Dr. Fetus, or, How I Learned to Stop Worrying and Love Abortion

A few months ago, in lecture, the lecturer used the word "baby" to refer to a fetus, then quickly corrected himself and uttered the word "fetus."

In medical school, we are taught to refer to a fetus as a fetus rather than a baby when speaking to an expectant mother, unless the mother refers to it as a baby and says that she plans to keep it. Last year we had a "communications workshop" where we had to practice giving genetic counseling to a standardized patient (i.e., an actor) about the risk of her baby having Down syndrome. Fortunately, my "patient" told me right off the bat that she planned to keep the baby no matter what, so I was spared from having to use the word "fetus" over and over again for the rest of the session, instead being able to do what most people naturally do: use the word "baby."

This is yet another area where the left claims to be merely trying to encourage neutrality, but instead winds up pushing the leftist vision. The insistence on "fetus" encourages people to think of a baby as an inanimate object. If a pregnant woman who is genuinely undecided about whether to give birth or have an abortion hears her baby referred to as a "fetus," she is implicitly and ever-so-subtly being counseled in the direction of abortion. More broadly, and more importantly in the grand scheme of things, the cumulative effect on society at large of hearing physicians refer to "fetuses" by default, and "babies" only when given permission to use that word by the mother, is to encourage us to think of fetuses as objects which can easily be disposed of if they prove inconvenient. There really is no such thing as neutrality here. It's common sense & human nature to think of a fetus as a baby, but of course the left is against this, because they would never want to encourage a woman who might want to have an abortion to give birth instead. So they go in the opposite direction and wind up implicitly encouraging abortion.

Human nature punches liberalism in the face

I have updated the Catalog of Clinical Liberalisms with perhaps the greatest offender yet: the question "are you sexually active" and its follow-up, "with men, women, or both?" This is particularly relevant because of a story I heard secondhand from a classmate last week.

During our first year, we have a number of clinical experiences wherein we spend one afternoon in a particular practice setting. In most of these we merely observe, but some students, when sent to the ER, have been asked to take patients' histories. Allegedly, so the gossip goes, one of my young female classmates was sent into a room to interview a patient, a young urban minority type, and asked him the famous "men, women, or both" question, whereupon he promptly took a swing at her, voicing offense at the suggestion that he was a "faggot." She was unhurt, but the patient had to be restrained for the remainder of the visit, and I assume the med student was somewhat shaken.

At one level, this reflects merely on the naivete of the medical student. One must assume that a seasoned physician, even a liberal one who believes devoutly in these clinical liberalisms, would not be so foolish as to ask this question so nonchalantly of a man who, were one permitted to employ stereotypes, one would know would not take kindly to it. At another level, though, it reflects on how out of step liberalism is with basic reality. After all, not only social workers but liberal physicians themselves advocate this system, and while their approach to the issue in daily practice may be more nuanced, they fully support the system of medical education that is teaching students that we must ask these ridiculous and socially destructive questions without qualification. Do they not know that incidents like this are bound to happen?

While I do not celebrate a physical assault on my fellow student, I find stories like this one heartening in a way, because they provide evidence that liberalism so contradicts reality and human nature that it cannot ultimately triumph.

Reduction in residents' hours doesn't reduce death rates

One of the most ominous trends in medicine today is the ongoing trend away from being a respected sovereign profession with a high degree of authority and independence toward a more "team-based, cooperative" (i.e., subjugated to insurance companies, government, nurses, hospital administrators,etc.) one. There are many reasons for this, but in general, it fits perfectly with modern liberal society's view of anything smacking of authority, convention, or a traditional hierarchical social structure as bad, and non-judgemental, tolerant egalitarianism as good.

The call for more humble, less authoritarian doctors has manifested itself in many ways, not the least of which is an increasingly hostile attitude toward the tradition of intense residency training with its associated long work hours and frequent lack of sleep. As some may not know, the term "resident" comes from the fact that under the original system, these trainees actually lived in the hospital and basically never left. Though that requirement was abandoned long ago, for a long time interns (residents in their first year of training) were "on call" every other night, and residents every few nights, and call, especially for interns, typically involved being up virtually all night performing patient care duties, with seldom more than a chance to catch a few cat naps throughout the night.

