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( my xmas stocking )
please see my comments in italics.
December 12, 2006
Cases
Beyond Medicine, a Doctor’s Urge to Save a Patient From Herself
~ a wise person once said to me, "if you think i need to be saved from myself, then i probably just need to be saved from you"~
By ALEX FRIEDMAN, M.D.
Doctors are obligated to guide their patients in making medical decisions.
But what happens when they believe a patient is about to make a bad personal decision?
Earlier this year, a patient of mine in her early 20s who was expecting her third child asked to have her tubes tied. A mother of two, with a full-time job and part-time school classes, she saw a fourth child as an impossible burden.
Tubal ligation is a quick, safe and effective surgery. It fails to prevent pregnancy only about 1 percent to 2 percent of the time. A small incision is made below the belly button the day after a vaginal delivery. The fallopian tube on both sides is fished out, and a knuckle of tube is tied off and cut out. The rest of the tube slips back into the abdomen. Altogether the procedure might take 20 minutes, and the patient goes home without a prolonged stay in the hospital.
I acknowledged to my patient that the surgery was effective in preventing pregnancy. In terms of making her life better and her happier, though, the prognosis was poorer.
~ By whose standards, exactly? are you helping her pay her rent? or feed her children, or pay her tuition perhaps? no? then shut the fuck up~
The best study done on surgical sterilization followed more than 10,000 women who had the procedure. Women under 30 felt regret much more often than those over 30, the researchers found. Other studies suggested that my patient, younger than 25, might be at even higher risk for regret.
~ "higher risk for regret" what is that supposed to mean? do we have the new "regret-o-meter" that quantifiably measures regret levels and assigns a certain level as "bad" or "below normal"? bring on the SOMA fellas! i just had a negative feeling! we cant be having that! nope nope nope!~
My patient could change her mind and have children after sterilization. A subsequent surgery could reconnect her tubes. She could undergo in vitro fertilization, removing the eggs directly from her ovaries, fertilizing them and placing them back in her uterus. But both options carry risks and are very expensive, and if my patient did not have the money, she would be out of luck.
~as opposed to the risks associated with multiple pregnancies in a short amount of time, or the expense of raising three kids and being a student yourself. ~
I wanted her to understand the implications of her decision.
~ you need to understand the implications of being a patronizing dick~
“What if your children died in a fire? Would you want more children?” I asked, a horrible to question to put to a pregnant mother.
~ cause children are like little toy versions of us! we break them, we just make new ones!~
No, she said.
“What if the relationship you’re in now ended and you met someone else? Would you change your mind?”
~ cause we need to replace children when their biological father is no longer around, without their biological father, children are worthless ~
Still no.
My patient’s request wasn’t unreasonable. She was choosing a form of birth control favored by millions of other American women. For her, I just felt it was a bad choice because in 15 years, much could change: her children might go off to college, she might be remarried, she could have a higher income. She might want a fourth child by then, and with excellent reversible birth control options like the intrauterine device, there was no need for her to take a risk with a tubal ligation.
~ uh, if she has a higher income, wont she be able to afford to reverse the procedure? or adopt a child? or maybe its still NONE OF YOUR FUCKING BUSINESS?~
“Treating people as rational adults means letting them do things they may bitterly regret later,” wrote Piers M. Benn, a medical ethicist at Imperial College London and the lead author of a paper on sterilizing young, childless women, published last year in The British Medical Journal.
If society let a person ruin her health by drinking a bottle of whiskey a day, Dr. Benn wrote, “it might be reasonable to ask what is so special about voluntary sterilization.”
~ because choosing to not be pregnant until menopause is completely and totally akin to being an alcoholic~
He is right in the abstract. Practically though, my hands would do the pulling, tying and cutting that changed a woman’s life in a fundamental way. Despite free will on her part, I would feel culpable if my actions made her life worse.
~ then suck it up and deal. we all have to do things we dont like, and in becoming a doctor, you are responsible to the patient. that does not mean YOU get to decide how her life can be better when it comes to elective surgery unless it is needlessly risky to her being ALIVE. after that its "mind your own business" time yet again~
“There are no clear-cut rules or guidelines that physicians can fall back on,” said Daniel Wikler, an ethicist and professor at the Harvard School of Public Health.
In the end, I decided my patient’s request was reasonable.
~"In the end I decided..." and who the fuck are you? Are you her uterus? are you her subconcious, or maybe her "maternal instinct"? no, you are a dick with a dick and a bit of sheepskin that seems to make you think you have the right to be a dick. Its true what my mom told me, higher degrees must be infused with something that encourages latent assholes to become RAGING ones.~
I hope the surgery gives her a feeling of control in her life and relieves some anxiety. If years from now she decides she wants more children, I’ll tell her what I think her best options are and try to talk her out of any bad ideas.
~and if shes been paying attention then she probably WONT come to you again, seeing as you have been so very not helpful~
funny how all of the people quoted as having expertise in this article were men, who have no concept of what childbirth is truly like. so secure in their positions as "experts" that they can presume to judge someones life when they probably are more familiar with her cervix than her personality.
December 12, 2006
Cases
Beyond Medicine, a Doctor’s Urge to Save a Patient From Herself
~ a wise person once said to me, "if you think i need to be saved from myself, then i probably just need to be saved from you"~
By ALEX FRIEDMAN, M.D.
