The only religion that my patients see me practice is medicine

The only religion that my patients see me practice is medicine

When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.

So I spoke with her. I explained that over the course of her career she would undoubtedly see people from all walks of life with a myriad of religious and or personal practices. I explained that medical care is not about fulfilling any personal need beyond the need to help.

I gave the example of a doctor who is a Jehovah’s Witness. Refusing to order a blood transfusion would be both unethical and malpractice.

I had an OB/GYN who practiced the same religion discuss how he felt that he could prescribe contraception and still honor his Church.

None of this mattered. In her eyes prescribing contraception was an affront to her religion.

“What if you don’t council a patient about condoms and she gets HIV?” I asked.

No answer.

“Do you think it’s ethical for a woman to take time out of her day to come for a well-woman exam and not leave with the contraception that she wants and needs?”

Silence.

“What if that woman leaves your office without birth control, gets pregnant, and is then beaten to death by her partner as pregnancy puts her at increased risk for domestic violence related homicide?” I persisted.

“My patients will know I won’t prescribe birth control or discuss condoms. They will get the Creighton method,” she said.

“How? Will you have a sign? Will your receptionist tell every patient who calls?” I asked.

If the answer had been, “I realize my personal belief system puts me at odds odds with the standard of care so I’m headed for pathology,” I would have commended her for her insight and given her a passing grade with a note about her contraception issues on her transcript.

But she responded that she was going to be a family doctor.

I spoke with the Chief of OB/GYN and the Dean of the Medical School. They agreed that refusing to be involved in any way with contraceptive or safe sex counseling should result in a failing grade on the clinical component of the rotation.

They agreed, that is until she lawyered up. A public fight about teaching contraception would just be too much, you know?

Shortly thereafter I resigned as the director of medical education for OB/GYN and left for a different state.

If a doctor can refuse to discuss contraception, essentially proselytizing to patients, then we should not be surprised that some pharmacists will refuse to dispense it and be protected by the law.

Ask yourself, do you want your own health care provider to consider their own religious or personal beliefs first before offering you medical care? If so, then everything is up for grabs. Everything. From blood transfusions and addiction medicine to fertility therapies and weight loss therapies because it all depends on how you interpret any given scripture.

The only religion that my patients see me practice is medicine. Anything else, in my opinion, is malpractice.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

Image credit: Shutterstock.com

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  • http://profiles.google.com/lauriemann57 Laurie Mann

    I’m really sorry Dr Gunter’s school didn’t lawyer-up over that case. It’s appalling to see medical schools take an anti-science attitude.

  • http://www.mightycasey.com/ MightyCasey

    I’m as horrified by this as I would be by an ob/gyn who prescribed abortion for all pregnant patients. This med student’s approach amounts to the same thing: forced medicine.

    I agree with Laurie that medicine has to grow a pair and start standing up for itself. Otherwise … we’ll end up where we are. Healthcare by committee. Should be doctor and patient only, with the patient as able to fire a doctor as vice versa.

    I certainly hope that the patients who come up against the doc that Dr. Gunter was teaching walk when she starts spewing her religious views vs. scientific ones. Unless those patients agree with her 19th century ideas …

    • cmartel2

      What exactly is being forced in a doctor who does not prescribe OCPs? (Absolutely nothing.)

      Second opinions are routinely sought out by patients when they do not buy into the opinion of their doctor. You speak of medicine as needing to “grow a pair,” but here is a future-doctor who wishes to practice as she so sees fit, and you want to gag her with your own committee. There’s more than a bit of hypocrisy in those statements you’ve made.

      Your reference to “19th-century ideas” frankly also wreaks of bigotry. The single largest Christian denomination in the world advocates against the use of contraceptives as of this very date. Might patients be interested in seeing a doctor who also holds those views and who might actually be quite knowledgeable about the Creighton method? Certainly. And others would be free to seek healthcare elsewhere, certainly.

      The only forcing I see from this example is a person in power attempting to use his influence to force a student into violating her moral conscience and a system that would attempt to respond accordingly, were it not for a greater fear of loss of time, reputation, and money at the threat of violating a future-physician’s First Amendment rights.

      This future-physician in no way stated that she was going to “spew” her religious beliefs but merely indicated how she would practice. Her stated method, the Creighton method, has been studied and found effective in peer-reviewed journal articles, including the “Journal of Obstetric, Gynecologic, and Neonatal Nursing.” What is this “her religious views vs. scientific ones” that you discuss?

      Full disclaimer: I have no religious qualms with the use of contraception, and my wife uses OCPs aside from when we wish to become pregnant.

      • http://www.mightycasey.com/ MightyCasey

        You’re most certainly entitled to your opinion. As I am to mine. We disagree completely.

        • Bastiat

          Except, according to the logic in your opening paragraph this student is not entitled to his/her opinion. You lambast the school for failing to stand behind Dr. Gunter, implying that you would support the failure of this student in this rotation. A failed rotation would result in the inability to graduate from medical school and as such the de facto censure of this student from the ability to practice medicine. As such he/she would not be entitled the opinion making ability we agree is paramount.

  • Carole Wegner

    I am so sorry your organization didn’t back you up. You have the high moral ground here, not the student. I am so grateful for physicians like you who put their patients’ needs first!

    • Bill

      I can’t believe that Ms. Gunter is advocating that physicians daily violate their consciences. This person believes that contraception is prohibited by God, yet you are telling her to disregard any religious notions and do something she believes is wrong. The discussion should not be about setting aside one’s religion when stepping into the clinic, it should be about why we have our beliefs in the first place.

      • http://www.facebook.com/profile.php?id=535135490 Anne Frates

        No, she’s advocating that she not place herself in a position where the ethical thing to do for the patient is against her principles. She should go into a branch of medicine that doesn’t have anything to do with contraception. then she can do everything necessary for the patient’s health without violating her own perception of religious principle. It is not reasonable to specialize in a branch that has a component that is generally expected and to hold out that you don’t believe in that option. Disingenuous to say the very least.

        • Bill

          Quoting from the article, “Ask yourself, do you want your own health care provider to consider their own religious or personal beliefs
          first before offering you medical care?”

          So yes, she is advocating that doctors shouldn’t consider their own moral beliefs, they should only offer medical care, regardless of if they personally think it is moral or not. You could easily make the same argument for euthanasia or human cloning for organs…. (Hey let’s not think about whether this is right or wrong, let’s just provide “medical care”. Anybody with a moral judgment just better go into pathology) . The author is saying your own moral compass as a physician shouldn’t matter, just do it anyway.

      • Molly_Rn

        This intern should not be a physician as she doesn’t seem to know that her duty is to her patient first above all. Or she should practice a different specialty.

      • http://twitter.com/NCBeernut Scott

        In addition to what other people have already said below, anyone who lets a belief that there is a spirit with a drug formulary of acceptable medications affect her medical decision making does NOT need to be a physician. Medicine isn’t for everyone – we are here to help people using the resources that are available, not to impose our beliefs onto others who come seeking help.

  • Talia

    I agree. I can understand that religion dictates personal choices but, as a doctor, you are a healthcare practitioner first, not a minister or priest. It is not this intern’s place to impose her religion on her patients, thereby putting their health at risk.

    • Fred Kohl

      Not giving a prescription is NOT “imposing” a religious belief on a patient; in fact, if the patient is referred elsewhere, it is both ethical and prevents either the patient from not getting what they want or the doctor being forced to do something they find morally problematic.

      However, forcing a student to do something against their religion, because doing so fits into one’s own secular humanistic world view, is morally tyranny of the first order. Doing so under the threat of failing a core part of a medical school curriculum, and telling someone that their religious beliefs should bar them from practicing ANY sort of medicine, is a civil rights violation (if Dr. Gunter was working for a state-funded institution, which she was if it was in Michigan, she was working as an agent of the state; her actions basically implied that someone of this young woman’s belief system was not allowed to practice medicine of any sort, and hence was an act on behalf of the state that limited the free practice of religion).

