‘I’m entitled to my opinion’.
It’s like hearing fingernails down a chalkboard. Or this doozy: ‘That’s just your opinion.’ (Actually no, it’s a fact based on statistics, evidence, years of study and even more years of experience along with diagnostic tests.)
But it’s not about university degrees… it’s about knowing your expertise. If I go to my mechanic for a car problem and he tells me I need new tyres but I think they look fine because of a video I saw on Facebook about ‘extending your tyre life’ that had 100,000 likes, does my opinion count more than his education and experience? Quite simply, no. And I’d be a fool to drive out of there on tyres thinner than my ego. Similarly, I trusted the plumber’s expertise last month when the drain under our house burst and I trust my accountant’s expertise with my tax every year.
After my last post, When Did We Become The Enemy?, whilst I received lots of heartwarming and humbling feedback (thanks so much, you insightful, evidence-loving folk!), I also received a significant amount of vitriol from the anti-vax, anti-medicine community. (Surprise, surprise!)
In response to my commentary on the high risk home-birth death of the yoga teacher, the comments were quite astounding along the lines of: ‘being in hospital wouldn’t have changed her outcome’. I would expect nothing less from a grieving community who need to justify their choices. But that doesn’t make it right. It’s simply not true. And it’s bloody dangerous to let these opinions go unchecked.
A patient openly posted about their ‘complicated’ pregnancy and defiantly posted about turning away from medical treatment. ‘They asked me to remain in hospital for the duration of my pregnancy. How does no sound?’, ‘3 docs said to me so you are declining staying’, ‘yes my body and baby know what to do in divine timing. I’m going home’ and ‘I’m not staying in your CARE model. Cover Ass Retain Employment’.
The same CARE model called upon to try and save her life when things didn’t go to plan… And people wonder why we are fed up and burnt out.
(I will clarify that I had nothing to do with this case nor any staff and have no ‘insider’ knowledge. I’m commenting on public posts and the comments sent to me after my last post.)
I dared to comment on a news article about this case in response to someone asking ‘How can this possibly happen in the age of modern medicine?’ I simply said ‘Modern medicine doesn’t always get a chance when someone chooses a home birth and it’s devastating to see people turn away from medical care when we have the best maternity wards and staff in the world.’
Well, didn’t that unleash a flood of abuse, enough to make me delete my post. The supporters, full of apparent ‘light and love’ until you disagree with their opinion, had the gall to say ‘being in hospital wouldn’t have changed the outcome’ and ‘out of respect for the family I should shut up’ and I’m just an ‘insensitive, disrespectful arsehole’ for suggesting this. This patient, by all accounts, was a beautiful soul who changed lots of lives through her yoga teaching and it’s a terribly tragic and heartbreaking case, particularly for 3 little girls left without their mum. And I care that she died. A Lot. (Too Much). However, out of respect for the exhausted, broken and traumatised health workers who were placed in an impossible situation yet did their best, and to possibly stop another death, I spoke up for a profession burning themselves to the ground trying to help the misinformed, the entitled and the ungrateful.
This could have been a very different outcome.
And herein lies the rub: do we let uneducated, untrue and downright dangerous opinions fester and multiply because it’s easier to stay quiet; or do we stand up and speak out for our profession, our education, our researchers, our patients and the rest of humanity, and in doing so open ourselves up to the backlash?
A possible cause of death in this case was an amniotic fluid embolism, a rare and catastrophic complication of childbirth with a high mortality rate in hospital births of 11-44% of women and 30% of babies. So, over 50% (and in Australia, up to 85%) of women can survive this tragic event if it occurs in hospital with timely access to medical help. And if it was any other complication: PPH, PE, DIC… she had a better chance of survivial in hospital. I’d take that over no chance any day of the week and I’d advise my patients to do the same. Then I’d back it up with the evidence and the RANZCOG expert statement on home birth posing an ‘unacceptable risk’, even more so in a complicated pregnancy. But the angry hoards won’t hear this as in their opinion, it wouldn’t have made one iota of difference. And, as we all know ‘everyone is entitled to their opinion.’
(Don’t believe my ‘opinion’? Here are the facts: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690249/ )
Interestingly, it seems with many home births, empowerment and control of the birthing process (#wildbirth #freebirth) is valued over the outcome (#healthybaby #healthymum). I don’t have (human) kids so call me naive, but I would have thought the whole point of pregnancy is to have a healthy baby that you get to watch grow up, and as such the delivery process, though extremely important, is ultimately just a means to this end? Whilst I’m all for patient-centred care, enabling as much patient choice as possible, it should NEVER be at the expense of safety. There is acceptable and unacceptable risk.
Primum non nocere (First, do no harm)
Cancer patients refusing chemo in favour of juice cleanses and chanting rituals, unvaccinated Covid patients filling ICU beds whilst trauma patients miss out, home births turning into tragedies, ‘Kambo cleanses’ using frog toxins that land patients in ICU, coffee enemas (why?), unnecessary IV vitamin infusions, bogus homeopathy tinctures, quackery chiropractic treatments for ‘vertebral subluxations’ that don’t exist… the list goes on.
Because nowadays, in the age of (mis)information, anyone can become a guru, start a website and preach unchecked opinions to the vulnerable.
There will always be another rabbit hole to fall down.
The anti-medicine, anti-evidence sentiment is rife and so often ends in patients landing at medicine’s door for an 11th hour intervention, to be saved by science when all else has failed.
We’ve reached a point where as medical professionals if we dare to speak the hard truths, aka, the medical facts, to try and stop people dying, we’re labeled insensitive, opinionated, argumentative, ‘full of shit’, uncaring, disrespectful or even as I had this week, (actually I copped all of these this week),… ‘an insensitive, disrespectful arsehole’ because we’ve offended someone. So I want to ask, what about the arseholes that convince vulnerable patients to take these risks? Who calls them out?
If sharing ‘offensive’ facts could possibly educate someone to make better choices and perhaps even save just one life, it’s worth it. Well, it used to be. But it takes courage and energy to stand up against misinformation and the opinions of the angry, ignorant and vocal minority again and again, and every time we go into battle the light becomes a little dimmer, the cuts a little deeper and fighting the good fight becomes a little less ‘worth it’.
I’ll keep trying to fight the good fight.
Dr Kate x
(Ps. You can practice yoga and love science!)
As I told my 80-year-old husband who was up a ladder, “Just because I can stake a rose, doesn’t mean I can set a leg. Get down off that ladder. There are experts who can repair the roof.”
The certainty that the idiots have that the tragedy would still have occurred in a hospital reminds me of Bukowski’s quote about stupid people being full of confidence and intelligent people being full of doubt.
We don’t know if the woman would have died in hospital (no one ever will) but we do know the odds would have been much more in her favour.
We don’t know that a chain smoker who died from lung cancer would have avoided lung cancer by abstention from smoking, but we do know the chances are very high.