Should doctors look to patients for validation of their ideals?

Whats Important To You?

One of my proudest moments as a physician occurred years after I stopped practicing.

At a holiday dinner table a cousin commented that had I faced infertility, I would have opted for adoption over complex medical treatment just as she had done. I was surprised since nothing could be further from the truth; I would have aggressively pursued every medical option.

It was her turn to be surprised since she remembered I was one of the very few doctors supported her decision to forgo infertility treatment without even trying. How, she asked, could I have kept my desires out of our discussion? Because, I answered, it is the job of a physician to support a patient’s choices, not to seek validation by having the patient make the physician’s preferred treatment choice.

It is the provider’s ethical obligation to support the patient’s goals not to substitute their own values — midwives and lactation consultants included.

I believe, as matter of both medical and personal ethics, that doctors should never look to patients for validation of their own ideals. It is the doctor’s legal and medical obligation to support the patient’s goals not to substitute his or her own values.

If a Jehovah’s Witness wants to decline blood transfusions, I have no right to insist that she accept them even though I would eagerly choose them if the need arose. If a patient wants to decline a life saving C-section for her baby, I have no right to insist that she undergo surgery even though I would accept immediately. If a patients wishes to treat her cancer with herbs and supplements instead of chemotherapy, I have no right to insist that she accept chemotherapy in favor of a course of action I know to be worthless.

I suspect most doctors would agree with my views; that’s what we are taught. In contrast, midwives and lactation consultants seem to think that is their job to pressure patients to mirror the choices that midwives and lactation consultants would make. They rationalize it by telling themselves that “normal birth” and breastfeeding are best; midwives and lactation consultants therefore imagine that they have the patient’s best interests at heart but not only is that deeply paternalistic; it is entirely untrue.

As Atul Gawande Tweeted yesterday in reference to new cancer treatments:

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The seriously ill have goals for their care besides just survival. When we don’t ask what they are (what tradeoffs they’d make & not make; what quality of life is unacceptable) and tune care accordingly, incl new treatments, the result is suffering.

This also applies to pregnant women. Many have goals for their care that may not include vaginal birth, refusing pain relief and avoiding interventions. Yet many midwives ignore those goals. They “know” that unmedicated vaginal birth is “best” and they force women into accepting it, going as far as creating promotional campaigns for so called normal birth.

It’s not that they don’t understand the concept of separating the patient’s interest from the provider’s interest. They have no trouble counseling women to ignore doctors’ recommendations on C-section, interventions and the advisability of homebirth, claiming that “birth rights are human rights” and often insinuating that doctors’ push interventions for their own benefit. Nonetheless, they appear entirely blind to the concept that birth rights include the right to a timely epidural as soon as a woman asks, the right to request term induction even if there is no medical reason and the right to a C-section on maternal request.

Many midwives are simply incapable of separating the patient’s interest from their interests. Their treatments recommendations for others reflect what they would choose for themselves; they need patients to mirror their preference for unmedicated vaginal birth back to them and they force them to do so. They often insist that patients who don’t agree aren’t properly informed or adequately supported.

The same midwives who would react (appropriately) with horror at a doctor forcing a C-section on a woman who has declined have no trouble forcing an unmedicated vaginal birth on a woman who doesn’t want one. That’s unethical.

Lactation professionals are, if anything, worse. La Leche League won’t even allow you to become a volunteer leader unless you have breastfed a baby for 9 months. Lactation consultants exist for the sole purpose of promoting breastfeeding; they promote a process independent of outcome even though the benefits of that process are trivial and side effects are common. It’s not for the good of babies. Breastfeeding doubles the risk of neonatal hospital readmission, increases the risk of neonatal hypernatremic dehydration and hypoglycemia and is the leading cause (90% of cases) of jaundice induced brain damage. Lactation consultants pressure women to mirror their own feeding choice back to them without regard to a mother’s personal needs, desires and priorities. That’s unethical

The bottom line is that patients don’t exist to support providers; providers exist to support patients whether or not providers approve of patients’ choices. It’s long past time for midwives and lactation consultants to recognize this.

