhere to find stats like these?

The funny thing I *think* I charge more for abortion pathology than OB doing em!! And no crazies come after me with high powered rifles!!!

I pwn U!

 

[Shredder]

but you miss out on all of the perfectly healthy abortees, i presume. as for fertilizer--manure, fish, babies...its all carbon and nitrogen ultimately, no problem. best to make use of whatever is at hand if people are starving

im still dying to know $/abortion as well as sterilization procedures

 

[trustwomen]

im still dying to know $/abortion as well as sterilization procedures

Except that you would be the worst example of an abortion provider in the history of the world, so nobody is interested in telling you. Sorry.

 

[trustwomen]

I was under the impression that a good number of the 'abortion docs' that work out of dedicated abortion clinics are NOT OB/Gyns but rather GPs whose surgical scope of practice is limited to this one procedure. Some of them hold licenses in several states and travel multiple clinics on a irregular itinerary (to avoid the militant pro-life fraction that believes in 38s and dynamite as their preeminent ways of political expression).

As for when a medical student gets exposed to D/C as a procedure. Most would have an opportunity to see it during their OB/Gyn rotation. As for 'learning' the procedure it is pretty much limited to OB/Gyn residents. (the 'medical' abortion using RU486 can probably be performed by anyone familiar with its use. For incomplete cases it will still be necessary to hava a provider available who can perform a D/C).

The first paragraph is correct, except that most of the traveling providers are indeed OB/GYNs (makes licensing easier).

Abortion training is available to any physician in any specialty - they will just have to seek it out. The National Abortion Federation would be a good group to contact.

 

[LADoc00]

Except that you would be the worst example of an abortion provider in the history of the world, so nobody is interested in telling you. Sorry.

Hey he is curious about how much money he can pocket if he added TABs to his practice. that is a perfectly legit ? and you answered by being a c-nt.

I believe the going rate for a simple straightword 1trim D&C is about 300-500 bucks a shot. I knew a guy who could do 12-15/day (as I got all the specimens) so we are talking volume here. NOW, that is compared vs medicare for tonsillectomy: 200 bucks. TABs are money makers, no question.

 

[trustwomen]

Hey he is curious about how much money he can pocket if he added TABs to his practice. that is a perfectly legit ? and you answered by being a c-nt.

I believe the going rate for a simple straightword 1trim D&C is about 300-500 bucks a shot. I knew a guy who could do 12-15/day (as I got all the specimens) so we are talking volume here. NOW, that is compared vs medicare for tonsillectomy: 200 bucks. TABs are money makers, no question.

If you'd read his previous posts, you'd see he wants to do abortions and sterilizations only on people that he doesn't think should breed. And I don't get the impression that consent would be required. So I stand by my statement.

The CHARGE for a first trimester abortion is 300-500$. Only a fraction of that actually goes to the doctor (well under 100$ - there, I said it). Clinics also have to pay overhead, as well as sono, blood work, and all the support staff, from that amount. The fees have increased hardly at all in about 30 years. You make more money doing pretty much any other kind of surgery (I think sterilizations are decently lucrative), and you certainly make a lot more money delivering babies.

 

[f_w]

If you'd read his previous posts, you'd see he wants to do abortions and sterilizations only on people that he doesn't think should breed.

That is the fundamental concept of abortion, like it or not. Someone thinks that someone else shouldn't breed.

And I don't get the impression that consent would be required.

Well, that is an opinion many abortion providers put forward when they fight state laws on required consent (some of the state consent laws are pretty bizarre, they are more about creating a feeling of guilt in th patient rather than informed consent in the classic medicolegal sense).

The fees have increased hardly at all in about 30 years.

Last thing I know, elective abortion is pretty much a cash business and as such the pricese are not regulated. If the price hasn't gone up in 30 years, this just means that there is a competitive market with too many providers.

 

[trustwomen]

That is the fundamental concept of abortion, like it or not. Someone thinks that someone else shouldn't breed.