Doctors are obligated to guide their patients in making medical decisions.
But what happens when they believe a patient is about to make a bad personal decision?
Earlier this year, a patient of mine in her early 20s who was expecting her third child asked to have her tubes tied. A mother of two, with a full-time job and part-time school classes, she saw a fourth child as an impossible burden.
Tubal ligation is a quick, safe and effective surgery. It fails to prevent pregnancy only about 1 percent to 2 percent of the time. A small incision is made below the belly button the day after a vaginal delivery. The fallopian tube on both sides is fished out, and a knuckle of tube is tied off and cut out. The rest of the tube slips back into the abdomen. Altogether the procedure might take 20 minutes, and the patient goes home without a prolonged stay in the hospital.
I acknowledged to my patient that the surgery was effective in preventing pregnancy. In terms of making her life better and her happier, though, the prognosis was poorer.
~ By whose standards, exactly? are you helping her pay her rent? or feed her children, or pay her tuition perhaps? no? then shut the fuck up~
The best study done on surgical sterilization followed more than 10,000 women who had the procedure. Women under 30 felt regret much more often than those over 30, the researchers found. Other studies suggested that my patient, younger than 25, might be at even higher risk for regret.
~ "higher risk for regret" what is that supposed to mean? do we have the new "regret-o-meter" that quantifiably measures regret levels and assigns a certain level as "bad" or "below normal"? bring on the SOMA fellas! i just had a negative feeling! we cant be having that! nope nope nope!~
My patient could change her mind and have children after sterilization. A subsequent surgery could reconnect her tubes. She could undergo in vitro fertilization, removing the eggs directly from her ovaries, fertilizing them and placing them back in her uterus. But both options carry risks and are very expensive, and if my patient did not have the money, she would be out of luck.
~as opposed to the risks associated with multiple pregnancies in a short amount of time, or the expense of raising three kids and being a student yourself. ~
I wanted her to understand the implications of her decision.
~ you need to understand the implications of being a patronizing dick~
“What if your children died in a fire? Would you want more children?” I asked, a horrible to question to put to a pregnant mother.
~ cause children are like little toy versions of us! we break them, we just make new ones!~
No, she said.
“What if the relationship you’re in now ended and you met someone else? Would you change your mind?”
~ cause we need to replace children when their biological father is no longer around, without their biological father, children are worthless ~
Still no.
My patient’s request wasn’t unreasonable. She was choosing a form of birth control favored by millions of other American women. For her, I just felt it was a bad choice because in 15 years, much could change: her children might go off to college, she might be remarried, she could have a higher income. She might want a fourth child by then, and with excellent reversible birth control options like the intrauterine device, there was no need for her to take a risk with a tubal ligation.
~ uh, if she has a higher income, wont she be able to afford to reverse the procedure? or adopt a child? or maybe its still NONE OF YOUR FUCKING BUSINESS?~
“Treating people as rational adults means letting them do things they may bitterly regret later,” wrote Piers M. Benn, a medical ethicist at Imperial College London and the lead author of a paper on sterilizing young, childless women, published last year in The British Medical Journal.
If society let a person ruin her health by drinking a bottle of whiskey a day, Dr. Benn wrote, “it might be reasonable to ask what is so special about voluntary sterilization.”
~ because choosing to not be pregnant until menopause is completely and totally akin to being an alcoholic~
He is right in the abstract. Practically though, my hands would do the pulling, tying and cutting that changed a woman’s life in a fundamental way. Despite free will on her part, I would feel culpable if my actions made her life worse.
~ then suck it up and deal. we all have to do things we dont like, and in becoming a doctor, you are responsible to the patient. that does not mean YOU get to decide how her life can be better when it comes to elective surgery unless it is needlessly risky to her being ALIVE. after that its "mind your own business" time yet again~
“There are no clear-cut rules or guidelines that physicians can fall back on,” said Daniel Wikler, an ethicist and professor at the Harvard School of Public Health.
In the end, I decided my patient’s request was reasonable.
~"In the end I decided..." and who the fuck are you? Are you her uterus? are you her subconcious, or maybe her "maternal instinct"? no, you are a dick with a dick and a bit of sheepskin that seems to make you think you have the right to be a dick. Its true what my mom told me, higher degrees must be infused with something that encourages latent assholes to become RAGING ones.~
I hope the surgery gives her a feeling of control in her life and relieves some anxiety. If years from now she decides she wants more children, I’ll tell her what I think her best options are and try to talk her out of any bad ideas.
~and if shes been paying attention then she probably WONT come to you again, seeing as you have been so very not helpful~
funny how all of the people quoted as having expertise in this article were men, who have no concept of what childbirth is truly like. so secure in their positions as "experts" that they can presume to judge someones life when they probably are more familiar with her cervix than her personality.
on a happier note, i have found a place to live. its at 41st and market and its a studio for $440. i havent signed the lease yet, as i need $280 more dollars before i can. its nice, the kitchen and bathroom are new and hes okay with my cats. i told him i only have 2, but what the hey. its 20 minutes from campus. so im looking at moving in in the first week of january. ..............................................YAHOOOOOOOOOOOOOOOOOOOOOOO!!!!
.