The horrific shooting at Planned Parenthood in Colorado Springs that left three dead serves as a stark reminder of the grave consequences of inflammatory politic rhetoric and poor legislation.
After his arrest, Gunman Robert Dear declared "no more baby parts" to investigators. Dear's terrifying actions have been linked to the national ongoing attack on reproductive rights as well as inadequate gun control laws. As a medical student, I fear that we will have many more Robert Dear's in this country unless we make sure that political interests do not continue to impede on patient-provider relationships.
A report called "Politics in the Exam Room: A Growing Threat" that was released earlier this year describes how existing laws prevent doctors from executing their professional and ethical duty to provide evidence-based care to patients, cripple their ability to protect the safety of their patients, and undermine the necessary trust in patient-provider relationships. The authors of the report focus on three issue areas: the clinical management of toxic exposures, reproductive health, and gun safety.
The report describes how fracking uses many toxic chemicals including a significant number of known or probable carcinogens. Yet, health care providers have to struggle to get information on fracking chemicals due to trade secret protections, preventing them from effectively treating patients who may have been exposed. Even if providers are able to acquire the information on chemicals, they are then prohibited from disclosing that information to anyone including their patients. Such mandatory non-disclosure agreements are a flagrant violation of the patient-provider relationship and also hinder any necessary communication with consulting health professionals and public health agencies as a means of optimally treating the patient's condition.
Since 2010, the report asserts that states have enacted more than 280 restrictions on abortion--a number that exceeds the total number of restrictions passed in the previous decade. Such restrictions include laws that require health care providers to provide information to their patients "that is inaccurate, biased, irrelevant or otherwise outside the medical profession's standards of care, and therefore undermine true informed consent." Other restrictions entail mandatory ultrasound or delay laws that coerce providers to go against their medical judgment when providing unnecessary care or withholding medical care altogether.
The report goes on to delineate how laws, such as "gag rules", limit providers' ability to counsel patients about gun safety even though it is considered a standard practice for pediatricians and family physicians. Authors of the report contend that, "health care providers routinely counsel their patients about a variety of hazards"; hence, "guns should be no different." By impeding free communication between patients and providers, these laws prevent patients from accessing crucial health care information.
Implications for Medical Care and Training
Ultimately, these laws hinder physicians' ethical and professional duty to care for their patients in a manner that is based on mutual trust and is reflective of the most recent clinical evidence. They have significant national implications as well. According to the report, more than 15 million people live within one mile of a recently-drilled fracking well; one out of three women in the U.S. will have an abortion by age 45; and more than 100,000 people annually in the U.S. suffer from gunshot wounds while approximately 1.7 millions children reside in homes with unsafe gun practices.
As a physician-in-training who is currently in the midst of learning how to conduct effective, patient-centered interviews, this is frightening. These laws go against some fundamental components of clinical practice that we are taught in medical school. We are constantly reminded about how vital trust is in patient-provider relationships. The importance of evidence-based medicine as a means of mitigating individual biases and providing the best care possible is also an essential part of our curriculum.
Unfortunately, these laws reinforce the need for medical students to not only be taught the essentials of physiology or anatomy, for instance, but also the tenets of advocacy. How can we make sure that progress of our profession isn't hindered by special interests? What steps can physicians take to tackle the more "upstream" factors of health so they are not left feeling disempowered upon recognizing the limited impact clinical care truly has on health outcomes overall? Overall, how can the medical profession work with the communities we are entrusted to serve towards creating happier, health-optimal conditions for all?
There is indeed a growing recognition, among the physician community, of the need for sustainable community collaborations and inclusion of physician voices in policy making. Soon after the Planned Parenthood shooting and hours before another tragic mass shooting, a group of physicians delivered a petition to Congress urging them to eliminate the restriction imposed on the CDC that has prevented it from conducting research on gun violence.
To date, over 4,000 health care providers and those in training from organizations such as the National Physicians Alliance and Doctors for America have signed on to this petition. There is much work that needs to be done but as medical students we can start pushing for necessary change right now through methods such as curricular reform, writing to inform and influence public opinion, and participating in local and national advocacy days.
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