For reasons to be seen next week, this comment I left on Amie Newman’s post, Home Birth “Common Ground”?, is decent pre-intro to the Defending Ourselves against Defensive Medicine series beginning here next Monday.
“For women who wish to plan a birth at home, or at a birthing center, it’s not about a distrust of physicians so much as it is about a choice not to make it about physician-oriented care at all.”
A wane in trust in the patient-physician relationship (and at a societal level) has been explored and documented for decades, much of it attributed to a veil being lifted about the heavy-handed (over)marketing of the efficacy of physicians in the last century, the “consumer” movement in general and patient awareness that there are many factors that motivate treatment decisions and this can foster a sense of suspicion and distrust. Oddly, I was just reading a 1996 JAMA article about managed care that discussed how awareness of gatekeeping and incentives bred animosity and frustration.
It is logical to assume that if a patient realizes that there are other forces driving “medical” decision making, they might look elsewhere for care in any specialty. I think you’re onto something, Amie, with your assessment that much of this has to do with realization that women are leaving physician-oriented pregnancy care for very rational, empirical reasons, much like when a patient is recommended the most aggressive treatment available in another scenario, such as back surgery, and decides that they would rather see how their body heals with physical therapy. Fortunately for patients, most physicians don’t seem to incur a narcissistic injury from this phenomenon and build an identity around it. In fact, most doctors that I talk to say about the same thing about home birth—it’s a woman’s right to do it, it scares me that someone would place distance between themselves and an operating theater, don’t do anything stupid and please don’t hold me responsible if you come in bleeding to death. Other than that, I don’t think most really pay it much mind, as it applies to such a tiny piece of the population. (Permalink to comment)