Monday, October 15, 2012

Advice from a CMA NFP doc, or "Forward!"

As the CMA conference ended and I, with my rolled-up poster, went up the elevator to my hotel room I met an NFP-only family practice doctor who seemed interested in my work. (Yay!) He gave me his email; then, we spoke by phone. I forgot how awesome it is to get encouragement from mentors who really share one's ideals! The march toward being a doctor gets a little mindless at times.

His advice:
  1. You're in a culture that doesn't appreciate the dignity of the person, the excellence of NFP, etc., and medicine is at the height of this lack of appreciation.
  2. Keep the faith.
  3. Stay confident; you know you're over the target when you're fired on. NFP is good medicine, especially long-term. It is medicine that conforms to the body's physiology and pathology.
  4. Let the comments slide and pray for those who disagree or make life difficult.
  5. Don't wear yourself out trying to convince people; just witness.
  6. Meet people (patients and colleagues) where they're at. Listen (only when you listen, can you speak effectively) and they'll come back.
  7. DON'T participate in things that your conscience is uneasy with.
    1. If a patient comes in for birth control, you can still do the H&P. 
      1. If she has a boyfriend, sit down and talk with her about her boyfriend. "What happens if you get pregnant?" you might ask. "Are you sure you want to have sex with a guy who won't stick around?" If nothing else, this is informed consent. It doesn't take much time, but it may help her begin deliberating early about these major choices.
      2. If she is there because of a parent's wishes, ask her what she would like to do.
      3. If she does decide she wants birth control, complete the H&P and in the oral presentation, simply state, "...and she is here for OCPs, but because of my faith I cannot provide that."
      4. Or, in residency: "Okay, that's your choice; I am not able to help you with that, so I'll call in one of the other residents and she'll take care of you. I will always be here if you'd like to see me again."
    2. During a C-section with BTL, assist with the section and state, "I'm happy to assist at surgery, but during the tubal ligation I'll back away from the table, staying sterile, until you're finished." If the attending makes it clear that they will therefore close alone, simply say, "Okay, thanks for letting me assist. I'll let you know how the baby's doing."
    3. Go to the supervisor if an attending grades you badly because of this, stating, "I am willing to take a bad grade for something I did badly or didn't understand, but..." If the supervisor doesn't help, ADF will.
He also connected me with some awesome resources, including One More Soul, AAFCP, IIRRM, the Gianna Centers that St. Peter's in New Brunswick is hoping to place everywhere, and (of course) PPVI and FCCA. There are some names I should apparently know: Erik Odeblad, Kyle Beiter, Anne Notle (I've actually met her!), and Joseph Stanford. Joseph Stanford and IIRRM are doing a lot of research, notably on men's interest in NFP (93% was the number this doctor gave me, but I can't find the study), couple's month-by-month intentions (CEIBA), and effectiveness of miscarriage prevention and infertility treatment (iNEST).

If we start a crusade, we could wear
long, white, matching outfits and carry
pointy things. Oh wait, doctors do
that anyway.
He also said that obstetrics/gynecology has, more than any other specialty, fallen behind. Cardiology is talking about calcium channel blockers in heart disease, but no one in gynecology cares what kind of channels the cervix has (apparently, the cervix also has important calcium channels?). He urged me to think about family practice (which I have, and don't want to again), but then urged that if I was going to practice OB/GYN, that I not get rusty--that I keep up with endocrinology, general health, etc--and not be a referral machine. (This is exactly my hope! People don't want six doctors.) He explained that the reason OB/GYN is behind is that it's imbued with a culture of death, which is wringing out any faithfulness and religion, even when it is detrimental to patients. A stat he threw out: in the 1950s physicians had an 80% pregnancy rate in women with PCOS; now we're at 23% with IVF. Doesn't that just make you want to preach a Crusade?

The march toward being a doctor just got  invigorating again. Forward!

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