Well, that is an opinion many abortion providers put forward when they fight state laws on required consent (some of the state consent laws are pretty bizarre, they are more about creating a feeling of guilt in th patient rather than informed consent in the classic medicolegal sense).

Last thing I know, elective abortion is pretty much a cash business and as such the pricese are not regulated. If the price hasn't gone up in 30 years, this just means that there is a competitive market with too many providers.

I disagree that this is the "fundamental concept of abortion". Rather, it is that someone (the patient) thinks that they, themselves, shouldn't breed (at that time and under those circumstances). Quite different, don't you see?

State laws on informed consent, are, as you say, designed more to create a feeling of guilt and nothing to do with medicolegal informed consent. They also have a ham-fisted one-size-fits-all requirement ("sorry, dear, you have to read the part where it says that the male is liable for child support - I know, he raped you, but I guess they figure you could still sue him..."). Furthermore, they are always attached to a delay period before the abortion can be performed - meaning that a single visit becomes two, which can seriously impede access for some women (again, this is the goal of these states). If there were no delays attached (women already get plenty of time to "think about it" between the date they call for their appointment and the date they are seen, believe me), providers would be putting up a lot less stink. Abortion providers already provide all the information and counseling/evaluation necessary to obtain medicolegal informed consent - indeed, they were pioneers in informed consent for surgery. We are quite good at screening out the unsure and the coerced - in every clinic where I've worked, people wound up being rescheduled every clinic day (I worked in high-volume big-city clinics, but I've heard the same happens in smaller clinics). Actual informed consent is essential to abortion care in the eyes of the providers. State-mandated misinformation which does nothing except reduce accessibility, is not.

Competition does not account for prices being so low everywhere. It does account for bigger cities having overall lower prices than clinics in rural areas, but the difference is only really significant in the (more expensive) second trimester. The clinic in Shreveport, LA, for instance, does not face a whole lot of competition. However, since abortion is not covered by insurance most of the time (or Medicaid either), raising the price increases the hardship on women, decreases much-needed access to abortion, and most clinics in embattled areas are quite feminist and cognizant of these issues. The clinic director in Shreveport is a professional acquaintance of mine; they often lower their fees when women cannot afford them - sometimes even operating at a loss. Not because they think anyone "shouldn't breed", but because they are softies. There is also a large network of private charities that help women access abortions they need (www.nnaf.org), again, not from eugenic philosophy (which is terribly offensive to them) but from feminist solidarity. I founded an organization that is a member of NNAF, and volunteered for WRRAP (www.wrrap.org).

 

[f_w]

Rather, it is that someone (the patient) thinks that they, themselves, shouldn't breed

Which wouldn't have any consequence if there wasn't a provider to concurr with them. It doesn't help if a patient thinks they need a cervical laminectomy, if they don't find a neuro or ortho surgeon to agree with them it won't happen.

Furthermore, they are always attached to a delay period before the abortion can be performed - meaning that a single visit becomes two, which can seriously impede access for some women

Oh god forbid you would have to think about it first.

If there were no delays attached ...... providers would be putting up a lot less stink.

Sure, if it wouldn't cut into the profit margin, it would be a lot less disruptive to the business.

Competition does not account for prices being so low everywhere. It does account for bigger cities having overall lower prices than clinics in rural areas, but the difference is only really significant in the

So, what other 'magic hand' if not the market is driving the pricing of abortions then ?

They are not regulated by medicare or the insurance sector, as such they are market driven. And market does include the customers ability to pay the price asked for. And as it seems, dedicated 'abortion clinics' tend to cater to the low income population ('Jane Doe white girl' of suburban middle-class upbringing just goes to moms gyn and gets here D/C as 'missed abortion' at the local ASC and nobody gets shot).

again, not from eugenic philosophy (which is terribly offensive to them) but from feminist solidarity.

It might be offensive to them, unfortunately many of the arguments put forward are taken from the 1920s textbooks.

