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Tuesday
May262009

"Doctors work from facts."

A commenter that I’ve seen before on KevinMD left the following reply to someone today:

In response to [previous commenter], I have to say that “judgment free” can’t mean “evidence free”. Doctors work from facts. If you’re going to pay good money and risk your health, you, the patient, should demand that there be evidence supporting a treatment. If there’s no evidence, it’s generally better to do nothing and save your money.

So don’t demand your doctor be non-judgmental when we’re trained to judge based on evidence. That’s what you should want. Trust me, the people selling the line of BS you’re buying are judging based on their bottom line, whether they’re selling a nutritional supplement, a book, or merely their own ignorance.

 

See, here’s the problem with this comment. I don’t know how this theory plays out in cardiology or dermatology or oncology. I do know how this can play out in medical maternity care.

 

I have to say that “judgment free” can’t mean “evidence free”.

Yes.

 

Doctors work from facts.

Well, that wasn’t my experience. When I was passed around from practioner to practioner who sat there with their calendars open trying to schedule a c-section for suspected macrosomia (47 cm fundal height and late-term ultrasound saying 10 lbs., 2 oz.)  in the absence of any risk factors, I asked them for their evidence. I had already dug through medical journals and found only Level C evidence and I let them know this in a very non-confrontational manner with some sincere pregnant lady tears and sniffles for good measure. The replies I got? Purely anecdotal. “I’ve seen shoulder dystocia and it’s really bad. You don’t want that.”

I don’t want that. You’re right. I also don’t want to get a piano dropped on my head from a third story apartment. Why are you not being honest about my odds? I just want facts, please. The clock is ticking and I’m not getting any less pregnant.

Also, Kendall Regional Medical Center in Miami-Dade County in Florida with a 70 percent c-section rate? Not working from facts.

 

If you’re going to pay good money and risk your health, you, the patient, should demand that there be evidence supporting a treatment.

This was sort of irrelevant to the thread (about an Oprah episode with Jenny McCarthy as her guest), but this is exactly what we often hear about the practice of midwifery. You can have a bonus point if you’ve ever heard vaginal birth referred to as a “treatment.” Double if you regularly hear word of someone “performing a VBAC” and that someone to which they are referring is not the woman.

 

If there’s no evidence, it’s generally better to do nothing and save your money.

So if there’s no evidence that a cesarean is necessary, we can all sit back, wait for baby to arrive normally, catch baby and save money. Okay!

 

So don’t demand your doctor be non-judgmental when we’re trained to judge based on evidence. That’s what you should want.

I do! I do want that! Why didn’t I see that in medical maternity care? When can we see that in American hospitals?

 

Trust me, the people selling the line of BS you’re buying are judging based on their bottom line, whether they’re selling a nutritional supplement, a book, or merely their own ignorance.

Oh my. The irony, the irony.

 

 

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Reader Comments (8)

Ditto that. It is ironic, isn't it?

I'm one of *those autism moms* who uses biomedical treatments for her child. I didn't for the first few years of her life but boy do I wish I had started them sooner. She has had way more progress this year than she ever had in her whole life with behavioral therapy alone. No, she is not "magically cured" of autism, but biomed is not all crap, either. My daughter and many other children like her are living proof.

My daughter's life, before I began some of that "woo" that Jenny McCarthy talks about, was a miserable existence. She had chronic yeast infections in her mouth and in her diaper area that did not respond to topical Nystatin. She had low muscle tone and would tire and cry easily; she tantrummed for a half an hour for no reason at all, sometimes three times a day. Her school would call me and I would hear her anguised wails and screams. She had bags under her eyes. She constantly itched her poor little bottom that was covered in yeast. She never slept more than four hours a night for over three years. You know, sleep deprivation IS a form of torture and I was at my breaking point from sitting up with her every night; can you imagine how she felt going to school every day after only three hours of sleep and being expected to learn and behave properly.

Then I took her to a DAN! doctor, started a low-sugar, low yeast diet, and began treatment with antifungals plus some other supplements, B-vitamins and probiotics. Guess what? She now sleeps through the night and wakes up happy and rested and ready to begin her day. The horrible black bags under her eyes disappeared THREE DAYS into oral antifungals; that was back around Christmas. EVERY ADULT who had daily contact with her was shocked at how her appearance changed so dramatically. Her incessant hyperactivity was greaty reduced and daily life with her became bearable for the first time in years. I seriously hated being her mother because she literally was ripping our house apart. She no longer tantrums for 30 minutes or more for no apparent reason. She is cheerful and happy instead of miserable. And so are the rest of us. We just got a new pediatrician and she said she has never seen an autistic child who looks so healthy and happy. Needless to say I am going to stay with this so-called "quackery" because none of the regular docs that I went to, sleep-deprived and IN TEARS would help me.

I am so tired of being called an idiot, told that the changes I am seeing in her are all placebo (I have PHOTOGRAPHS to prove the difference in her appearance, for Pete's sake), called a tin-foil hat-wearing anti-vaccine lunatic, a child abuser, and being told that I deserve to have her taken away from me from other people on the blogosphere who do not know our situation or anything about us. So goddamn sick of it. I don't care if what I am doing is "unproven"; the proof is in the pudding and it is in my child. I think it is sad that someone would think she does not deserve to be healthy and happy like she is now because my treatments for her are "unorthodox". So what would people have me do? Take her off all her supplements and antifungals and fill her full of enough psychiatric drugs to stun a bull elephant? Would I be a "good mother" then? It really pisses me off to no end.

