Friday, September 30, 2016

Blogging = Self-Publishing (It Doesn't Count)

I like to think about bioethics, theology, and the philosophy of medicine. I like to write about them on this blog. But I realized a few months ago that burying my essays in a blog is no good. I'm not saying this blog is a waste of time. It's a useful outlet for a verbal processor (me) and a nifty window for a few others to see into the life of a resident. It's also been a tiny hub for OB/GYN residents and students who want to practice according to their consciences.

Having come to this conclusion, I will keep sketching out my thoughts here, but I will no longer keep my thoughts limited to this page. This blog is exactly what the subtitle says: it's my experience. It's an open diary. That's why there are stories, schedules, and random cooking and ulcerative colitis posts.

But to be productive, scholastic dialogue has to happen in existing, professional avenues. That means NCBQ, LQ, Obstet Gynecol, and AJOG. And to be useful, advice on conscience has to be more accessible and more generalized. And that means I'm very excited to announce that I'm helping with a new project. It's called Conscience in Residency, and it's a single place for students, residents, PhDs, and even pharmacists to go for practical advice in following their conscience. (It's technically going live tomorrow, so be excited that I gave you first peek.) Apart from telling you I helped in CIR, I won't ever announce a publication, to protect anonymity. Bummer! Publications are major parties. Maybe every time I publish I'll just put up a picture of fireworks, 0-30 randomly-generated days after acceptance or epub or print? Would that be vain?

This also means you'll see disappearance of a few posts that are being rewritten for publication, or have been published. Sorry if the blog gets a little disorganized and links die! (Rest in peace, links.)

Thursday, September 15, 2016

The "Safe Harbor" Idea is a Myth

I am going to apply for a fellowship that doesn't involve contraception. Am I running away?

There are several fellowships off generalist practice that could try to circumvent prescription of contraception. One could to MIGS, and only be a women's surgeon (sometimes management of endo could leave you in a tricky spot). One could to gynecologic oncology, and only operate and give chemo on women with cancer (safest bet, but hardest to get). One could do MFM, and only take care of people who are already pregnant (postpartum concerns especially in the heart failure patients becomes tricky). Am I running away by seeking one of these?

I don't think so. I want to do MFM for another reason: my interest in early pregnancy, ectopic rescue, and placentation. I love complex physiology. I love crises and encouraging women through them. I love life and protecting it. I am going into MFM to bolster the research that supports the embryo and the fetus as a person. I'm doing it to be more effective as a pro-life physician.

It bothers me when people assume I'm doing MFM to avoid contraception. At the same time, I can't hide the fact that it's rather convenient that MFM means my scope of practice isn't as restricted.

A few people I've told about this decision are very happy with it and give the response that makes my skin crawl. "Oh, so the contraception think won't be much of an issue. It's like a safe harbor." I hate being called a coward. (It's too close to the truth, anyway.) Besides, I'm not really escaping anything. MFM is soaked with termination and sterilization. What kind of escape is that? In order of most to least protective, it goes Onc > MIGS > MFM. 

I also dislike that Catholics should have to seek a "safe harbor." We should be able to practice in any field. If we have limits, we're like 100% of other physicians, and we are fortunate (?) to live in a country where the things we don't provide can be provided by someone else. I shouldn't have to go hide in internal medicine or surgery (I thought about it!). I should be able to be an OB/GYN. If we all ran away into safe harbors, who would witness to the truth? Who would challenge the paradigm?

Not only the "safe harbor" idea fundamentally flawed, but it's also a myth. There is no safe place to be a physician who trusts his conscience more than he trusts his lawyer and the guidelines of his professional organization. In the coming decades it will be a growing challenge for anyone who wants to do the right thing, whether or not he plans for a safe career.