ethics question womens choice in ob/gyn

[Leukocyte]

I realize that some of my view points might be considered offensive. If this is the case, I apologize - it is not my intent. The other side is argued so often and so strongly, that I guess I felt the need to "compensate."

What the hell dude?!

If a patient has the "right" to refuse you (for whatever reason/excuse/opinion she might have), then YOU have the right to your opinions/reasons/excuses.

Why in God's name did you apologize for?! Your female patient did not apologize to you when she refused you, did she?

This is a free country, and you have the right to free speech...If someone does not agree with you, then SCREW him/her.

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[sarcopenia]

Leukocyte,

Thanks for your post ... it's nice to know I'm not the "only one" who thinks this way.

As for the "free country" bit, I'm not sure where you are from, but here in Canada, that term is debatable. [edit for grammar]

These crazy "Human Rights Commissions" (which some have called human wrongs commissions) are using their sweeping powers to force doctors to "check their religious and/or moral views at the door" and basically do whatever the patient wants, even if this means referring them for prophylactic appendectomy, or amputating a healthy limb. In practice, it might not go THAT far, but the implications are there.

Put it this way, people in my country have to be careful about posting on forums like this ... these commissions have been known to (and indeed, have ADMITTED to) anonymously posting hateful / controversial items on boards like this and then subpeonaing (sp?) all sorts of identifying information from the site owners, etc.

Sorry for the hijack.

Also, I hear you about "politics in clinical medicine." I have some research experience as well, and every so often, I fantasize about using my MD to become a principal investigator instead. As a scientist, money is not as plentiful, and the "publish of perish" threat hangs over one's head. But at least there is free thought and free speech. Nobody cares if a researcher is "quirky" or controversial...

 

[Leukocyte]

Leukocyte,

Thanks for your post ... it's nice to know I'm not the "only one" who thinks this way.

As for the "free country" bit, I'm not sure where you are from, but here in Canada, that term is debatable. [edit for grammar]

These crazy "Human Rights Commissions" (which some have called human wrongs commissions) are using their sweeping powers to force doctors to "check their religious and/or moral views at the door" and basically do whatever the patient wants, even if this means referring them for prophylactic appendectomy, or amputating a healthy limb. In practice, it might not go THAT far, but the implications are there.

Wait, wait, wait....are you 'effin serious?!!!! Canada is like that? Our neighbour to the north? The country we always get compared to like it is our older brother...with phrases like, "why don't you just be like Canada?"
Really? Wow. I guess "America" is the best country in the world like they say. Proud to be an American, man! Go USA. I love this country man...and yes, I love this president, no matter what anybody or the Dixie Chicks think (however they are HOT, by the way).

Why then do people keep f'cken comparing us to Canada? Does Micheal Moore know about this?

USA, USA, USA, USA.....

http://www.youtube.com/watch?v=Llgunu-FlX4&feature=related

http://www.youtube.com/watch?v=gc0JveFySB4&feature=related Blame Canada!

 

[Farmer Jane]

Both of these statements are absurd.

"When a male gyn doctor is prepared to talk to ME whilst HE is naked in stirrups with something shoved up his bum as I ( the woman patient ) am fully clothed then I will allow him to treat me"

No female physician would talk to a patient while the patient is clothed and the physician is receiving an exam.

"Why as a woman, should I be expected to be intimately examined by a muslim male doctor when his own wife and daughters wear a veil and full body clothing ? How can this doctor treat me with respect as a woman when I am doing something that he obviously would disapprove of his own female family members doing ?"

Muslim male doctors do not disapprove of their female family members receiving medical care.

I think patients have the right to choose their doctor within reason. If the doctor of the patient's preference is not available, then the patient may choose to accept care from another doctor or to refuse care. I don't think providers need to bend over backwards to accommodate every whim.

 

[fexhzzzzhfi]

firstly everybody is entitles to an opinion even if another person does not disagree with it, there is no need to apologise for your opinion if that is your opinion, agree to disagee, I'm not sure about the swearing even if it's couched as F******* and the spin off of that is that surely you should respect a patients opinion even if it is not yours ??

more questions I'd like to ask :

a) does anyone know of a gynaecologist who's wife/daughter has been examined by groups of medical students ?

b) how do you view a male gynaecologist treating his mother, daughter/sister ?

c) how do you view a female gynaecologist treating her mother/daughter/sister

many thanks

L

 

[exPCM]

I like this thread because I am a firm believer that OB/GYN rotations in medical school should be optional and this thread reinforces my belief. There is obviously a female preference among some patients and providers in the OB/GYN world. I do not think medical students should be forced to do rotations where they are allowed to be discriminated against. Hence I hope we will begin to see OB/GYN rotations placed in the optional category at more and more schools in the coming years.

