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Firing Patients

Thomasrobey72x723Thomas Robey -- Fourth year students must fixate on personal statements and residency applications this time of year -– that’s why you’ve seen a few articles in that vein, and why I've been away from my desk. Not to fear, I'm back with something a bit more juicy on my plate today.

Recently, I was enjoying a pleasant Pacific Northwest evening at a lawn party celebrating a friend’s dissertation defense. The discussion moved from salmon burgers to medical education, and settled on topics related to the obstetrics and gynecology clerkship. It wasn’t long ago that I was in Fairbanks, Alaska delivering babies, so I thought I could add to the banter. Little could prepare me for an assertion that one of my more outspoken friends made. He said, “All medical students should be required to learn how to do abortions.”

That deserves a paragraph break. He went on to propose that all physicians be required to perform abortions if requested. This is related to the current debate in many states among doctors, pharmacists and lawmakers about whether a pharmacist is entitled to refuse a prescription of the high dose progestin “morning after pill.” You can imagine my friend's perspective that pharmacists must be willing to provide patients with their prescribed medicine –- especially if they are the only shop in town. Must also physicians provide every therapy at the request of a patient? For anything other than abortion, most people agree the answer is yes. For obvious reasons, dilation and curettage or mifepristone treatment for abortion are in their own category. It's funny that every medical student already has the skills to perform these procedures.

What many people don't know is that dilation and curettage is a very common procedure used for a number of uterine problems. And who hasn't prescribed medicines? So in that way, I could tell my friend that his first proposal is already being done. But what about requiring docs to do abortions? The majority of American physicians -- no matter their political views -- hold that if a woman asks for a doctor to terminate a pregnancy and that doctor's personal beliefs do not tolerate the procedure, the physician should refer her to a colleague who is able to provide that care.

This reminded me of an excellent teaching point my psychiatry attending made a few weeks ago. His patients are exclusively from our county hospital's population, which means he works with difficult patients who have been refused care (“fired”) by other psychiatrists. If you've done a psychiatry rotation, you know who I'm talking about. Some people with borderline personality disorder are impossible to work with; when everything is in black and white, it's hard to make stepwise progress. (By the way, on your board exams, these are the folks who say, “You're the only doctor who really understands me.”) These patients routinely get fired from practices. You're just another name on the list of many who've wronged the patient.

That is, unless you connect in a meaningful way. It may not work with everyone, but offering to fire a patient could be one step on her way to recovery. You've made a rudimentary connection with the patient, but for one reason or another, some cracks have appeared in the therapeutic alliance. When you say, “I don't think I can provide the best care for you. I can help you find another doctor,” some patients hear, “I care enough about you that I'm willing to send your business elsewhere so that you can get better.” In the three instances my attending offered to fire a patient, each decided to stick with him on new shared terms.

The same respect for the patient's priorities of care that the beleaguered psychiatrist has for his patient should be offered by the pro-life gynecologist. As entitled to her personal beliefs as she is, that doctor cannot provide the best care for her patient until she refers her to a clinic that will perform the requested procedure. Those who value the principle of autonomy in medical care will demand this be done. Of course, it's not so clear as this! The alternate view is that non-maleficence toward the conceptus demands the provider's refusal of the procedure. Currently, American law supports the former perspective over the latter, but that hardly solves the matter. In reality, many women first seek abortions from clinics known to conduct them. And for some individuals, there isn't a provider for hundreds of miles of where they live who will do the procedure. Maybe my friend had a good point, after all...

As a student, you may find yourself in the midst of conversations about the limits of patient care. When is it okay to fire a patient? Is it when there is no more need for treatment? Is it when patients go on Medicaid? When he misses three appointments? When she wants an abortion?

What happens when your idea of going into medicine to help people contrasts with those peoples' ideas about getting help?

Disclosure: Because this is a topic that many feel passionately about, readers may benefit from knowing that I support the perspective that abortion should be “safe, legal and rare.” I support sex education, contraception and waiting longer to have sex, am uneasy about practicing or procuring an abortion, and fully support a woman's right to seek that therapy.

September 17, 2008 in Thomas Robey | Permalink


"What happens when your idea of going into medicine to help people contrasts with those peoples' ideas about getting help?"

It's exactly what I have been wondering for about the past 2 years... are they worth it all our efforts for somebody who doesn't even want our help?