      • Talia

        I’m sorry but I disagree. When the doctor is with her patient she is a doctor first and must do what’s in the best interest of the patient, even if that includes prescribing OCP medication. In the same vein, “forcing” a doctor who does not believe in blood transfusions to give a transfusion to a patient who needs it, would also, be moral tyranny of the first order, according to your views (correct me if I’m wrong). Medicine has its own set of morals and, when one is practicing medicine, those morals should be adhered to, even if they fly in the face of religious views. It’s not a pleasant situation, but there must be consistency. What would happen if I decided I wouldn’t auscultate my patients’ hearts because it went against my religion and therefore for this service they would have to go elsewhere? The line must be drawn somewhere.

        • Fred Kohl

          I think there’s several differences:

          1) There is a difference between OCP’s and blood transfusions — blood transfusions are given in emergencies (in general), OCP’s are not. And even when you’re talking about “emergency” contraception, the window for treatment is 1-2 DAYS, ie: ample time to refer on to another provider. For blood transfusions, the window of opportunity is sometimes NOW.

          Having said that, I am not 100% opposed to a Jehovah’s Witness who never wanted to give a blood transfusion ever being a doctor, of any sort. Now, I would have a problem with them being an ER doctor, or a surgeon, or something where this is an issue. But a dermatologist? A pathologist? Probably not so much of a problem…

          2) Auscultating a heart is a basic job function for any doctor that interacts with live patients (I suppose excepting pathologists, radiologists, etc). But seriously, if you find someone who has a religious objection to heart auscultation, I’ll entertain that possibility; as far as I know, none exists.

          OCP’s are one portion of a job for SOME doctors. See my other comments, but basically this doctor could (a) refer patients for OCP’s to someone else, or (b) pick a specialty where this isn’t an issue.

          The bottom line is “Can the patient get the care they need [want] in an acceptable time frame?”

          For a surgeon or an ER doctor, sorry, blood transfusions are a core job function, and one you need to do in a timely fashion. Not a good career option for a Jehovah’s Witness. (But again, let the residency application process take care of that — don’t need to flunk them out of med school if they want to be a pathologist.)

          Re: OCP’s, even for a family physician, not so. *Lot’s* of patients see a GYN for their GYN care, and a family physician for their hypertension, thyroid disease, allergies, or whatever. Why wouldn’t that work for the patients of this future doctor who wanted OCP’s?

          • Homeless

            So a doctor that practices Scientology in a not urgent environment should be able to refuse certain treatments.

          • Ariella13

            Firefighters are supposed to run TOWARDS a fire, not AWAY…likewise doctors are supposed to treat their patients and offer EVERY alternative available REGARDLESS of their own personal views, so that the patient can make an informed decision regarding their own health. We are moving away from paternalism and encouraging more autonomy in order to work as team.

            As per the “acceptable time frame” that you mentioned, it would be a disservice to the patient to delay treatment under any circumstance as it reduces the effectiveness of this particular treatment. “Emergency contraceptive pills are for emergency use only…because of the higher possibility of failure compared with non-emergency contraceptives”- World Health Organization.

            I recently finished my family practice rotation and i can assure you that the vast majority of patients seeking OCPs were pre-teens and teens that desperately needed guidance and someone to discuss the pros & cons of each birth control method available in the market. Parents usually bring their children to these practices because its more convenient as they can be seen by the same doctor, consequently these kids are able to establish a relationship with these physicians before reaching sexual maturity. Please try to understand that these minors are often afraid and embarrassed to seek GYN care when first becoming sexually active and this is the population that is most at risk for unplanned pregnancies! so to answer your question, NO, it wouldnt work out for 1/3 of her patient population.

            The medical student in question would have surely made an excellent cardiologist,geriatrician, Ortho surgeon…you name it! but the fact that she expressed a desire to become a FAMILY physician is very troublesome and i commend DrGunter for taking a stance. The student may be an exemplary human being but she should strive to be an EXTRAORDINARY HEALER when she puts her white coat on, and this means advocating for her patients, not her conscience.

            Sincerely,

            A devout Catholic

          • http://twitter.com/jimocarroll Jim Carroll

            Are Jehovah’s Witness healthcare providers proscribed from administering blood to people of other faiths?

      • http://twitter.com/MelissaDee_ Melissa Dee

        You, good sir, are delusional.

      • gradchica

        Doctors have the right to refuse to prescribe any medication. They are under no obligation to prescribe anything to anyone. That’s why they can refuse to prescribe narcotics to “drug seeking” patients or refuse to prescribe something their patient saw on a TV commercial and wants but that the dr doesn’t think would be best for their situation. Why is birth control so different? I know a family doc who doesn’t prescribe it bc she thinks it is harmful to women and does not correct their problems, instead it only covers up the symptoms without fixing the underlying pathology.

        • Molly_Rn

          Drug seeking patients are a far cry from a woman wanting and needing contraception.

          • Dennis F.

            what if religion forbids one to prescribe narcotics or any other medication or procedure, what if any other reason( no experience with it, not included in training, doubt the evidence it is based on etc) makes one not prescribe it? there are some practices who would not even see patients, much less prescribe, because of insurance or lack of or because medicaid doesnt pay as much etc. i think the best way is to explain the options, which one one can give and whch ones one cannot based on belief, experience, doubt about efficacy etc. and offer a referral for those she chooses which one cannot give for whatever reason. of course the final arbiter is to enact a law which will delineate which drugs or procedures should be prescribed without exceptions; of course that has to pass by the majority, either thru congress and/or constitutional amendment. majority always wins and history and standards of care and the laws are always written by the victors. and they can always change in the future.

          • Molly_Rn

            You make absolutely no sense.

          • Dennis F.

            all laws, all viewpoints are relative; and they change over time; the only way we can settle which is right or wrong is to submit it to the supreme court.

          • Molly_Rn

            The supreme court is a right wing shill at this point in time and doesnt know right from wrong. Doing the right thing is based on what is expected from you by your profession; I took an oath that I keep. It is an ethical and moral decision and is based on what is right for my patient not my religion.

        • Erin C

          Doctors have the right to refuse narcotics when they feel it is against their better judgement to do so, that doesn’t mean that they will withhold them from ALL patients. Furthermore, she stated that she wouldn’t even counsel her patients on the use of OCP’s or condoms. That seems negligent to me. She should at least inform them of their and if they seem interested refer them to another physician.

          • gradchica

            Fine, perhaps she “should” tell patients about hormonal contraceptives–granted, it’s not as if patients are unaware of the existence of contraceptives and can’t find out anything on their own with a quick internet search. She should give them the info other docs do–in my case, the docs that gave me hormonal bc said “Take this pill daily and you won’t get pregnant”. No info on how it worked, drawbacks or pluses to any particular type, just “Take it and no pregnancy”. So I’m not sure what kind of in-depth counseling you envision, but the pro-contraception docs I’ve been to–in 3 states, so it’s not just one random dr–give very little in the way of info. So let’s require all doctors to go through advantages, mechanisms, and all possible side effects. Also, what would or should she tell people about condoms? They are not prescribed by doctors, so….does anyone over the age of 12 in this country not know what a condom is or not know that pretty much every grocery store and pharmacy has them,with handy “how-to” instructions included in the packet?

        • http://twitter.com/NCBeernut Scott

          There is a huge difference between not prescribing a medication or treatment that is not deemed medically appropriate and withholding a medically appropriate treatment due to one’s personal religious beliefs. HUGE.

          • gradchica

            Again, what about doctors who do not prescribe hormonal birth control because they, in their medical opinion, think it is not good for the patient? There are indeed doctors, OBGYNS and family docs included, who do not prescribe hormones because they do not think they are physically good for their patients. They use other methods to treat actual problems or diseases and offer natural methods of family planning for that part of the equation. Some of these docs do have religious reasons as well for not prescribing, but that doesn’t take away from the fact that they do not think they are medically necessary or good for their patients. Contraceptives are not “medically necessary”–they do not cure anything, only mask symptoms, and other methods for family planning are available.

