The FALSE assumption about what drives doctor’s recommendations

Many women / parents are reluctant to trust their own ability to make rational, informed decisions about their medical care provider’s recommendations.

I believe this is partially because of the assumption many people have that medical professionals like doctors and registered midwives make recommendations and perform procedures according to, and only to, evidence-based guidelines. This assumption leaves women feeling like “Doctor must know best”, and that if a medical recommendation is being made, it must be based on purely strong evidence supported by science.

However, the article, Many Pelvic Exams Are Medically Unjustified highlights a example of how this assumption is often very wrong:

“Despite…recommendations, about 87% of the physicians surveyed said they would perform this examination on 18-year-old healthy women. Physicians also said they perform the examination to reassure patients, to meet patient expectations, and to ensure “adequate compensation for routine gynecological care””

This is not evidence-based practice, and illustrates an example of how likely (in this case, 87%) physicians can sometimes be to make practice decisions for reasons very much other than ones based in clinical science.

Although performing an exam to “reassure patients” may sound positive on the surface, it actually can be quite detrimental. This particular exam is not evidence based, therefore “could result in unnecessary surgeries or women being falsely reassured.”

The other reasons given, which were that they perform they exam because their patients assume they will do it and so that they get paid enough for a clinic visit are quite clearly not good medical practice.

And be careful not to shrug this off, thinking “this kind of thing just happens in the US”.  In fact, a 1999 study found that doctors paid on a fee for service basis (the conventional way physicians are compensated for their services in Canada) “write more prescriptions for antibiotics than their salaried counterparts”, indicating that the way a doctor gets paid CAN impact their clinical recommendations here in Canada as well.

Side note: Something interesting to consider is that, according to an article from Canadian Business, the former dean of Queens University says the “fee-for-service model tends to reward rapid, technical procedures over the delivery of holistic care”. I don’t know enough about this to have an educated opinion at this point, but it certainly might provide some insight in terms of our very technological model of birth in our maternal health care system. Perhaps something to explore in another post!

While the pelvic exam article mentioned above  is not about childbirth, I think this is an important issue for birthing women to understand because it clarifies why asking questions to make informed decisions for yourself is important when consulting a medical practitioner.

Medical professionals have very specific and extensive medical training and expertise, and this is why we may choose to consult with them!  Still,  they are only human like you and I, and their decision making is subject to human flaw, bias and error (again, perhaps unconsciously) just like the rest of us. Ask questions, get informed, and use that information to make your own decisions about your body and your birth.

Research on influence on healthcare:

• Undue industry influences that distort health care research, strategy, expenditure and practice

I welcome your comments and discussion below!

Jessica Austin, Childbirth Support & Information in Vancouver, BC