Posted by: Diego Nova | Sep 17, 2008 5:46:37 PM

I do think as you regarding abortion, until I was involved in an uncomfortable situation. A very close relative got pregnant, being me the only "doctor" in the family (coz i´m still a student) they asked me about some abortion pills they found on internet. I was in shock, this person was someone I really care about and I was afraid that if I refused helping them they will do it anyway. My big dilemma was if I should disclose what I know about the abortion pills (misoprostol) I had been through obstetrics and seen the procedure being done.

I didn´t help them find more information about it, I just said what I knew and have seen and told them that if they chose to terminate the pregnancy there was no turning back, I encourage them to considerate other options however I didn`t show neither approval or disapproval, finally I said I will support their decision and be sure the do it as safely as possible.

Days later I found out they choose to do an abortion; I felt that I did nothing to discourage them, but at the same time I still wonder if I had the right to do it. If I should have taken more responsibility or if it was ok to stand by.

At the end I do believe a woman has the right to choose, so I think I sticked to that belief regardless it´s harder that one could imagine.

Posted by: P | Sep 18, 2008 6:26:59 AM

I believe Dr. Robey's disclosure statement myself. There is not enough space in this blog for me to state why I would and would not assist a patient with an abortion. As with every dilemma, I always try to look at as many aspects of the situation as available before making a conclusion. This issue is one of those. One thing I would never do is deprive a patient's right to choose.

Posted by: Angelou | Sep 23, 2008 3:07:13 PM

Very excellent article! You raised several valid points from different viewpoints.
I strongly disagree with your friend. There are several procedures that medical students are not required to learn - abortions just happen to be one of them. Unless he is willing to learn every single procedure in the medical repertoire and spend 2 decades in school, he can't push procedures on the rest of us.
More importantly, I would never push a pregnant patient to have/not have an abortion. I will present all her options and allow her make an educated decision. I expect the same courtesy; no patient/medical licensing body/government should ever push me to perform a procedure. Like you, I believe abortions should be safe, legal and rare and sex education should definitely be taught in our schools. But just as it's a patients right to get an abortion, it's my right to refuse to perform one.

Posted by: | Sep 23, 2008 3:14:01 PM

Specific to abortion: medicine and society are never going to get around the fact that a life is being terminated (presumably against their own wishes). Unfortunately we live in a selfish world where rights are only protected for those able to voice their objections...and then only if WE decide it merits.

and yes I am a 20+yr healthcare professional

Posted by: dave | Sep 23, 2008 3:24:49 PM

but a pharmacist does have a choice, as do doctors and any other employed person... the choice becomes whether or not that person decides to do that job at the time and place. a pharmacist is not required to hand out every kind of medicine. but he or she may have to find a pharmacy that will allow for someone to stand up for what they believe in. likewise, as a doctor, i will never perform an abortion. i am not legally required to perform abortions. if a hospital somehow required that of me, i would simply make the choice to work elsewhere. standing up for your beliefs is what being an american is all about... all people should have that right, even doctors.

Posted by: raeleigh | Sep 23, 2008 3:44:59 PM

The suggestion was that the procedure be learned. The author took gratuitous liberty in going beyond the 'question' and substituting an incongruent tangent.

Posted by: onemoreperspective | Sep 23, 2008 4:24:49 PM

I was a bit confused at first as to how you would tie the two topics together, but good job! I remained engaged throughout. As a medical student who believes wholeheartedly with your "legal, safe, and rare . . . sex ed . . . ." statement. I applaud you for putting out that perspective. No one is really advocating that abortions should be performed willy-nilly, but in some cases they are what the patient would prefer and what is best for her life (financially, psychologically, emotionally, physically). Kuddos!!!

Posted by: J Wash | Sep 23, 2008 4:33:44 PM

This discussion really isn't about abortion issues, it's about the doctor as an actual human being, not some glorified superhuman demigod of goodness. Just as every patient deserves to be treated with respect and consideration, the doctor has the right to respectfully decline an action that violates their morals and values, as long as continuity of care is protected. I am pro-contraception but anti-abortion; it would be just as unethical for a institution or the government to insist I perform an ethically questionable procedure as it would be for me to use my authority as a medical professional to impose my personal ethical views upon the patient. At least in an area with multiple health avenues, it really is that simple.

