THE OBSTETRIC STRATEGY IN WOMENS MEDICINE Nelson Soucasaux Gynecologist and writer In my book Novas Perspectivas em Ginecologia (New Perspectives in Gynecology), I suppose I have demonstrated the total absence of scientific and logical reasons that could justify the persistence of the usual tie of Gynecology to Obstetrics and that, as a matter of fact, this tie is nothing more than a very efficient professional strategy for gaining more patients. In this way, now I would like to add some more comments about how this strategy works. In Novas Perspectivas em Ginecologia I have explained in details what I use to call the obstetric view of women, which is an archaic cultural distortion deeply rooted in our society that consists on, mistakenly, considering motherhood as the supreme womens fulfillment. In spite of being in almost total disagreement with the reproductive, existential and psychological reality of most modern women, this old-fashioned point of view still has strong influences in several areas. In Womens Medicine, this obstetric view of women is partly responsible for the persistent domination of Gynecology by Obstetrics ( or by the obstetric thought ). Heavy psycho-socio-cultural factors remain reinforcing this situation. Concerning the great influence of socio-cultural factors on medical science, Louise Lander remarks that ... Medicine as social institution rather than scientific discipline also means that particular medical doctrines continue to be espoused in the face of objective evidence of their fallaciousness (Lander, L. - Images of Bleeding - Menstruation as Ideology, Orlando Press, New York, 1988 ). I believe this observation is quite applicable to this serious problem of the traditional tie between Gynecology and Obstetrics. Physicians who are fundamentally obstetricians seem to be inclined to play the role of gods in the female clinic. Many of them still regard Obstetrics as the center of Womens Medicine... Their professional strategy consists on choosing quite well the ideal moment for leaving the long-lasting mark of their presence on the female life. To practice Womens Medicine having Obstetrics as the center is very advantageous for the clinic because, during pregnancy, women are in a situation of great psychological and emotional vulnerability, having a special need for great support in order to safely go through the complicated adventure of gestation and childbirth. For obvious reasons, they search for this support on the person of the obstetrician. Within this very peculiar existential moment, if a woman becomes satisfied with the obstetric assistance given to her, the obstetrician can easily assume the position of a heroic character in her fantasy, and even become mythicized by the patient. This process usually takes place in womens minds at subconscious or unconscious levels. The regrettable result of all of this is that, after parturition and puerperium, the obstetricians easily become able to guarantee the permanence of the patients, becoming, from that moment on, also their gynecologists... The total ignorance on the part of most women about the enormous medical differences between Gynecology and Obstetrics also contributes a lot for the occurrence of such thing. The professional strategy the obstetricians make use of for getting gynecologic patients is based just on this. Sadly, the great majority of women do not know - and the opportunity to know is not given to them - that Gynecology and Obstetrics are very, very different medical specialities in their respective clinical, physiological, pathological and therapeutic aspects. Even the obvious fact that, while Gynecology takes care only of women, Obstetrics takes care of women and fetuses, does not seem to be enough to call their attention. Therefore, patients do not know that the competence of a professional as obstetrician absolutely does not presuppose his/her competence as gynecologist. On this subject I also always emphasize that, given the enormous technical advancements of present-day Medicine, it is more and more difficult ( or even impossible ) for the same physician to practice two medical specialities so wide and different as Gynecology and Obstetrics with the necessary competence. In this way, from the point of view of the security and responsibility in the practice of Medicine, I think that the usual integrated practice of Gynecology and Obstetrics by the same professional must be condemned . However, regrettably, what continues going on at least here in Brazil is just the opposite - and, what is even worse, at an institutional and official level ! Note: this is an adapted and slightly modified excerpt from my above mentioned book Novas Perspectivas em Ginecologia ( New Perspectives in Gynecology ), released in 1990 by Imago Editora, Rio de Janeiro.
Posted on: Sat, 23 Aug 2014 06:34:59 +0000
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