 

[smq123]

b) how do you view a male gynaecologist treating his mother, daughter/sister ?

c) how do you view a female gynaecologist treating her mother/daughter/sister

Doctors shouldn't treat their own relatives. Why would gender make a difference in that?

I like this thread because I am a firm believer that OB/GYN rotations in medical school should be optional and this thread reinforces my belief. There is obviously a female preference among some patients and providers in the OB/GYN world. I do not think medical students should be forced to do rotations where they are allowed to be discriminated against. Hence I hope we will begin to see OB/GYN rotations placed in the optional category at more and more schools in the coming years.

Why on earth should OB/gyn rotations be optional?

If there is truly discrimination against medical students (particularly males), then that means that the atmosphere of the specialty needs to be changed....and that the solution does NOT lie in making the rotation optional.

I honestly feel that ALL physicians should have exposure to OB, and I don't believe that patients should discriminate based on gender. Hopefully, more of my fellow residents will think like that as well.

I feel like there are things to be learned in the OB rotation, even for people who aren't going into that field. It is astonishing, even as a medical student, to see how many Emergency Medicine and Internal Medicine providers are unable (or unwilling) to do a basic speculum and pelvic exam. (Really, it's not that hard - heck, even I can do it!)

It's also sad to see how terrified otherwise good physicians become when they're presented with a pregnant patient. (She's not made out of glass - she won't break.)

You could argue that you could learn these skills on other rotations - like family med or emergency med. However, if that were true, than why can't ER and IM residents do these basic exams?!

Finally, there were some patients on psych, family med, and surgery who refused to have a medical student in the room. There were patients who were reluctant to have RESIDENTS in the room. Does that mean that these rotations should be made optional as well?

I'm sorry, but your post didn't make a lot of sense to me.

 

[exPCM]

I honestly feel that ALL physicians should have exposure to OB, and I don't believe that patients should discriminate based on gender. Hopefully, more of my fellow residents will think like that as well.

You could argue that you could learn these skills on other rotations - like family med or emergency med. However, if that were true, than why can't ER and IM residents do these basic exams?!

Yes, the students can learn some basic skills on FP or ER rotations if they are receiving proper training. The ER residents and most of the IM residents where I trained actually could perform basic exams.

At many schools, anesthesiology, ophthalmology, pathology, urology, and orthopedic rotations are not mandatory. I think these specialties are as important as OB. I do not see why OB should be given more exalted status than these specialties and be made a mandatory rotation. How many psychiatrists, ophthalmologists, anesthesiologists, pathologists, neurologists, cardiologists, etc. are ever going to do a pelvic exam in their practice? I do not see why students are forced to do OB rotations which permit discrimination on a routine basis. On psych/IM/other rotations you typically see infrequent rather than routine exclusion of medical students.

 

[smq123]

At many schools, anesthesiology, ophthalmology, pathology, urology, and orthopedic rotations are not mandatory. I think these specialties are as important as OB. I do not see why OB should be given more exalted status than these specialties and be made a mandatory rotation.

I think the reason why OB is a "required" rotation, where as the others that you mentioned are not, is that the mandatory rotations are supposed to expose students to either a) very routine, basic medical conditions that all doctors should be familiar with, or b) emergent conditions that need medical attention immediately.

There are certainly a lot of emergencies in OB/gyn that people should learn how to recognize. Placental abruption, chorioamnionitis, impending delivery, ovarian torsion, etc.

There are few emergencies in ortho, urology, and ophtho. (And most of the emergencies in ortho and uro are fairly easy to recognize.) Any emergencies in anesthesia are likely to happen when an anesthesiologist is there anyway. And there are NO emergencies in pathology.

How many psychiatrists, ophthalmologists, anesthesiologists, pathologists, neurologists, cardiologists, etc. are ever going to do a pelvic exam in their practice?

How many prostate exams am I going to do as an OB/gyn? Does that mean I should be exempt from doing any during my ER rotation? How many 7 year old children am I going to take care of as an OB/gyn? Does that mean I should have been exempt from my peds rotation? (I hated my peds rotation, but I still think I should have done it.)

How many exams of ANY kind does the average pathologist do? None. Does that mean that 4th years who are going to go into pathology should be exempt from any clinical rotations during their 4th year?

On psych/IM/other rotations you typically see infrequent rather than routine exclusion of medical students.

