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The "I Can't Believe There's No Abortion Thread" Part Deux: Electric Boogaloo

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  • Deutsche Gopher Fan
    replied
    Abortions up 40% in Minnesota

    gee I wonder why

    https://minnesotareformer.com/briefs...0-since-dobbs/

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  • LynahFan
    replied
    Originally posted by dxmnkd316 View Post
    Just for the record, I missed the point that the doctor refused to prescribe the medicine just because she was child-bearing age. The second she was given the warnings and said, "duly noted," she should have been written the script as if it were a dude walking in there.

    that's informed consent. If the doc didn't prescribe, that's beyond informed consent and it's now well into not-so-good territory where doctors are prescribing morality.

    That said, it seems like we're all in agreement the doctor shouldn't be prescribing something that doesn't work. Which doesn't appear to be the case here. It seems like it was withheld for other reasons.

    hopefully I've got the story straight now
    That’s how I read it….the first time. :P

    Total agreement that doctors shouldn’t prescribe treatments that are factually ineffective or are medically unnecessary. Those are exactly the things that we send doctors to med school for 8 years to become experts on.

    But when a doctor denies an effective treatment for a real condition on the basis of his personal value judgments, I get a little hot under the collar. Sorry about that….

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  • dxmnkd316
    replied
    Just for the record, I missed the point that the doctor refused to prescribe the medicine just because she was child-bearing age. The second she was given the warnings and said, "duly noted," she should have been written the script as if it were a dude walking in there.

    that's informed consent. If the doc didn't prescribe, that's beyond informed consent and it's now well into not-so-good territory where doctors are prescribing morality.

    That said, it seems like we're all in agreement the doctor shouldn't be prescribing something that doesn't work. Which doesn't appear to be the case here. It seems like it was withheld for other reasons.

    hopefully I've got the story straight now

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  • leswp1
    replied
    Originally posted by psych View Post
    I understand what you’re saying, but in this particular case, I disagree with you. I personally don’t think the doctor is bad or evil. He thoroughly examined the patient, including asking her plenty of important questions that needed to be asked. For instance, her taking offense to him asking about if she’s with a steady person is her taking it the wrong way. That said, if her story is to be believed, he told her that if she wasn’t of childbearing age, he would have prescribed her the medicine, because it was “highly effective”, per the neurologist. From the sounds of it, this particular drug isn’t anymore harmful to take as prescribed for a non-pregnant woman than, say, acetaminophen. Thorough neurologist should have documented everything he talked about with her, including the fact she said repeatedly she had no plans to get pregnant, not to mention she wasn’t currently pregnant. In that particular moment, his prescribing her the medication was not harmful to her current condition. Not prescribing it left her in debilitating pain, apparently to the point she could black out from it.
    Your ivermectin example is irrelevant to this particular case. No real doctor was prescribing ivermectin to treat Covid. Apparently this particular drug the neurologist wouldn’t prescribe the patient is highly effective in treating cluster headaches, and he would have prescribed it if she was 70 instead of 30. It’s almost like he really didn’t believe her when she said she had no plans to get pregnant. The judgment call here does seem a step too far.
    Finally, unexpected pregnancies can definitely fear families apart, as you mention, but I can’t imagine the fallout if this patient blacked out while driving a car, and then killed herself or another family. The hypotheticals are endless here.
    All good points. I was using invermectin because people wanted it and expected they should get it if they insisted. I was probably not clear.

    I also may not be understanding the actual scenario. When I read it the whole tone of the thing seemed to be the doc should just hand over the med because she thought it would work. It set me off. I continually think to myself how grateful I am not to be Practicing. Between the laws that are not medically sound, the attitude people have that medicine should be like burger king I would be sued for sure.

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  • psych
    replied
    Originally posted by ScoobyDoo View Post

    Wanna bet?
    Fine. But unlike the case we’re discussing here, where there is apparently ample evidence that the medication the neurologist withheld from the patient was, in his words, “highly effective” for cluster headaches, there was not a single shred of evidence ivermectin had any positive effect on treating Covid. In fact, there were plenty of negative effects, as you know. The “do no harm” principle definitely applied there. The cluster headaches case, there is no current harm done to the patient by prescribing the medication- rather, harm is done by withholding the medication.

