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Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S From: art fougner, md (evsono@pipeline.com) Mon Aug 14 08:14:34 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S" Previous message: Ann Hillard: "In a Fat Woman? How fat is that? Specify please." In reply to: Dean Huffman: "Re: Legal impact on Medicine - was VBAC" Next in thread: art fougner, md: "Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S" no reason - who needs one save that it is politically incorrect to suggest such a heresy?! and as an aside, the veterinarians in our neck of the woods are performing more sections. you think they know something? art At Sun, 13 Aug 2000, jkulkin wrote: > >No one said it shouldn't be, but for what reason? The higher rate is not >associated with less perinatal mortality. As you know, C/S is associated with a >3-4 fold increase in morbidity and mortality though the rates are very low. > >JK > >"art fougner, md" wrote: > >> acog's missive re: lowering the c-section rate seems rather disingenuous >> to anyone who's been following the vbac threads here. personally, who's >> to say the section rate should not be higher? >> >> art >> >> At Fri, 11 Aug 2000, jkulkin wrote: >> > >> >I encourage everyone to read the new ACOG proposal on reducing the C/S rate >> >by 2010. There is a section on the legal issues impact on the C/S rate. >> >Clearly, the threat of litigation caused many to be quicker to section >> >although now years later we know it does not improve neonatal health. That >> >doesn't prevent an action from being filed. Get a chance to read this >> >because I think it will be an interesting thread for the list. A few >> >questions I had today while reading it are: >> > >> >ACOG makes a statement essentially encouraging docs to do less episiotomies >> >such that we see a lower inscidence of pelvic floor dysfunction. If I recall >> >correctly, every midwife I've worked with advocated this yet docs have >> >resisted. It is interesting that in this section and the one on the OB >> >nurses impact on C/S rates, ACOG fails to mention midwives anywhere. I >> >wonder why that is???? >> > >> >It talks about the need to coucil patients about VBAC and encourages everyone >> >to do so. It also mentions that variation in practice style impacts the VBAC >> >rate. Nowhere do they suggest trying to standardize this to remove >> >individual physician bias and reduce variation with recommended content for >> >patients to read. Rupture rates and complication rates are now well known. >> >I found it interesting how they suggest hospitals, nurses and health systems >> >try to educate the public as well Reading between the lines, I think they >> >recognize they are in a difficult position with the membership on this >> >issue. I think employers will continue to try to get this data and publish >> >your C/S and VBAC rates so that their employees have more measures on >> >clinicians. >> > >> >I'm halfway through the document which you can buy from ACOG. More later. >> > >> >Jay >> > >> >"Joanne Bulley, MD" wrote: >> > >> >> Art- >> >> >> >> Correct me if I am wrong - but it is my understanding that the legal >> >> folks major influence on how medicine is practiced is a rather new twist >> >> to medicine that was not always there - or was not as big a factor in >> >> the recent past - or in other geo-political areas. I am 45 and have >> >> always practiced in the US with the threat of (and defendant in) >> >> non-meritorious suits. >> >> >> >> Let's hear from the others on the list (older, non US?) as to opinions >> >> on whether it is new that the legal division is dictating what should be >> >> the art of medicine. >> >> >> >> Joanne >> >> >> >> At Fri, 11 Aug 2000, art fougner, md wrote: >> >> > >> >> >Joanne - >> >> > >> >> >what's new about that? >> >> > >> >> >art >> >> > >> >> >At Fri, 11 Aug 2000, Joanne Bulley, MD wrote: >> >> >> >> >> >>At Thu, 10 Aug 2000, Efrain Ramirez wrote: >> >> >>> >> >> >>>I have been arguing for about 2 years - again - IMHO - the legal >> >> >>>division will have the final saying on this - >> >> >>> >> >> >>Unfortunately - much of what could or should have been left to the "Art >> >> >>of Medicine" is now in the hands of the ever present and under-worked >> >> >>(but over-paid) attorneys.... >> >> >> >> >> >> >> -- >> >> Joanne Bulley, MD >> >> Keene, NH, USA >> >> -- >> art fougner, md >> >> A series of 1000 cases begins with but a single anecdote. -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: art fougner, md: "Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S" Previous message: Ann Hillard: "In a Fat Woman? How fat is that? Specify please." In reply to: Dean Huffman: "Re: Legal impact on Medicine - was VBAC" Next in thread: art fougner, md: "Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S"

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