Re: Sad but true --->Call the question!
From: Barbara Nicol MD (blnicol@ix.netcom.com)
Thu Feb 16 11:01:46 2006
Assuming that "unreasonable" includes "unjust" as a subcategory, yes.
(I'm not quite sure what you mean by unreasonable, but I think it means
unjust in this context.)
- Barb
At Thu, 16 Feb 2006, doctorjoe@aol.com wrote:
>
>So do I understand this to say that you think it is UNreasonable to have a gender bias, absent some religious preference or extenuating circumstance like abuse?
>
>Joe P.
>
>-----Original Message-----
>From: Barbara Nicol MD <Call the question!">blnicol@ix.netcom.com>
>To: Multiple recipients of list OB-GYN-L <Call the question!">ob-gyn-l@dns.obgyn.net>
>Sent: Thu, 16 Feb 2006 11:37:41 -0600
>Subject: 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
>
--
Barbara Nicol MD
St. Luke's Health Care Center
San Francisco CA USA
