June 10, 2009

Do We Over Value Technology to Personal Touch

I just received my copy of New York Magazine yesterday and noticed that it was the “Best Doctors” issue. I eagerly opened it to see if I knew any of the featured doctors, since I have worked with quite a few over the past 6 years as a labor support doula. I found that I knew one, Dr. Joan Kent OB/GYN from NY Pres-Weill Cornell. I would like to note that out of the 18 OB/GYNs listed, she – along with only one other – was not described as a “high risk, fertility specialist,” or by having any other surgical specialty.

The magazine explains that the list is compiled from peer recommendations, not from client/patient recommendations. They say: “The idea is that medical professionals are best qualified to judge other medical professionals.” I believe there is some truth to that, but it emphasizes that the medical profession (in this case, obstetrics) follows a pathological model of care. Meaning that doctors are trained to look for what is abnormal or pathological as opposed to accepting a wide range of what is normal. So does that mean, then, that there is a higher regard for doctors who know how to do the “fancy” procedures instead of those that are comfortable sitting back, observing and caring for the low-risk mother? If I was teaching a yoga class with my peers watching or judging me, would they be more impressed that I taught a challenging, difficult series of poses as opposed to a simpler, but perhaps more appropriate, basic class? I would like to stress that we do need specialists for abnormal conditions or situations, but it was shocking that out of the list of 18 OB/GYNs, only two were “average, low-risk doctors”. (I won’t even go into my distress that there was no mention of a midwife in this article.) As a low-risk woman, I would so much rather go to a doctor that has a low cesarean rate then one who has a high one. Yes, the doctor who has a high rate may be more proficient at performing that procedure since that doctor performs them more often. However, I would think that there may be a problem based on the mere fact that the doctor does perform this surgery so often.

Are we valuing technology and complicated procedures more than we value instinct and personal touch? Two years ago I went down to Summertown, Tennessee to take a week long midwifery assistant program at The Farm with Ina May Gaskin and the renowned Farm Midwives. While there, I learned how to feel for fetal position. The technique that made the most sense to me is called Leopold’s Maneuver. It consists of four distinct hands-on actions, each helping to determine the position of the fetus. I worked with some actual pregnant mamas along with teaching dolls. This technique is primarily what the Midwives use to determine fetal positions. After learning this technique relatively easily and seeing it function with good accuracy, I noticed that it is never used in hospitals!! Upon admittance to the Labor and Delivery floor, an ultrasound machine is wheeled into triage to determine whether the baby’s head is down. Why go straight for the costly technology, especially since the overuse of ultrasound is in question relative to its safety to the fetus? Why not just have the residents place their hands on the laboring mother’s abdomen? Along these same lines, why are unmedicated, laboring mothers strapped to an external fetal monitor designed to tell everyone when that mother is having a contraction. If she is indeed unmedicated, she will likely be able to tell you when she is having a contraction. If the mother does not perceive the contractions, the nurse or doctor can feel the uterus hardening since the whole belly tightens during the contractions. Another great example of toned-down technology is the fetal scope. It is an instrument used to listen to the fetus’s heart rate without exposing the baby to ultrasound waves like the doppler or ultrasound machines. The fetal scope is definitely “old school”, but that doesn’t mean it doesn’t work! Look below for a picture of it. The care provider listens like they would through a stethoscope. The horn-shaped part is at the mother’s belly and the flat part against midwife’s or doctor’s forehead. I wonder if a high risk OB/GYN walking into an “average” risk doctor’s or midwife’s office and seeing them use the fetal scope or the Leopold maneuver instead of more modern machinery would look down upon these less advanced devices.

fetal scope

The New York magazine article also features stories about several of the “Best Doctor” candidates talking about their first time performing procedures that were scary for them. The author explains that: “In relating the stories of their inaugural attempts to remove a brain tumor or deliver sextuplets, among other harrowing scenarios, the doctors in question display an almost superhuman ability to cure what ails us-and an altogether mortal mix of self-doubt, fallibility and compassion.” Maybe we, as a society, have put the doctor and his/her modern technology into the “superhuman” category to such an extent that we no longer look to or value the simplicity of human touch and instincts.

Take a look at the hospital sketch from Monte Python Meaning of Life. It illustrates quite humorously how impressed we are with the machine that goes PING!



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