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Friday
Jul302010

Pregnant? Check your skepticism at the door.

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By Jill—Unnecesarean

 

I’m going through a phase in which patient safety/ patient empowerment literature keeps falling into my lap whether I like it or not. Thank you to those of you who have sent me your books and told me about your blogs. Thank you to the random person who left their copy of a book about how to avoid being the victim of medical blunders on that picnic table.

We’ve had some interesting discussions on the Facebook fan page in the past few weeks about the overuse of medical care which are starting to steer toward why the concepts of the empowered patient, the informed consumer or participatory medicine seem to elicit minimal public outrage when talking about anything but maternity care. The short article Most U.S. Physicians Practicing ‘Defensive Medicine’: Survey indicates they order more tests, procedures than necessary came out last month, which featured a link to Navigating the Health Care System: Asking Questions About Medical Tests. I’d say that a lot of fan page members thought the last letter to the editor listed here was just delightful, especially the part when Random Lawyer D00d grumbled about how the “natural birth fetishists” could now choose dangerous vaginal birth after cesarean.

In response, reader Sharon remarked on the fan page that a family member chose two months of bed rest followed by intensive physical therapy to treat a slipped disk instead of back surgery. Sharon is pretty sure that no one called her a natural spine fetishist. Maybe she just didn’t hear the people gossiping about how her sister in law was incredibly selfish and overly concerned with the experience because she preferred the metaphysical benefit of a “natural” recovery of her spine. No, seriously. I heard recently that women really want vaginal births because they think there’s a metaphysical advantage over cesareans. Diagnosis of hysteria, anyone?

I would be lying if I told you that I’ve never perked up upon hearing pleasant sounding buzzwords on the news like “efforts to reduce number of surgical procedures” and “cost-effectiveness” and “patient safety” and “quality indicators” and “patient empowerment” and “navigating the health care system” and “when to get a second opinion” and so forth. Really, what’s the difference between trying to avoid overtreatment as a pregnant woman and trying to avoid it as an orthopedic patient? The orthopedic patient with too many questions will simply be labeled annoying or a pain-in-the-ass (as seen on comments on KevinMD) by doctors, yet labeled a proactive consumer on feel-good, three-minute local news segments. However, a skeptical pregnant woman with similar questions or concerns about overtreatment and their local hospital’s 49% cesarean rate seems to gets a different label, and it’s usually not something respectful like “rational, educated consumer.” Straw man arguments are clearly more fun in that they appeal to the lowest common denominator and, as a sexy bonus, they divert attention away from said 49% cesarean rate at one’s local hospital. Denying that there is a problem may spit-shine a few egos but it has no benefit to patients.

Keep talking about your overtreatment or misuse of medical procedures, my friends.  

 

 

Share your overtreatment story here:

The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health, and What You Can Do to Prevent It

 

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Reader Comments (4)

Yes, in my recent blog post about participatory medicine, I noted how acceptance of e-patients and patient autonomy in decision-making varied by field. Since participatory medicine is often dominated by folks who have had cancer, it's very well-accepted there. But somehow, applying informed, thoughtful decision-making is perfectly fine in medicine UNLESS it's in maternity care. When you have a baby on board, you are supposed to check your intellect, your skepticism, and your autonomy at the door.

http://wellroundedmama.blogspot.com/2010/04/participatory-medicine-and-why-you.html

Here are some quotes from my blog post about it:

I think obstetric providers are threatened by the Participatory Medicine model partly because of the vulnerability to litigation they feel in this field and partly because of the high level of paternalism and misogyny in the field.

Even the same OB-GYN who is open to working in partnership with a woman on decision-making if gynecological cancers occur, often did not give that woman any meaningful say in her choices when she was giving birth.

This is part of the paternalistic view of birth, one that now sees the baby as the primary patient and the mother's needs as endangering the safety of the baby; one that sees the mother as a hysterical, overly-emotional person who is not competent to make her own decisions near the end of pregnancy or while in labor.

In this worldview, the mother is the enemy, the culprit and scapegoat if anything goes wrong. The caregiver is seen as needing to save the baby from the mother's "hostile" uterus, selfish personal habits, or narcissistic desires for a "good" birth.

When a caregiver views mothers as the main source of harm to the real patients (the babies), is that caregiver going to see that source of potential harm as a real partner in decision-making? Or the main obstruction in the way of "saving" the baby?

