No one challenges obstetricians. I’ve seen the effects of this in all aspects of the profession, but it is especially frightening in a court of law. The tried and true defense for obstetricians who are sued is “only we can judge what we do.” I will never forget two obstetricians practicing in partnership in a small rural town in Idaho- the only obs in town. When testifying in a deposition in preparation for a court case, they were questioned about giving a patient a dose of Cytotec for induction that was two to three times the maximum dose generally used. They replied that the dose was the standard of practice in their community. When asked where this standard of practice came from, the two obs replied simply: “We are the standard of practice.” This insistence that only members of the tribe can understand what tribal members do and why they do it results in standards of practice that tribal members want- doctor friendly practices. What it comes down to is that what is euphemistically called a “standard of practice” in a given community simply means whatever the local doctors do, regardless of whether or not it is good practice as defined by scientific evidence- a frightening level of power and control.”
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