A Physician Fights Surgery

Physician and bioethicist Carla C. Keirns described the potentially dangerous impact of medicalization on her own childbirth in the Narrative Matters section of Health Affairs this month. A segment of that writing was reproduced in the Washington Post yesterday.

In each piece, Keirns outlines the challenges she faced in vaginally delivering her son in a hospital environment that seemed committed to performing a caesarian section. Particularly given Keirns’ expertise in and familiarity with health care, the lack of patient-centered care in the story is striking. Several staff suggested that surgery was a foregone conclusion while others appeared unprepared for her son’s long-awaited arrival.

The full write-up in the Post is well worth the few minutes it takes to read.

In the longer Health Affairs rendition, Keirns spends considerable time discussing the ways in which policy changes might prevent other women from facing similar pressures to undergo surgical births. After reviewing several proposals that have been kicking around health policy circles for years, Kierns concludes,

“If policymakers hope to change the rate of obstetric interventions, we’re going to have to change the culture of medical practice.”

It’s a conclusion that is as intellectually satisfying as it is practically frustrating. I’ve offered a similar suggestion in discussing the need to contain national health care expenditures. Several other leading authors and organizations have recently latched onto this idea that culture is the origin of evils. I don’t disagree, but I am tiring of texts ending here.

The pressing questions then become –What does it look like to change the culture of medicine or the culture of health in the United States? Sure – we can take a “do everything” approach, but are there leverage points where a targeted intervention can create outsized impacts? This is the health services research agenda we should be pursuing in 2015.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.