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  • ScoobyDoo
    replied
    Originally posted by psych View Post
    No real doctor was prescribing ivermectin to treat Covid.
    Wanna bet?

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  • psych
    replied
    I understand what you’re saying, but in this particular case, I disagree with you. I personally don’t think the doctor is bad or evil. He thoroughly examined the patient, including asking her plenty of important questions that needed to be asked. For instance, her taking offense to him asking about if she’s with a steady person is her taking it the wrong way. That said, if her story is to be believed, he told her that if she wasn’t of childbearing age, he would have prescribed her the medicine, because it was “highly effective”, per the neurologist. From the sounds of it, this particular drug isn’t anymore harmful to take as prescribed for a non-pregnant woman than, say, acetaminophen. Thorough neurologist should have documented everything he talked about with her, including the fact she said repeatedly she had no plans to get pregnant, not to mention she wasn’t currently pregnant. In that particular moment, his prescribing her the medication was not harmful to her current condition. Not prescribing it left her in debilitating pain, apparently to the point she could black out from it.
    Your ivermectin example is irrelevant to this particular case. No real doctor was prescribing ivermectin to treat Covid. Apparently this particular drug the neurologist wouldn’t prescribe the patient is highly effective in treating cluster headaches, and he would have prescribed it if she was 70 instead of 30. It’s almost like he really didn’t believe her when she said she had no plans to get pregnant. The judgment call here does seem a step too far.
    Finally, unexpected pregnancies can definitely fear families apart, as you mention, but I can’t imagine the fallout if this patient blacked out while driving a car, and then killed herself or another family. The hypotheticals are endless here.
    Last edited by psych; 10-11-2023, 05:21 PM.

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  • leswp1
    replied
    Originally posted by LynahFan View Post
    "Do no harm" is a nice bumper sticker, but means nothing in practice. The flu shot hurts (harms) my arm - ban them?

    The only reasonable and rational standard is actually "do net good." The patient may value different outcomes differently than the doctor - and it should be THEIR valuations that are used when tallying up the net good that is done.
    The flu shot hurts is harm? I think this is a reach. Cardiac bypass hurts. Multiple things 'hurt' but the risk (pain) is significantly outweighed by the benefit.

    This whole thing makes me realize how much the view of the medical profession has become warped and framed in an adversarial way.

    Google and Bing, Web MD, etc present simplistic facts in a way that gives the impression of knowledge. There is no acknowledgement of complexity. There is diminished respect for the expertise developed after extensive education and experience that results in understanding the nuances that make a huge difference. (I worked in healthcare for almost 40 yrs. I learned early on that people who had long experience knew stuff that wasn't in a book.)

    Medicine is not Burger King. Folks don't have the right to chose a treatment that is inappropriate because they want it or are convinced it is the right answer. The current culture encourages people to believe they have a right to to get what they think they need. They should aggressively pursue what they want. Instead of the Dr declining to use an inappropriate treatment, the doctor is passing judgement, making decisions for the patient, playing God, not taking the patient's wishes into consideration.(Ivermectin is a great example of people who went to the University of Google and knew they needed what they wanted, claimed it was being withheld and they knew more than the specialists.)

    This is not about 'the patient may valuing different outcomes differently than the doctor'. You are assuming treatment will succeed or has a high likelihood of success. The patient values [X] outcome, they will get treatment, and the outcome they want. The woman has the right to take chances. Not getting that, a potentially successful treatment is being withheld.

    The Provider's knowledge and experience with a medication allows them a deeper understanding re the potential for success and risks. So the pt values [X] outcome, this outcome is not guaranteed (may not be possible or may be transient). The treatment may cause significant harm, cause other irreversible conditions that may not be treatable. It is negligence to give someone something that could cause significant and possibly permanent harm.

    Desperate people make desperate decisions. They also very often regret those decisions. (anyone who has been in Practice for awhile can tell stories for days about this) If the treatment is guaranteed to work the 'patient valuations' should be considered and fully discussed. You seem to be assuming the valuations are based on what is realistic. It doesn't always play that way.

