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Re: Breech birthFrom: Henry Gregor (henrygregor@yahoo.com)Mon Nov 28 16:05:56 2005
Amen, amen, amen....Gail wrote earlier "Who has the right to allow a woman (sic) to anything". Lost in that view is who has the right to requrie md's to perform procedures that carry an unacceptable risk/benefit ratio re their potential to continue caring for other patients?. ... Lynn spoke eloquently to that issue. In a similar vein, I'd love to do VBAC's ... did them bunches and bunches in the eighties. But then, even Jeffrey Phelan - a superb researcher and advocate for VBAC's - published his group's VBAC consent form in OBGYB Mgt...what a firestorm! Lot's of letters condemning the consent form as a terrifying document designed to frighten patients rather than inform them. And I remember his reply, i.,e., that is what his group had found by hard experience what was needed for them to have a chance to negotiate through the tort system that occurs in America... and this from a "pioneer", if you will, re the procedure. (On another note, totally unrelated, but potentially amusing to listers, I remember an interview wherein either Phelan or one of his colleagues responded to a charge that the reason more women were not having VBAC's was because md's were not educating patients. The response was a very droll and understated observation that whereas he came from an instituiton with a widely recognized and published reputation for advocating VBAC, and felt they were committed strongly to patient education, they had analyzed their patients and had identified two groups with the highest rejection of VBAC options....they were women who were lawyers and physicians ... two groups he felt were particularly suitd to assimilating the available info and making an informed patient choice.) So...how about this: if any of us move to Gail's location, I'll bet most of us would be glad to look differently at homebirths. Gail, should you move here, you can proselytze our legislators and work for creating an environment that supports homebirth under conditions you have so admirably described. Barring that, we could all probably move on to another thread. Hank Gregor OBGYN North Carolina ENDODOK@aol.com wrote: It is so easy for the inexperienced (ie never sued) individual to scream loudly about choice. They do not understand the financial and mental stress associated with any lawsuit- filed, threatened, settled or dropped. We are required by our liability carriers to inform them of any possible suit thus a potential claim file is opened. Even if ultimately the case goes nowhere, or if filed and dropped, the physician is "tagged" so to speak, and as these reported potential cases accumulate, the companies are spending money, and this results in surcharges that push liability premiums higher and higher. Being vindicated in a filed suit that went to court is of no solice, as those defense costs ( which can easily cost over a $100,000) are part of a doctor's run/loss record, which is recovered by the insurance company by large surcharges. The patient's consent may not carry the verdict for the defense. Acknowledging procedures that carry significant risk for a suboptimal result (eg VBAC/rupture/ maternal and/or fetal injury/death), the defense has to be avoidance of such situations. Personally, I am awaiting next year's liability statement from my carrier. It may be the last straw for me to continue medical practice. JGB
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