 

[trustwomen]

Which wouldn't have any consequence if there wasn't a provider to concurr with them. It doesn't help if a patient thinks they need a cervical laminectomy, if they don't find a neuro or ortho surgeon to agree with them it won't happen.

Oh god forbid you would have to think about it first.

Sure, if it wouldn't cut into the profit margin, it would be a lot less disruptive to the business.

So, what other 'magic hand' if not the market is driving the pricing of abortions then ?

They are not regulated by medicare or the insurance sector, as such they are market driven. And market does include the customers ability to pay the price asked for. And as it seems, dedicated 'abortion clinics' tend to cater to the low income population ('Jane Doe white girl' of suburban middle-class upbringing just goes to moms gyn and gets here D/C as 'missed abortion' at the local ASC and nobody gets shot).

It might be offensive to them, unfortunately many of the arguments put forward are taken from the 1920s textbooks.

It's clear that you aren't really open to what I'm saying (the "god forbid" statement was addressed in the exact part where you put your ellipsis, for example). And clinics actually make more money from two visits than from one - but they still fight against these laws. You obviously believe the anti-choice stance that providers are out to make a quick buck - not true. You could make more money doing just about anything else in medicine.

When a doctor delivers a baby, does that mean he/she thinks that the patient should become a mother? I know a few OBs who work in public hospitals who would disagree with that. They usually try to keep their personal feelings out of it, period. Unless they have to call the social worker or child protective services.

Medicaid does pay for abortions in a few states, and many private insurance plans do cover it. So there is some influence there. Many rich women can indeed go to their doctor, but a surprising number wind up at clinics anyway - most abortions are done in freestanding clinics. I'm not surprised that clinics are viewed as catering to the "low-income" - from what I understand, SDNers consider anything under 6 figures as "low-income". Middle-class women (sorry, "upper end of low-income") also usually wind up in clinics. I also already explained what force, other than the "market", drives abortion prices - it is compassion. Or was that somehow unclear in my post?

1920s textbooks do not drive abortion care today. Feminism has really taken over that field.

 

[f_w]

It's clear that you aren't really open to what I'm saying (the "god forbid" statement was addressed in the part just after that which you quoted, for example).

Actually, it was not. Think about it after they receive information on the expected risks, expected benefits and alternatives of the proposed procedure. It is good medical practice to obtain consent at a visit separate from the surgical date. A consent obtained from a patient in a gown is pretty much worthless.

And clinics actually make more money from two visits than from one

What, somebody is making money on this ? I thought this is done strictly out of the goodness of providers hearts.

most abortions are done in freestanding clinics.

Most elective abortions we know of and that the discussion is about.

1920s textbooks do not drive abortion care today. Feminism has really taken over that field.

And I am not sure what is worse. You can't view the abortion debate isolated from the population control and eugenics ideology.

 

[trustwomen]

Actually, it was not. Think about it after they receive information on the expected risks, expected benefits and alternatives of the proposed procedure. It is good medical practice to obtain consent at a visit separate from the surgical date. A consent obtained from a patient in a gown is pretty much worthless.

The "benefits and alternatives" of the proposed procedure are already pretty clear in their minds. Do you really think that they simply don't know that they could have a baby instead? Information on the risks, sure, that's important and is an essential component of informed consent. However, patients almost universally believe, coming in, that abortion is riskier than it actually is. (I remember one teen who honestly believed she had a 50% risk of dying, that's what she had heard at a CPC; yet she was there in front of me - trembling, but there. I asked why on earth she would come here if she thought her chances of survival were 50/50, and she said "I really can't have this baby". I answered - quite unprofessionally, I'm afraid - "wow, no ****".) When I talk about the risks, they are relieved, not alarmed.

