Tuesday, October 21, 2008

Hey Batter Batter

So I just returned from a medical education trip at Las Vegas about obstetrical ultrasound in high risk OB patients. This is an area of interest for me since I do OB and do OB sonograms. I wanted to write a little blog about my educational experience and its application. I have to say that I walked away from the experience a little bothered. You see, this conference was taught by big-wig ivory tower doctors that do a lot of research from Denver, UCLA, Columbia (New York), and even Italy. The main theme of the whole 3 days was that we can diagnose things earlier and earlier with ultrasound so that termination of pregnancy can be offered by 22 weeks if there is something wrong with the baby. This theme just floored me! I can't believe that as medical costs rise and outpace spending in other areas, and as people's health insurance costs continue to rise, our educators were preaching to do more testing earlier to diagnose abnormalities earlier, mostly in the name of information for the mother so they could decide what to do with their pregnancy. The majority of these tests they are now recommending are primarily for the detection of Down's syndrome and congenital heart defects. Why diagnose these conditions earlier? Well, it does lead to being prepared at delivery with the appropriate staff and care, but why does it matter to diagnose it at 10-14 weeks versus 18-22 weeks when it can usually be diagnosed with other tests that are much less expensive? It is to allow a parent a choice to terminate the pregnancy if something is wrong. My friends, I have major ethical issues with this point as a doctor. As a family doc, I take care of lots of people with mental and physical disabilities, including people with Down's syndrome and congenital heart defects which have been repaired. Many of these patients are wonderful people who contribute more to society than fully functioning "well" people. For example, I have some patients with Down's syndrome who are now in their 6th decade of life, are rarely sick, are always happy, have utilized little health care resources, and have held various jobs for over 30 years. I also have patients who are in their 50's and have a diagnosis of fibromyalgia, have not worked in 15 years, who live off of our tax dollars in the form of social security/disability, who utilize more and more health care dollars, and have completely functional limbs and mind that allows them to go bowling, cook, clean, take week long vacations to the beach, but they just can't work. The point I am trying to make is that just because a fetus has a genetic problem doesn't mean that that "person" does not have a huge potential. Potential cannot be measured by any standard medical test that I know of. To base a decision regarding the life of a baby on whether or not that baby has a problem (genetic or not) is a fallacy. Don't get me wrong. The genetic testing is accurate, but the largest part of the equation is missing, and that blank cannot be filled in until potential has been given its proper environment and circumstance to reveal itself, at which time the point of termination is moot. If you did genetic testing on every person, you would undoubtedly find genetic flaws in every person's DNA (why do you think we get old and die?). It does not mean, however, that that flaw has any significant consequence. Perhaps those individual flaws are what makes us unique as individuals. Thus, genetic flaws do not always result in negative results, and when they do have known negative results, the degree to which they are negative depends in a large part on the environment in which they are expressed. I thus believe that in this case, more knowledge is not necessarily better. Knowledge does not always lead us to correct decisions. That requires wisdom, which requires knowledge yet is separate from it. My point is, my friends, that knowledge does not always help provide the correct answer. It is sad when in medicine we try to get more answers through more knowledge but it ultimately only leads to more questions.
My friends, medicine will never be able to provide you with 100% of the answers. We are not God. We can't explain everything, nor can we predict everything. There are no guarantees in this life in regards to health, and that includes pregnancy. There are risks, and a responsible person, which I believe is a requirement to be a parent, should recognize those risks as a possible reality when they decide to pro-create. Life is full of curve balls; you can't stop the pitch from coming and you can't leave the game. All that is left for you is to do your best with what you have.
So what did I learn from this conference?
1. Ivory, though white, is not completely pure (referring to the ivory towers of medical education, of course).
2. Knowledge does not always facilitate wisdom, but rather can hinder it.
3. There is a huge monkey on the back of choice and action, and its name is responsibilty.
4. In the words of Forrest Gump, "Life is like a box of chocolates, you never know what you're gonna get."
I look forward to your comments and opinions.


Kimber said...

I agree with you wholeheartedly on every point you made. I haven't met a Down's Syndrome patient yet that I didn't like.

Farm Chick said...

Very good points...I can only imagine how frustrating these events can be.