  • Lisa
  • Eater of Worlds

    Well, I guess we’ll just stop men from being OB/GYNs until they start bleeding every month for close to 20 years before they become a doctor, eh?

  • KeeperOfTheBooks

    Thank you. 🙂

  • NoLongerCrunching

    I need advice. How would you handle it if you were an LC in a “Baby Friendly” institution where you could be written up or lose your job over supporting a patient’s choices?

    Yesterday I told a patient “as an LC in this hospital I’m supposed to promote exclusive breastfeeding. But as a mother, and in my professional experience, I believe you when you say your baby is hungry.” Then I told her about the Fed is Best foundation.

    Her first baby had lost >10%, she was pumping every TWO hours in the first week and getting only about 20% of what her baby needed, and her breasts did not feel like they had tons of glandular tissue. She also had other risk factors for delayed onset of milk production. I told her I wasn’t really supposed to give her information about supplementing, but I just can’t bear to hear about situations like she and her first baby experienced. It doesn’t even support breastfeeding to let a baby lose that much weight.

    But today my stomach is in knots because if anyone gets wind of me saying those things, it would probably put me in serious jeopardy professionally. My family would be in real trouble if I lost my job. I’ve already gotten a bad reputation for recommending supplementation when not officially “medically necessary.” It’s surreal that babies are allowed to get to the point that they’re dehydrated before we intervene. It’s horrifying. How do you think I should handle this kind of thing?

    Edit: the prevailing thought is that allowing a baby to “be exposed to formula” is equivalent to being blasé about diabetic patients ordering a pile of jelly beans for breakfast. (Literal words from a coworker.)

    • Empress of the Iguana People

      Your coworker is batty.

    • Cartman36

      I think that the best thing you can do is be very detailed in your charting and notes. That way if you are reprimanded you can say, look, this patient lost X amount of weight, I was concerned about dehydration because of X. You are making a reasonable judgement call as a medical professional and unless they have clearly defined “medically necessary” it seems unfair to hold you accountable to a standard that they haven’t defined.

      Also, I would never admit to “recommending” formula. I would use words like “reassured” or “provided support” for a decision to supplement that the mother had already made.

      As far as the analogy your coworker made, its a stupid one because formula doesn’t cause problems that breastfeeding supposedly protects against. I.E. your baby won’t develop type 2 diabetes BECAUSE of formula. BF MAY have a protective effect against type to diabetes (although I firmly believe this is likely a confounding issue).

      Oh, and the response I would have to your coworker with the jelly bean analogy in the future would be something like “wow, i hope you realize how smug and judgemental that sounds about something that is an intensely personal decision for each mother”.

      Good luck! I am sorry you are in this situation.

    • RudyTooty

      “…where you could be written up or lose your job over supporting a patient’s choices?”

      Is this in your contract?

      I am a CLC and a CNM. I know *exactly* what you’re talking about with the promotion of breastfeeding only over FEEDING THE BABY.

      I have recommended formula – with parental request – and I always feel like I’m looking over my shoulder, and that I have to do extensive documentation for why I made that decision.

      BUT – gosh – as a person who believes that women should be able to do whatever they want with their bodies (or not want to do with their bodies) I don’t think I should be policing their choices about how they feed their babies.

      Sometimes I tell colleagues that I’m “pro-choice” and that extends to what women do or don’t do with their breasts, and I don’t care if they’re leaking colostrum by the gallons, no woman has to breastfeed if she doesn’t want to.

      I understand the feeling, though, of being worried you will be reprimanded for straying from the baby-friendly protocol. I know that feeling well.

    • Isilzha

      I hope someone with knowledge and experience about this replies to you because I’m horrified and very disturbed that you’re put in that position.