    >>I find this incredibly ironic. I am a woman. I experienced the judgement when filling prescriptions, the change in laws, etc. I practiced in a time when women's rights (medical and otherwise) were coming to be. I spent my career advocating for women. This Dr did a good job. He cared enough to know that pregnancy could put her life at risk, could result in a pregnancy that might not be resolvable. He went beyond, knowing that unplanned pregnancy often results in the dissolution of relationships, significant and permanent financial setbacks, talked to her about everything that could be affected. For his caring and thorough approach, treating her as a whole human being, he is bad. If he did give the med and any of those things happened he would be accused of not caring enough to talk to her about the potentially huge, lifechanging, irrevocable changes.


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  • psych
    replied
    Originally posted by LynahFan View Post
    "Do no harm" is a nice bumper sticker, but means nothing in practice. The flu shot hurts (harms) my arm - ban them?

    The only reasonable and rational standard is actually "do net good." The patient may value different outcomes differently than the doctor - and it should be THEIR valuations that are used when tallying up the net good that is done.
    Yeah. Definitely not a law. Informed consent exists for a reason too. Doctor provides the patient all the information she needs about how a category X could provide her hypothetical fetus in a hypothetical pregnancy she doesn’t want problems, as well as health problems to herself. Doctor lets patient know if she changes her mind and wants to get pregnant, see him ASAP so they can discuss how to taper her off the category X medicine and get her on something else. Doctor is doing harm to real patient with real debilitating, life-altering pain. Doing no harm to a hypothetical fetus over a real human being with real pain doesn’t make any sense.

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  • Kepler
    replied
    Originally posted by LynahFan View Post
    The only reasonable and rational standard is actually "do net good."
    Careful, Mr. Singer.

    Leave a comment:


  • LynahFan
    replied
    "Do no harm" is a nice bumper sticker, but means nothing in practice. The flu shot hurts (harms) my arm - ban them?

    The only reasonable and rational standard is actually "do net good." The patient may value different outcomes differently than the doctor - and it should be THEIR valuations that are used when tallying up the net good that is done.

    Leave a comment:


  • leswp1
    replied
    Originally posted by LynahFan View Post

    Yes, very well said - and I still completely disagree. Who do doctors think they are? Gods? Why is it any of their business to try to protect the hypotheticals emotions of people who are not their patients. They do not get to play judge and jury on the morality or wisdom of patients’ decisions. We’ve been fighting for 100 years for the right for patients to make their own decisions. Informed decisions, of course. If the doctor said, “in my reading of the literature, there are well documented trends that many people experience this or that from the course of action you’re selecting, so you should think carefully about your particular situation before YOU make the final decision, and then I, as a service provider, will do my part so long as the law and regulations allow it.” But the that’s not what happened.

    The doctor is saying, “I don’t think you’re making the decision that I would in this case, so I’m overruling you.” F that.

    Could a doctor refuse life-saving treatment to a female smoker so she doesn’t become pregnant someday and end up giving that hypothetical kid a birth defect?
    I get this sentiment... and I don't. This isn't' about protecting the hypothetical emotions of people or playing judge and jury regarding morality or overruling a decision 'I would 't make'.

    Some of these meds (category X) almost always cause fetal demise or significant abnormalities. There are 2 risks here.

    There is a very real potential for serious physical sequelae occurring in the person who gets pregnant. Pregnancies with fetal anomalies are often higher risk for complications that affect the woman. The complications can be serious and may result in the death of the mother. The risk for complications increases as the pregnancy progresses and may become acute well after the time pregnancy can be terminated. The result can be the death of both mother and fetus. This was an issue BEFORE Roe was overturned.

    The pregnancy may result in fetal demise before birth or if live birth occurs there may be significant fetal anomalies that require highly complex care- that may still result in death- often shortly after birth. Yes, I get that you may consider this a personal choice of the parent(s) but is it ethical to put them in the position to almost guarantee this will occur?

    This is one of those things where the libertarian concept is great in theory but not great in practice in a number of ways.
    -The oath is 'Do no harm'. Is it ethical or moral on a Provider's part to do something that almost surely guarantees harm on some level because the person wishes to take risk?
    -Is it ethical to require a Provider to do something that almost surely will result in harm because someone wants to do it? The drugs that are Category X are not just a chance, they are pretty much guaranteed to have a bad outcome.
    - If we think that is OK then why have rules that don't allow unlimited use of substances?
    - People have a right to make choices where they are the ones who deal with the consequences and do not affect others.
    -who pays for the care of the person who will almost certainly have serious medical complications? The bills are massive- extremely likely the person will end up being unable to cover the expense. Permanent disability of mother, child (if it survives) or both means society pays. I have no problem paying for people who need care. I do have a problem with people who think they have a right to take a course of action that almost certainly will result in society dealing with the result.