May 27, 2009 | Unregistered Commenternavywifeandmom

I am sorry to go off on a rant like that; I guess it had nothing to do with the topic at hand, did it?

I am with you on the whole vaginal birth as a "procedure". I never had a C-section, but I do think it is ironic that you would have to get permission to use your vagina for one of its intended purposes.

No, natural is not always "safer", but for God's sake, neither is high-tech. Balance, people, good grief!

May 27, 2009 | Unregistered Commenternavywifeandmom

Very good post and analysis of his comment...
Do I get points.... sorry to say I HAVE seen written on MD charge sheets and heard a select few say they have performed VBAC's.
It's such a sad state of affairs... :-(

May 28, 2009 | Unregistered CommenterBirth_Lactation

navywifeandmom, you are always welcome to rant here. Rant freely!

I'm so happy for you and your daughter. The condescending, dismissive attitude that treatments that somehow work yet can't be recommended because there's no RCT to back it up seems to be universally annoying, frustrating and hurtful. How hard would it be to say, "That sounds unlikely and I've never seen any evidence that would support that, but I'm glad that you found something that has improved your child's quality of life so dramatically"?

To answer the question in your last paragraph, yes, I think that in some people's eyes, surrendering your freedom of conscience to medical authorities does make you a good parent/person/citizen. Compliance and conformity remain high on the list of American virtues.

I hardly think you're nuts, for what that's worth! On the contrary, I'm hanging onto your e-mail because I have a few friends that have been wanting to try some different treatments for their children with autism. I'm glad you commented.

May 28, 2009 | Registered CommenterJill

It is also my experience as an L&D nurse where many birth attendants, mostly obstetricians, have a "I've already made up my mind, don't confuse me with the facts!" type of mentality. It really boggles my mind how some folks like the one who made that comment in your post get SO ANGRY at the thought that perhaps there are some birth attendants out there that are far from perfect and have their own, not their patient's, best interests in mind.

~Melissa
www.nursingbirth.com

May 29, 2009 | Unregistered CommenterMelissa

I think you also need to show the other side of c sects I had to have an emergency Csec after 36 hours of labor and no progress and my sons heart rate dropping to 5 beatsa min beacuse he couldn;t handle the stress! My 2 ended up also being a csec. They found I COULDn't naturally deliver due to unforseen complications! So there are those of us who REALLY need them and DO NOt do them by choice or DRs conveinence. I would have LOVED to expereince a natural birth but it is not in the cards for me. So you do have to bear that in mind also if you are goingto be a truly informative sight to give people ALL theinformation!

Hi "Mom",

There is nothing here that is disrespectful of the need for emergency c-sections or the women who need them. If you check out the "About and Contact" page, you can read more of what the site is about, okay? It's not anti-cesarean or some kind of shaming mechanism for women who need or want c-sections.

When you say you think this site should have "ALL the information," what are you referring to? What would you like to see here? I'd love it if you would share your feedback. I don't believe that there is any need to show more of "the other side of c sects", as that information is available at the drop of a hat from doctors, published pregnancy literature and probably on TLC right now on the popular show "A Baby Story." I guess you could call this another side of the other side of c-sections.

If there is one aspect that is niched out here, it's giving women who do still have a "choice" between a) scheduling a c-section for allegedly valid medical reasons and b) just going ahead and giving birth vaginally some evidence-based information to work with in their decision making process along with some birth stories (anecdotal information). Vaginal birth after a previous c-section is safe in most cases contrary to what most doctors tell their patients. Scheduled c-sections for suspected large babies, especially in low-risk, first time moms are totally bogus and not based on a shred of medical evidence. If there were an accurate way to predict a) the size of a baby and b) whether baby will experience injury, then it would be wise to schedule that c-section. Until that crystal ball is developed, spontaneous vaginal delivery remains the safest birth to for which to plan and some women are into that.

It sounds like maybe you're running into some nutters who are giving you a hard time about having had an emergency c-section or scheduling a repeat section? I hope you tell them to mind their own effing business! We all have the right to weigh risks and make our own decisions. Some women feel that vaginal birth will be safer for them and have a hell of a time finding doctors who will attend their birth and want to be at least somewhat versed in the wide body of current scientific evidence supporting their decision. If a woman's doctor recommends an elective repeat c-section and she agrees that it is the safest for her to bring her child into the world, then she will in most cases be well-supported by her doctor, the hospital and the risk-averse medical climate in the U.S. and beyond, rendering the information on this site largely uninteresting and irrelevant.

I am always open to feedback so please let me know what you would like to see. You are welcome to share your birth story if you would like.

Jill

May 30, 2009 | Unregistered CommenterJill--Unnecesarean

Let it be said that obstetricians NEVER let evidence stand in the way of how they practice!

June 1, 2009 | Unregistered CommenterKeysmama
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