    • Eater of Worlds

      Besides what others are saying, please start looking for a new job. Your hospital is actively promoting dangerous, life threatening decisions for babies. There seem to be many job openings. The majority seem to want an RN, but looking at childbirth educator and IBCLC rather than lactation consultant turned up many positions all over the country. You shouldn’t have to live in fear of your job for giving proper information that can save the life of that child.

  • mabelcruet

    Has anyone been following the news about the new royal baby? The papers are full of how the Duchess of Cambridge gave birth to her third baby with no pain relief, she refused an epidural, she did hypnobirthing and delivered with only a midwife present (and 3 obstetricians next door, a full neonatology team, anaesthetic team etc just in case). And she’s going to breast feed. So expect a lot of guff about how everyone can give birth like a duchess, you don’t need all that medical intervention.

    • Empress of the Iguana People

      Only enough to know “hey, she had a boy. Good for them!” The rest I don’t give a fig about.

    • Sarah

      Do you not remember all that birth like a queen, use midwives guff from the second time round? Neglecting to mention, of course, that the gynaecologist got knighted shortly after George was born.

      Also, according to William, Charlotte was sleeping through pretty early in the day, about seven weeks. Does rather leave one wondering if some formula might have been involved somewhere…

      • Empress of the Iguana People

        Maybe, maybe not. My first was bf’d exclusively by that point and he slept through the night very early, too. Some of us just luck out with sound sleepers

        • Sarah

          True. And maybe she did, who knows?

        • StephanieA

          I’ve heard of those unicorn children, and I’m always jealous. I get babies that wake often and never learn to soothe themselves so we end up crying it out at 6 months (and I formula feed). My kids also drop naps young- they just don’t need as much sleep as some I guess.

          • Empress of the Iguana People

            If it makes you feel better, said child is being stubborn about potty training and is up at 6 every day.

      • Heidi

        Mine still isn’t a great sleeper at almost 2.5 years old so who knows? I wasn’t expecting it either because I was a sound sleeper early on. He refused to give up his middle of the night bottle until 10 months and never exceeded 4 oz. at a time. I had purchased a couple of 10 oz bottles in anticipation of him taking 6 or 8 oz at a time and they didn’t get used once. He eats in a similar fashion.

        • EmbraceYourInnerCrone

          Mine slept through when she was very newborn but it did not last beyond 3 months or so. She was formula fed and like yours refused to give up the middle of the night feeding also always took 4 or 5 oz. Good appetite just couldn’t eat a lot at one time. She was like that as a kid and a teenager. The only time she ate second helpings was before a big growth spurt. She is also a night owl and always has been. I learned to keep snacks in the car to prevent hangry melt-downs, because she seemed to need smaller , more frequent meals instead of 3 big meals a day.

  • StephanieA

    Going off the infertility discussion Dr Amy mentioned- has anyone ever ran into negative comments from ‘feminist’ blogs about having biological children? Especially in relation to climate change? In response to a climate change article I mentioned that many people have a strong desire for biological children, and this probably won’t go away. I also mentioned that I was pregnant with our third child, and I really wanted biological children. Other commenters said that it sounded like I’m ‘addicted to pregnancy’ since I don’t want to adopt. I find that so ridiculous- I highly doubt that most women who have kids are addicted to pregnancy!

    • mabelcruet

      What a hateful thing to say to anybody! I’m not a mum, but there is a similar sort of pattern in the pet-world too. My sister wanted a cavapoo (cross between a King Charles spaniel and poodle) so got him from a breeder (a properly certified one, not a horrible puppy-mill) and she has faced comments about spending all that money on a dog when she could have got one from the local animal sanctuary and given a home to an unwanted pup. OK, so adopting a child is several multitudes more of a commitment to take on, and I can understand people wanting a biological child of their own-its a basic drive that most animals have and we aren’t any different.

      • Empress of the Iguana People

        The comments on my collie picture! A) you can in fact get breeds from the pound. B) you can in fact find a reputable breeder who’s keen on keeping the dogs as healthy as possible. C) Did you know that guide dogs (in the US at least) are just about always breeds (labs mostly, these days). The reasoning is that you know what diseases a pure breed is most likely to get and what sort of temperment a pure breed is most likely to have. It simplifies the puppy search. They still have rejects, but it’s easier than searching all the pounds in the state for the right combination of intelligence, gentleness, and eagerness to please.

