Showing Up Late

It was for many reasons that I let myself burn out of my surgical practice sooner than I'd imagined going into it. Mainly, I guess, was the amount of work I was doing at the end, so much more than my partners, days on, days off, weekends off; calls all night. The usual. But I'd signed up for that, really; no matter how hard it got it was less demanding than my years of training, back in the days of the iron men and women. No, I think what finally did me in was the psychological toll taken by ever-mounting rules and demands of one bureaucracy or another, all of which seemed predicated on the idea that, unless proven otherwise, I (being a physician) was incompetent, unethical, uninformed, and greedy.

But I never had to face an outrage like the one sweeping the country as it descends into theocracy and (attendant) stupidity. I speak of the forced transvaginal ultrasound craze that is the darling of right-wing, regressive, hypocritical and gynophobic legislators around the country. And I'm sorry that it took a reader sending me this link to a post that's going viral to remind me I should have said something sooner. As a physician, I've been tardy. (Although I've mentioned, many times, the dangers of teabaggR theocracy; and I posted favorably about the satirical legislation -- which failed, because, you know, it's guys -- requiring men to get prostate exams before being allowed to take E.D. medication...)

Yes, this is different. It's bad enough to have to justify, to some kid in an insurer's cubicle, a decision I've made about the care of my patient. Or to fill out a form indicating why I've chosen to order supplemental oxygen for a post-op patient, or to use a blood product. But to be told I must, under penalty of prosecution, perform a medically unnecessary, invasive (and, when not wanted by the patient, a degrading) procedure by declaration of a state legislature... well, I can't imagine standing for it. (Garry Trudeau ran a series of Doonesbury strips about it last week, which were censored by many newspapers.)

My guess -- admittedly prejudiced, which is not to say inaccurate in this case -- is that a lot of doctors in the states where such requirements are brewing are perfectly happy with it. It comports with their personal religious beliefs and is consistent with the fundamentalist view of the subjugation of women. But it's no excuse: there's a principle here. Legislators have no business forcing unindicated procedures on patients or their doctors, and doctors who acquiesce are complicit, whether they like the theology or not.

Wait a minute, I can hear some saying. Haven't you written in favor of medical efficiency research, and tying it to Medicare reimbursement? Isn't that the same thing? Why yes, yes I have. And no, no it's not. What it is is medical people -- experts!! -- investigating what works and what doesn't; which treatments aren't justified when less expensive, less risky, more effective ones are available. That is nothing at all like -- it's the opposite of -- idiot legislators telling a doctor she must perform a medically unnecessary procedure on a patient for political and religiously-motivated reasons.

I'd like to think that, if forced to do such a thing, I'd refuse, and speak out forcefully. In the name of my patients' best interest; in the name of drawing a line between religiosity and health care. Typing away at my computer, hemi-demi-retired, it's easy to proclaim. And, as well-written and right on as the linked opinion piece is, I infer that the author is not in a state where the test is required: he/she is calling on docs who are to refuse. Easier said than done, I'd suppose; in places where such legislation is considered reasonable, I'd guess they'd have no problem destroying a doc who'd speak out on behalf of his/her patient against such heavy-handed, moralistic, and demeaning intrusion.

That it's unjustified in every way except a narrow-minded and spiteful religious one is pretty clear. What's behind the shroud, though, is much worse: it's just an inkling of the kind of society we'll be living in if religionists like Rick Santorum or Newt Gingrich (or, depending on whether he shakes the Etch-A-Sketch or not, Mitt "I'm-Whoever-You-Want-Me-To-Be" Romney) gets into office and has like-minded people running Congress. Legislating that vulnerable women, who are making a horrendously difficult decision, must undergo forced vaginal entry by (if only partly indirectly) a gang of religious zealots is just the beginning. We ain't seen nothing, yet.