          • http://twitter.com/NCBeernut Scott

            You are not understanding the concept. The ethical decision to not prescribe a treatment is based on whether or not the physician believes the treatment to be medically appropriate. You gave an example of this. The decision to deny a treatment based on religious beliefs is not ethical and is not the same, even if the treatment isn’t life-saving. It shouldn’t matter. This girl needs to find a different profession – like I said in another post, medicine isn’t for everyone.

          • gradchica

            Should this go for anyone who has an ethical qualm with any medical procedure–the “find a different profession” comment, I mean? For example, should all doctors in states with physician-assisted suicide be required to perform that procedure, regardless of their ethical problem with killing a patient? Or is contraception different? Also, who should or can judge if they are giving it “real thought”? What if they are giving it “real” thought, but you simply do not agree with their reasoning? There is a “real” moral and theological tradition and deep reasoning that informs many docs’ decision not to prescribe. Whether this particular girl has tapped into that or not, we don’t know–may she had, but was flustered by her attending’s badgering or felt the situation/setting wouldn’t be conducive to such an explanation–would a medical student on rounds being chewed out really be expected to offer a detailed explanation of moral reasoning to someone who clearly does not care why she wouldn’t want to prescribe?

            Contraception is not a life-saving procedure, so why should doctors with ethical issues be disqualified from practicing medicine? To not cause a woman a few minutes’ inconvenience? The non-BC-prescribing docs I know advertise that fact, so patients know before they even make an appt. If they for some reason didn’t read that info, the receptionist informs them that if they need bc, they will need to find another doctor. Seriously–that is an inconvenience, at most–the need to call another doctor’s office to get one’s desire for bc fulfilled. It is not a medical necessity. So to avoid 5 minutes of inconvenience–or perhaps, a few minutes of “feeling bad” that someone doesn’t 100% approve of one’s sexual choices–we should ban all doctors who don’t want to prescribe birth control from the practice of medicine? My doctor friends shouldn’t have been allowed to go through their internal medicine years–when they might have been asked for bc–to get to their gastroenterology or cardiology fellowships–when they are not and never will be asked to provide bc? How about my radiologist friends? Most docs who don’t prescribe bc self-segregate to specialties and sub-specialties that do not intersect with birth control, but many have to do a year or up to 3 years in internal medicine residency before they can go on to their specialty.

            Also, what about patients like me who don’t take birth control and want–or for some of my friends with PCOS or infertility problems, need–a doctor who is trained to treat their problems without hormonal contraceptives? For example, a doctor trained in NaPro technology can diagnose and treat many fertility problems without shoving their patients directly to artificial insemination and IVF. My NaPro technology-trained family doctor friend can treat my pre-menstural cramps and pain without bc, but it takes more of her time and effort to run the hormone levels/trial and error to get the timing and dosage right of the right vitamins, etc, to relieve the pain. It’s much easier for a dr to give me a prescription for bc to mask those symptoms, but I would rather have a natural method–and few, if any, “traditional” pro-bc docs are willing or trained to do that.

          • http://twitter.com/NCBeernut Scott

            I think that it is unethical to make the decision to treat or not treat your patient based solely on your own religious views under any circumstances. You can ask any all of the “What about _____?” questions you want. My answer to all of them is that if your religious views are the deciding factor, it isn’t a profession cut out for you. And by the way, physician assisted suicide does NOT mean “killing your patient.” If you believe that they meet the ethical criteria for physician-assisted suicide, you are providing them with a humane means to an end that they will probably seek out otherwise, giving THE PATIENT the power to choose to take that option or not. You aren’t the one shoving pills down their throat.

      • Molly_Rn

        I sure hope you aren’t a physician unless you put a big sign out that says, I will impose my religion on you so watch out!

      • http://twitter.com/NCBeernut Scott

        So what about the patient of a rural family doc serving a poor
        population…I guess every time a contraceptive needs to be prescribed,
        the patients can get denied and forced to find some way to get to the
        next practice that could be miles and miles away and pay yet another
        co-pay (IF they are insured) to see somebody who will give them a simple
        medication? Sorry, I hope she never becomes a doctor – we don’t need
        people like that.

  • NormRx

    Physicians do this all the time. Do you really think Jewish doctors that keep pushing circumcision are not letting their religious beliefs come into play?

    • http://www.facebook.com/jewel.markess.3 Jewel Markess

      Do you actually have any study that shows that Jewish doctors push circumcision more than any other? Because if they did, it would go AGAINST their religious practice.

      Jewish religion is NON-proselytizing. It does not seek converts. The sinagogues are not even open normally, if you are in a city and want to visit one even if it’s a historic landmark, you have to ring a bell unless it’s a service.

      Circumcision for practicing Jews – and many are not – is a religious act to show belonging to Jewish religion (as I understand it feel free to contradict), and there is nothing in their religion that would make them want others to have it.

      Many doctors in the US counsel it both Jewish and non-Jewish. I seriously doubt Jewish doctors recommend it more than non-Jewish doctor, but feel free to show your data.

  • FerialDay

    Why (or how) are people with these beliefs licensed? A hairdresser who refuses to cut black people’s hair should lose their license to practice. A pharmacist who refuses to fill a prescription should lose their license to practice. And the same for a physician.

    • Fred Kohl

      Because (a) being African American (your example) is one’s race, and how one is born & taking oral contraceptives is a choice; (b) because medicine involves A LOT more than prescribing contraceptives, and a lot of (most?) fields of medicine would never be asked to do this; this student wasn’t refusing to treat the patients at all, just do one treatment she saw as objectionable. How is someone having a moral objection to prescribing birth control a reason to not allow them to be a neurologist, dermatologist, orthopedist, opthomologist, etc, etc, etc?

      • Benny Little

        Fred, the specialties you mentioned would probably be fine for a Dr that did not want to prescribe contraceptives, but she said she was going into Family Medicine, which would put her in constant contact with patients that may need contraceptives, etc.

        • Fred Kohl

          True, but

          (a) a lot of family physicians refer out GYN care anyway, so they could always see a GYN for those issues; heck, family medicine has fellowship tracks in stuff like sports medicine; and after an experience like this, who knows, maybe this poor student decided dermatology was a better career option, after all :-)

          (b) even if she did do routine GYN care (which I agree would include discussing “family planning”) she again could simply do the “this is an option, if you want that you can see a GYN/Dr. XYZ” option / approach.

          Contraception (at least the “preventive” type) isn’t an emergency; and even if you’re talking about emergency contraception, it isn’t such a time-sensitive emergency that a patient couldn’t be referred out (24-48 hours is more than ample time to arrange for a patient to see a GYN, heck even be seen by an emergency room physician, who might feel more comfortable with the practice). It isn’t like this student has a moral objection to doing CPR or treating heart attacks…

          I would hope that our society is “big tent” enough to allow health professionals to practice in a way that allows them to not have to do everything, but instead refer out things they’d feel uncomfortable doing.

          It just seems to be a little extreme to say that this person shouldn’t be allowed to be a physician *at*all*, which is what a lot of posters (and Dr. Gunter, essentially) are saying.

  • buzzkillersmith

    The first six posters below have their views and have a right to those , but there is another side. To many people, including doctors, abortion is tantamount to killing innocent people, the relatively strong abusing the relatively weak, and there is an excellent argument to be made for this. You and I might not agree with this, but there is no mathematical equation that can prove one side right and the other wrong. And you of course, given your sophistication, realize that these arguments come down to personal preference, which is based on the interaction of your psyche and the culture in which you live.
    Other people, even in this country, have other cultures and read other books and listen to other pastors and they will continue to do so. Who controls what happens in this country is a matter of political power, not absolute morality.
    The same is true with contraception although, given our culture, it is less controversial.

    Admitting that there are two sides to these issues does not mean you have to give up your political positions, but it might convince you to more from black and white to the gray area that is the actual situation here.