        • Empress of the Iguana People

          this is too fun a picture to not include. Dad got him when I was an older teen.
          https://uploads.disquscdn.com/images/fe7f3c6ca5db1fb33e3d5f4db8e1a7b0ce900a2e9652e8fabd81a41d4957472e.jpg

        • Eater of Worlds

          Guide Dogs actually breed a few different breeds, and the regional Guide Dogs don’t always breed the same breeds. Besides health, they breed for dogs that would be good at being service dogs for the blind and the deaf-blind. Right now the north east group does mostly Labs, Goldens, Lab x Golden and Poodles. Most have stopped labradoodles in their programs. Other service dogs for the blind use other breeds, GSDs, barbets, smooth collies, dobermans, boxers, vizslas. Other service dogs for things like hearing or seizures are not as breed limited and you can use mixes and hearing dogs especially can be shelter pulls. There are many reputable hearing dog groups that only use shelter dogs.

          So some groups do breed for hearing dogs, Paws With a Cause uses labs, goldens labxgoldens, poodles or a variety of small breeds for hearing dogs. International Hearing Dog is all shelter dogs.

          • I read “dobermans” as “dachshunds” and I have to tell you, the mental image of a dachshund in a guide harness with a comically long handle is… pretty amusing.

          • Eater of Worlds

            Hounds make terrible service dogs because they are at the mercy of their eyes/noses. Imagine a Doxie getting a whiff of rabbit and taking of after it, with their blind owner in tow. Maybe even a funnier image than just the harness, especially if you imagine it in Looney Tunes style.

            For those who don’t know, doxies were bred to go after badgers and minis were bred to go after rabbits. In Europe rabbits are burrow dwelling animals and they don’t try to run away like US rabbits, they try to run to their burrow and hide. Current doxies have an exaggerated body shape that doesn’t lend itself to being a dog hat can get into a tussle with a badger underground and live, but if you look at Tekels you can see how a working dachsund looks like. The naming is confusing, it changes depending on if you’re in Germany or out of it. https://nationalpurebreddogday.com/teckel-and-dackel-and-dachshund-oh-my/

            Some working dogs http://www.thefield.co.uk/gundogs/teckels-the-wire-haired-dachshund-sporting-sausage-dog-27100

          • They’re also the most aggressive dog breed toward strangers. My BFF’s mum has two. One is a doll… the other is *the devil incarnate.*

    • Empress of the Iguana People

      Occasionally. Mostly on the ‘net.
      I’ve no objection to adoption, but it’s a lot harder to adopt than to have your own for your average couple. Heck, even for some of us who aren’t average, one round each of IVF and FET was still easier and cheaper. (we know we got lucky)
      A lot of people aren’t emotionally equipped to handle older children and/or the disabled children who’re up for adoption, either, and there are only so many healthy babies to go around.

      • StephanieA

        Yep. My parents adopted, but decided to do international adoption. The cost ended up being upwards of $30,000, not to mention the time involved and being able to take two weeks off work to travel to China to get the baby. A lot of that is just not doable for many people.

        • Empress of the Iguana People

          It was 15k for the round of IVF.

          • Allie

            I had 3 fresh and 2 frozen rounds. Result: 1 pregnancy loss and 1 healthy singleton girl. I can’t wait until she pulls out “I didn’t ask to be born” to which I can reply “that reminds me, you owe me $50k”

          • Empress of the Iguana People

            *hugs* I know we got lucky

      • lsn

        Here it is considerably more difficult and expensive to adopt than it is to do IVF, and the chances of adopting locally are very small. Of course the response then becomes “you should foster” – which is not the same, and kind of unhelpful. I asked the person who told me that (and who had 3 children conceived with no problems) why she wasn’t fostering then, and she shut up.

