doctors

Willing and Unable: Doctors' Constraints in Abortion Care

admin — Sun, 22 Aug 2010 00:00:00 +0000

Ninety-three percent of all abortions are done in abortion clinics. Only three percent of non-metropolitan counties in the United States had an abortion provider in 2005, while thirty-one percent of metropolitan counties had at least one. After completing their residency, half of physicians who plan to perform abortions as part of their practice actually do so.

These startling facts prompted Lori Freedman to embark on the study summarized in Willing and Unable: Doctors' Constraints in Abortion Care. Freedman is a sociologist working for Advancing New Standards in Reproductive Health (ANSIRH), a collective of researchers and scholars at the University of California, San Francisco. Through this study, she “primarily wanted to find out what keeps physicians who feel positive about providing abortion from doing so.” She interviewed thirty ob-gyns—twenty-two women and eight men—who graduated between 1996-2001 from four residency programs in which abortion training is routine. The interviews, along with historical context and analysis, make up the core of the book.

While some may assume that doctors don’t “have the guts” to do abortions or are primarily afraid of violent retaliation—which is understandable given that eight abortion clinic workers and/or doctors have been murdered since 1993—the reasons are more complex and wide-ranging. The reasons Freedman uncovers include the managed care currently regulating doctors’ services, the stigma attached to being labeled an “abortionist,” the fact that abortions do not often result in a significant amount of revenue, the efficiency and quality of care provided by abortion clinics, and the extent to which physicians see providing abortion as a professional duty.

Willing and Unable begins with the introduction of Freedman’s research question and methods, establishes the various factors influencing physician autonomy, and provides context for the debate over abortion. Most notably, Freedman points out that the loss of fetal life is not, in fact, the most morally offensive element of abortion for those who rabidly oppose it—despite their propensity to wave around graphic pictures of aborted fetuses—since many support abortion in the cases of rape, incest, and fetal anomaly. Rather, the element of abortion that rankles many anti-choicers is “the notion that women can shirk the mother role. Deeply embedded in American society is the belief that women who have sex implicitly become obligated toward parenthood more so than men.” Therefore, any woman who avoids this responsibility is assumed to be irredeemably selfish.

From here, Freedman’s book covers a wide span of topics. The next five chapters trace the history of abortion care in U.S. medicine, the various ideological reasons why doctors are willing or not to provide abortions, the choices surrounding “learning, doing, and having abortions,” the various manifestation of the “institutionalized buck-passing of abortion care,” and the dynamics of miscarriage management within Catholic-owned institutions. The concluding chapter recaps Freedman’s main points and outlines ways to increase the number of abortion providers and integrate abortion into mainstream practice, both of which would lessen the stigma attached to abortion.

Freedman’s balance between analysis and physicians’ interviews is highly engaging. In chapter four, she teases apart the variety of choices involved in abortion care—not simply a woman’s choice to have an abortion or not—through the prism of Dr. Rina Anderson’s experience. After initially opting out of abortion training, Dr. Anderson chose to re-enter the program, then chose to perform abortions in private practice primarily in the case of fetal anomalies, and finally, chose to carry her own pregnancy to term despite the fact that her baby had a fatal condition and would die soon after birth. Dr. Anderson’s story is not only moving but also reveals the layers of choice involved in abortion care for both provider and patient, especially when they are one in the same.

While Freedman’s book explores a unique perspective within the abortion debate, I couldn’t help but want more—more interviews and information pertaining to a wider sampling of physicians. Perhaps I wanted more because what Freedman provides is so compelling. These are memorable portraits of physicians who find themselves confronted with the “choice” of either providing abortions or practicing obstetrics and gynecology, which—like the options available for many women faced with an unwanted pregnancy—isn’t much of a choice at all.

Written by: Dr. Jennifer A. Smith, August 21st 2010

Dr. Mary Walker: An American Radical, 1832-1919

admin — Mon, 01 Mar 2010 17:01:00 +0000

By Sharon M. Harris

Rutgers University Press

Dr. Mary Walker: An American Radical, 1832-1919 is a plethora of facts, evidence, and tightly woven themes that are well-researched by Harris, yet the book isn’t boring or dry. I found it inspirational and enraging at the same time. Women of the past made it easier for women today by tirelessly battling for women’s rights (and for men who were not white property owners). Walker was a dutiful and energetic soldier. She served in the Union army during the civil war as a commissioned medical officer although she had to fight to get that official position.

Harris’ work reveals that Walker spent every waking moment living the fight for equality and justice for all. When other physicians slammed her for treating the working class (that were considered beneath male doctors), she kept on. Men and women alike ridiculed her for even believing she had the brains to be a registered physician, but she persevered.

Being a female activist back then was quite difficult. The suffragists, including Susan B. Anthony and Elizabeth Cady Stanton, were adept at bickering and jockeying for centre stage, and Walker was no exception. Gaining the right to vote in the U.S. (eighteen months after Walker’s death) has not erased these divisions among activists today. From personal experience, I can attest to being treated as invisible by many middle class activists because I’m a sole-supporting parent and working class.