    • http://twitter.com/phaseofmatter Pascal

      The worrying thing here is that it is not about abortion, it is about contraception. Contraception is the single best method to prevent abortions, so in a certain way the stance of this intern will lead to more of what she hopes to prevent.

      I see your point about looking both ways, but I don’t agree that this specific issue is a grey area. There is no gain for anybody if this intern’s personal beliefs become practiced medicine. She will cause harm and thus should not be allowed to become a licensed doctor.

      • buzzkillersmith

        A lot of licensed docs simply do not deal with this issue. Someone could become an orthopedist or rads or derm and totally side-step the issue.

        • http://twitter.com/phaseofmatter Pascal

          I agree, I was putting too much weight behind the “family doctor” statement.

      • http://www.facebook.com/ladycygnus Christina Hampton

        Actually, when provided with contraception a young adult is more likely to have sex since it is now “safe” from unwanted pregnancy. This increased rate of sexual encounters is like throwing the dice more often, eventually you will throw snake-eyes. There are any number of things that can cause contraception to fail, from a broken condom, to not taking the pill at the same time every morning, to even taking antibiotics for an ear infection. Yet when doctors were trying to push contraception onto me none of this was mentioned. Rather than say “you know, sex outside of marrage isn’t healthy and the only fool proof way of not getting pregnant is to not have sex” they said “you’re too much of a wimp to say no to a guy, you don’t deserve any better than to be used, so here is a pill that will break your body and allow you to be used for a bit longer.”
        Contraception is NOT good health care and it does NOT prevent abortion (half of all women getting abortion were using some kind of contraception the month they conceived).

      • Bastiat

        Technically speaking, Abstinence is the single best method to prevent abortions.

  • anomalouserudite

    “The only religion that [your] patients see [you] practice is medicine.”

    That is such a patently false statement, unless your “religion” is none at all. Even then, your patients’ care is the consequence of a perceived and applied form of ethics and morality. Certainly you, as a physician, make recommendations based upon how you interpret “best practices” through the lens of your subjective worldview.

    This article demonstrates a profound lack of perspective on behalf of the author, while misrepresenting her as someone of insight or moral authority. I’m floored by the intense bigotry and partiality the author projects. It is deplorable. Were I the dean at the school, I would have reprimanded you on the spot, and celebrated your letter of resignation.

    You actually highlighted how poor an educator you are, touting your story as championing rationality and best practices. Are you so dense?

    I wonder if your student was silent after your insinuation that the student’s religious beliefs will result in patients getting AIDS because the student refuses to prescribe contraception. She was probably stuck with the hypothetical scenario that any woman would come to the doctor to get condoms, when they can go to Wallgreen’s and buy a pack for $2–and the reality being that most women come for other forms of contraception, such as oral contraceptives, that have no benefit in protecting women from STD’s.

    I, too, had to pause while reading that, because it doesn’t make any sense, Dr.

    You proposed moral hypotheticals that were ridiculous, and had no bearing on the student’s performance in clinical rotations. It was patently absurd. And not everything a patient “wants” do they get. SURELY you understand this! Are you writing Rx for every patient begging you for narcotics? You aren’t? But they “want it and need it.”

    Come on. Let’s get real here.

    The worst part of all of this, ultimately, is you wrote the article all this tie later after the incident, confirming that you have not matured. It’s such a shame.

    • buzzkillersmith

      Your statement that the doctor here has no claim to moral authority is absolutely right. The doctor might or might not have insight and a profound understanding of the moral questions raised by these issues.
      I have been a doc for 23 years and I would never state that my moral sentiments are in some sense superior to those of others by virtue of what I do for a living. We are authorities in diagnosis and treatment, and that’s about as far as it goes.

    • Fred Kohl

      Agree — the fact that Dr. Gunter is bragging far and wide on the internet about her bullying this student shows all the more what an unethical physician and morally tyrannical educator she is.

  • http://kalamazoopost.blogspot.com/ Tony Indovina

    A medical student has some obligation to learn the science and rationale about the care patients will receive, and a medical school has an obligation to educate future doctors about this care and determine what standards are taught.

    Medical students do not prescribe contraception, and for that matter cannot counsel patients without supervision, thus obviating any ethical conflict. But that does not mean students have no obligation to know what that counseling entails as well as the indications and contraindications to the various contraceptive methods.

    If his woman has an ethical problem with contraception, then fine, she does not have to prescribe it once she is a licensed physician, but that will not prevent patients who are on contraception, or request contraception from happening upon her practice. They will, and needs to be prepared to know what is in those oral contraceptives her patient has taken, what are the side effects, the sequelae.

    In residency, ob-gyns learn about abortion procedures and counseling although many have an ethical problem with abortion and the vast majority will not provide abortion in their practice. Why learn it? Because patients get abortions and invariably any ob-gyn will be required to take care of a patient who has had a recent abortion and is having a problem, or will have a pregnant patient who is requesting an abortion referral. To refuse to acquire any knowledge of the procedure is negligent. Likewise with contraception.

    All medical students should have some familiarity with artificial birth control for no other reason that over 90% of women will have been on some form of it at some time in their lives. Get real.

    • Fred Kohl

      Agree that knowledge is helpful, even if you disagree with the practice/issue at stake.

      However, what I was responding to was the more general tone of the conversation that “doctors who don’t prescribe birth control shouldn’t be allowed to be doctors.” Yes, mostly by respondents, but looking at Dr. Gunter’s blog (in general), and the overall tone of the above post, a sentiment it would seem she wouldn’t argue with.

      I guess what would be interesting to know, and we’ll never know since we weren’t one of the two people in the room, what exactly “anything to do with contraception” really meant.

      Yes, refusing to even know the mechanism of action, side effects, etc of oral contraceptives would be the mark of a poor student. However, I wouldn’t be surprised if that wasn’t *exactly* the case, and it was somehow something quite different that the student objected to (e.g. “I want you to go in and counsel this patient on how to take oral contraceptives.”)

      And no, medical students don’t “treat” patients without supervision.
      But, in reality, they do treat patients. They round on patients,
      examine patients, make treatment recommendations on patients, etc. And
      while things have changed quite a bit since I was there, they still do
      interact with patients in a way that, in function, they often act as the
      patient’s physician, with the attending swinging by to sort of make
      sure everything went OK. So a student being in a situation where they are being asked to do something they find morally problematic, and feeling an obligation to “opt out” isn’t as bizarre as you imply.

      Having been to medical school and endured residency training, I can assure you that bullying on the part of medical attendings is real. I have seen grown men and women reduced to tears by attendings publicly belittling them. I have seen students harassed by attendings, including publicly berating them for having a belief system different than the attending. (And this worked in a variety of directions — one resident I know was “ripped a new one” for refusing to put a bunch of lines in an infant for whom she thought it would be futile, unethical, and abusive to the patient… basically, the attending was ticked they had to do it themself.)

      I’m old enough that I’m told, and I’d like to believe, that bullying by attendings is somewhat less common than when I was in training. However, I also get the impression it still is alive and well (or so I’m told by the medical students I teach).

      And yes, let’s “get real.” The surgical specialties, including Ob/Gyn are the most notorious for this. And Dr. Gunter’s account of the dialogue doesn’t suggest someone who compassionately tried to get a student to the “see the light” and learn something — it comes across more as an egotistical, disruptive physician trying to brow-beat a medical student into submission. It’s quite possible that with enough incidents like this, the U of Colorado wasn’t at all sad to no longer have Dr. Gunter in charge of medical education at their school, or practicing at their hospital…

      • http://kalamazoopost.blogspot.com/ Tony Indovina

        Your experience of medical school and residency is different from mine, having finished ob-gyn training 20 years ago and involved with medical student (not residency) education for the last two decades.

        Students are NOT allowed to counsel patients about treatment or anticipatory guidance without an attending physician present, and even then I know of no attending that would allow a student to dictate the conversation. Patients do NOT view medical students as their physician, the division is extremely well-delineated as it should be.