        • Tigger_the_Wing

          Good for you. That was a very unhelpful thing for her to say!

          I had five of my own, and fostered. I was entirely supportive of my sister’s decision to adopt when, after attempting IVF, it was discovered that she and her husband would never be able to have their own biological child. Her adopted son was born the same day as my eldest grandson.

          No-one should have their decisions criticised by other people – what works for one family is unlikely to work for another, because every person in a family is an individual.

    • The Kids Aren’t AltRight

      Not to mention that we do actually need children to keep civilization going, care for the future elderly, etc. Furthermore, a lot of inequality persists because women are expected to do a disproportionate amount of child care for no compensation, and not supporting mothers makes feminisms goals impossible and undermines the movement. Or that you can’t just go pick up a baby from the pound: adoption is a complicated and emotionally fraught process for all involved. (Not to say adoption can’t be wonderful; it just isn’t some panacea for all people and situations.)

      I have, unfortunately come across quite a few of these “feminists” in my time. Strangely enough, a lot of this type of women I knew in college moved on to become placenta eaters, which I cannot explain.

      • StephanieA

        I’ve always wondered this, as the flip side of having less children has to have negative consequences. Who supports the aging population if we stop having kids? Who will be the new innovators and problem solvers? Of course there are groups that take it as far as humans should just go extinct to save the planet.

        • Tigger_the_Wing

          This.

          I was once told, after making that exact same point, that I was being ‘selfish’ for wanting children to look after me in my old age. I retorted that we’ll all need looking after in our old age, and isn’t it more selfish to expect the younger generations to look after us, having done exactly zero work in looking after them? I don’t care if another woman has or wants children (none of my business), but I cannot abide hypocritical criticism of my own decisions.

          Anyway, my daughter willingly took on the role as my carer (my husband works abroad, and only comes home twice a year); I try to make her job as non-onerous as possible.

          • StephanieA

            I do worry that since I have all boys, I won’t have anyone to take care of me in old age. I know that’s very stereotypical, but it is a concern of mine.

          • Eater of Worlds

            My FIL took care of his parents, he had 9 siblings. The siblings all helped but he lived with them and fed them and helped bathe them and cleaned and shouldered the majority of the physical and emotional work of caring for them. It really just depends on your relationship with your kids rather than them being male. Raise your boys to be independent and know how to cook/clean/respect others especially the objects of their affection. Teach respect of women. If you have a solid relationship with your children they are going to want to help you out, especially if you help yourself by having solid retirement goals and plans. Some mothers have really messed up relationships wth their kids, narcississm or are jocastas and try to turn their sons into emotional husbands (called emotional incest). That kind of behavior pushes your kids away.

            I personally would never help my mother age because I cannot take living with her and dealing with her infantalizm and disrespect of me as a a person and attempts to control every part of my life. For instance, I’m Deaf, I asked her to learn ASL and would pay for it but she refused. Now she repeats things 10-15 times (which is disrespectful, she knows it doesn’t work that way), she gets angrier and angrier the more I tell her I cannot understand her, she dismisses me when I make her write it down by rolling her eyes and huffing and puffing passive-aggressively. If you truly love and care for your kids you’d 1. learn the language that they have to use, especially because you made them deaf by your own behaviors and 2. you wouldn’t act like the deafness is new and you would know what proper terms to use for your child’s identity (Deaf, deaf, hard of hearing and hearing impaired are all different) and 3. you’d allow them to arrange for their own needs when going to museums and such. And she just screams and argues when I attempt to explain why acting this way isn’t acceptable to do to a stranger, let alone your own child.

            I don’t think that’s so hard to avoid doing, to avoid that kind of treatment, to respect and love your kid while maintaing healthy boundaries and being self-aware of how your actions effect others.