The exclusion of medical students is something that needs to be changed - but it is NOT something that defines the field. During my rotation, patient requests to have students out of the room were always met with "Well, this is a teaching hospital, and they need to learn." It depends on how pro-active the clerkship director is willing to be. It doesn't mean that it's a bad field that students shouldn't have to learn - it just means that more clerkship directors across the country need to take more measures to ensure that ALL students (regardless of gender) get a good learning experience.

 

[exPCM]

The GAMMS (Go Away Male Medical Student) mentality is well established in the UK and becoming more the norm in US OB rotations as well.
see: http://student.bmj.com/issues/06/03/careers/112.php
Only 0.2% of male physicians in the UK are going into OB/GYN and we will see a similiar percentage in the US very soon given present trends.

 

[fexhzzzzhfi]

the rational and polite replies

I ask these questions out of my interest in the psychological arena of ob/gyn and it's conceptions and mis-conceptions

I would be interested in further replies and students thoughts on my questions,

for example, do you view a male gynaecologist examining his daughter or sister in ther same way you would a male ENT doc syringing his daughter or sister's ear ?

I think the other question is also relevent from that point of view - has anyone seen a ob/gyn doctor's wife/sister/daughter being examined by student doctors ? It's a question I'd ask if I was studying the field

x

L

 

[Global Disrobal]

I think this topic has been beaten to a bloody pulp Can we move on to a new topic please!

Where are we going with this? "Have you seen an OB/GYN perform a Pap on his mom, while the medical student stood there, watched, and commented on the OB/GYN's daughter..." Give me a break and lets use up this forum for more fruitful discussions especially with the interviews approaching.

 

[shamrock13]

the rational and polite replies

I think the other question is also relevent from that point of view - has anyone seen a ob/gyn doctor's wife/sister/daughter being examined by student doctors ? It's a question I'd ask if I was studying the field

L

1. My grandmother has allowed medical students to perform pelvic exams as part of her gynecologic care. When presented appropriately most people understand that rampant medical students are not running around with speculums looking for vaginal exams, that they are there to learn and will be supervised at all times by at the very least a senior resident.

2. I have taught many many male medical students with no problems leading them through speculum exams... I have also had female medical students turned away. It truly depends on the comfort level of the patient.

3. Womens health presents significantly different challenges than presented in many other fields... pregnancy, childbirth, as well as social issues such as domestic violence. THIS is why it is a core rotation, because EVERYONE should understand how and when physiology of women changes.

 

[ici_cute]

do you view a male gynaecologist examining his daughter or sister in ther same way you would a male ENT doc syringing his daughter or sister's ear ?

What do you think? This is getting funny

Originally Posted by fexhzzzzhfi View Post
b) how do you view a male gynaecologist treating his mother, daughter/sister ?

c) how do you view a female gynaecologist treating her mother/daughter/sister

Doctors shouldn't treat their own relatives. Why would gender make a difference in that?

Basic medical ethics...where ever you go. Doctors shouldn't treat their own relatives, full stop.
hmm...would this answer later leads to...do you view a male FP prescribing cough syrup after examining the throat the same way a male gynae giving prescribing vaginal cream after a vaginal examination of their own daughter? question?

LOL

 

[drnzp]

Surgery residents can tell you about all sorts of patients that they have had that came in with very embarrassing chief complaints - "light bulb in the rectum," "vibrator stuck in esophagus" etc. Emergency Medicine guys will tell you all sorts of equally embarrassing situations that they face almost daily.

And yet, NO ONE says, "Well, that surgery resident removing that light bulb from that woman's rectum had better be a female!" They seem to limit this only to GYN and breast surgery....but what makes them so very different?

My guess is that people who put light bulbs up their rectums are the people who have no preference for male or female. FWIW google Graham Reeves and see why some women insist on only having a female gyn.

 

[smq123]

FWIW google Graham Reeves and see why some women insist on only having a female gyn.

Like I said before, women who insist on only having female GYNs, and cite examples like Graeme Reeves to "defend" that choice, are almost certainly subconsciously sexualizing the encounter. Or else they are letting their biases and assumptions unduly influence their decisions.

Who is to say that a FEMALE lesbian OB/gyn could not sexually molest a female patient? Who is to say that a male urologist could not sexually molest a female patient? Why do male OB/gyns get excessively singled out?

Furthermore, Graeme Reeves is a clear exception in that he needs professional help to manage his numerous personality disorders - in other words, he molested women because he has severe psychiatric issues, and NOT because he is a male OB/gyn. He would be molesting patients even if he were a cardiologist. He is no reason to refuse care from a male OB/gyn.

 

[drnzp]

You've made some valid points.
I'm not saying it's wrong or right if women only want a female gyn, but it amazes me that some male Drs seem to have no empathy for how they feel. That's what worries me.