        In my residency, one of the attending physicians was the medical director for the state organization of right-to-life and hewed tightly to Catholic principles, so his group never prescribed contraception or performed sterilization. The group was very well-respected by residents, students and other attendings no matter their feelings on abortion and contraception. Likewise, the group referred patients appropriately for contraception and terminations…but they were not ignorant of the science and the counseling that patients underwent.

        We learned the principles of natural family planning along with artificial birth control, and were tested on our knowledge and efficacy of these methods. That is what education is supposed to be and continues to be in good programs.

        Your characterization of Dr Gunter is unfair, assuming she is “bullying” and “egotistical” and “disruptive” is not consistent with her post. You are correct that we do not know all the facts of the situation, so why do you assume the Dr Gunter was inappropriate?

        • Fred Kohl

          See my comments above (re: Doc C’s comments); but basically, it was the tone of her post, not the least of which was the title, which seems to be a carte blanche jab at any religious person of any persuasion.

          Yes, you are right, I was not there and I have never met Dr. Gunter. But her post sure reminded me of the rantings of some academic/state university GYN’s I’ve run across whose “bedside manner” makes Dr. House look more like Marcus Welby.

  • http://www.facebook.com/fdeng Francis Deng

    FYI, the state school in question is the University of Colorado. She moved to California. Colorado is also where a US district court judge stuck down the contraceptives mandate of Obamacare.

    • Fred Kohl

      interesting; Colorado = “midwestern”?

      • Molly_Rn

        The far right
        seems to think their beliefs are worth more than anyone else’s. They are adamant;
        you cannot stop them from imposing their beliefs on the rest of us. I am an
        atheist and do not believe in any god, or “good book” or heaven or
        hell so you can rant and rave at me all you want and I know it is just
        superstition not factual. When a patient comes to a physician for care they
        need to feel that their health and what is best for them, not the physician’s
        religious beliefs, are what will guide the physician’s care. If you are opposed
        to contraception don’t use it yourself, if you are opposed to abortion then
        don’t have an abortion yourself (might be tough for you guys who don’t have a
        uterus). I have prayed with patients, who asked me to do so; I have supported
        them in their beliefs. It was more important for me to be supportive of them
        than to tell them that I don’t believe in their god and their prayers, so there
        it is all nonsense. That isn’t what my job entails. What is important for my
        patients is more important than what I believe about religion. I guess I am
        lucky because I don’t have to worry about sin or hell or heaven; I just do what
        I believe is right and ethical.

        • http://www.facebook.com/laura.mitchell.3781 Laura Mitchell

          As a nurse, I keep my personal beliefs separate from my practice. Why? Because my personal beliefs are just that: personal and I have no right to impose them on other people, especially people who are vulnerable. If someone asks, I’ll discuss those beliefs. It’s not my place to judge, but it is my place to care.

        • anomalouserudite

          You need to carefully reread what you just wrote. Look for key words in your atheistic response: “Believe,” “Ethical,” “Moral…”

          Please, Tell us all again how you’re an atheist, and have no place for religion in your life.

          • Molly_Rn

            The words believe, ethical and moral have nothing to do with religion. I believe the world is round, I believe the ground is hard. I have taken an ethical oath as a nurse to care for my patients. I have a moral obligation to protect the weak. My morals are based on what I know to be right and wrong with nothing to do with any god or gods, religions or fear or reward. I have no place for religion in my life or any other superstitions. I also do not believe that having a black cat cross my path or walking under a ladder will cause me bad luck. I equate those superstitions with religion. Try looking up the words in the dictionary and you will see that you don’t need religion of any kind to use those words about yourself.

          • anomalouserudite

            Excuse you, I have no need to look up words in a dictionary. I think, however, you may benefit from a course in philosophy. You make sweeping conclusions about such things as “knowing what is right and wrong,” without taking into consideration why you “know” these things to be “right” and/or “wrong”.

            As an atheist you have the insurmountable task of justifying rationally for yourself why any particular act or experience is “right” or “wrong” or otherwise. What you will conclude before long is, your worldview is established in the arbitrary and conventional.

            The reason I chastised you about your utilization of those words in particular is because it demonstrates a profound lack of perspective on your part as an atheist who ridicules the “religious” for practicing what they “know” to be “right,” “ethical,” and “moral,” saying what they believe is superstitious and not factual–this is the very thing you do yourself. That’s what stood out to me as hilarious and hubristic.

            The hubris in your response called for someone to point a finger at you to tell you you have no idea what you’re talking about.

            You will undoubtedly continue to console yourself in bed at night, saying religion and superstition are the same thing–believing in prayer is the same as rubbing a rabbit’s foot for good luck, and so on. Good for you. You are profoundly and, likely, irreparably misguided about your conclusions, but that’s up to you.

            The chief point here, and in the article, is that a faculty member made a decision to trump the moral and ethical choices of a student based upon the faculty member’s personal, and arbitrary, understanding that her own ethics and morals were of greater significance than those of the student’s. Not only that, but the faculty member tried to trap the student in a round of questioning that was utterly ridiculous.

            You yourself fault the “far right” and the “religious” for making claims to moral and ethical superiority, while simultaneously doing the EXACT same thing. The faculty member did the EXACT same thing. You are faulting people for acting EXACTLY as you do. The main difference between them and you is they believe there is an objective moral foundation by which all human beings abide, and on which all people can trust. You, on the contrary, believe all morals and ethics are subjective, and only go as far as the individual.

          • Molly_Rn

            Oh how glorious to be so self righteous. The student was still wrong. :-)

      • http://www.facebook.com/laura.mitchell.3781 Laura Mitchell

        Kinda sorta Midwestern, kinda sorta mountain.

  • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

    Let me just say that Fred Kohl has absolutely OWNED everybody in this thread. Well done sir!

    I agree 100%. Gunter is being ridiculous in this gestapo practice to block someone from becoming a doctor simply because reasonable people can disagree on contraceptives.

  • http://www.facebook.com/jewel.markess.3 Jewel Markess

    What about contraceptive prescribed for reasons other than birth control? For example in some cases of premature ovarian failure many doctors prefer birth control to hormones especially when there are some hormones still there. There are other cases too. She said she’d never prescribe them, so I guess she meant for other reasons too? So she’ll not prescribe them even when medically indicated.

    What about women for whom pregnancy is dangerous or those who because of some conditions aren’t able to carry the baby to term?

    It’s not just the issue of a woman who wants contraceptives and who can go to another doctor but also a woman for whom contraception may be medically necessary not getting the right advice from the doctor that could have tragic consequences e.g. when pregnancy is very high risk.

    And again what about Jehova’s witnesses and blood transfusions?

    • gradchica

      The student in question said she would provide training for her patients in NaPro technology/the Creighton Method, which is as effective in preventing pregnancy as oral contraceptives–so that would answer your objection about dangerous pregnancies. Also, there are ways to treat many reproductive problems without contraceptives, although most docs just prescribe the pills bc it’s the easiest “solution”. If she decided another method was more effective/better for her patient, it would be her decision as a doctor, just as it would for any therapy decision. The patient could find another doctor if she disagreed. Also, if this woman is Catholic, the Catholic Church does allow for medically necessary hormonal birth control, provided it is actually medically necessary–ie, taking it to clear up some acne probably wouldn’t cut it.

  • http://twitter.com/phaseofmatter Pascal

    The reason I am being so harsh is that this student (not intern, my bad) demonstrates a total lack of critical thinking skills. It is one thing to say “I won’t prescribe oral contraceptives, go to another doctor”, but the issue here is that this student doesn’t want to deal with any contraceptives. If a family physician says “I will not discuss condoms”, this is a very dangerous thing. If you go into medicine, family medicine in particular, and just ignore the fact that teenagers will explore their sexuality, then you are in the wrong place.

  • http://twitter.com/phaseofmatter Pascal

    It was my understanding that this student wanted to become a family physician, if not then your first point has some validity.

    As for “oral contraceptives”: the issue is that this student refuses *any* contraceptives, not just oral ones. Condoms can hardy be perceived as abortifacient. If simply discussing Condoms is out of the question then I doubt this student would bring up the issue to teenager patients. Don’t forget, even if her patients would self-select to a very religious group, their children may not share those world views and may not realize that they should seek another doctor.

