Saturday, June 25, 2011

Guest Post: In Response to "Anonymous"

The comment published as a post below came from my recent blog post about gestational diabetes and is so detailed (and says what I would like to say better than I can say it myself) that I decided it deserves full guest post status. It's in response to an anonymous commenter who'd had this to say:

I understand that you have a birth plan and that everything in your mind should go that way. From your first birth I think you should understand that it doesn't always go that way. However, at the end of the day you have to respect that the hospital is just doing their job to make sure your baby and you stay healthy. 

And here's the rebuttal:

I have to disagree with what "Anonymous" said. The actions of doctors and the hospital aren't to keep Thomasin and her child "healthy".  The Hippocratic oath may say to "first do no harm" but policies are in place to reduce risk of fatality and abide by AMA guidelines.  Risk that ultimately could mean malpractice claims.  If patient health was truly the primary concern, then much of the research on medical practices from other countries would be applied in this country but that is not the case.

The word "Health" is greatly misunderstood in our society.  Many people say that if they aren't coughing, sneezing or running a fever, that they are healthy.  This, however, is not the medical definition of "Health". The World Health Organization defines health as "A dynamic state of complete physical, mental, spiritual and social wellbeing and not merely the absence of disease or infirmity."  MD's in our society are not following this definition and if they are trying to provide care that lives up to this definition, they fall very short.  MD's in our society do very little to help prevent illness.  Sure they suggest annual physicals for screenings of various things but that is not prevention.  That is "watchful waiting" and the battery of screening procedures only screen for disease or infirmity (something that is less than half of the definition of health), not COMPLETE physical, mental, spiritual and social wellbeing (the majority of the definition of health).  How many people have sat down with their primary care physician on several successive occasions when you don't have any symptoms to discuss your mental, spiritual and social well-being?

The reason MD's don't focus on the other aspects of health is that, in many cases, it can't be easily quantified and analyzed.  So, MD's focus on disease and infirmity, not health.  Our society has sick care, not health care.  When you're sick, you go to the doctor, the doctor orders a test and gives you a pill, after the fact.  This approach is clearly emphasized in Thomasin's prenatal care.  A discussion of proper diet and exercise, to help prevent an unhealthy pregnancy including GD, was never once mentioned.  It wasn't mentioned until after the GD diagnosis was made and at that point, the only advice given was to avoid high glycemic index foods. That's it.  No more.  End of story.

Also, MD's tend to rely heavily on quantitative analysis. They test your blood, urine, hair and skin to look for chemical alterations.  This can be good.  It provides a great deal of information on the patient's present condition.  However, the problem arises when only these test results are used to create a clinical picture of a patient.  Every patient comes from a different place and has different contributing factors.  I am not saying that a doctor should try to find a normal value for the physiology of every patient (But be aware that people do in fact have minute discrepancies in their normal values for these medical tests and that is why normal values fall in a normal range and are not absolute values and normal values can fall outside the normal range.  The normal range is based on one standard deviation unit from the mean value).  If MD's truly wanted to create a complete clinical picture, more information has to be considered before making a diagnosis off of a single test.  Also more information needs to be considered before prescribing treatment.  If you have an ulcer, you have alterations in your levels of stomach acid.  So, prescribe a drug to falsely alter the chemical composition of your stomach contents, right?  But what of your ulcer is due to stress?  Shouldn't your stress, the true cause of the problem, be fixed before the more invasive treatment of altering your physiology? Unfortunately, that is more complicated than prescribing a pill.

Thomasin had a thyroidectomy but there has been no study on the normal blood sugars of pregnant women who underwent thyroidectomies so she is lumped in with normal subjects who can regulate metabolism on their own.  Thomasin, however, is now dependent on the MD's to dictate to her what her metabolic rate should be and is dependent on them to make adjustments.  Her input on how she feels and functions under those prescribed levels is not considered, even though the normal range is actually rather large.

For those who don't know, the thyroid produces hormones that impact other organs which produce other hormones that play a direct role in blood sugar levels.  When concern was expressed to Thomasin's doctor that this might not have been taken into account prior to labeling her with a diagnosis, the doctor admitted that yes, a thyroidectomy would impact blood sugar and her medically regulated levels of thyroxin could have been less than optimum at the time of the glucose testing and that fact alone could have made the difference in her diagnosis but there is currently no study on that subject so it will be completely neglected.  

So here is Thomasin, nothing more than the sum of her parts as far as the allopaths are concerned… let me rephrase that, nothing more than the sum of the parts that allopaths can measure.  If we were merely the sum of our parts then we would be able to take bits and pieces from here and there and assemble them into a living thing, just like Dr Frankenstein did.  However, this is not the case, every living thing is far more than the sum of its parts.  It's silly that I should have to make that statement but the allopathic approach is just that.  The test results say your low on this chemical, here is a pill that makes those levels normal.  Oh, that pill we gave you has a side effect of causing this other chemical to be too high but don't worry, we have a pill for that too.

The problem here is that what is best for most people was put in front of what is best for Thomasin.  The bureaucratic approach of  procedural correctness at the expense of people's needs… the "do the best you can for most patients instead of the best you can for each patient" has left Thomasin as an unfortunate outlier.  Choosing to look out for her own best interests, which the MD's are not doing, does not mean that she should still have respect for their approach to her care.  In fact, the doctor stated very clearly that this situation "sucked" as she put it and she would actually like to use a less invasive approach moving forward but if she doesn't follow policy, she would lose her hospital privileges and could lose her job.  Now, while it is understandable that someone might not risk their livelihood for a patient, it does not warrant respect.  That admission by the doctor stated, in very plain and simple terms, that policy took precedence over the appropriate approach to Thomasin's condition and pre-natal care.  Someone who would risk their livelihood for the well-being of a patient and to provide the most appropriate care to a patient, does warrant respect.  There are still doctor's in the world that believe in the oath they took with all their heart soul.  It's too bad there aren't more of them out there who are willing to stand up for what is best for their patient.

Anyone who would say that the medical community in our society has the health and best interests of patients in mind should probably look a little more closely at some of the policies in place in the medical community and then step back and look at the big picture of the global medical community and not take so much on faith alone (that is dangerous).

If MD's really care about a patient's health first and foremost then why do we have the highest rate of cesarean deliveries (especially elective cesareans) of any country? A method of delivery that carries the most prevalent and severe side effects of any birthing method.  Why do we have the highest rate of circumcision of any country? A procedure where risk (albeit relatively minimal) outweighs any health benefits (which are zero).  This contradiction goes beyond obstetrics alone.  If a patient's health was truly the primary goal over risk of injury, there would be no cosmetic surgery to improve self image.  Rather, there would be more emphasis on trying to help that patient be happy with who they are and help them work to better their self image naturally.  There would be no prescription of drugs that caused side effects.  Instead, there would be more emphasis on wellness programs (diet and exercise) than on medicating an illness.

As someone who holds a doctorate in health care, who has spent countless hours reading medical texts and research from both here and abroad, I can say that just doing your job doesn't warrant respect because just doing your job means just that… following company policy and fulfilling your job description.

Adhering to the oath you took and pushing back on the medical establishment in the best interests of your patients in spite of company policy, is something that deserves respect.  Because at the end of the day, the patients are the doctor's patients, not the establishment's patients.  If something goes wrong, the establishment isn't held responsible, the doctor who treated the patient is.  It is the responsibility of each and every doctor to provide the best care for their patient.

Perhaps the Hippocratic oath in this country should be rephrased to "first follow procedure, then do the lesser of two evils…"


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