 

[smq123]

I'm not saying it's wrong or right if women only want a female gyn, but it amazes me that some male Drs seem to have no empathy for how they feel. That's what worries me.

Ummm....

This is the kind of attitude that some women have, and I find it VERY disturbing.

Female GYNs are NOT necessarily "more empathetic" or "more compassionate."

I once observed a female GYN do a pap smear. It was extremely disturbing - the patient was so uncomfortable that she started to cry. To "soothe" the patient, the female gyn started stroking the inside of the patient's thigh, right next to the groin.

When (surprise, surprise!) the patient was NOT soothed, and began to sob harder, the female gyn said in a stern voice, "Stop crying. It's not that uncomfortable. STOP crying!"

Some people, regardless of their gender, are just not very empathetic or kind. Some "male Drs seem to have no empathy," but some female doctors don't have any empathy either!

So many women will tell you that gender discrimination against females is wrong, but then why do they practice gender discrimination against males? By assuming that a male gyn is not going to be kind, understanding, and compassionate, they're letting their own assumptions get in the way of reasoning and logic. That's a pretty hypocritical (and very disturbing) attitude.

 

[drnzp]

I came to the conclusion that some male DRs have no empathy after reading Luekocyte's rant.
If you want to give examples I'll give you my own. I've had two c sections. One performed by a male OB with a team of male:female ratio 50:50. And one performed by an all female team. With the male:female team it was impersonal, they were talking about their holidays and it was as if I wasn't even there. Oh except for when I felt violently ill from the morphine then male anesthetist started yelling at me because I nearly pulled the pulse oximeter off. At the second c section I once again felt violently ill. This time the young female anesthetist actually seemed to feel sorry for me and tried her best to stop the nausea while a nurse gave me a wet cloth for my forehead. Also they actually seem excited by the fact that I was giving birth and congratulated us. Of course it is pointless giving examples but I'll feel comfortable about it when medical students themselves feel comfortable about intimate exams.http://www.mja.com.au/public/issues/189_05_010908/out11362_fm.html

 

[smq123]

If you want to give examples I'll give you my own.

We could match anecdote for anecdote. But that's all they are - anecdotes. These are NOT meant to be blanket statements.

Some male doctors have zero empathy....but some female doctors are equally brusque and harsh. And some male doctors have LOTS of empathy - one of the OB residents that has the best bedside manner with women in labor is a man. He had so much sympathy and compassion for them, because HE had helped his wife through the delivery of their 3 children. <shrug> It all depends on the PERSON, and not on the GENDER.

Of course it is pointless giving examples but I'll feel comfortable about it when medical students themselves feel comfortable about intimate exams.http://www.mja.com.au/public/issues/189_05_010908/out11362_fm.html

What are you trying to prove with that article?

I would NEVER feel comfortable examining a fellow medical student - and I am going into OB/gyn! Nor would I want to be examined by a fellow medical student, male or female!

A month or so after I decided to go into OB/gyn, my sister got married. My sister is also a physician, although in IM. Her mother-in-law jokingly asked me that, if my sister got pregnant, would I want to deliver that baby. Before I could even open my mouth to answer, my sister yelled, "NO! She's not going anywhere near me! We're sisters, and I am NOT letting her see my private parts!"

Sometimes, when it comes to intimate exams, gender just doesn't play a role.

 

[nic23]

What do you make of this?
http://pmj.bmj.com/cgi/content/full/84/992/318

 

[pillowhead]

\

A month or so after I decided to go into OB/gyn, my sister got married. My sister is also a physician, although in IM. Her mother-in-law jokingly asked me that, if my sister got pregnant, would I want to deliver that baby. Before I could even open my mouth to answer, my sister yelled, "NO! She's not going anywhere near me! We're sisters, and I am NOT letting her see my private parts!"

Sometimes, when it comes to intimate exams, gender just doesn't play a role.

When my sister gave birth (she is not a physician), she and her husband wanted me in the room for the entire labor AND delivery. I had just graduated from med school at the time. Now I'm a PGY2 and she's due in April and they both want me in the room again but I may be on call. I guess we're all just different when it comes to modesty stuff.

I, on the other hand, have already told my non-physician husband that he can stand at my shoulders and watch the delivery from up there when i give birth. he actually thanked me and seemed relieved.

