Are Abortions taught in Med School? Debate someplace else though.

[aaronjw]

Physicians must not withhold information about the existence of a procedure or treatment because providing that procedure or giving advice about it conflicts with their religious or moral beliefs.

 

This says nothing about referrals. I have no problem discussing the options with my patients. But I myself will not give a patient a referral. I would advise them to see one of my colleagues.

 

Advise patients or individuals who wish to become patients that they can see another physician with whom they can discuss their situation and in some circumstances, help the patient or individual make arrangements to do so.

 

The College will consider the extent to which a physician has complied with this guidance, when evaluating whether the physician’s behaviour constitutes professional misconduct.

 

I think the bolded highlights an important distinction that a physician needs to weigh in whether refusing to refer a patient to another based on physicians' moral or religious beliefs would constitute professional misconduct.

[ellorie]

The question I am wondering about is - if you say to a patient, with respect "I am sorry, I do not perform that procedure, but I can refer you to someone who does" and they say "Why not, doctor?", what do you tell them?

 

Would you just say that you do not feel competent, or are not trained?

[lalab]

What if you we're to say something like this: "this is an area of medicine where sometimes a physician's own belief is preventing the patient from giving the best quality of care. I would believe that my colleague so and so would be able to provide you the best quality of care in this circumstance." That's what I would do IF I had such beliefs.

[Fresh fry]

The question I am wondering about is - if you say to a patient, with respect "I am sorry, I do not perform that procedure, but I can refer you to someone who does" and they say "Why not, doctor?", what do you tell them?

 

Would you just say that you do not feel competent, or are not trained?

 

It is not in my scope of practice. Nough said

[aaronjw]

What if you we're to say something like this: "this is an area of medicine where sometimes a physician's own belief is preventing the patient from giving the best quality of care. I would believe that my colleague so and so would be able to provide you the best quality of care in this circumstance." That's what I would do IF I had such beliefs.

 

better to say that you do not have sufficient training in such medical procedure and to offer to refer said person to another who would be more qualified to provide care than yourself.

 

Less chance of being sued I'd imagine lol

[rmorelan]

The type of medicine I plan on entering (pathology), I should never be in this situation.

 

except on the relatively brief clinical side.

 

and if you were in that situation you would be compelled to provide the full range of information for you patients. That is actually part of what it means to be a doctor. For those that cannot of course there are suitable branches of the field to go into and that is a fine approach. If you cannot do something for whatever reason you cannot do it and adjust accordingly. However just like if you are unable to perform any core part of any field etc to the point you cannot provide or arrange standard of care - be it skill, personal beliefs, manual dex, mental distress....whatever then you shouldn't in that field. It is just a part of being professional - the patient comes first.

 

So if you cannot provide an option you basically have to refer. You cannot block access to a treatment that is considered standard of care whatever your beliefs. If you chose to you are open for sanctioning and you should be - although of course it is a touchy subject Again this is not really a problem as you can self select the field you want to go into.

[A-Stark]

It's not really sketchy at all. If the condition is non-life threatening, you have no obligation to treat or make a referral..

 

Pregnancy can certainly be life-threatening. Not that it matters, because you have an obligation to provide information and, even if you don't make a formal referral, point patients in the right direction for requested/required treatment.

 

Of course, it's rather necessary to point out that anyone can lodge a complaint with the College about you for anything.

 

Anything.

[aaronjw]

Hm I'll report back on this thread once I actually get some clinical training. Give me a few more months.

 

It falls in line with the Clinical Competence guidelines as outlined by CPSO http://www.cpso.on.ca/policies/policies/default.aspx?ID=2102

[leviathan]

Pregnancy can certainly be life-threatening. Not that it matters, because you have an obligation to provide information and, even if you don't make a formal referral, point patients in the right direction for requested/required treatment.

 

Of course, it's rather necessary to point out that anyone can lodge a complaint with the College about you for anything.

 

Anything.

Anyone should be emphasized too. They don't even have to be someone you saw as a patient.

[tooty]

Complaints don't mean anything though. It's the lawsuits you have to worry about.

[leviathan]

Complaints don't mean anything though. It's the lawsuits you have to worry about.