Remember, you have to compare the medical risk with that of the only possible alternative for your pregnant patient - childbirth - and of the two, abortion carries far less risk. But women don't choose it because of the medical risk (unlike why they might choose a lap chole instead of a standard one), so I don't think that knowing the medical risks (again, which are lower than the alternative) should require a subsequent waiting period. Besides, nobody has "informed consent" sessions when women begin prenatal care, where the benefits of carrying to term are weighed against those of abortion, do they (just to make sure she knows ALL her alternatives, y'know)? Followed by a state-mandated wait of a few days before they can begin prenatal care? When I had my lap chole, they had me sign the consent while I was in the stretcher heading toward the OR. Abortion patients get counseled and give consent well before they even put on their gowns. And they can change their minds anytime, up until the curette is actually inserted into the uterus.

Wow, do you really have to debate which is worse, feminists or eugenicists? I guess feminism really is getting a bad rap these days. Score one for Susan Faludi...

 

[f_w]

However, patients almost universally believe, coming in, that abortion is riskier than it actually is.

Still doesn't relieve the surgeon from the obligation to discuss these risks with the patient.

Remember, you have to compare the medical risk with that of the only possible alternative for your pregnant patient - childbirth -

Correct. Childbirth is scary. To be completely honest, you also have to throw in a 25% chance of needing major surgery (C-section) for the alternative childbirth.

so I don't think that knowing the medical risks (again, which are lower than the alternative) should require a subsequent waiting period.

Obtaining consent without a period of time for the patient to think about it and proceeding directly to a procedure can certainly be done, whether it is ethical and legally sound to do this is on another page (I try to avoid it, even though my current practice setting rarely leaves that opportunity).

When I had my lap chole, they had me sign the consent while I was in the stretcher heading toward the OR.

If this was anything but an emergent case for acute cholecystitis, this was equally wrong (if it came down to a botched lap chole going to court, this 'consent' could easily be thrown out turning it into a situation of battery and assault).

Wow, do you really have to debate which is worse, feminists or eugenicists? I guess feminism really is getting a bad rap these days.

I guess my sense of humor was lost on you.

 

[trustwomen]

Still doesn't relieve the surgeon from the obligation to discuss these risks with the patient.

Correct. Childbirth is scary. To be completely honest, you also have to throw in a 25% chance of needing major surgery (C-section) for the alternative childbirth.

Obtaining consent without a period of time to think about it and to proceed directly to a procedure can certainly be done, whether it is ethical to do this is on another page. I try to avoid it, even though my current practice setting rarely leaves that opportunity.

If this was anything but an emergent case for acute cholecystitis, this was equally wrong (if it came down to a botched lap chole going to court, this could easily be thrown out turning it into a situation of battery and assault).

I guess my sense of humor was lost on you.

Abortion providers do discuss all the risks with the patient. Always. First, the counselor goes over them in detail, answers any questions, and the patient signs the consent form. Then, usually hours later, the doctor double-checks before starting the procedure, asks if she has any more questions, and in some clinics she signs again. There are lawyers, funded by anti-abortion groups, that specialize in lawsuits against abortion clinics - the goal is to get them to lose their insurance and/or go out of business. Life Dynamics is heavily involved in this type of stuff - their stated goal is "an America where abortion may be perfectly legal, but nobody can get one". Providers are experts in informed consent and are very very careful - like I said, they are pioneers in this particular practice.

When I did counseling, I didn't even mention C-section as a risk of childbirth. Maybe I should have? And do they talk about these things to prenatal patients? (i.e. consider carefully your decision not to abort...) Somehow I doubt it.

Women who seek abortions often have real access issues surrounding money and time. They often have children at home, low incomes, and have to travel far to get an abortion. Two appointments doubles the hassle and doesn't change anyone's mind (the unsure ones are "caught" by the counselors in one-day procedures too, and rescheduled). Recall that the real goal of these laws is to impede access to abortion, not to "let women think about it". A woman's decision is based on reasons other than medical risk. The (very low) medical risk of abortion does not even factor into it. Just like the (higher) medical risk of childbirth doesn't factor in to the decision to keep the baby.