            Read here about terrible mothers and MILs and you’ll see how easy it is to avoid growing old alone https://www.reddit.com/r/JUSTNOMIL/ This one is about dealing with toxic parents, primarily narcissists https://www.reddit.com/r/raisedbynarcissists/ Often funny, sometimes horrifying. Some mothers have tried to kill their grandkids intentionally by feeding them things they are allergic to, have lost power and control over their kids and have lost control of theirselves and attempted to kill their daughters in laws, kidnap their grandkids, beat their children’s pets to death, it’s endless what these horrible mothers do. But when you read these stories and become part of the community, you begin to understand how some small things you might think are fine can become a big thing later, so you can fix that small thing now. It’s stress relief to know you are not like these women (there are subforums for fathers/fathers in law, family as a whole, significant others) but you learn a lot about your own behavior as a mother from reading these stories. You have to sign up to post but you don’t to read.

            All that simply to say that since you are worrying about being a good enough mom, your sons are probably going to love you to bits their entire lives and want to help you.

        • Eater of Worlds

          China is having issues. Not just with supporting a rapidly aging population with a smaller population under them and having too many males because they aborted females for cultural reasons. But growing up with generations of kids knowing that they can only have one child has made these young adults feel that one child is the normal situation and they don’t want more kids. The cost is a big reason and larger families just aren’t typical anymore except in rural areas, where the kids are left behind while the family works in the city and sees them maybe once a year. They’d rather stick to one kid and actually be able to see and raise that child than have two. There are also other issues like pressures put on women by the spouse because men hold more power in that country but gender roles are changing becausae of the one child policy. So that’s just a quick rundown of 1 child policy problems and that doesn’t even get into the nitty gritty of it.

      • Eater of Worlds

        No kidding. I can’t afford private adoption and I don’t want to deal with the heartache risk. Can’t afford 100-160k for proper surrogacy. So yay, foster to adopt, right? Nope, they won’t allow me because of medication I take, even though it’s not an issue if you have bio kids, privately adopt or do surrogacy. They don’t want it in the house. So childless I remain, adoption is definitely not a perfect solution.

        • Daleth

          God that all sucks. I’m sorry. I don’t suppose egg donation or embryo donation is a possibility for you?

          • Eater of Worlds

            I don’t have a uterus, so no.

  • KeeperOfTheBooks

    OT: a rather late announcement, but I haven’t been online much recently. Baby Books, 3rd edition, arrived healthy and happy right about a month ago. He and I are both doing well.
    His birth, a repeat C-section, was very different from those of my other kids. I’ve written on here before about how, incredibly grateful as I am for the C-sections that saved their and my lives, I still felt an emotional regret that I didn’t “get” to experience labor et all. Well, it seemed I really, really lucked out this time around, in that I did experience labor somewhat, but baby and I were just fine afterwards, and I got some much-needed closure, to boot.
    I’d never gone into labor before; however, my water broke this time, so we had the excitement of a run to the hospital, where we discovered baby to be head-down, swimming in a lot of meconium, but still doing fine on the monitor. I was offered the option of trying for a VBA2C (wait…I thought those never happen in hospitals? she says sarcastically) or having a RCS right away, whichever I preferred. Sure, let’s try for that VBA2C. Had a wonderful nurse who, like me, had baaaad PPD after her first C-section, yet also had a very balanced view about the whole thing. Wonderful Nurse also caught before anyone else that baby decided to flip *obtuse* a few hours into labor, and that he’d passed a bunch more mec at about the same time.
    RCS it was. However…I “got” to labor, I “got” to experience having my water break, and I’m genuinely really happy about that, odd though it no doubt sounds to some.
    I also made the day of a half-dozen nursing and anesthesia students when I told my OB and anesthesiologist that I was happy to have any students who needed the experience in the OR. My OB did a bit of a double take: “That’s…not a common request. We usually hear the opposite!” Me: “Hey, how often do *I* get to help train doctors and nurses? The more the merrier!” Which cracked them both up, and, strangely enough, having those (very happy and grateful) students in there cheered me up a bit out of the “damnit, another C-section with the accompanying horrible allergic reactions during recovery” funk. (That, and DH’s promise to pick up a bottle of my favorite wine on his way home.)
    Lastly, once baby was out, my OB paused, and pointed something out to his assistant, then said, “Hey, Dad, take a picture of this.” Then he explained that with this pregnancy, it had become clear that my uterus is heart-shaped/bicornuate, which explains the weird malpresentations of all the kids in utero. So, I got an answer as to how that happens, which was good. More importantly, the thinning he’d seen at the previous section seems to have resolved entirely. Yay! And *most* importantly, I ended up with my arms full of happy, blinky, snuggly baby, who we all adore and who I’m going to get off the computer now in order to love on.
    PS: Zoloft still rocks. So does running. Between them, PPD is being kept well at bay. Everyone here keep up the good work. I’d bet that a few years ago, before I found this community, not being able to have a VBA2C would be devastating. Now, though, I can be grateful for CSs, happy my kids are here safely, and while I admit to being a bit jealous of those of my friends who don’t have to deal with allergies to who-the-hell-knows-what component of surgery after having a baby, it doesn’t consume my every waking thought as it did after the first C-section, and that’s in no small part because of the time I spent here. Thank you!