Posted by: Jessica | Sep 23, 2008 4:43:55 PM

I agree with the previous notion that the intention was not to debate the ethics of referring/not referring patients to abortion providers specifically. It's just that the abortion issue illustrates the dilemma rather well. As an abortion counselor, I have seen a number of women who were denied any information outside of carrying to term. The relationship between a woman and her ob/gyn tends to transcend many other types of doctor/patient relationships. For many women, this is the person that is that bridge that brings their children into existence. Take this back to tribal peoples and midwives. The bewilderment and betrayal woman feel when reproached for breaching the subject of abortion is immense. I know first hand. I believe that no doctor should be required to perform procedures that are outside of his/her moral compass. Being that abortion is a sanctioned, regulated, and accepted to be safe in the scope of western medicine, providing a simple name or suggestion to google it is not asking the selling of souls. Transitioning into the firing of patients. Tomorrow I find myself in a not unfamiliar position of seeing a patient only months for the same procedure. There is also the case of the patient approaching double digits. One feels a sense of apathy at times, at others a renewed sense of motivation to dig deeper. Knowing one from the other, and when to pass it off seems to be the key. Thank you. Sorry so very long.

Posted by: Kory | Sep 23, 2008 7:17:01 PM

The right to have ANY procedure belongs to the patient. Regardless of the situation. The right to refuse a patient's request belongs to ANY medical professional. So it has been said... so it shall be. A woman's choice is hers to bear and a medical professional's choice is thiers and their's only. If the procedure is something you feel comfortable doing, then learn it and do it. It's not our decision to make as a whole, it belongs to the woman carrying the embryo. If a sterile procedure is not done aseptically, then she will accomplish the end result at any means, therefore compromising another "life" (and our tax money).

Posted by: Nicole | Sep 23, 2008 8:05:37 PM

I would propose that discussants separate the question of "abortion" from the question of whether doctors are required to perform any and all treatments requested by a patient. First of all, the doctor is a trained professional who does not have to follow the patient's wishes, since the patient's wishes are often misguided (med students: wait till you become doctors and your patients start demanding all kinds of treatments that you believe are not right for them).
Secondly, doctors have the right to refuse to perform elective procedures if they so choose. I am an orthopaedic surgeon, and I would certainly contend that I have the right to refuse to perform, let's say, a knee replacement (*an elective procedure*) on a patient for some reason I choose, even something as simple as "I don't get a good feeling about this patient's attitude toward me and how they would respond if any complications occurred." However, you must also be willing to verbalize this with the patient and be reasonable with them, including referring them to someone else for a second opinion. You also cannot refuse to perform surgeries based on discrimination. I have performed knee replacements on several HIV-positive individuals, for example. You simply take precautions during surgery to avoid needlestick injury, etc.

In a similar fashion, one should realize that the vast majority of abortions are entirely elective procedures. The separate issue of performing a procedure that is life-saving (not usually a situation that I as an orthopaedic surgeon encounter, but perhaps, a neurosurgeon seeing a patient with head trauma and impending brain herniation) or limb-saving (release of a compartment syndrome in my practice) when the physician is the only person available to perform that procedure leaves less room for the physician to refuse to perform the procedure. In a similar fashion, an abortion would not be considered an elective procedure in a life-threatening situation.

Most practicing physicians that I have discussed this with in two separate top-10 universities feel this way. I acknowledge that on the coasts where I have worked, there is a tendency toward a more liberal stance than in the midwest and southeast (where I grew up - but that was many years ago, also).

A doctor should also not refuse to perform emergency surgery on a patient based on financial reasons - I happily perform surgical fixation of unstable fractures for the uninsured patients who have been admitted to the trauma service at the private hospital where I now work. However, I also agree that non-urgent issues do not have to be dealt with in the private hospital in the acute situation and they can be referred for these non-urgent issues to a county facility that routinely cares for the uninsured and compensates their physicians on a different model - paying the doctor a set fee regardless of the patient's ability to pay (not the case at my institution).

Also, to make this more complicated, there is a difference between refusing to perform a procedure that you normally DO perform (for patient-specific reasons) than refusing to perform a procedure that you don't ever perform. I willingly perform knee replacements for HIV-positive patients as long as they meet the standard criteria I utilize in selecting any other patients for knee replacement (pre-operative X-rays and physical examination; adequate motivation to participate with rehabilitation program; functional capacity to withstand the stress of surgery; etc.)

As a further example, I would not perform a knee replacement on a patient who is an active drug abuser. However, this has nothing to do with my feelings about this person's choice to use illicit substances. Instead, it comes from my oath to do no harm to the patient, because a patient who is actively abusing drugs after a prosthetic joint replacement is likely to "seed" the prosthesis with infection, and end up with potentially limb-threatening infection, a situation far worse than the arthritis he started with. By doing a knee replacement, I would have directly placed him at high risk for a far worse condition than he began with.