    >>Could a doctor refuse life-saving treatment to a female smoker so she doesn't become pregnant someday and end up giving that hypothetical kid a birth defect?
    This is an excellent example that makes my point.
    First- the lack of expertise means the person is not aware of the risks or underestimates them.
    Second- it sounds as though you think the potential risk is like playing the lottery- possible but unlikely.

    So, the real answer to this is the problem with prescribing birth control pills to female smokers is not birth defects or even increased pregnancy risk. The risk is a significantly higher risk of blood clots forming in the woman. These clots can result in severe medical conditions including but not limited to problems with blood flow in the limbs, lungs, heart and brain and in extreme cases- death.

    True story- when I was working I had a patient land in the ICU with a pulmonary embolism. Another provider thought it was OK to roll the dice and ignore the risk of prescribing the pill to a 2 pack a day smoker. The woman took months to recover, lost her job, was overwhelmed with medical bills, her family suffered significant financial setbacks and disruption because she was unable to contribute either financially or in the care of her other children. Was that OK to do?

    It isn't judgement re someone's morality or playing holier than thou. It is being responsible for do no harm.

    Edit- also adding it is also possible with complications in pregnancy or a late termination that you could put the woman's future fertility at risk. Part of the discussion with any of these meds is to provide the woman enough info to make decisions that allow for the best possible outcome for her needs without causing her harm
    Last edited by leswp1; 10-10-2023, 08:28 PM.

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  • French Rage
    replied
    Yeah it's the purely hypothetical aspect that rubs me the wrong way here. If she was already pregnant, or if she said she planned to get pregnant, then I can see some concern about taking this medication. But the fact that she could, well a lot of things *could* happen, but we don't hold back on important medication based on that. Or at least we shouldn't. Should she not be allowed to have a drink while taking this medication, as it might get her tipsy and then she has sex and then she gets pregnant? While we're at it, let's also not let her leave the house, that might also cause her to meet a guy and then maybe get pregnant? I mean, I know that sounds like a childish exaggeration, how strict do we want to be to prevent her from getting pregnant?

    I know her "I'll just have an abortion" response sounds flippant, but I also could see her getting a little ****ed that she can't get medication she needs to help her painful headaches and being annoyed at the whole situation.

    I also understand somewhat where les is coming from, from the point of view of a provider. These new laws put them between a rock and a hard place, they want to help but they also don't want to be sued to oblivion or jailed. While it may sound like people are placing it on the provider, since they are the proximate one issuing the decision, I think the vast majority of the people upset at these stories realize that it is the lawmakers who make the decisions that put the providers in these situations; most if not all of them would not have those laws on the books, which interfere with their ability to make the correct medical decisions they are trained to make, if they could help it.

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  • LynahFan
    replied
    Originally posted by dxmnkd316 View Post
    Really well said Les.

    Something really bothers me about this. She was recording the appointment?
    Yes, very well said - and I still completely disagree. Who do doctors think they are? Gods? Why is it any of their business to try to protect the hypotheticals emotions of people who are not their patients. They do not get to play judge and jury on the morality or wisdom of patients’ decisions. We’ve been fighting for 100 years for the right for patients to make their own decisions. Informed decisions, of course. If the doctor said, “in my reading of the literature, there are well documented trends that many people experience this or that from the course of action you’re selecting, so you should think carefully about your particular situation before YOU make the final decision, and then I, as a service provider, will do my part so long as the law and regulations allow it.” But the that’s not what happened.

    The doctor is saying, “I don’t think you’re making the decision that I would in this case, so I’m overruling you.” F that.

    Could a doctor refuse life-saving treatment to a female smoker so she doesn’t become pregnant someday and end up giving that hypothetical kid a birth defect?

    Leave a comment:


  • Deutsche Gopher Fan
    replied
    Yeah i can attest from over 20 years ago- trying to go on a med like accutane as a female of child bearing age is a real treat

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