As a radical, Walker could not walk down the street without being physically assaulted for not wearing feminine clothes. Bricks, food, and yells often greeted her as she carried on her way. Today, nobody throws bricks at me while walking out in public, but men still stop their cars to yell at me if they don’t like what I wear. After reading about Walker’s experiences, I took some comfort in knowing that while we have made progress since Walker’s time, we still have a long way to go before all men, women, and children are treated with the respect they are due.

Walker is an example of how we need to continue to fight to be given the same rights as the more privileged members of society. Harris presents Walker in a balanced light that made me want to keep reading until the final page. Maybe in a hundred years, women will not only be able to vote, but also get paid on par with men and walk down the street knowing they are safe.

Written by: Nicolette Westfall, March 1st 2010

Doctor Olaf Van Schuler’s Brain

admin — Fri, 17 Apr 2009 23:33:00 +0000

By Kristen Menger-Anderson

Algonquin Books

A thriller that spans five centuries, Doctor Olaf Van Schuler’s Brain is entertaining and thought provoking. Thirteen generations of eccentric New York City doctors navigate genius, madness and morality. This book is eerie, smart, unique, and very delicately crafted, telling many stories in every layer of time.

The Van Schulers and Steenwycks are a family of eccentric, genius, medical people, mostly doctors, some more on the fringe than others, some mad. Each has his unique specialty. Their fallibilities play out over obsessions with the brain and the mind. Each generation is engaged in inventing a medical fad of the era. For some, the result is tragic. For most it is less clear whether the result has been heroic or tragic. Always, someone has been fooled.

One physician hides both his mother’s extreme madness and his study of the brain from the Catholic Church. He is convinced he will cure her. He also suffers from lunacy. His obsession with collecting the brains of deceased animals escalates into a gruesome, out of control spiral that condemns them both. Others are almost as odd, though less secretive and polarized. One testifies in favor of a philandering widow, that his deceased wife died of spontaneous combustion by alcoholism. Another performs an experimental surgery, one of the first lobotomies, on his younger sister, hiding this from his older sisters. One Steenwyck is a medicine showman. Wives swallow gulps of radium to promote fertility and feed it to their husbands, revealing secret wishes.

The Steenwycks continue the tradition of cutting edge medicine into the modern era. The protagonists in the last two or three chapters happen to be women. Neither the oddness nor the deceit seem quite as striking or overt in the last era. But maybe that is because we are living in the same time. This novel is quite a reflection on changes in beliefs and the application of science. The only time the change seemed abrupt was the later shift to the 1980s, though maybe that is because it is closer to now. This is what makes it so thought provoking: the gradual transition from backward ways that were once new, all the way to the controversial new.

The novel was truly a pleasure to read and thoroughly researched. The odd medical techniques are real, and nested in the beliefs and social climate of each era. It would be especially fun for anyone interested in the history of medicine. It would be interesting to use to generate discussion in a seminar related to ethics, the history of medicine, or the history of New York City.

Written by: Heather Irvine, April 17th 2009

Patient Listening: A Doctor’s Guide

admin — Wed, 23 Jul 2008 11:44:00 +0000

By Loreen Herwaldt

University of Iowa Press

We talked for 45 minutes. It didn’t take much. You’re not asking them to be a guru, a Tibetan monk, a psychologist, or practice in a different field. Just ask one more question, two more questions. Somehow everything comes into place much quicker.

This patient’s story captures the meaning of this collection of prose by twenty-four writers who have extensive experiences as patients. Loreen Herwaldt is a physician and educator in Internal Medicine and Epidemiology at the University of Iowa who selected close to one hundred pieces in Patient Listening in order to help students and medical practitioners appreciate the importance of communication and listening in their service.

An introduction and additional section, along with responses from other professionals, orient educators and practitioners on how to use this book. Here, a section of prose by a patient summarizes the purpose of what follow, “Medical training is fantastically narrow and intensive. It has to be…I’m not saying doctors need to go to liberal arts college…but I think it would be important to get the patient’s point of view.”

The patients' experiences are negative and positive, sometimes both are heard from the same author. Some experience alienation, for example, while overhearing a teaching physician excitedly pegging her as “a great case” and telling students “[t]hey were going to have an opportunity to do things they didn’t normally do.” Another appreciates a statement made by a surgeon who suddenly gets that the two don't have a good rapport: “No, you’ve had enough trouble with your eyes, you’re not having trouble with your doctors as well.”

Patients also take responsibility for their own experiences: “I thought if I got really sick, people would pay attention.” Another woman, who had a bone marrow replacement, describes taking the advice of hospital staff: to put up a picture of herself when she was healthy, so friends would remember and other staff members would be more likely to treat her like a “normal” person. Another appreciative piece relates, “I could not imagine getting 87,000 phone calls the way my hematologist does and not being half crazy. But he’s not… When I see him he is incredibly focused… and he’s very compassionate."

On average, the prose in Patient Listening has a tone that is critical of patient-doctor relationships, but there are many positive examples interwoven. In short, this book would be helpful read for anyone in either of the “two classes” described by one author: the “healthy in white coats, calling the shots” and “the great cases.”

Written by: Heather Irvine, July 23rd 2008