  • Doc C

    Kudos to you for taking a stand, and shame on the senior medical officials at the medical school where you formerly taught. I have many times been in the position where I had to offer advice that countered my personal beliefs; it was certainly a difficult situation however i always tried to put the patients’ needs ahead of mine. (I will leave it to my patients and colleagues to judge my success.)

    When we pledge the Hippocratic oath, it also applies to situations such as you describe. In such a case, she would be violating this oath. At the very least, she would need to be up front with the patient, inform them clearly and openly of the options, and be willing to refer them to a physician who could provide them with the requisite care if the patient wished. Not being willing to do so makes her unfit to practice medicine, as far as I am concerned.

    To those who make statements that forcing the student to do something against their religion is “moral tyrrany” or similar, I would point out that every physician is in the position of being, at some point, the sole point of contact for a patient. This may be while they are the intern on call, or while they are in practice. It is not always possible to get patients to an alternative physician within the time frame required (while the “emergency window” may be 48-72h, a patient may not present for 36-48h, leaving very little wiggle room). Also, one would actually have to bring up the topic (e.g. contraception) in order to justify the extra referral and associated costs/time – is this potential doctor willing to do that?

    Finally, she indicated that wished to become a family physician. This entails two to four years of residency (depending on where it’s done). It also requires teaching. One of the core tenets of medicine is teaching (the word doctor is derived from the latin word for teacher). If she is unable to adequately fulfil this component of the training program (and by being unable to discuss/teach her junior colleagues the aspects/risks/benefits of contraception, she isn’t), then by definition, she doesn’t meet the current standards to practice medicine (as defined in essentially every developed country.)

    There should be no compulsion for her to personally prescribe contraception; on this I wholeheartedly agree. A large training program could certainly come up with some sort of workaround to provide prescriptions where required. However, she should be able to, at the very least, present the option to the patient in an unbiased (if cold and clinical) manner, state clearly that her beliefs preclude her from prescribing, and then call in the appropriate persons if required.

    • Fred Kohl

      Agree w/ most of what you said. Agree that you need to be able to at least discuss the subject, even if it is to say “Yes this is available, but no I don’t do this, but this is who does.”

      Just remember, Dr. Gunter *failed* this student, in a core course; ie: this student couldn’t graduate without “getting around” Dr. Gunter. If you went to a medical school anything like mine (or the two I’ve taught students from), I’m sure you
      witnessed “hazing” by attendings. My biggest beef was the way Gunter
      presented this scenario just screamed “bully attending.” There was no mention, whatsoever, of this student being offered a “workaround.” It wasn’t presented as “Hey, I really tried to compassionately encourage this student to at least refer the patient on for this type of treatment.” It came across as the typical academic “ripped this peon a new one” type hazing; the fact Gunter is bragging about it online as some sort of “reproductive rights martyr” just reinforces the impression of her being some sort of disruptive head case.

      Yes, I don’t know Dr. Gunter, and no I was not there. But let’s face it, academic OB/G’s (or other surgeons) don’t have the best reputation on these sorts of issues. And yes, that may be a “stereotype,” but it’s a stereotype justly earned by the actions of a lot of GYNs/surgeons; and Gunter did very little to dispel that stereotype in the way she presented the case.

      • Doc C

        I guess it goes to interpretation of intent – I made the assumption that the whole process was conducted in a non-confrontational and educational manner (probably because that is what I make an effort to do whenever possible; again, I leave it to others to judge my success.) I agree that surgeons in general don’t have the best reputation for being non-confrontational, although I was fortunate enough to have a few good ones early in my medical school, so at least I got a taste of the “right way” before facing far too much of the “wrong way”.

        I fully support your statement that “hazing”, in whatever form, is inappropriate. Inasmuch as it detracts from the teaching component of medicine, it should be actively removed from teaching programs, but there is too much of the old school attitude which says “I did it, so you will too” or any variation of the “sh** flows downhill” mentality.

        I guess that just demonstrated a concept that I try to teach to my own students – don’t make assumptions about the intent or meanings of others, because you will only project your own inherent biases and you will often be wrong. Mea culpa.

  • Homeless

    Clearly, the solution is to council women not to ever have sex unless procreation is desired. A good vibrator will help.

    • Janelle

      um, you forgot half the people it takes to have children

  • cmartel2

    As a fellow physician, I can’t say I agree. Physicians are granted the ability and latitude to prescribe according to their personal moral and ethical principals, provided that their prescribed practices are evidence-based and can be supported through literature and do no harm to their patients. We see practitioners using comparative and alternative methods routinely and even more commonly, integrative styles of medicine.

    We also see physicians practice their own form of medical ethics, refusing care to patients who request surgery when we do not see it is in their best interest. It is then up to the patient to seek out a second opinion if they wish to have a surgery performed, and it often is.

    What you are doing, of course, is creating a double standard wherein certain ethical principals practiced by physicians are given higher regard than others–namely dismissing religious beliefs of the individual physician.

    There is noting proseletyzing about refusing to speak about safe-sex practices. Indeed, there is nothing inherently religious about abstinence from sex or the belief that sex should only be performed without contraception. That certain religious groups happen to take this view is inconsequential on face value.

    There is nothing life-threatening about not being offered contraception. Any patient has ample opportunity to seek care elsewhere if they disagree with the personal beliefs of the physician. Your example of the transfusion is clearly not in the same ballpark, as the life of the patient is dependent upon the immediate actions of the physician.

    It would be expected that these issues may raise some ethical questions on the practice of medicine by simply glancing at our society. Your moral rigidity on this matter is a bit disconcerting from my perspective. We as physicians should be able to practice medicine according to our conscience.

  • gradchica

    wow. It seems that you are the intolerant one who went out of her way to attempt to impose your views on this young woman. Because, seriously, how many OBGYNS don’t prescribe contraception? Really, if any woman in this country wants it, she can easily find it from a dr, a free clinic, a private clinic, wherever. Do you need to push out the few doctors who don’t agree with you? Really? Are you so threatened by them? Why not let patients make the decision of whether or not to give this doctor their business? There are doctors–family docs and OB/GYNs who do not prescribe birth control and they have thriving practices. Your concerns about how one would go about notifying patients are moot–they would be her problem, not yours. There are precedents, so a no-birth control practice has been done. Personally, I would welcome a OB/GYN who did not prescribe contraception & who practiced NaPro–and I know plenty of women who would as well. BTW, what if she did not want to prescribe contraception because she thought it was a poor practice of medicine and harmful to women? I know doctors who take that position as well.

  • http://www.facebook.com/ladycygnus Christina Hampton

    As a young woman who has visited many doctors I’m appalled…by YOU. I’ve been to doctors who listened to my concerns only to tell me to go on the pill. Bad cramps? Pill. Acne? Pill. Want to have sex? Pill. If I expressed any concern at putting a class-1 carcinogen into my body that wouldn’t actually FIX anything they would tut-tut my concerns. “Side-effects are rare, you’re healthy, don’t worry and just take this medication for the rest of your fertile years.”

    The ONLY doctor who has ever cared enough to try to HEAL my body has been a doctor who refused to prescribe the pill. Try talking to someone who isn’t a medical student, try talking to a doctor who has been in the field for years about WHY the pill isn’t good medicine (or even medicine at all). There are healthier ways of regulating fertility that don’t involve selling out to a pharmaceutical company.

    Contraception only treats the symptoms, it’s like giving pain killers to someone who has internal bleeding and sending them on their way. No, even worse, it’s like bashing them over the head with a frying pan so they are knocked out and stop complaining. It’s pathetic medicine. I’m PISSED at all the doctors who refused to actually live up to the Hippocratic oath, who didn’t help me live a healthier life and instead tried to poison my body and destroy my self worth.

