My Uncle John put up a very interesting response to the last important post that I put up (no not the one about the snow). I realized that I had probably not completely made myself clear when I read his first line, “Your anger concerns me.” Oops. I did not mean to sound angry by any means, a little upset about a flaw I perceive about the medical system, but not angry. Instead of simply copying, pasting and responding to what Uncle John said, I decided to simply write a follow up in response to the issues he brought up. So here goes.
First, I would like to say that I do not want to reduce the amount of choices in medicine. On the contrary, I want to increase choices for everyone involved. In my health services class we have been discussing some extremely interesting topics such as serving the un- and under-insured, bringing up the level of service to people who can’t afford it, and what would happen if we had a true free market economy within the realm of medicine. The US does have the closest relationship to a free market of all the industrialized nations and I’m very glad of it. In fact I wish we had a bit more of one. I would love to be able to truly be a good “shopper” and be able to find the best care available for what I can afford, and not be forced to accept a lesser value of care at a certain facility because my insurance company won’t pay for my care somewhere else.
Also, I agree with Uncle John that the bottom line in business should not be categorized as being either good or bad. The problem that I see and wish to address is a not so noticeable anti-competitive trust that seems to be going on in the medical field today. It’s not necessarily a control on prices as much as it is a control on information given to the patient. The idea that “doctor knows best” is extremely patronizing and creates a problem in the realm of informed consent. The definition of informed consent means that the doctor, hospital, what-have-you, tells you the risks of the procedure and the probabilities of the outcomes in order for you, the patient, to make a rational decision based on the information you’ve been given about the care you wish to receive. The thing that I think is going on is that patients are not getting enough information in order to make an informed decision about their care.
At the OB clinic where I shadowed a couple of summers back, I believe that the physicians were truly trying to think about their patients, but I also noticed that while they were mentioning epidurals and induction to every pregnant woman they saw, they were not always mentioning some of the outcomes that could result from having these procedures. If the patient had prior information about these procedures and questioned their usage, then the physicians would go into more detail about the procedures and outcomes. An epidural completely numbs the lower half of your body creating a scenario where you have a hard time knowing when to push for contractions during a normal vaginal delivery, causing labor to be longer, which could increase fetal distress and subsequently require an emergency c-section in order to “save the baby.” By marketing the option to reduce pain for the mother during labor, the physicians I shadowed were not illuminating all of the possible outcomes of the procedure.
The article that I cited in the last post was much more socialistic than my own position and I’m sorry that it might have come across as what I thought should be the future of medicine. What I wanted to address, and seemed to have not done the best job, was the fact that patients are not being given the necessary resources to make the best decisions.
I would just like to reiterate that my motivation for becoming a midwife is not vindictive. I am not out to stick it to the medical field. I want to become a midwife primarily because I have always been interested in natural healing, as I said earlier in the post. The article was simply something that opened my eyes a little wider to the thought that I’ve had for a long time that patients are not always treated like thinking adults as I believe they should be. One of the largest appeals for me about natural forms of medicine, like midwifery, is that it takes into account that people can make decisions about their care and should be part of the decision process instead of simply doing the first thing offered by a doctor. We need to be more mindful of the information that we’re receiving and not always take everything at face value. I’m not denigrating the knowledge of physicians; in fact I’m very glad that they have the fortitude to go through the rigors of medical school and residency in order to serve me as a member of the public. I just want to be a more informed consumer and be able to have the best care for my particular needs.
If a doctor thinks that induction and c-section are the best care for me and my children, I want to know all the whys and probabilities involved, not just be told that it’s a safe procedure and lots of people have had it done safely. If there are better alternatives for my particular care and the care of my children, I want to be able to make a choice with all the options in front of me. I think the growing popularity of midwifery for birth is not necessarily due to its inexpensiveness or efficiency (even though those are powerful arguments for someone poor like me) but the fact that midwives can be more focused on fine tuning their care to best suit the needs of their patients.
The problems are not black and white and neither are the answers. There are a lot of gray areas that need to be addressed. But this is one area where I might be able to help address what’s going on and be a part of the solution.
neumatikos 