How I Spent My October Vacation

The result of having passed various postgraduate exams along the way is that I seem to have ended up on a bunch of mailing lists of editors who have me tabbed as somebody who’s interested in going that extra mile to keep up with latest medical practice.  Hence, I get so many journals falling through my letter box that our poor postman probably has a hernia.  (And let’s not even talk about the effect on my husband.  I have finally got used to reading them out of his sight and not leaving the ickier pictures lying around – until then, he told me it was like living in Fred West’s library.)

In all fairness, I am someone who’s interested in going that extra mile to keep up with latest medical practice.  Few things beat the satisfaction of having a patient ask me something that, thanks entirely to my own hard work and diligence, I can actually answer.  The problem is that it’s actually more like going the extra fifty miles.  This is a highly exciting time to be a doctor – more research results come out every day, and we’re starting to actually base our practice on them instead of the time-honoured standby of This Is The Way We’ve Always Done It – but when it comes down to the nitty-gritty of actually reading all that research (even in summary form) and trying to keep some kind of handle on what’s decent quality, what’s not, and what’s just been debunked by an even more recent research study, it can get somewhat overwhelming.  When you add in the number of review articles by specialists on appropriate up-to-date treatment of the truly astonishing variety of diseases, injuries, and assorted malfunctions that the human body can develop, and then recall that I’m trying to fit the reading of all this around actually doing the job I’m doing all this reading about, not to mention taking care of a toddler and having the odd bit of life of my own – well, you can probably see why there have only been a few months in the past several years where I haven’t had a tiresomely large Journal Backlog Pile stacked up waiting to be read.*  Still, I have – spurred on by the Clearing Paper Clutter Month over at Flylady’s – been making a concerted blitz on the Journal Backlog Pile in recent days.  I’m taking some annual leave this week, so I’ve actually had a bit more time than usual to catch up.

Between last Saturday and yesterday, I’ve read one and a bit Updates, one GP, one Doctor, three Pulses, one BJGP, two and a half Prescribers plus one supplement, part of a Practitioner that needed finishing off, the first few pages of this week’s BMJ, one MPS Casebook, and a few random assorted articles on pain control, renal failure, and probably a couple of other things I’ve forgotten that showed up in the mix.

This morning, the post brought one copy of GP (with additional booklet on cholesterol-lowering protocols enclosed), one copy of Pulse, one copy of the Journal of Family Planning and Reproductive Health Care, and the latest handout and newsletter from the Arthritis Research Campaign.

Any vacancies for painters on the Forth Bridge?

*The few months in question were the few months when I was on maternity leave.  Having a (first) baby who wants to nurse non-stop does have the advantage of letting you catch up on your reading, since there’s not much else to do. **

** In retrospect, though, trying to read an article on scalp disorders while I was in advanced labour probably wasn’t the smartest move I’ve ever made.

If you’ve just found this blog…

…then hello, welcome, and please do join me over at http://www.goodenoughmummy.typepad.com, which is where I blog these days. (However, if you want my archives from summer 2005 to early 2006, then you’re in the right place right here.)

(Quick addendum for anyone who finds me from the comments on Raising My Boychick – Sorry about using this blog as a link rather than my regular blog. For some reason, I can’t use the Typepad blog as a URL in comments on that particular blog. If anyone else has had that problem and come up with any solutions, I’m all ears and gratitude.)

Morality clause or judgement clause?

If anyone can think of a catchier title for this, by all means let me know.  Then again… maybe this isn’t the kind of post that should have a catchy title.

The other week, I was checking out the latest Grand Rounds in order to give myself a bit of a break during lunch, and one of the posts listed was a link to a post in which a woman described her troubles getting emergency contraception after a broken condom.  The Grand Rounds host commented thusly in linking to the post: "I fully support a physician’s choice to practice according to their
conscience, and am sympathetic to this particular point of view, but I
still felt badly for this gal’s experience unsuccessfully finding emergency contraception."

So, I clicked on the link, expecting to find a post about someone who’d been given a hard time from one or two people in her quest for EC.  Maybe I’m naive, but I would never have expected anything like the kind of troubles I read about.  Do read it.  Please.

Now, I do understand that there are people who believe that life begins at conception and that prescribing a dose of hormones that may potentially prevent a fertilised egg from implanting is thus morally equivalent to murder.  While I don’t share this view myself, I do – very reluctantly – admit that someone who feels that way might have a valid case for calling in a morality clause that exempts them from prescribing EC.  This is not to say that I consider their case a given (that’s a subject for a post in itself) – simply that I consider that argument worth at least, well, considering.

But that isn’t what happened here.

To assorted ER doctors in whatever anonymous area of rural Ohio this is: Guess what?  If you’re basing your decision on whether or not to prescribe EC on whether or not the woman concerned is married, then I’m afraid you do not get to claim a morality exemption clause.  If you’re OK with prescribing EC to a married woman, then you clearly _don’t_ believe that that insensate pinprick-sized speck of cells is a human being whose right to life you must defend.  There are possible logical grounds for claiming that a fertilised egg is a human being – I don’t agree with them, but they do exist.  There are no possible logical grounds for claiming that a fertilised egg is a human being if it happens to be residing in the genital tract of a woman who is currently single but not if it happens to be residing in the genital tract of a woman who is in possession of a marriage certificate.

Doctors who feel that way are not claiming a morality exemption clause, although I’m sure many of them conveniently manage to convince themselves that they are.  They are making a judgement about the lifestyle of the woman concerned.  If you are prepared to prescribe EC for a woman who was raped or who’s married but not for women who don’t fall into those two categories, then what you are doing is basing your judgement not on your beliefs about the status of the fertilised egg, but on whether or not the woman chose to have premarital sex.  You are claiming that a woman who made this choice should not be allowed to take the same steps to avoid an unwanted pregnancy as a woman who is living up to your view of what constitutes morally acceptable sexual standards.

The purpose of morality exemption clauses is to allow doctors to avoid performing actions themselves that they feel to be morally wrong.  it is not to allow doctors to punish other people who have performed actions that the doctors feel to be morally wrong.  Refusing treatment to other people solely because you do not approve of their lifestyle choices is not morality.  It is bigotry.

A semantic milestone

Jamie is now twenty-two months old.  As he was coming up to this age, it occurred to me that this seemed to be the ill-defined point at which it seems appropriate to stop referring to age in months and start referring to it in years with qualifiers.  Which means that Jamie is now nearly two.

Nearly two.  My little boy – who runs everywhere and can climb the climbing frames at the park and walk up and down stairs if he has a bannister to hold, who’s been in his own room for the past few weeks and now eats meals at his own little table and chair because he’s outgrown the high chair – is nearly two.  Two years ago he was a bump; a year ago he was a crawler and a cruiser, fascinated by life but with little concept of what any of it meant.  These days, he loves being read to and music and spinning round and round and dancing and going to Tumbletots and watching the Teletubbies, especially the baby in the sun.  And he’s nearly two.