The example of the psychiatrist threatening to "fire his patient" confuses the discussion because it is not related to the issue of performing a procedure that the physician feels is ethically un-performable.

Finally, I agree with the comment that not all physicians can perform all procedures (would you want an obstetrician to perform your knee replacement? or an orthopaedic surgeon to perform an abortion? Do all doctors have to be able to perform craniotomies???) Thus, I think people outside the medical field who want all medical students to learn how to do abortions are simply grossly misguided. This has no relationship to a person's beliefs about whether or not abortions should in general be performed. A physician who is trained as an obstetrician must acknowledge that if he is unwilling to perform an abortion in "any" situation, then he must not take up practice in an area where he would be faced with the situation of being the "only available doctor" if a life-threatening condition requiring abortion were to present itself.

Posted by: JTB | Sep 23, 2008 9:49:29 PM

"I am pro-contraception but anti-abortion; it would be just as unethical for a institution or the government to insist I perform an ethically questionable procedure as it would be for me to use my authority as a medical professional to impose my personal ethical views upon the patient."

I am pro-choice and this is the most valid comment I've heard regarding this issue. Well done.

Posted by: Joe | Sep 23, 2008 11:52:59 PM

Imprssive discussion. In some cases, it's personal choice of the doctor wants to do an abortion or not. I'm also seeing a mixed amount of hiding behind religion here, although it has not been brought up out onto the table for all to see. What happens if the patient's religion allows it and the doctor's doesn't? Or the other way around, the patient's religion won't allow it, but the doctor's religion does and also the doctor deems it necessary?

I'm especially targeting the Jewish religion, whose recognition of "when does life begin"? According to the Mishnah, life begins AT BIRTH. Now we have politicking going on in the nation with McCain saying "at conception". I'm sure you all have gone over this argument internally before expressing your views on if you would do an abortion or not.

Medicine is not always religion neutral. Some of you are affiliated with faith-based hospitals and have to follow guidelines there. I'm sure that's top priority. If the hospital doesn't allow it, even if you would do it, I'm sure you would refer the patient elsewhere.

I'm sure you all would do it if the baby is deformed (most likely you'll have patient consent), making this elective. The life of the mother is in danger (patient consent may or may not be given, depending upon status of patient and baby), and this is an emergency situation that must be done. The third and last option is the most controversial - rape. This one is a real problem, both religiously for Christians, doctor and patient and from a psychological standpoint for both. While I see "have a safe abortion" by all means, This category is the one that has the pharmacies up in arms, as well as the doctors. And this last one is the one that doctors use the oath to hide behind - "do no harm", instead if they won't do it and refer out to another.

These are the real roots of if you will perform an abortion or not. Isn't it? Religion is always in the way, sometimes, some ways, in some cases. Let's be honest about this. Right now, it's still a firestorm issue in the nation - the baby doctor in Kansas who will do it ANYTIME (including partial-birth abortions) for $5,000. Only to be contrasted with Palin having a Down's syndrome child when 87% of the nation will abort in this case. She was 44 and knew the risks were high.

Same thing happened in my extended family. Late pregnancy, a birth with Down's and other defects, but lived institutionalized for 12 years, then passing away from pnuemonia. We've discussed it for years afterwards whether it was paint fumes 12 years ago from painting the house, etc. It can tear a couple apart and in this case, it did. It just ate away at the marriage bit by bit. Just because our religion was silent on this issue. The family was split 50/50, so it was a difficult choice for the couple to make. Doctors advised abortion. But the mother said no. In this case, the doctors are in the clear. You sometimes have to look beyond the immediate decision and look at future family dynamics. It's not just the patient and doctor. That decision has future effects for a long, long time.

Posted by: JBS | Sep 24, 2008 4:53:51 AM

I think you make a reasonable point when it comes to "troublesome" patients. When it is a problem of personality we, as doctors or doctors-to-be, need to remember our ego needs to be the last thing that is engaged in our patient relationships.
The difference in this particular situation is that it isn't so much ego, as it is personal moral beliefs.
I think that as professionals we should be able to be "pro-choice," we should have the right to choose what procedures, scripts, advice we give based off our own moral codes. To suggest otherwise is not a model of mutuality but simply consumerism.
To expect a patient to acknowledge that I may have personal beliefs is a reasonable expectation. To think otherwise places me, the professional, in a position where I am simply a waiter.
I offer a selection of services with my personal suggestion and the customer chooses which they would like.
I believe that it is possible to provide comprehensive care and yet not place yourself in a situation where you are questioning if you broke your own moral codes.