I wasn't emergent, but I am Canadian; meaning I can't sue easily like Americans do, anyway. To be fair, the doctor had spoken to me about it earlier that day, although I didn't really get answers to all my questions.

And I guess I'm living proof of the old canard about feminists and their sense of humour, sigh... 😉

 

[f_w]

Abortion providers do discuss all the risks with the patient. Always. First, the counselor goes over them in detail, answers any questions, and the patient signs the consent form. Then, usually hours later, the doctor double-checks before starting the procedure,

While I can't pull up the legal reference, there was actually a lawsuit between a physician and one of the commercial abortion providers where the corporation alledged that abortion is not medical practice and therefore the surgeon has no right to perform an informed consent himself 😉 I don't think that this practice represented the industry as a whole, but it was interesting to watch this play out.

And do they talk about these things to prenatal patients? (i.e. consider carefully your decision not to abort...) Somehow I doubt it.

Actually, the DO talk about this in prenatal visits. If you go to an OB/Gyn or more typically his nurse for a 'now its time to have a child' visit. (but wait, thats a concept from 'world of people who want kids' and as such entirely irrelevant).

They often have children at home, low incomes, and have to travel far to get an abortion. Two appointments doubles the hassle and doesn't change anyone's mind

Oh, I thought abortion clinics see all layers of society. Just in your last reply, you tried to convince me that you see CEOs daughters at your facility every day.

Recall that the real goal of these laws is to impede access to abortion, not to "let women think about it".

I don't believe state legislatures should mettle in the practice of medicine. If there is an issue of invalid consents, it ought to be addressed in the forum of the state medical board or in the courtroom during malpractice action. This is how the rest of medicine is regulated, why would we need specific state laws on this if it wasn't done with a purely political agenda ?

I wasn't emergent, but I am Canadian; meaning I can't sue easily like Americans do, anyway. To be fair, the doctor had spoken to me about it earlier that day, although I didn't really get answers to all my questions.

If your lap-chole went well and was medically indicated, you wouldn't have grounds to sue in the first place. This only plays a role if the surgeon clips a bile duct in the process and everything goes to hell from there.

 

[trustwomen]

While I can't pull up the legal reference, there was actually a lawsuit between a physician and one of the commercial abortion providers where the corporation alledged that abortion is not medical practice and therefore the surgeon has no right to perform an informed consent himself 😉 I don't think that this practice represented the industry as a whole, but it was interesting to watch this play out.

Actually, the DO talk about this in prenatal visits. If you go to an OB/Gyn or more typically his nurse for a 'now its time to have a child' visit. (but wait, thats a concept from 'world of people who want kids' and as such entirely irrelevant).

Oh, I thought abortion clinics see all layers of society. Just in your last reply, you tried to convince me that you see CEOs daughters at your facility every day.

I don't believe state legislatures should mettle in the practice of medicine. If there is an issue of invalid consents, it ought to be addressed in the forum of the state medical board or in the courtroom during malpractice action. This is how the rest of medicine is regulated, why would we need specific state laws on this if it wasn't done with a purely political agenda?

That lawsuit just sounds bizarre. It certainly isn't representative, and there might be another dispute behind it?

I'm surprised to hear that abortion is always mentioned in prenatal visits, in the same way that childbirth is always mentioned in abortion visits. It's only fair, really. I just didn't think it happened. I stand corrected. And the people who want kids are the same people who choose abortion, by the way; just at different times in their lives. The vast majority of women who choose abortion either have kids already, or want them eventually (but not now).

Abortion clinics do see all layers of society. Well, OK, not the CEOs' daughters - unless they didn't tell the CEO in question, which could happen - but I have seen lawyers, engineers, business owners, even med students. The women hurt by these laws, however, are the poor ones. (Just like any abortion laws, really... rich people will always be able to get the abortions they need, just as they did before Roe v. Wade.) I wasn't trying to say that all the patients will be harmed by these laws, or that all patients are poor. Sorry for being unclear.