    • sdsures

      Congratulations!

    • fiftyfifty1

      Congrats! That’s happy news.

    • Sue

      Wonderful news – congrats!

    • Empress of the Iguana People

      Congrats! and hooray for zoloft.

    • Christine O’Hare

      Congrats! Isn’t it a beautiful thing, this corner of the internet that frames CS’s for what they are – another way to have a baby which is also sometimes the safest option. Definitely helped me to think about my C in a positive way.

    • Megan

      Congrats! We are about to have our third too (and my third section). I’m glad to hear PPD is not caising you grief either!

      • KeeperOfTheBooks

        Best of luck to you all! I hope it goes smoothly as possible!

        • Megan

          Thanks!

    • Tigger_the_Wing

      Congratulations, and I’m delighted that you had the best care and were able to ‘pay it back’, so to speak, by helping to train the next generation.

    • PeggySue

      CONGRATULATIONS!!!! Please that happy, blinky, snuggly baby a kiss for me!

  • Empress of the Iguana People

    Healthcare is, after all, deeply personal. Part of the attraction to naturopaths is the supposition that they’re doing individualized care, but they’re just bastardizing the real thing.

  • mabelcruet

    Some of the lactivists that drop in here to ‘educate’ us have very clearly demonstrated they have no idea what valid consent means. They have no concept of providing unbiased and evidence based information, and no concept of working in partnership with their patient. Doctors in particular have generally moved away from a paternalistic pattern of working but the same can’t be said for other health personnel.

    I have always had cats-in the past I have had cats who needed surgical treatment and one who had a tumour. I asked my vet what he would do if it was his cat needing chemotherapy. He was very clear in saying that it wasn’t about him and his choices for a pet, it was about me and mine. He could advise me about pros and cons but ultimately the choice was mine. That’s how health care should be in any sphere-the person should get information to enable them to make a decision based on their own preferences. My vet gave me data about success rates, complication rates etc, and information about standards of care, but he didn’t push one plan of action above another.

    • Tigger_the_Wing

      I’m glad you have such a great vet. The vet my son and daughter-in-law use for their cats seemed to be a good one, until two of their cats (litter brothers) developed severe, painful, kidney problems, a few months apart. We happened to be visiting for the first one, and it was the second time this had occurred in this cat, yet the vet wanted to pursue unpleasant (for the cat) and expensive treatment with a very small chance of a good outcome. Given that this was the second time through with this one cat, they had decided it was kinder to put him to sleep – but had to argue against the vet, when they were feeling emotionally vulnerable. In the end, the vet came out to the car park where I was sitting (the house was inaccessible) and discussed the situation with me, and finally accepted that the best course of action from the cat’s point of view was to put him to sleep.