FWIW, my ob/gyn is male and he is AWESOME. I've found that once you become a doctor, it's really hard to find a doctor to relate to that still treats you like a patient. When you're a patient, you want to be treated with empathy and you still need a doctor to explain things to you but many many doctors seem to have a hard time dealing with their doctor-patients and assume that you shouldn't have any questions. My ob/gyn is super empathetic, really easy to talk to, always makes sure my questions are answered, and is speedy and as painless as possible with the physical exam. I have been to several female gyns in my life and this guy has by far been my favorite. For a small subset of women, like rape or abuse victims, I can understand wanting a female obgyn. For the vast majority of women though, I think they need to understand how completely UNsexual the physical exam is for physicians and that empathy is absolutely not a character trait that one gender can claim over the other.

 

[Kubed]

The GAMMS (Go Away Male Medical Student) mentality is well established in the UK and becoming more the norm in US OB rotations as well.
see: http://student.bmj.com/issues/06/03/careers/112.php
Only 0.2% of male physicians in the UK are going into OB/GYN and we will see a similiar percentage in the US very soon given present trends.

I know i'm behind the times, but I loved that article. Thanks for posting!

 

[boyob]

Well I couldn't get through all the posts but as a male ob gyn I have no problem at least putting in my opinion. Honestly I hate it when people short order health care....this is not picking an ipod color. The standard is for a competent MD period. If anyone said we should have a form in case you didn't want a black doctor, or a gay doctor, or how about how you feel about abortion.... people would be pissed. In fact if twenty years ago they had a form that asked if you wanted a female or male it would be fought tooth and nail as discrimination. That being said if you have such a preference the burden is on the pt to secure this not the system.

 

[civic4982]

I agree with the other posters that allowing a patient to discriminate based upon the sex of her doctor is unacceptable.

The same question could be asked if it was ok for a patient to request that only a male surgeon perform her procedure.

The other examples of requests by race/sexual orientation/etc. are valid in this discussion.

If the patient doesn't like the care they're receiving or the sex of the person they're receiving it from then they are free to refuse care completely. Our institutions are in place to give them the best medical care possible. If they have an issue with the details then send them out the door...

 

[GooGooGaGa]

from a personal point of view, for ob/gyn care, it really depends i believe, on 'bedside manners'. for example, when i was younger, i opted usually for a female doctor, until i needed some uncomfortable procedure done. i felt she really jabbed me with that needle, so after that i opted for older males. they worked out fine. but then, once i got pregnant, i located a group of female midwives (yes, i wanted that birthing hottub and bouncey ball instead of sterile hospital environment; at 8 centimeters i did want the epidural though). i was comfortable with the ladies in my condition, very huge, hungry, moody mom to be. they knew all the little comforts that pregos want. they had the personal experience. i did, however, end up with a c-section, performed by a male surgeon. the midwife held my hand along with my husband, so comfort level along with meds worked out well.

 

[RGMSU]

It's always interesting when this issue comes up. If females can get into urology and practice on males, then males can get into OBGYN and practice on females. Simple as that. Anything different is called reverse discrimination. Anybody who knows anything about medical training knows that you quickly lose your sensitivities about genitalia and so on as soon as you walk into gross lab at med school the first time and see perineum male and female prosections. Grow up people. I am a male considering OBGYN. I have nothing but the best intentions, and I would hope patients would evaluate me based on abilities as a physician rather than what's between my legs. Not sure how the latter has anything to do with it.

 

[RGMSU]

I like this thread because I am a firm believer that OB/GYN rotations in medical school should be optional and this thread reinforces my belief. There is obviously a female preference among some patients and providers in the OB/GYN world. I do not think medical students should be forced to do rotations where they are allowed to be discriminated against. Hence I hope we will begin to see OB/GYN rotations placed in the optional category at more and more schools in the coming years.

OBGYN rotations optional? Are you serious? That would really improve the quality of American medical education wouldn't it? A doctor - ANY DOCTOR - who doesn't know how to deliver a baby? Give me a freaking break man.

 

[RGMSU]

Everybody has the right to choose their own physician. I believe most women are mature enough to understand that a male physician is perfectly capable of addressing OBGYN medical concerns in a professional and compassionate manner. The women who think the whole world is trying to take advantage of them probably have some underlying issues that they need to address. And no, I certainly don't consider it an ethics question. It is the patient's responsibility to choose a provider. Not anybody else's responsibility to discern that or help them discern it. We should really be glad in America that ANYBODY goes into OBGYN, considering the malpractice trends. That's what I would be more concerned about than the gender trends of the field. And contrary to popular opinion, I've heard of some men who feel a bit squeamish about having the legs in the stirrups for a female urologist, so it's a two way street. If we were discussing discriminating against women in any medical field, I'm sure that would be much more unacceptable than discriminating against men though wouldn't it?

 

[Nancy]

How do med schools handle training to do abortions, speaking of ethics questions?