They do in the sense that it wastes your time. You have to sit down and formally respond to all complaints and correspond back and forth and it can take months. Not going through this personally but I know people who have.

[blindsideflank]

methotrexate for ectopic pregnancies must be taught. (i didnt read the whole thread so sorry if this has been stated)

there are many other indications for an abortion and it is a treatment just like antibiotics are a treatment

[rmorelan]

It's not really sketchy at all. If the condition is non-life threatening, you have no obligation to treat or make a referral..

 

You have an obligation to provide standard of care and duly inform you patients of all medical options that would be reasonably medically appropriate - you have to tell your patients as well what a reasonable person would want to know - that is an important part of consent (one of the 3 requirements actually). The criteria isn't restricted to life threatening procedures. That would be far too narrow.

 

Your personal belief shouldn't block access to that information and ultimately referrals if the patient wants one once they have been fully informed.

[tooty]

I contacted the CMPA and an advisor, who is a physician, called me back and cleared up some points.

 

1. It is acceptable by the College that the physician refers to a physician who refers to an abortion physician. The act of referring to a referral is deemed by the College to be still helpful to the woman in her seeking an abortion. What is completely unacceptable is to refuse to refer her to anyone.

 

2. If you do refuse to refer and the patient complains to the College, they will "come down hard" on you. I didn't ask about what that means exactly but I'm sure it would be quite unpleasant. If you continue to refuse patients, you will lose your licence.

 

3. If the patient also sues you for refusing a referral, the probability of you losing in court is 100%. The CMPA will not defend you anyway (because you would lose 100%), and would advise that you offer to settle.

[aaronjw]

Very interesting.

 

Thanks for clearing this up!!!

 

I contacted the CMPA and an advisor, who is a physician, called me back and cleared up some points.

 

1. It is acceptable by the College that the physician refers to a physician who refers to an abortion physician. The act of referring to a referral is deemed by the College to be still helpful to the woman in her seeking an abortion. What is completely unacceptable is to refuse to refer her to anyone.

 

2. If you do refuse to refer and the patient complains to the College, they will "come down hard" on you. I didn't ask about what that means exactly but I'm sure it would be quite unpleasant. If you continue to refuse patients, you will lose your licence.

 

3. If the patient also sues you for refusing a referral, the probability of you losing in court is 100%. The CMPA will not defend you anyway (because you would lose 100%), and would advise that you offer to settle.

[NLengr]

The CMPA is awesome. Full stop.

[rmorelan]

Start looking now, if you don't refer someone you will lose your licence after you are appropriately sued into the dust.

 

I am afraid so - I wasn't trying to state an option - but rather the college's position on this - the ultimate body that grants you the licence to practise. If you want that licence you have to obey their rules.

[rmorelan]

They do in the sense that it wastes your time. You have to sit down and formally respond to all complaints and correspond back and forth and it can take months. Not going through this personally but I know people who have.

 

And the darn thing follows you like a plague - there is more paperwork for renewals etc. it is a mess.

[Jochi1543]

I don't recall much discussion of therapeutic abortion (vs. D&C for miscarriage or MTX for ectopic) in med school. I'm not sure it happened at all outside of the ethics courses. We were given a list of various obs-gyne clinics to schedule office days while on the O&G rotation, and the abortion clinic was on that list. I scheduled a half-day there, and I know some other people had, too.

 

We have a Medical Students For Choices (MSFC) chapter at U of A - I think all schools do. So people interested in getting therapeutic abortion (TA) training can certainly get involved with the group and gather resources. Ethics notwithstanding, this is a touchy area from a medical point of view, too. I attended a Q&A session with some abortion providers that was organized by MSFC. IIRC, all the providers were O&G residents or staff and they were pretty skeptical of GPs doing abortions, whether pharmaceutical or surgical, but particularly pharmaceutical. Their reasoning was that if you are going to prescribe the patient Methotrexate and it fails, you better be prepared to go into the OR and sort things out surgically, which isn't usually an option unless you are specifically trained in surgical abortion and have admission and OR privileges. So while it was never said outloud, the overall vibe was "GPs should stay away from abortions."

