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Re: Sad but true --->Call the question! From: Barbara Nicol MD (blnicol@ix.netcom.com) Thu Feb 16 10:36:28 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Previous message: Jamie: "Re: Sad but true --->Call the question!" In reply to: Jamie: "Re: Sad but true --->Call the question!" Next in thread: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Reply: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Reply: Jamie: "Re: Sad but true --->Call the question!" Reply: D. Ashley Hill: "Re: Sad but true --->Call the question!" Reply: Ina May Gaskin: "Re: Sad but true --->Call the question!" No, I disagree. As professionals, we should not allow "all reasonable avenues" to exercise a discriminatory preference. I think that in general, we need to tell patients that we think our male colleagues are competent and caring (when they are <g>). This is for several reasons (1) it is truthful, and as professionals we have an obligation to tell our patients the truth, gently, when it's clear that they're in error (2) it is just, and as humans we have an obligation to justice (3) it is self-protective (I won't have to come in in the middle of the night because my cross-cover is male, or have twice the clinic schedule he does) and (4) (probably most important) it is an opportunity for clarity with the patient that this is a medical and not a sexual interaction, or even a social "girl-talk" interaction. Then if she describes with an unusual circumstance - past abuse, religious constraints - that's when individualization of treatment comes in, but without giving ground too much. In general, abuse victims need lots of support, and may need special consideration in this area, but I think that one worthwhile goal for healing from abuse is the ability to receive medical care from anyone who is available and competent. We should regard the inability of abuse victims to receive care from men as a possibly dangerous handicap which might impede care in an emergency. Counseling, support, and desensitization are indicated. Going along with it without challenge is not ultimately healing, although I also recognize that recovery is a process taking years. Some patients were abused by women and will require slow acclimatization to treatment by female providers, as well. I find the case of women with religious prohibitions more compelling, because of a personal wish to respect the religious necessities of others when possible, but I do take care to explain to these patients that in emergency situations their care might be compromised if the first or only provider available is male. We do make every effort to provide safe care for these patients, of course, but the fact remains that some of our obstetricians and anesthesia providers are male, to say nothing of the emergency room physicians or the nursing staff, and full informed consent demands an explanation of this. Some feel that in a genuine emergency they can accept care from males, and others do not. Sometimes compromise is possible. (I've had patients receive regional anesthetic with their entire body covered except for the lumbar region and eyes, for example.) Again, she always has the right to refuse care, but our system does not always provide the ideal alternative. (Nor am I aware of any system which provides complete health care to women in a female only setting that is fully equal in scope and competence to that provided in Western mixed settings, but I could be wrong.) I confess to remembering that when I was a teen, I wanted ANYONE but my mom's gyn. Looking back, I think he was probably a pretty skilled guy - my younger sister was a 2nd twin breech, and my mom had a pretty smooth recovery from her surgical stay under his care. At the time, such subtleties were lost on me - my only search criterion was someone who didn't know my mom really well. So I guess I'm not opposed to all forms of discrimination, if "not my mom's doctor" counts. <g> And we all know that personality is an issue - some of us get on better with some patients than others. I'm not arguing for robotlike interchangeability, just encouraging patients to choose their physicians based on characteristics that matter. Respectfully, -- Barbara Nicol, MD At Thu, 16 Feb 2006, Jamie wrote: > >No, I got it, but maybe I wasn't clear enough. I think that all >reasonable avenues should be pursued to allow patients to exercise this >preference. And that patients always have the right to refuse >treatment, but not the right to demand an alternative. In the case of >gender preference for sexual health, the alternative should be offered >if at all possible. > -- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA Next message: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Previous message: Jamie: "Re: Sad but true --->Call the question!" In reply to: Jamie: "Re: Sad but true --->Call the question!" Next in thread: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Reply: doctorjoe@aol.com: "Re: Sad but true --->Call the question!" Reply: Jamie: "Re: Sad but true --->Call the question!" Reply: D. Ashley Hill: "Re: Sad but true --->Call the question!" Reply: Ina May Gaskin: "Re: Sad but true --->Call the question!"

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