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==Deficiencies of Abortion Counseling== | ==Deficiencies of Abortion Counseling== | ||
# For most women, abortion is a complex decision and has numerous implications as how she sees herself. | #For most women, abortion is a complex decision and has numerous implications as how she sees herself. Is she taking control or losing control over her life? Is she acting morally, or immorally? Responsibly or irresponsibly? Is she good or bad, honorable or dishonorable? Is she betraying her maternal desires or honoring them by putting off being a mother until she is better able to be a good mother? Or is she a mother, already, despite whatever she does, and will she mourn as a mother? All of these are tough questions that many struggle with before as well as after an abortion. | ||
# For most women, abortion is an emotional decision. | #For most women, abortion is an emotional decision. Emotions and logic may conflict on many levels and emotions may affect the logic. This is one reason so many report great ambivalence. The strength of their opinion for or against abortion can be swayed every day, just by mood, or just by little incidents which tilt the balance one way or the other. | ||
# If abortion is a complex | #If abortion is a complex decision, how can counselors give well informed, good advice unless they explore that complexity and help the woman to sort through it. How can you give good advice on a complex, nebulous, emotional issue in just five or ten minutes....especially if you are avoiding asking questions that may "aggravate" the complexity of the issue? | ||
# If abortion is an emotional issue that is often surrounded by ambivalence, isn't it even more vitally important for the physician to bring a cool, unemotional perspective to the table to help the woman in the decision making process to bring as much foresight to the decision as possible? | #If abortion is an emotional issue that is often surrounded by ambivalence, isn't it even more vitally important for the physician to bring a cool, unemotional perspective to the table to help the woman in the decision making process to bring as much foresight to the decision as possible? How can a doctor give good counsel without asking good questions? | ||
# Abortion clinics like to pretend that the women who come to them have already thoroughly thought through their decisions. | #Abortion clinics like to pretend that the women who come to them have already thoroughly thought through their decisions. They like to think that their job is not to explore the decision but rather to simply help women to get through the day with as little stress, questioning, and discussion as possible. That's a nice fantasy. And it is also a way of avoiding getting involved in complex, emotional realities. | ||
# If an abortion can have such a dramatic effect on self-perception, isn't it | #If an abortion can have such a dramatic effect on self-perception, isn't it irresponsible for doctors to allow people to rush into it in a state of panic and fear? Especially when young women are being pressured into it by confused parents and boyfriends? | ||
#Arguably, the only other operations that can impact self perception as much as an abortion are a radical mastectomy and a sex change operation. Doctors don't ignore the psychological effects of those procedures. Why should they ignore it for abortion? | |||
===Screening For Other Elective Surgeries=== | |||
====Lasik==== | |||
AFTER PRE-SURGICAL SCREENING, 25% OF PATIENTS IDENTIFIED AS POOR CANDIDATES FOR LASIK | |||
Twenty-five percent of patients undergoing tests for Lasik who are found to be poor candidates for Lasik eye surgery. “Here's the real rub: One in four patients who seeks Lasik and undergoes a battery of pre-surgery testing is deemed a poor candidate. Maybe the cornea is too thin, or the pupils too large, or nearsightedness too severe, or their expectations unrealistic. But it's not clear just how many patients get screened appropriately, and some forge ahead anyway. ‘Some patients are just not a cornea laser eye surgery patient,’ stresses Dr. Kerry Solomon of the Medical University of South Carolina, a spokesman for the American Society for Cataract and Refractive Surgery. ‘There are still other options for them. And some are, quite frankly, better suited to staying with their glasses and contacts.’” (Associated Press, “Tired of wearing glasses? Afraid of Lasik? There are options,” Capital - Annapolis, Annapolis, Maryland, May 11, 2008) | |||
20% - 30%. Percent of Lasik applicants who are rejected. “‘Twenty [percent] to 30% of people who walk in to get Lasik get sent away without it,’ says [Dr. Jayne Weiss, director of refractive surgery at the Kresge Eye Institute, Wayne State University School of Medicine], who chaired the [FDA] ophthalmic devices panel. ‘In my practice, it's closer to 50%.’” (Valerie Ulene, “FDA to study Lasik's long-term effects on lifestyle,” Los Angeles Times, June 16, 2008) | |||
Why should abortion patients automatically be given an abortion when the risks are greater? | |||
====Bariatric Surgery==== | |||
'''[http://www.webmedcentralplus.com/article_view/doi:10.9754/journal.wplus.2015.00454 The use of Personality Inventories in Pre-surgical Psychological Evaluation of Bariatric Patients.] Cox S. WebmedCentral plus BARIATRIC AND METABOLIC SURGERY 2015;6(4):WMCPLS00454''' | |||