      I couldn’t believe it when my son phoned me in tears a few months later because the second cat had gone down with the same thing (must have been a genetic problem – both cats were quite young) and the vet was still trying to push the expensive, painful treatment with a low chance of a good outcome. I told him that if the vet wasn’t going to be kind to the cat, to put him on the phone to me and I’d give him a good bollocking. I think that the threat was enough, because the vet conceded without my having to talk to him.

      Some surgeons, whether veterinary or otherwise, see every patient as a personal challenge to their skills, rather than as autonomous individuals with views of their own.

      • Eater of Worlds

        I hope your son found a new vet. It sounded like that vet wanted money more than having the best interests of the animals at heart. When I put down my super healthy relatively young cat except for her fucked up bladder, my vet was all for it because my cat had no life. He also had no problem in telling me that my dog isn’t going to recover and it was just a matter of when in the next few minutes or so that I was done saying goodbye so he could put my pet out of their misery. They should never force something the way that vet did. If one course of action is clearly better than the other, I think a vet has the responsibility to make sure that is understood. But vets also know people aren’t infinitely rich and despite their own disappointment they have to accept the owner’s choices.

        When my dog died recently I think the vet was expecting that I wanted to do anything for my dog, as that was what we had done before. However, anything had a good chance of working, and this time it wouldn’t So the vet did some procedures to make my dog comfortable until we could pick her up. She was there for a regular cancer checkup which takes a few hours so we would drop her off and get her later, except some bad stuff happened when she was there which we were very thankful for because the vets could do something for her and it gave us time to say goodbye. Cost an arm and a leg and my left tit but it was worth it for that extra time. They were relieved that I wasn’t going to ask them to do heart surgery on her that had only like 5% chance of working, and she wouldn’t live long anyway with what what she had.

      • PeggySue

        I had a bad experience with a very young vet when my tiny rescue terrier mix was sick some years ago. The vet wanted to run $4,000 worth of scans before doing any treatment at all, implied that I was an uncaring owner, told me the dog might become worse overnight–I said, then you will call me and we will talk. She said, then you will approve the scans, and I said, “Read my lips–I do not have and cannot get $4,000. We will talk.” She wanted then some more expensive testing because the dog had an abnormal blood value which, said the vet, probably meant leukemia or cancer. I said, no. Treat her overnight and have the treating vet call me in the AM. The treating vet in the AM was an older, board-certified internist. He called and said, you can pick her up as soon as the IV is done, I think she’ll be fine. I said, what about the leukemia? He was stunned. No, he said, in the context of her presenting symptom the blood value was fine. Boy was I mad. The little dog recovered fine btw with some medicines and some fluids.

        • mabelcruet

          That sounds very similar to some junior doctors-I think they are worried and frightened of missing something, and don’t have the breadth of experience to properly assess what they are seeing. There’s an old medical saying ‘when you hear hoofbeats, think of horses, not zebras’. But sometimes juniors will plump straight for the zebra-the rare and unusual, and mostly its not. It does take a while to develop the confidence to say ‘lets take a step back, watch and wait and review later’. And of course, the older you get, the more you see all the wonderful and weird ways different medical conditions can present-younger ones inevitably don’t have this breadth of exposure (which is why they are supervised at the beginning of their careers, at least in the human medical world).

      • mabelcruet

        When I first moved house, I signed on with another vet just around the corner from where I live, but I wasn’t impressed at all the first time I visited the surgery. I was taking my 3 brand new kittens for their vaccinations-they were tiny, all three fitted in one carrier. Behind the counter there was a huge German Shepherd-enormous big hairy beast, and he came over and started sniffing around the kittens and pawing at the carrier-they were terrified, poor things. I asked the receptionist to move the dog and she said ‘oh, he’s a lamb, he won’t hurt them’. But they didn’t know that, did they?

        I think my new one (that I’ve used 15 years now) is excellent-he’s always been very sensible and practical, and very pragmatic about treatment and we exchange war stories, he’s as fascinated by human pathology as I am about animal pathology. I was vaguely wondering about it, but if I wanted to change I’d have to go all the way back to vet school and qualify as a vet first, and there’s no way my A level results are good enough for that!