Obviously, this system is unacceptable to liberals, because it is associated with producing authoritarian, "hardcore" doctors who think they know it all and can do it all, who have an air of confidence about their ability to handle any medical situation. Because this is non-egalitarian, it must be abolished. (The presence of liberals with this attitude within the medical profession has been greatly exacerbated by the presence of large numbers of women within the profession, who are concerned with "balancing" work and family life, a topic on which I have yet to write substantially about.) Liberals will bleat about how it's all about patient safety, but in reality I think they just can't stand the idea of doctors being so "hardcore," as they say, and, as I've learned as a new medical student, there are many liberal doctors and future doctors who feel this way too.

Starting with the famous Libby Zion case in 1984, there has been a movement to limit the number of hours residents can work, culminating in the Accreditation Council for Graduate Medical Education's enacting the 80-hour-limit workweek for residency programs in 2003. This is a private accreditation rule rather than a law, but the threat of congressional action was imminent, and the ACGME felt that the medical profession would be better off self-regulated than federally regulated. The rules made it difficult for some programs to meet what they felt were long-established standards of postgraduate medical education: for example, a surgery resident might have the opportunity to participate in a rare procedure thanks to an emergency, but would now have to be sent home because he had reached the 30-consecutive-hour limit on in-hospital time. Still, the thread of congressional action was due to alleged patient safety issues, so everyone has been waiting with bated breath to see if the work hour limitations resulted in fewer medical errors.

Well, surprise surprise, a new study has come out showing that they haven't:

"We can say conclusively that the duty-hour regulations did not worsen patient mortality. There was a lot of concern about that, and we can conclusively say that's not the case," said Dr. Kevin G. Volpp, staff physician and core faculty member at the Center for Health Equity, Research and Promotion at the Philadelphia Veterans Affairs Medical Center. "We can also say that there's some evidence of benefit in terms of mortality outcomes."

The only statistically significant difference the studies found was an improvement in mortality for medical (as opposed to surgical) patients at the VA. Meanwhile,

"The big question is how regulating work hours will affect the quality of training of the next generation of physicians who will be taking care of all of us for the next several decades," said Volpp, an assistant professor of medicine and health care systems at the University of Pennsylvania School of Medicine and Wharton School of Business. "That's the question no one really knows the answer to."

I don't know the answer either, but I have a prediction: it will make the quality of training worse.

Some may think that I, as not only a medical student who has yet to run this gauntlet, but an older one who will be running it in his mid-to-late thirties, am crazy for standing up for the old system. Certainly all of my fellow medical students whom I have heard voice an opinion on the matter have expressed disdain for the old system and support for the work hour restrictions, believing if anything that they're still not limited enough. But here's the rub: the disdain the express for the old system is of a piece with the disdain liberals express toward our society's traditional historical culture. Everything old, traditional, and Western European must go, because those old white males just didn't "get it." They were products of an ignorant and benighted time who didn't realize that people who strike a healthy balance between work and personal life make better doctors, instead believing that doctors have to be type-A macho jerks. They think that the younger generation has discovered the wonderful idea of shift work for the first time, which for some reason no one ever thought to apply to medicine before, but now that they have, the entire world is going to be filled with goodness and light. It doesn't occur to them that if doctors are shift-based, salaried employees, instead of independent professionals, they will continue to lose prestige, income, and the respect they traditionally as the final authority in the world of health care, until they are just yet another class of pencil-pushers overseen by middle managers.

This is a good example of what might be called the "positive feedback loop of liberalism," where once a liberal idea has infected a person or group, it begins to escalate, creating ever increasing and more fervent demands for even more liberalism. The work week rules were ostensibly established for safety reasons, but they soon created a shift-work mentality in new doctors; these new doctors forgot about the safety issues, and the idea of just plain not having to work as hard became the raison d'être for the restrictions. But since in an important job one will always have to work hard, someone looking for limits on hard work will never be satisfied; so the demands for ever more lenient standards--even more work-hour restrictions, part-time residencies and part-time attending/private practice positions (driven largely by women seeking to have families), and the transition of certain specialties, and in the ideals of some the entire profession, toward a shift-based salaried employment model rather than a sovereign independent professional model--never cease and grow ever more stringent.

There are certainly other reasons for this besides the ACGME work hour rules: for example, increasing numbers of women in the profession, a topic I really must address in its own entry, and the general immaturity of our society. The work hour restrictions, however, are a prime example of the law of unintended consequences, the deleterious effect of our society's obsession with "safety," and the way the medical profession, like our society in general, has become effectively suicidal due to liberalism.