Wednesday, July 11, 2012

Medicine: The Art vs. The Politics and The Business

So lately I find myself disappointed in a few things in my current field of study. I actually started this post about a month ago, but things have been so crazy with post-school year stuff that I haven't had a free moment. I am now down from 12-hour days know, only 9- or 10-hour days. But when I came back to this post, I realized this stuff still upset me. So here it is:

I recently discovered that a local hospital, one of many like it in the country, refuses to have anything to do with abortion counseling. This not only affects medical students, but patients nationwide.
Now, I'm not saying a hospital shouldn't be able to decide whether or not it can conduct abortions. That is the hospital's and its parent organization's priority. But when the hospital refuses to train its medical students in this delicate matter, that doesn't seem right. Medical care these days is completely focused on being transparent, and making sure patients are well-informed so that they can give proper consent.  That means knowing all options and being able to assess them all as objectively as possible. Our patients trust us as doctors/future doctors to help them with these decisions, but we cannot do that if we are not familiar with the options!
Obviously abortion is a very controversial subject and doctors will differ in opinions regarding it. It's difficult to control how a doctor will feel about the procedure and how they will present it to a patient. It's even more difficult to predict how certain patients will react to the idea of abortion and whether or not they will be offended. That's why third-year medical students spend 6 weeks learning basic skills of how to help pregnant women and the babies they carry, and why those that choose to specialize in obstetrics and gynecology after they graduate spend four years in intense training and then a lifetime of working to become experts in the field.
The fact that these hospitals are leaving out this important and very relevant aspect of training/patient care means that the doctors trained there cannot serve patients as well as those trained elsewhere.

I'm not saying I'm pro-choice. I'm not saying what I feel on abortion because it doesn't matter. All that matters is that if a patient asks about the procedure, I need to be ready to discuss it with them. If I'm trained at the hospitals that I talk about in this post...I won't be ready, and unable to accept a patient's trust. And as idealistic as it sounds, I don't want to accept that.

I know there's not a whole lot that one blog post read by a handful of people can do (thank you for reading, by the way!) to change a massive hospital system. But another subject that really troubles me is a little more personal, and may be able to have a little more of an impact, and coincidentally also falls into the OB/GYN realm.
I am working in a doctor's office this summer and a week and a half ago, a patient came in, just a few years older than me, who had given birth over the weekend. The birth was fine, but the young mother was exhausted. Granted, the pain and suffering of labor leaves every mother exhausted (not that I know from experience, but I've seen it). However, this girl was really struggling after a couple of days at home, and developed violent stomach pains that sent her to the Emergency Room. She was unable to eat, so they gave her a nutritional IV and the pain subsided...but then they just sent her home. Didn't let her stick around to follow up and make sure she was okay, they just sort of shoved her out the door. She ended up in our office because the pain had her doubled over and she could barely walk, and between the pain and the new baby, she had not slept in days. A test showed that her hemoglobin level was a measly 7.8 (normal is 15). We all wondered, "Why did they let her leave the hospital?"
I work for a doctor who offers some less-widely-used treatments, so we gave her a couple of IVs of B12, Vitamin C, and other nutrition and mineral supplementation for an energy boost, and some pain management therapy. After just a few hours in our office, she felt a little better, though still weak. She came back the next day for another IV and looked amazingly better. She was able to walk and everything. It wasn't an instant cure - she became weak again, though less so, and needed to come back for more pain management and nutritional IV treatments. But they were helping.
Over this past weekend, the pain again became so severe that she had to go back to the ER. They finally investigated further and discovered that she had retained products of conception in her uterus - placental and/or fetal tissue (more so placental in this case, I assume, since her birth was otherwise normal) that are known to cause pain. She is going in for surgery to hopefully resolve the problem.

This happens only in 1% of all pregnancies, so I admit that it would be hard to find that as the cause of her condition. But if she had been allowed to rest in the hospital just a little longer instead of being shoved out the door, they would have seen that there really was something wrong, and maybe the physicians could have investigated sooner so she would not have had to suffer for over a week when she should have been enjoying her new motherhood. I'm not blaming the doctors or the hospital. But this is what medicine has become, a business where the customer must be helped and then moved along, dismissed as soon as possible in order to keep new patients coming in. It can't be changed instantly, but I hope that I can remember this story in the future and try to remember that occasionally my patients need more than just to be shuffled through, treated, and streeted.