As for your statements about the legislatures, 👍 👍 👍

 

[bananaface]

It is good medical practice to obtain consent at a visit separate from the surgical date. A consent obtained from a patient in a gown is pretty much worthless.

Women don't begin the process of deciding to end a pregnancy upon arriving at a clinic. They show up because the decision has been made. What mandated waiting periods do is to stand in the way of good medical care by promoting a culture of delay and denial of service.

 

[LADoc00]

Women don't begin the process of deciding to end a pregnancy upon arriving at a clinic. They show up because the decision has been made. What mandated waiting periods do is to stand in the way of good medical care by promoting a culture of delay and denial of service.

The same can be said of mandatory gun waiting periods! Lets all get on the same team here.

 

[bananaface]

The same can be said of mandatory gun waiting periods! Lets all get on the same team here.

I don't see how that is relevant to healthcare. 😕

 

[LADoc00]

I don't see how that is relevant to healthcare. 😕

Waiting periods are waiting periods...everyone shows up at the service source having already DECIDED on their choice. I agree with your logic but it need to apply to everything.

 

[f_w]

Women don't begin the process of deciding to end a pregnancy upon arriving at a clinic. They show up because the decision has been made. What mandated waiting periods do is to stand in the way of good medical care by promoting a culture of delay and denial of service.

Patients also come to the surgeons office convinced that only surgery will cure their lower back pain. If they happen to come upon an ethical back surgeon (what are the odds), the 'risks, benefits and alternatives including the alternative of no procedure at all' will be explained to them. After that, they have opportunity to think about it, get a second or third opinion and make an informed decision before they schedule their surgery.

An ill-informed decision regarding elective surgery, made before the patient enters the office, doesn't relieve the physician from the obligation to provide procedure related information and to give the patient opportunity to think about it.

 

[CatsandCradles]

Wow it's over 400 now!

Great debate guys!

 

[f_w]

What mandated waiting periods do is to stand in the way of good medical care by promoting a culture of delay and denial of service.

An abortion is not a medical emergency. Within the frame of a couple days, waiting does not increase the procedure related risk. Giving someone the opportunity of thinking about their decision after they have received the facts from an unbiased source promotes good medical care. I can't quite follow you when you state that it leads to 'denial of service'. Or do you interpret it in a way that a woman who doesn't come back after the information/consent appointment is one 'that got away' ??

 

[PTPoeny]

An abortion is not a medical emergency. Within the frame of a couple days, waiting does not increase the procedure related risk. Giving someone the opportunity of thinking about their decision after they have received the facts from an unbiased source promotes good medical care. I can't quite follow you when you state that it leads to 'denial of service'. Or do you interpret it in a way that a woman who doesn't come back after the information/consent appointment is one 'that got away' ??

It is not a medical emergency, but when women have to travel far to a clinic, it can mean that getting an abortion is no longer practical. A google search revealed a range of sources citing that 87% of US counties have no abortion providers. (they were all pro-choice, but I couldnt find a pro-life group that quoted any number) So as most women not in a city will have to travel some distance to find an abortion provider, this is not that outrageous of a consideration. Many states with these laws require a consultation in person. A woman may not be able to get a baby sitter/take time off from work/miss class for a number of hours on two separate days that are that close together.

I wholeheartedly support the idea of making sure that a woman is completely comfortable with her decision, but most women already are by the first time they come to the doctor. I beleive that a consultation always occurs on the day of the procedure. All sorts of other medical procedures can be rescheduled for a different day as a result of information learned during the pre-procedural consult, why not limit the waiting period to those who need it? Initial phone consultation? I do not know the answer, but these laws are not it.

The other risk is that medical abortions have firm cut-off dates and they are frequently less expensive as they do not need a procedure room. If a patient finds out how far along they are 2 days before the cut-off, is two days to think about it instead of three that big of a deal? But these laws again do not have room for such cases. Also frequently the price goes up after a certain day and there are cases with financial burden increases if you make a woman wait three days.