Family physicians aim to be “patient-centered.”  It’s not always clear, however, what that means.  It doesn’t mean that we give antibiotics to anyone with a cold who wants them.  It doesn’t mean we prescribe narcotics for anyone who requests them.  We practice medicine responsibly while paying attention to  our patients’ concerns.  Being patient-centered is more than good listening; it’s actually involving patients in the decision-making around their care.  For example, for someone with high cholesterol and risk factors for heart disease, we might ask, “Would you want to start on medication or would you like to work first on diet and exercise?” And then, that discussion gets into the nitty-gritty of what is possible for this patient.

Given that patient-centeredness has become the catchword of good doctoring, it stuns me that teachers in my field find it acceptable to ignore abortion.  While discussing an upcoming meeting around reproductive health care (it was billed as expanding access to abortion, contraception, and miscarriage care) I met with objections from an assistant residency director.  Her residents, who had been invited to the meeting, were “offended that the training was presented from a ‘choice’ point of view.”  The options for treating miscarriage are almost the same as the options for an unintended and unwanted pregnancy, and the counseling skills are similar – yet these residents wanted to learn about miscarriage without having to learn anything about abortion.  They were “offended” that this broader context was even offered to them.  She reassured me that these residents were very good doctors who take their jobs very seriously.  She told me I should “remove the skill from the politics.”  I guess, to her, learning about abortion is not part of offering care to women; it’s not medicine, it’s “politics.”

I have been thinking and thinking about this, and I just can’t find a way to envision these people as good doctors for women of reproductive age.  They refuse to learn about abortion- a medical procedure that 3 out of 10 US women will have had by age 45.  They are not interested in learning how to counsel women about this option in a non-judgmental way.  And, they don’t even wanting to attend a meeting about contraception, miscarriage and abortion because abortion will be discussed as part of the care that we give!  So, how will they treat the woman who comes to them with an unintended pregnancy?  Will they refuse her anything but enrollment in prenatal care?  Will they try to talk her out of an abortion if she asks about it? Will they misinform her (since they have refused to learn about all available options)?  It’s hard to fathom how this could be a patient-centered encounter.  I just can’t imagine that these residents will become good doctors.  If they think that they know what women should do in such a core area as when to have their children, won’t that “I know better” attitude carry over into other parts of their practice?  And in the end, if a doctor can’t let a woman decide for herself if she is prepared to bear a child, how can that doctor possibly be patient-centered?