  • http://twitter.com/smurphier Susan Murphey

    Betraying the public trust far outweighs the value of equal opportunity to enter medicine. (There are several ethical schools of thought, several ways to put value on the aspects of an ethical decision; we will disagree based on our way of bracketing and valuing aspects of this decision.) My values and my ethical framework focus on the community’s (a career’s-worth of patients’) benefit, not the individual’s (physician’s) benefit. And the law sees it that way also.
    Religious freedom and ethical values freedom are very different from the legal duties required of a graduated, licensed physician. In fact, they are more parallel to the public trust that is enforced by law. Historically, individuals have more choice whether to pursue medicine or another profession than patients have (due to information disadvantages and economic/social forces) choices when choosing a physician. And the government still pays a majority of our medical education costs.
    It is SCARY that this medical student never defended her position; she only restated, entrenched in one view. Research on decision-making skills shows this to be a fault, not a virtue. Understanding different viewpoints and counseling or representing the patient’s values may be a skill this student lacks and now may never get, or “get”. And by failing to understand contraception and its impacts on health may result in untold harms by this physician to patients and the community, regardless of her career choice. Master the information and skills or pass on the diploma. Agree to the legal standard or forfeit the license. I wouldn’t want her as my physician or policy representative; maybe as a researcher, but there are other degrees for that profession.

  • Molly_Rn

    Totally agree with you and find this intern a real danger to society. Our job isn’t to proselytize but to provide the best care possible. To do otherwise is unethical and immoral. It is very scary when future physicians think they can impose their religious beliefs on a patient.

  • lemaman

    Religion has no place in medicine.

  • http://twitter.com/DiNovia DiNovia

    Brava, Dr. Gunter, for taking this stand. I worked with a resident once who also refused to counsel re: contraception but she also expanded it to refusing ED medication to unmarried men and flat out refused to treat, for any reason, any LGBT person. Needless to say, she and our institution were sued. We settled and quickly.

    The medical student, by exerting her religious beliefs over her patients, is doing one thing and one thing only: she is telling the patient that she is superior to them in their determination of their healthcare needs. The medical student has no right to exert her religious beliefs over that of the patient.

    Many religious sects allow the usage of contraceptives but this student, by not prescribing them, is telling them that her religious beliefs are the only ones that matter. That can be construed as religious discrimination, too.

    There are two solutions to the situation:

    1) The student should go into podiatry or some other form of medicine that does not put her at odds with her religion.

    2) Failing that, she should understand that her religious freedoms end where her patients’ freedoms begin. That is to say that if the student does not wish to take contraceptives because of her own religious beliefs, that is perfectly allowed. The minute she imposes the same on a patient who believes the contrary, she is violating their rights to their own beliefs. She is obligated to present treatment options that conform to the standard of care both federally and within her institution. If she cannot do that, she cannot do her job. Period.

    • Dennis F.

      the only way this can be resolved is thru majority consensus, either by supreme court ruling, making a law etc. and this can change in the future; the state boards can make a requirement that ALL should prescribe this and this otherwise it is malpractice, of course people will challenge that in the courts and so on and so forth…. just like the death penalty and marijuana issues, different opinions, there will always be pros and anti’s.

  • http://www.facebook.com/richard.rosol Richard Rosol

    I think it’s time to stop being polite and tip-toeing around people’s religious convictions, especially when they are at odds with their community. So now is ANYTHING fine when done in the name of one’s beliefs?

    I do not have to respect anyone’s religion. Yes, I will protect one’s right to believe–or not. But I cannot stand by and watch someone inflict misguided beliefs on another human being. This student should have failed her rotation for failing to comply with its requirements. OB/GYN is reproductive medicine. Do it, or get out. We are not asked by our patients to believe, we are expected to serve.

  • Justin

    Thank you for this cogently written article. I agree 100%. That entitled little brat student you mentioned should not be anywhere near the family medical practice profession.

    • Courtney84

      I whole heartedly disagree! There are many who would relish the option of having a physician who practices medicine in a way that is in line with their beliefs. Certainly, it would be wrong if she were not informing her patients that she does not provide contraception counseling or prescriptions, or mislead them about the safety or efficacy of natural family planning. She is not unfit to practice medicine merely because she has values that she is unwilling to check when she walks into the exam room.

  • Janelle

    Regardless of whether the embryo has embedded or not, it by all accounts meets the scientific criteria for life (e.g. cellular communication, cellular respiration, growth). Obviously these are human cells. So what we have here is a live human being.

    It is on this basis that some people object to contraception from a moral (and/or religious) standpoint. It could cause the death of a human being. Before or after implantation, this might logically be regarded as the moral equivalent of abortion.

    • Molly_Rn

      I can scrape some cells out of my mouth and they are human cells, but not a person. What you have is a morula at first and then blastocyst (at 5 days) not a human being. If you are going to take some moral stand at least get your facts straight. And just because you think “life” begins at conception doesn’t make that the truth. Many of us don’t agree with you and are sick and tired of you and your ilk shooting your mouth off about our rights..

      • Janelle

        There is indeed a philosophical debate about whether a zygote/morula/blastocyst/etc. counts as a person.

  • James Gibson

    It’s too bad the word “religion” is used so much today as a catch-all for any mode of thinking or decision-making not strictly based on 2+2=4 type of logic. In reality ALL of medicine has to do with value judgements which empirical science is simply not capable of offering. To say a particular person –man, woman, elderly, pre-born– has a life worth bettering through health care of any sort is a VALUE judgment. There is no empirical evidence which can tell you how to judge whether one person has more of a right to certain types of health care than another person (or for that matter, has more right than a non-reasoning animal). All of these judgments have to do with principles, which may –or may not– have anything to do with religion. And ALL health care has to do with principles.

    • anomalouserudite

      Spot on.

  • Matt

    The objections to this students position are logically inconsistent. Many who oppose abortion and contraception do so on the grounds that this is murdering innocent children. Refusing to prescribe medication that accomplishes these ends is refusing to participate in this act. A doctor or pharmacist who refuses to participate is following their conscience.
    Comparing this to a Jehovah’s Witness is a logical fallacy. Jehovah’s Witnesses do not accept blood or blood products because they interpret Scripture to forbid this for believers. They do not care if others accept blood. An ER doctor or surgeon who is a Jehovah’s Witness would not refuse a blood transfusion for their patient because they do not care if that patient gets blood. They will not accept it themselves but they do not refuse to provide that care.
    Asking a doctor to prescribe medication that kills babies is completely different. It is not enough that the doctor chooses not to take this medication herself, she should not be expected to participate in this if she opposes it. Sure, you can go somewhere else to get it done, but you can’t make me participate.
    As a physician you treat patients in the best way you know how. But this does not mean you check your morals or values at the exam room door. A believer should have the same values and convictions in their home, at their work, in the grocery store, and at the park.

  • LastoftheZucchiniFlowers

    Dr Gunter speaks for most of us and is the key reason why Mitt Romney and his surrogates failed to win the election. Women do NOT WANT lectures from their doctors/providers and certainly NOT from ANOTHER WOMAN. This medical student should spend a semester in India/Africa or any other 3rd world nation where life is short and cheap, disease rampant and M&M excessive for women due to their lack of control over their reproductive destiny. Perhaps AFTER that ‘student’ experiences the myriad horrors of uncontrolled fertility she could return to this nation where that choice will never be abrogated by sanctimonious martinets whose misguided hubris allows them to believe that they can make any decision for another woman vis a vis childbearing.
    In reality, patients CHOOSE their doctors based on rapport and decency and I suspect the ‘student’ IF she ever emerges from the rigors of medical school, etc., will not have many females in her practice and will likely NOT BE HIRED by any group which receives 3rd party payment. ‘Simple arithmetic’ as a smart guy recently said. In the end, most patients will not see a provider like the ‘student’ Dr. Gunter describes. The failing grade was diligently and duly earned by the ‘student’ who deserved her ‘F’. She knew the requirements of the course before she enrolled and will eventually have to choose another speciality. I suggest UROLOGY!

