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Friday
Jan142011

No One Truly Benefits from Defensive Medicine

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By Desirre Andrews, President of ICAN


A woman’s pregnancy should be a positive time as she prepares for the birth of her baby.  Unfortunately, in this age of defensive medicine, a pregnant woman must arm herself with evidence-based information and self-advocacy skills.  She must be willing to act in a self-protective way to be certain she is getting individualized patient care versus the cookie cutter care modern medical practice normally affords.

This phenomenon of defensive medicine may largely be born out a very human response to the expectation of perfection we have in society today, especially with care providers.  We have developed a willingness to hand personal authority over to our care providers.

For years, doctors have been deified, treated as being better than everyone else.  Perhaps it is in their ability to save lives. We simply expect them to be able to do everything, but they can’t.  They are human.

Doctors and patients might be able to see the human face of medicine if the traditional practice style that valued provider-patient relationship came back into use. 

Today, with OB appointments being no more than ten minutes each visit, how can a personal, trusting relationship build between the two parties? It cannot.  A woman can not be sure she can fully rely on her provider to know her well and help her make decisions that are in the best interest of her and her baby.  The provider must rely on what he or she is comfortable with offering and doing to patients instead of taking each mother and baby into consideration individually.  It is no surprise the circle of distrust and fear is palpable by all sides.

Prior to ever practicing medicine, the defensive attitude comes with the education a physician receives in medical school and the training in residency.  The lesson is that your patients are not as educated as you are, always practice to defend yourself and get the patient to agree to the course of action you want no matter what.

With this attitude, what sort of “care” practices is a woman facing? Higher induction rates to lessen the rare fetal demise that can occur “post dates”.  Higher cesarean rates because a physician does not want to incur risk of a VBAC mother going for a vaginal birth, even though catastrophic uterine ruptures are not common place.  Viewing all OB patients through a lens of high risk or as an emergency waiting to happen. 

All aspects of managed and medicalized birth occur because a physician is not comfortable, has fears, has worries and/or is not willing to practice outside of that mode because tolerate risk has been depleted.  The physician desires to create a zero risk environment because of a lowered risk threshold either by training or by an adverse outcome in the years of practice.  The humanness of the mother has been left out of the equation, while the ideal of a “healthy” baby is elevated in this physician centered point of view.

We as ICAN believe that every mother has the ability, responsibility and intrinsic right to make medical care decisions for her pregnancy, labor birth and baby.  She should be able to obtain true and complete informed consent from her provider. We believe it is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective), to refuse to support VBAC (vaginal birth after cesarean) across the board without individualized assessment, or to skew cesarean as the easier, safer choice as a standard course of practice.

In the big picture no one truly benefits from a defensive medicine practice style. Providers and patients all lose.

 

 

The International Cesarean Awareness Network is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, provide support for cesarean recovery, and promote vaginal birth after cesarean (VBAC). Every year we give support and information to thousands of women through our main office, local chapters, and email support group. We provide impartial information, based on the latest research, which is easy to access for women and their care providers.

 

 

 


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Reader Comments (6)

Well said! I concur.

January 14, 2011 | Unregistered CommenterNaomi

I really do like the way this discussion has been more than just birth activists talking to themselves or thinking from their own point of view (useful as that is). And you can't make changes if you don't understand what you're trying to change.

January 14, 2011 | Unregistered Commenteremjaybee

I'm surprised there aren't more comments.. considering ICAN is only THE BEST RESOURCE FOR SUPPORT EVER for women who've had c/s (necessary and unnecessary) and potential VBAC's!

Give the non-profits a little love ;) They love you!

ICAN, love what you do.. and it's more than just trying to get women to have VBAC's, their meetings and general info are also very supportive and informative for women who've had c/s for unavoidable/necessary reasons.. Sadly, the informational black hole about c/s, how women feel after them, how women recover from them, the myriad of complications that can come from them (including things most people don't think can happen because of a c/s, like, gallbladder troubles or sexual pain, trouble conceiving in the future.. among other issues), also extends to those who actually needed one.. not to just those who didn't.

<3 ICAN!

Great article! I agree completely.

January 14, 2011 | Unregistered CommenterFogedaboudid

I love ICAN, too. For an all volunteer, completely consumer-based organization, they accomplish a lot. I appreciate that Des spoke on behalf of the organization for this series.

My main critique of the post is that defensive medicine actually does benefit people. If the benefits were not continuously being reinforced, no one would be repeating the behaviors.

It could be considered similar to the idea of perverse financial incentives in health care. From CNN (Feb 10, 2010):

Even as the health care debate turns to blood sport in Washington, some analysts say the debate is ignoring one of the leading causes of rising costs: the way health care providers are paid." They are rewarded for more services, not better services. They are rewarded for more care, not better care," said Dr. Elliott Fisher, a lead researcher for the Dartmouth University Atlas of Health. "Most of the U.S. health system is paid simply for each service, regardless of the results of that service." The result is what Fisher calls a "perverse incentive" to order more medical services. That may bring a doctor or hospital a healthier bottom line, but it does not provide any better health for patients while driving up costs.

We might be tempted to say that there is no benefit to fee-for-service medicine and that nobody wins, when in actuality we collectively participate in a system because our behaviors are reinforced in some way.

Defensive medicine could be looked at through the same lens.

January 14, 2011 | Registered CommenterJill

I love the work ICAN does as well. I agree with Jill, though, that someone clearly benefits or the system would not be continuing. As Dr. Phil often said (oh, yes, I'm referencing Dr. Phil): no matter the outcome, if you keep doing something then you are doing it because you are getting something out of it. Whether it's actually saving lives, or just feeling like you are: something is there.

January 15, 2011 | Registered CommenterANaturalAdvocate

The title is very accurate -- "No one *truly* benefits from defensive medicine" -- when you think of what the main and really the only benefit that "medicine" has, and that is, that people are healed/cured/helped and doctors get to do that healing/curing/helping. The money is or should be a side benefit. [I'm not griping at doctors making money; I know that med school is horrendously tough, and they learn a lot, and they work a lot, and should be financially recompensed for their time and knowledge.] However, "defensive medicine" certainly doesn't help the patients, and the doctors get hamstrung as well in their practice.

Jill's quote about being "rewarded for more services, not better services" is very true. We patients and also doctors are locked in a paradigm of "insurance pays." Unfortunately, insurance pays for more services, not better services, whereas patients would reward doctors for better services, not necessarily more services. This article came to my attention the other day, and I think it worth sharing. Essentially, a doctor set up his practice to be cash-only, and because of the reduction in overhead (not having to hire a team of people to deal with the headaches of filing insurance/Medicare, and dealing with rejections), he is able to give 45-minute office visits for about 85% of what other doctors must charge for a 10-15 minute visit. He assumed that the majority of his clientele would be those without insurance or Medicare, but found that a slight majority of his patients have insurance/Medicare, but prefer to pay him cash because of the extra time/service he provides; and he really doesn't charge that much more than what many of his patients would have to pay out-of-pocket at another doctor's office.

I think the paradigm needs to shift.

January 15, 2011 | Unregistered CommenterKathy
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