Posted by: Ted | Sep 24, 2008 5:32:40 AM

I read your article with interest, and found it well balanced. Until I read the disclosure, which states you are 'uneasy' about the provision of abortion.

Your view point is one I hear often: women should be allowed the right to choose, but I don't want to help them if they choose abortion. Well who should? By training as a doctor you have taken on a responsibility to provide a service to your patients, and I don't think doctors should have a right to pick and choose between which services they provide. Particularly when they base their decision on what makes them feel good or 'uneasy'.

The number of doctors willing to perform abortions is dwindling in the UK as gynaecologists are allowed to 'opt out'. There is a serious concern that there will not be adequate provision in the future.

I think a lot of doctors opt out because it's not a very glamourous career choice and doesn't make great dinner party discussion, not because they've seriously considered the ethics and implications of their choice. I think it is very easy to just say no to taking part in this aspect of medicine, and much more difficult to really think about our duty to our patients and what role we should take in the provision of abortion. I think as a profession we need to stand up and take responsibility for all aspects of the care of our patients, even if we find it personally difficult.

Posted by: Lucy | Sep 24, 2008 10:09:15 AM

I am a medical student and I have been a staunch Catholic all my life. Somehow in the latter a physician is looked at as an assassin to be hired hence even one that refers to the other has somehow taken part in the assassination. It scares me to see practising Catholic physicians "fire" a patient who is brought hours later to the UTH in a body bag. Suicide! she swallowed an overdose of drug A.
What will I do when my turn comes? Will I fire when I know that hours later the patient has 25% chance that they'll be brot in a bodybag?

Posted by: Dien | Sep 24, 2008 10:48:20 AM

Many people may think that doctors should satisfy what the patients ask them to do as part of the service, even if it means abortion. I do agree with the "service" we should provide, but i personally feel that doctors have an obligation both to provide service AND to be moral. To me, morality seems to be part of my idea of a doctor (sadly, not everybody's) It is probably "not our call" to decide who lives or die.

Posted by: workaholic888 | Sep 24, 2008 11:17:24 AM

Congratulations for your article. I'm an Orthopaedic surgery second year resident from Mexico, but I'm also a physician, and I've worked one entire year in the country side doing my social service, besides, controversy have been aroused about legal abortions in Mexico City.
As background, being part of a strongly catholic society you can imagine that abortion is seen like a devilish thing. The fact is that in Mexico, as it is in many developing countries, abortions ocurrs ilegally everyday.
According to the World Health Organization the deaths produced by clandestine abortions have raised from 500,000 to 585,000. More than 98% of these occur in the Third World. Complications include bleeding, deadly generalized infections, chronic infections and inferility. The previous complications are cause to spend excesive economical and human resources that can be used in another health problems. In Mexico there are nearly 800,000 clandestine abortions per year. The lower the socioeconomical status is, the worse the prognosis becomes. Between 13 and 20% of all the maternal mortality comes from complications of clandestine abortions, and in some places one of each two of these deaths are due to clandestinity. The chances to die after a non-legal abortion are 300 higher than if the procedure is performed in ideal conditions.
The election is simple: by providing sexual education, contraception, family planning and safe abortions maternal deaths and orphanhood will decrease. Abortion is never a solution, but a legal abortion is always better than an illegal one, and supporting the first we're improving the public health of our communities.

Posted by: Efrain Farias | Sep 24, 2008 12:27:57 PM

The problem with modern day medicine is that the doctors have come to be regarded more as vending machines than knowledge banks to be tapped into. As has been stated multiple times above, patients expect to get any procedure that they want done to them. The problem for professionals is what to do when our beliefs contradict what the patient wants done.

A really good supervisor I once had told me that no matter what I personally believed, it wasn't fair to the patient to force them to go elsewhere. Unless I knew someone closeby who could provide the same service at the same or less cost to the patient, why should I decline lending my knowledge to the patient and not preform the procedure.

The thing that really bugs me though (that really only furthers the vending machine argument) is that there are several legal cases where the patient has successfully sued the doctor for not providing a service - even if the doctor suggested the patient go elsewhere and that it was against the doctor's beliefs. The law doesn't give us any backing because we are the ones in the position of power and the patient is the vulnerable one.

