Epidemic?

Yesterday I linked to the anesthesiologist who couldn’t stand the audacity of patients to actually make decisions about their own health care. Today I am going to link again to the blog of the doctor who posted the anesthesiologist’s letter, and highlight what the doctor said in writing the lead-in to the letter:

Call me old fashioned, but I am not alone. I often believe that patients don’t have the capabilities to make proper decisions about their clinical options. When the issue is childbirth, excuse me, patients are often nuts. Just witness the epidemic of home childbirths!

To which I respond,

Call me old fashioned, but I am not alone. I often believe that if patients don’t have the capabilities to make proper decisions about their clinical options, then that shows a deficiency on the part of doctors and the medical establishment to effectively communicate the options, or to take into account patient autonomy, desires, and rights. When the issue is childbirth, excuse me, doctors are often nuts. Just witness the epidemic of C-sections!

But on home childbirth being “epidemic” — excuse me? The online Oxford English Dictionary defines “epidemic” like this:

1 a widespread occurrence of an infectious disease in a community at a particular time.

2 a sudden, widespread occurrence of something undesirable

We know that birth is not “an infectious disease” (although women may get an infectious disease at the hospital that they would not get at home), so I’m assuming that birthing at home is “something undesirable” to this doctor — but “sudden, widespread occurrence”? I can hope — and in a few years we may get the statistics to see if The Business of Being Born has created an increase in the incidence of home birth. But the 2003-2004 CDC stats show less than 1% of all live births happening at home (0.9% from 37 weeks onward occur at home), whether that was the plan or not. Even if it suddenly doubled, it still wouldn’t reach the dictionary definition of “epidemic” because it wouldn’t be widespread (without regard to whether or not it is “undesirable”). While women from every state do choose home birth, whether it is legal or not for midwives to attend them, geographic distance alone does not make something “widespread” if it remains relatively uncommon. For instance, school shootings have occurred in the last ten years in all parts of the United States, for while it is certainly something greatly undesirable it is not “epidemic” even though it has occurred in places as “widespread” as Littleton, CO, Pearl, MS, the Amish schoolhouse (in PA?), and the college shooting (in NC?).

Maybe if he, y’know, actually listened to these women instead of just demeaning them, he might actually get a clue about what they want and why they are so vocal about it. Can you imagine this patronizing attitude existing in any other profession of the world with as much impunity as the medical profession (and obstetrics in particular) has? When I take my car to the mechanic, I don’t tell him how to do his job because it’s his job and I’m paying him to do it. But I do tell him what I want fixed and what I don’t want fixed; whether I want my oil changed or not; whether my wipers need replacing or not. Can you imagine taking your car to the mechanic, and getting it back a few hours or days later, with it repainted, a new A/C (even though the other one was fine), new wipers, new tires, and a fresh oil change, when all you wanted was to have the tires aligned? And when you complain, the mechanic retorts, “Don’t tell me how to do my job, and I won’t tell you how to do yours!” And then he expects you to pay his bill in full, even though you didn’t need $1000 worth of work done, and you really resent him changing the color of your car without your knowledge or permission, even though the old paint did have a couple of scratches in it.

So, while you might not hang over the mechanic’s shoulder and tell him how to take out and replace your air conditioner, or rotors, or solenoid (I learned that term from War of the Worlds — I have no clue what it is or what it does, but it sounds like I do when I toss terms about)🙂 you can sure as heck tell him what work you want done and what you want to forego, especially when it’s your car and your cash. He works for you, just like doctors do. It may be wise to listen to the opinion of your mechanic and your doctor, but that doesn’t mean you have to always follow everything that is said. For one thing, your mechanic may be unscrupulous… and so might your doctor be — which is why it’s always a good thing to get a second opinion, or even a third. Because there is often a difference of opinion even among highly respected and well-qualified professionals, of any profession — from mechanics to economic forecasters to medical doctors.

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