    • anomalouserudite

      Are you a crazy person? Many close friends/colleagues of mine practice family medicine in the Third World–all of them are opposed to abortion, and will not offer patients abortive “contraceptives”. It’s apparent to me you actually have no clue whatsoever what you’re talking about.

      Abortion is altogether different from the other issues being discussed in this thread. Women in the Third World (or in any place for that matter) being subjugated sexually, and not having control over their “reproductive destiny” is not a strong case-maker for birth control or access to abortion. Such action actually goes further to establish the mindset that women will continue to be viewed as sexual object solely by their respective cultures (what a hopeless view!) so they may as well be provided birth control and abortion (what a hopeless “solution”).

      • LastoftheZucchiniFlowers

        While I grow weary with the fact that many non-clnician pedants frequently post here (usually in response to pro-choice – as opposed to specious Pro-BIRTH positions) I will say to ‘anomalous’ that, no, I am not a crazy person and note your fine manners and articulation skills you’ve revealed here. After three decades in the field I can say with confidence that your ‘friends/colleagues’ in the third world are missionaries; not physicians. Note that YOU and NOT I used the word ‘abortion’. Neither did I reference abortifacients at any time. It is YOUR agenda and not mine which has you foaming at the mouth. Read your own comments to hopefully gain insight into your peculiar post, I responded to Dr. Gunter’s postiion in full support of of her assigning a failing grade to the medical student she wrote about. I will now, however, make the case that your second paragraph which follows your initial slur is entirely non-sequitur. It is raving commentary like yours which makes me appreciate Sermo as a closed forum.

      • anomalouserudite

        *smh*

        If you want to try and squash opposition to your ignorant and patently incredulous rant by flexing–what you clearly perceive to be “intellectual”– muscle, you have chosen the wrong target. You make certain assumptions about one of whom you have no knowledge apropos of his educational and professional background. I can thoroughly and utterly dismantle your tirade before the end of lunch, though I get the strong sense you are of the incorrigible type, and such an undertaking may very well be a waste of an hour of peace.

        You have so much egg on your face–in any other setting than this excruciatingly partisan blog, you would have done yourself in. It’s astonishing really. Rereading your OP, and your reply to me, the inanity of your argument and position should be quite embarrassing for you.

        In brief:

        1.” Women do NOT WANT lectures from their doctors/providers and certainly NOT from ANOTHER WOMAN”

        - Doctors lecture patients ALL the time regarding a plethora of harmful personal choices their patients on a daily basis make. Are you unaware of this fact? Are you sure you practice medicine?

        2. “This medical student should spend a semester in India/Africa or any other 3rd world nation…”

        - Your logic is grossly aberrant, if not just flatly defunct. You’re arguing that all medical students who spend an international rotation in the Third World will come to different conclusions than did the student in question?

        3. “…where life is short and cheap, disease rampant and M&M excessive for women due to their lack of control over their reproductive destiny. Perhaps AFTER that ‘student’ experiences the myriad horrors of uncontrolled fertility she could return to this nation where that choice will never be abrogated by sanctimonious martinets whose misguided hubris allows them to believe that they can make any decision for another woman vis a vis childbearing.”

        - So you never used the word “abortion.” However, elementary reading comprehension will lead any reader to fairly and accurately conclude you MEANT “abortion.” Please don’t try to make it seem like you didn’t have abortion in mind when you wrote that–it only makes you look silly. Not to mention you essentially projected the exact sentiments of the angry-pro-choice neo-feminist, secular-leftist mentality. I’m not fooled by your failed attempt in your follow-up comment to make yourself seem like less a lunatic (as you evinced in your OP), while attempting to project that state onto me. Very poor form, indeed.

        4.”IF she ever emerges from the rigors of medical school, etc., will not have many females in her practice and will likely NOT BE HIRED by any group which receives 3rd party payment.”

        - It seems you live in a comfy box on one of the coasts, but if you would ever venture out from the fences of the asylum, you may discover a world vastly different from the construct you’ve conjured in your mind, and broadly and indiscriminately applied to the rest of the world.

        5. “After three decades in the field I can say with confidence that your ‘friends/colleagues’ in the third world are missionaries; not physicians.”

        - And here I am trying to figure out what “field” you could possibly be in. If you believe my friends and colleagues aren’t physicians, sounds like you need to take up your concerns with the ABFM, ABS, and the ABO. It honestly sounds like a personal problem you need to work out.

        The personal insults you level at me, poorly attempting to demonstrate a high degree of intellect and perspective, are bush-league. Maybe on your precious Sermo you are some big, swinging you-know-what. Not with me, champ.

        Come correct, or don’t come at all.

        • Molly_Rn

          Buzz off. Go some place else and rant and rave. No one can have a discussion with your self righteous windbag self flailing all over the place.

          • anomalouserudite

            You are internalizing in a way that suggests you don’t have a logical/rational foot to stand on. I’m not acting “self-righteously.” Who needs the dictionary now? Again, when your arguments–and your buddy’s–are dismantled, all you can do is call me names. Poor form indeed. You are going to believe what you want because you have chosen a very emotional, illogical position. It’s evident your views are based on nothing substantial.

          • Molly_Rn

            You call everyone names and are arrogant and obnoxious in your responses. You are the pot calling the kettle black. I believe they are putting a photo of you next to the word arrogant in the dictionary, no definition necessary. Now are you happy? No you will just rant again. Why do you darken the door of the site? A truly intelligent person doesn’t respond like you do.

        • LastoftheZucchiniFlowers

          ‘MY precious Sermo?’ You prove my point. Finally, your use of ‘swinging -you-know-what” and subsequent, tender epithet, “champ?” A child’s attempt to get his/her parent’s attention but colloquially pedestrian. Given the total absence of erudition above a change in screen name is in order: “Torquemada wannabe” fits your penchant for proselytizing diatribes.

          • anomalouserudite

            Cool story. All your posturing was defeated, and the best you could do was attempt to diminish my arguments ad hominem. You are so curiously fixated on my screen name, as well. Continue to deflect; when one is defeated, he cannot do much else.

          • LastoftheZucchiniFlowers

            When one is a religious zealot possessed only of misguided fervor and energies one (you) is cannot practice good medicine. Your series of poorly aimed and trite volleys make your myriad shortcomings of your position painfully apparent to everyone except you. Lack of insight pathognomonic for the disorder. Stick with your ‘ministry’. My full waiting room is reminder that I have squandered more than energy on the trivial blatherings expressed above.
            To reiterate: Kudos to Dr. G for standing up to what the brilliant Bill Maher dissected in his brilliant movie, RELIGILOUS.
            In the exam room, NONE of us should be practicing anything BUT medicine.

  • Molly_Rn

    Fred, since you are against birth control pills, the morning after pill and abortions, then don’t have any. And since you aren’t a woman, I have a problem with you knowing anything at all about women’s healthcare, their feelings about their contraceptive or reproductive health or anything we women feel about anything.

  • Suziq38

    Once I had to have an operation and the anesthesiologist asked me if we could pray.
    I thought it was a great idea.

  • Courtney84

    My ob/gyn is Catholic and does not prescribe contraception. He is part of a practice with five physicians. Those other 4 physicians prescribe contraception and the ‘usual’ OB/GYN things. It is on the website for the practice that this particular physician provides natural family planning services and does not prescribe contraception. When I called to make my first appointment I was informed that the physician I was scheduling with did not prescribe contraception, but did provide natural family planning counseling. He also practices NaPro fertility treatment which is somewhat controversial. He sees patients from 5 states and is always scheduling pretty far out. He is well known in the Catholic community where I live. While it may not be what every patient wants, there is certainly a market for Catholic OB/GYNs who care for women in a way that is inline with Church teaching.

  • http://twitter.com/sandrastephens Sandra Stephens

    I think this is exactly the kind of case that needs to go all the way to the Supreme Court. I’d be incensed if I went to this doctor and wasn’t told beforehand that her religious beliefs would be an active factor in her treatment recommendations. Her stance was not only unethical, it was immoral.