July 30, 2010 | Unregistered CommenterWellroundedmama

Amen and hallelujah to this. The problem of overtreatment spans the life cycle -- from the birth context, whose excesses we know very well, to pediatricians who overprescribe antibiotics and are too quick to recommend ear tubes, to the overuse of antidepressants in people for whose problems they are neither appropriate nor effective, to the excessive use of diagnostic tests like mammograms and prostate screening, to the proliferation of pacemakers, ventilators, feeding tubes, and so forth for the very old and terminally ill, and much, much more. Maternity care is exceptional because of the reproductive rights aspect -- the idea that women can be forced to accept treatment they don't want if it is seen as being in the best interest of the fetus. A person who has cancer has the right to decline aggressive treatment, and while her providers might think she is crazy to do so, they aren't going to go to court to get an order saying they can strap her to a gurney and administer chemotherapy.

My first personal experience with overtreatment was in the context of infertility -- the first RE I saw put me on a self-described "express train to IVF", which I resisted because I didn't think there was any evidence that we needed IVF to conceive, which proved correct when it took only one cycle of Clomid. The RE had said we would have only a 2-3% chance, and I felt deeply betrayed at having been led down a path toward a very invasive and expensive form of treatment that was wholly unnecessary. I have been very skeptical of doctors ever since, and chose midwives for both of my sons' births.

July 30, 2010 | Unregistered CommenterStar

It is true that there are two patients involved in maternity healthcare. There's just no way to deny that. But what I see happening is that the HCP hired by and supposedly attending to patient A, the mother, is sometimes drawn into an advacocy role for patient B, the baby. Furthermore the state and possibly the HCP seem to believe that the needs of patient B, who would not even exist were it not for patient A, supercede the needs of patient A. I don't understand why the assumption is that the needs of the two patients are HOSTILE to each other though.

Except for cases of abortion done to save the life of the mother, the needs of the two patients are the same, right? The so called natural birth "fetishists", advocate for normal birth BECAUSE of its saftey record. We ask questions BECAUSE these interventions do have risks to BABIES as well as to moms. (and as we NCB advocates must constantly issue disclaimers, yes some interventions in some circumstances do have benefits as well) We seek out alternatives BECAUSE we want to be sure we are doing THE BEST THING not only for ourselves but FOR OUR BABIES too.

August 1, 2010 | Unregistered Commentermrsculpepper

<<A person who has cancer has the right to decline aggressive treatment, and while her providers might think she is crazy to do so, they aren't going to go to court to get an order saying they can strap her to a gurney and administer chemotherapy.>>

This is true in pretty much every situation, unless of course we have a parent who believes in natural cancer healing and wants to try this method if her child gets it...I have not researched the issue well but have friends who have (in response to parents with cancer) and who say that treating cancer with the normal medical methods results in a shorter lifespan (statistically speaking) than just letting the disease run its course. They also strongly believe that there are natural means of completely healing it. So...logically...if their child were ever to get it, I am sure they would prefer to use the natural means, which they believe are better *for their child.* I don't know if they could find a pediatrician to be on board with it however...fortunately the one they have is the most likely one I know to possibly allow that w/o giving them heck, and let's hope they never have to deal w/it.

But I bring this up because the only place that the state/doctors seem to think they can dictate to us and ignore patient autonomy is when a child or fetus is involved. For some reason, parents that choose treatments other than the mainstream (think of those that choose not to vaccinate...or to vaccinate on an alternative schedule or selectively), are often considered nutso, or worse abusive or neglectful, when all they are trying to do is do what they believe is best for their children.

Again, I have not done my own cancer research, but I know the friends I referred to have spent hours and days and nights doing it... not that they are definitively right or wrong... I believe that alot of what works in medicine is based on the patient's underlying beliefs and preferences. So whereas natural healing may not work for someone completely plugged into the medical way of doing things....the reverse is also the case, in that medical means of healing may not work so well for someone who believes fully that natural means are sufficient and effective. Where has the human element gone in medicine? And why is our culture's default belief that children have to be protected from their parents? Yes, some do...but that number is quite small...most all parents want what is best for their kids. We need to get back to culturally understanding that this is the default, until parents prove otherwise (through true abuse or neglect), or nothing will ever change in birth or peds (imho).

August 2, 2010 | Unregistered CommenterAnne
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