Personally, if a patient asked me for an abortion, I would sit down and talk to her asking her why she wanted it and had she considered all the options (medical, surgical, putting the child up for adoption - though this is practically unheard of in Australia). I would then ask her to go home and to come back tomorrow and tell me her decision giving her time to make an autonomous choice. I'm not anti abortion or pro life... I just agree with my supervisor of past - if we were given knowledge to share it and then refuse to do so, we are going against what we were taught.

Posted by: Aashish | Sep 24, 2008 12:55:00 PM

It is just simply a matter of a patient coming to us for help. Being a Physician/Surgeon for over 25 years, I have read countless articles where doctors, especially the recent graduates, feel that they are the final decision makers in a patients care. And if they should be anti-abortion in practice, they feel this self entitlement to "play god" and make the decision for the patient is solely theirs. Remeber, patients come to us for help (and I don't mean patients who doctor hunt in order to maintain their addiction to opiods, etc). There asking us to help them should not be based on our feelings as to whether or not we agree with the concept of abortion. No matter how much we feel our knowledge of this topic is superior to the patients need for this treatment, there is no way for us to know and fully understand the facts behind this patients history. Does the oath of "first do no harm" apply to a patient seeking the end of their pregnancy? Or is it more an issue of hiding behind moral values because we do not feel comfortable or completely capable of performing such a procedure? In any procedure, any caregiver will have doubts as to whether the outcome of the procedure is going to go as well as possible, or even begin to second guess hoping that the procedure did go well and will not end up with any complications. This second point regarding whether or not the procedure will end up ideally with no complications is an issue that all physicians with experience, whether it is removing some ganglion that has attached itself to a carpal vessel that needed some repair suturing all the way up to whether or not the cardiac patient with the tumor inside the pericardial sac was fully extricated or not.

The point being whether or not a patient is requesting a Dermotologist for the removal of a mole on their face, or to an OBGYN for an abortion. The patient came to the physician in search of help. Unless being a Doctor entitles us to practice the work of god, our true goal is to help the patient, is it not???

Posted by: Jonas | Sep 24, 2008 4:37:24 PM


Like usual , the problem lies on the foundation. The policies created by
the super senior doctors and also the selfish money-minded lawmakers as well.

They are being too unspiritually scientific , which eventually
will bring ultimate disaster to the human race.

We have to stop acting like a machine. We are not robotic doctors.
We are human doctors with heart, human sense, moral and ethics.

The words like autonomy has its limit.

Please don't let your mind get clouded by the
ever-evolving lifestyle trend, my fellow friends.

Evidence-based Medicine need to be reviewed from time to time. Not everything
can be proved and yet we still believe in it.

My messsage is very simple. Everyting has its limit.
To certain extent, it is beneficient. But we can't go on feeding these selfish, self-centred individuals.
They are parasites.

Posted by: r9genius | Sep 24, 2008 11:56:15 PM

Wow..AboRtion..im a 1st year medical school.
And this is my recent continuous exam question:
A female patient(client) came to you and asking you to do an abortion.she is 18 years old.However,her boyfriend try to be responsible by telling that he will marry her.(sort of.."im sorry,but i"ll marry you)
a)Will you tell her request to her parent?
b)Will you tell her condition or referring her case to any religous department around?
c)Will you do the abortion?

It is told that the same question might be ask to 4th and 5th year student.Or even to the postgraduate student!

Posted by: Ace | Sep 25, 2008 9:17:33 PM

GET over it. This subject is ancient...We have evolved...Abotion is legal, women have a right to choose, Why can't people leave it alone???!!!! We don't need to impose our moralistic views on the woman who has to make this decision. Isn't there some more progrssive medical subject to ponder at this date in time.

Posted by: Melody | Sep 25, 2008 10:33:14 PM

Thanks for your comments, everyone.

Some of the critical comments responding to my entry suggested it was inappropriate for me to draw similarities between firing psych patients because you cannot help them any more and referring patients to another provider if you are uncomfortable not performing a procedure (namely, abortion). At the core of my argument is my concern that patients get the best care available, and that they should seek said care from the best individual able to provide it. Most of the rest took the opportunity to voice their own opinions about abortion in medicine. Some of my critics argue that all doctors should be willing to provide abortions (that's not going to happen). One reader questioned my disclosure that I was 'uneasy' with providing abortions myself. I'm not sure how to respond to that... Finally, one reader has argued that we must get over the fact that the country is divided about abortion. I would argue that adopting this perspective would effectively invalidate half of your patients' beliefs.

Posted by: thomas | Sep 27, 2008 10:01:16 AM

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