“Evidence-Based Medicine”
As many readers will already be aware, my wife and I experience some difficulty in our practice of Natural Family Planning. Because of our erratic charts, our NFP instructor recently recommended that we ask my wife’s doctor to do some tests on her vitamin D, iron, prolactin and testosterone levels.
Now, our family doctor is not supportive of our choice to use NFP. She asks what we use for birth control and, when we say NFP, she writes “none” in our files. She quietly, but obviously, shakes her head at our superstition and irresponsibility. When my wife asked her for the tests our teacher had requested, the doctor seemed quite put off. It was as though we were wasting the system’s valuable resources chasing a phantasm. We were informed that, though the doctor would grant us the tests this one time, we should understand that this is not normal practice. We should not expect to be able to get such tests on request in the future. In her own words, our doctor prefers to do “evidence-based medicine.”
But, however reluctantly, the tests did get done. We heard back from the clinic in quite a timely fashion. My wife’s testosterone and prolactin levels were fine. Her iron and vitamin D, on the other hand, were seriously low. She needed to be on supplements – and soon!
Our doctor felt that my wife’s vitamin D and iron levels were cause for sufficient alarm. But how would she have ever known about these problems if the requested tests had never been carried out? Nothing in her own practice gave her any “evidence” of my wife’s condition.
On the other hand, a woman, whose only medical training comes through a faith-based community group interested in fidelity to the Catholic Church’s teaching on birth control, was able to look at a series of NFP charts and hypothesize that something was off. Tests confirmed that hypothesis.
I’m not sure what our family doctor considers evidence, but my understanding of the scientific method is that our erratic charts constituted evidence of a potential (and, as it turns out, actual) vitamin and mineral deficiency. We wonder if, in the future, this experience will make our doctor a little less suspicious of our method of family planning. If she really is interested evidence-based medicine, the fact that an NFP volunteer caught a serious medical condition that she herself had overlooked should at least give her pause.
Brett Salkeld is a doctoral student in theology at Regis College in Toronto. He is a father of two (so far) and husband of one. He is the co-author of How Far Can We Go? A Catholic Guide to Sex and Dating.
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Not just an issue of NFP, but it is also an issue of doctors needing to listen to their patients. If a patient thinks they have a good reason to believe something is off, it is good for them to do the test. It’s certainly strange for a doctor to a-priori determine something without a test and then say it’s because of “evidence.”
Brett,
Is t possible for you to find a good catholic doctor in your area? I believe the Paul VI institute keeps a nationwide list of doctors who are NFP certified.
Frustrating, isn’t it? One plans action using NFP by deciding how to act based on observed evidence!
One of the fruits of socialized medicine. Doctors are gods, patients are rubes.
Brett,
While we have not had any major episodes with unbelieving doctors, we have heard our share of similar stories. Regardless of the effect it has on your doctor’a perception of things, although that is not negligible, I pray this will finally make things a bit easy for you and the wife.
Thanks for sharing
I think I’d be looking for a different doctor. As Ben said, there may be some in your area who are NFP certified. And Henry is right, doctors need to listen to their patients more. Hope your wife is feeling better.
Ben,
No luck so far. Does the Paul VI Institute include Canada?
Charles,
Not sure what this has to do with “socialized medicine.” This kind of thing happens all over the US too.
I consider myself responsible for my own health, and I consider my doctor as a valued advisor and consultant. Together we work out what I need to do in order to stay healthy. At times he might feel my lifestyle threatens my health, and tells me so. If I feel I cannot change my lifestyle, then he helps me adjust what I feel is acceptable to a more healthy situation.
I have in the past walked out on doctors that treated me like I was their project, after reminding them that I was the one paying the bill and he was part of what I considered a service community.
While it has never happened, I could understand that after a discussion a doctor might decide that a test was not necessary and therefore my health insurance should not have to pay for it. But he had better be prepared to have the test done if I paid for it, and at that he had better have some pretty good arguments.
In this case I would be looking for a new doctor yesterday. This is not a matter of NFP, this is a matter of a doctor not recognizing symptoms pointing to a serious problem. Such actions are, in my opinion, the stuff of which malpractice suits come from. I would be looking for a doctor willing to work with me, and even if such a doctor did not believe NFP was effective, he would would help me as best he could.
I would be asking all of my friends for recommendations NOW.
Yet another dimension to consider is the importance of emotional health and healthy relationship to patient health. A doctor unwilling to honor her patient’s personal and spiritual practice isn’t fully supporting the patient’s health. Whether or not she is of the same religion as the patient, religious tradition can be a powerful ally in promoting and maintaining health.
Does anyone else feel the burden of living with industrialized medicine and medical practice driven by procedure codes the insurance industry cooks up?
My wife and I have had mixed reaction from doctors regarding NFP. Generally, we found OB-GYN’s to be more supportive than family doctors, particularly in Manitoba. However, we did find that some doctors seemed to be annoyed with the charting, as if by knowing that much about her own body, she was trespassing on a sphere of knowledge that is sacred to the medical profession. Perhaps certain (medical) mysteries are not appropriate for the laity to question or seek to understand.
I am entirely on Brett’s side here, but didn’t we have a discussion not too long ago (which I can’t now find) in which some lamented that doctors weren’t really doctors any more but were just people who gave patients whatever they asked for? I much prefer patients taking a major role in deciding what is best for them, but it seems like in this case the doctor was saying, “Who’s the doctor here?”
I believe that if patients wants to use NFP, doctors should work with them. I can, however, imagine that some doctors might feel that if they work with a patient on NFP, and the patient gets pregnant, the patient will say it is the doctor’s fault. In this case, I think it is the doctor’s obligation to say, “NFP isn’t within my area of expertise. Let me give you the name of a doctor who will work with you on this.”
One of my previous primary care physicians developed the very annoying practice of writing notes in my file and making me sign them on any matter that might conceivably lead to a malpractice suite. “David affirms by his signature here that he was warned about dietary cholesterol etc. etc.” One of his patients had died as a result of disregarding his advice, and the patient’s wife sued. My doctor had the documentation to prove he had warned the patient. So he then began making sure he could document everything, and it was extraordinarily annoying and unlike anything any doctor I had been to before or have been to since has ever done.
“I am entirely on Brett’s side here”
Ahhh . . .
I was quoted out of context! The full quote should be
“I am entirely on Brett’s side here, but . . . . ” :-)
There is an awful lot of talk about “conscience protection” for medical professionals, but if one really wants doctors to be allowed to follow their consciences, what do you do with doctors who honestly believe NFP is not the way to go if one seriously wants to postpone the next pregnancy? Or doctors who believe a woman ought to have an abortion in order to safeguard her life or health?
In any case, clearly the doctor here was proven to be in the wrong when the tests she did not want to run came back with alarming results.