As I am preparing for the transition from student to physician it has become more important for me to address the actualities of patient care versus the ideals that are discussed when we are being taught. After being away from clinical medicine for about a year and now being immersed in it again, something that I had contemplated as a medical student has come back to the foreground of my thoughts.
What do physicians and hospitals mean when they say “we don’t allow a patient to do X” or “a patient must do X.” I have heard this most often when discussing obstetrics as in the examples below.
“We don’t allow patients to go past 42 weeks.”
“The hospital does not allow VBACs (Vaginal Birth After C-section).”
Realistically, a physician can discuss these issues with a patient, present the risks and benefits, use strong language like “we don’t allow” and “you must”, but, in the end, it is the patient’s decision and they have the right to refuse. Many, maybe even most patients will take the advice of their physician and do whatever they recommend. However, there is going to be a segment of the population that does not agree with conclusions that the physician and/or hospital has reached and decline.
In reality, what does a physician who says “we don’t attend VBACs” do when a patient, who they have seen for nearly 9 months, refuses to schedule a repeat c-section and shows up at the hospital in labor? Will they refuse to admit the patient or admit them and then annoy the patient during the entire labor until either they give in and allow the c-section or the baby is born vaginally. What about a patient who is at 41 weeks gestation and refuses to schedule an induction for 42 weeks? Will they discharge the patient from their care when labor is imminent and refuse to attend the birth when labor finally begins. Will some go so far as to perform the procedure without their consent? Or try to obtain a court order to force them?
This place is where the theory we learn in school and the reality of patient care meet in direct opposition.
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