 

That said, obstetricians are busy with their emergency obstetrics, cancer surgeries, and other specialist surgeries, so I have yet to work with one who did TAs. The doctor who I shadowed at the abortion clinic was a GP who spends one day a week just doing TAs and had been for a long time.

 

You can certainly obtain TA training at UBC, although I forget the details. I know one of the newly graduated residents in my program is doing hers some time soon. I think it's a 2-week program? A D&C or vacuum aspiration is not terribly difficult, you just have to have the judgment and skills to stop hemorrhage and get an obstetrician if things get out of control.

 

I'm interested in TA training, but of all the surgical procedures I've witnessed, it was certainly the most physically repulsive, and I almost passed out. That was before I went through all my surgical rotations, so I'm still hoping that I can get into this field later - I'll be arranging some exposure to abortions again soon.

[lalab]

I don't recall much discussion of therapeutic abortion (vs. D&C for miscarriage or MTX for ectopic) in med school. I'm not sure it happened at all outside of the ethics courses. We were given a list of various obs-gyne clinics to schedule office days while on the O&G rotation, and the abortion clinic was on that list. I scheduled a half-day there, and I know some other people had, too.

 

We have a Medical Students For Choices (MSFC) chapter at U of A - I think all schools do. So people interested in getting therapeutic abortion (TA) training can certainly get involved with the group and gather resources. Ethics notwithstanding, this is a touchy area from a medical point of view, too. I attended a Q&A session with some abortion providers that was organized by MSFC. IIRC, all the providers were O&G residents or staff and they were pretty skeptical of GPs doing abortions, whether pharmaceutical or surgical, but particularly pharmaceutical. Their reasoning was that if you are going to prescribe the patient Methotrexate and it fails, you better be prepared to go into the OR and sort things out surgically, which isn't usually an option unless you are specifically trained in surgical abortion and have admission and OR privileges. So while it was never said outloud, the overall vibe was "GPs should stay away from abortions."

 

That said, obstetricians are busy with their emergency obstetrics, cancer surgeries, and other specialist surgeries, so I have yet to work with one who did TAs. The doctor who I shadowed at the abortion clinic was a GP who spends one day a week just doing TAs and had been for a long time.

 

You can certainly obtain TA training at UBC, although I forget the details. I know one of the newly graduated residents in my program is doing hers some time soon. I think it's a 2-week program? A D&C or vacuum aspiration is not terribly difficult, you just have to have the judgment and skills to stop hemorrhage and get an obstetrician if things get out of control.

 

I'm interested in TA training, but of all the surgical procedures I've witnessed, it was certainly the most physically repulsive, and I almost passed out. That was before I went through all my surgical rotations, so I'm still hoping that I can get into this field later - I'll be arranging some exposure to abortions again soon.

 

 

This was the most helpful post I've read in a long time. Thanks so much for the insight!

[covarubious]

Speaking of letting person beliefs influence your practice...

 

http://www.richarddawkins.net/news_articles/2013/7/14/women-have-reproductive-duty-says-rhythm-doctor

[aaronjw]

Speaking of letting person beliefs influence your practice...

 

http://www.richarddawkins.net/news_articles/2013/7/14/women-have-reproductive-duty-says-rhythm-doctor

 

Or letting your retardedness influence your practice...

[covarubious]

"Lee, a doctor at Wairau Community Clinic in Blenheim, stood by his views and actions. "I don't want to interfere with the process of producing life," the Catholic father-of-two told the Herald on Sunday."

 

Doesn't prescribing the rhythm method do that? Or does he know it doesn't work and is trying to con women into getting pregnant?

 

"Lee also does not prescribe condoms, and encourages patients as young as 16 to use the rhythm method."

 

He works for a clinic run by the Marlborough Public Health Organization. Public health?

 

"Teen pregnancy might be a girl's "destiny", he said, and it was certainly not as bad as same- sex marriage.

 

The only circumstances in which he would prescribe the contraceptive pill would be if a woman wanted space between pregnancies, or had at least four children.

 

"I think they've already done their reproductive job"."

 

Wtf??

[xkittens]

Or letting your retardedness influence your practice...

What was the difference again?