Obstetrics and gynecology is a field of medicine that is no stranger to controversial topics — abortion, sexuality, contraception, circumcision, transgender issues and even breastfeeding are among issues we deal with on a daily basis.
However, I recently witnessed a heated debate in a midwives’ online clinical discussion group after some members became upset that certain sensitive and controversial topics were covered in the required reading for recertification.
These clinicians feel if they do not believe in something, they should not have to discuss it with patients and do not need to know about it. But I find it rare not to discuss a difficult or sensitive topic during the course of a day at the office.
The online discussion made me think about how often our personal beliefs affect the care we provide patients. I know a physician who is devoutly Catholic. When I worked with her, she was employed by a clinic that served a very poor community, and the majority of her patients were migrant farm-workers. The only form of contraception this physician would discuss with patients was natural family planning. She did not perform tubal ligations.
While I absolutely respected her beliefs and admired her tenacity, I thought she would have been wiser to seek employment in a Catholic institution, where the philosophy of practice matched her own beliefs.
In my opinion, providers who do not believe in abortion should not be forced to counsel patients regarding that option. However, I do think that patients should be informed upfront of a clinician’s beliefs or a practice’s ideology, and given the option to be referred elsewhere for complete pregnancy options counseling.
Everyone is entitled to his or her own beliefs, but should we be imposing our personal values on patients? In terms of continuing education, is it wise to limiting ourselves to only topics that we see on a regular basis and are comfortable with?
I think that there is value in expanding our knowledge base with new research on unfamiliar and possibly sensitive topics — the appropriate care of transgendered clients, for example – especially if we don’t have direct clinical experience in these situations..
I do not know where most of my patients’ beliefs lie in regards to many sensitive topics, but I do know that I will try to provide the most comprehensive, unbiased care possible regardless of their beliefs.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.