:Bariatric surgery has emerged as an effective treatment for long-term weight loss and associated co-morbidities of obesity. However, not every patient who is interested in bariatric surgery is an optimal candidate. Pre-surgical psychological evaluations attempt to identify patients at risk for sub-optimal outcomes following bariatric surgery. Because no consistent guidelines exist for what variables must be assessed during a pre-surgical psychosocial evaluation, many providers remain unsure of how to best identify patients that may be at risk. About half of practitioners include measures of personality in the psychological assessment, yet it is unclear if these measures represent useful tools in predicting surgical outcomes. The current article reviews the evidence regarding commonly used personality inventories in pre-surgical assessment. Literature suggests the MMPI and MMPI-2 demonstrate poor prognostic value in determining outcomes following surgery. The MMPI-2-RF and PAI can be considered possible options to include in assessment, although research has yet to confirm prognostic ability. | |||
'''Psychological evaluation of bariatric surgery applicants: procedures and reasons for delay or denial of surgery. Obesity surgery. Walfish S, Vance D, Fabricatore AN. 2007 Dec 1;17(12):1578-83. | |||
''' | |||
==== Dermatologic surgery ==== | |||
Gloster Jr HM, Roenigk RK. Preoperative psychological evaluation. Roenigk and Roenigk’s Dermatologic Surgery: Principles and Practice, 2nd ed. New York: Marcel Dekker. 1996 Jan 23:65-76. | |||
==== Chemonucleolysis ===== | |||
Wiltse LL, Rocchio PD. Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome. J Bone Joint Surg Am. 1975 Jun 1;57(4):478-83. | |||
=====Heart Transplant===== | |||
Mai FM, McKenzie FN, Kostuk WJ. Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. Br Med J (Clin Res Ed). 1986 Feb 1;292(6516):311-3. | |||
==== Other medical procedures ==== | |||
[https://scholar.google.com/scholar?q=preoperative+psychological+evaluation&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ved=0ahUKEwiptZPQmqvQAhWE5oMKHQZDCiYQgQMIGzAA preoperative psychological evaluation] | |||
[https://scholar.google.com/scholar?q=pretreatment+psychological+evaluation&btnG=&hl=en&as_sdt=0%2C26&as_vis=1 pretreatment psychological evaluation] | |||
=== Avandia Comparison === | |||
[http://www.npr.org/templates/story/story.php?storyId=128545983 Doctors Face Dilemma Over Prescribing Avandia] In this NPR interview Daniel Einhorn, a clinical endocrinologist and medical director of the Scripps Whittier Diabetes Institute in San Diego, has quite quotable comments regarding the fact that treatments that look good at first may later be discovered to be problematic and doctors need to be able to reconsider former recommendations: | |||
:"Now we see that we can't always predict the benefits or ultimately the risks of every drug. We need to follow them for as long a time as possible and with as many people as possible and be very critical about our observations. Even a drug that seems safe and seems promising may let you down in the long run." | |||
[http://news.google.com/news/url?sa=t&ct2=us%2F0_0_s_4_0_t&usg=AFQjCNFyScARGQ35jndnrPlqsNKYwVef1g&cid=17593773799034&ei=Zb4_TJitGI3mNJGGisMB&rt=MORE_COVERAGE&vm=STANDARD&url=http%3A%2F%2Fwww.reuters.com%2Farticle%2FidUSN1511649320100715 Don't dump Avandia, diabetes groups urge patients] | |||
Panel recommends allowing Avandia to continue to be on the market, despite evidence of risks, since the evidence or risks is not overwhelming. | |||
Avandia is contraindicated in patients with NYHA Class III and IV heart failure. In February 2010, David Graham, the FDA's associate director of drug safety, recommended that Avandia be taken off the market. Graham argued that Avandia caused 500 more heart attacks and 300 more heart failures than its main competitor. | |||
Vioxx, by contrast, was withdrawn from market. | |||
==No Regrets== | |||
On August 19 People magazine [http://www.people.com/people/article/0,,20298807,00.html published Kourtney Kardashian's lengthy explanation] why she chose not to abort her unplanned baby. Kardashian stars with her sisters Kim and Khloe and other family members on E!'s Keeping up with the Kardashians. Here's what she told People: | |||
:"My doctor told me there is nothing you will ever regret about having the baby, but he was like, 'You may regret not having the baby.' And I was like: That is so true. And it just hit me. I got so excited, and when I told Scott he was so excited. But I think if I had said I'm not going to keep it, I really think he would have pushed me into keeping it...." | |||
[http://www.jillstanek.com/pop-culture/what-pro-aborts.html See also...] | |||
===Another Case=== | |||
:He was kind, reassuring. "Anna," he said. "Are you ready? If so, we will give you a little injection in the back of your hand and transfer you to the table. Is there anything you would like to say?" | |||
:"Yes," replied Anna. "I'm really sorry, but I've changed my mind." But instead of being annoyed with her for wasting their time, the medical team seemed to be overcome with a sudden, unexpected euphoria. | |||
:"The doctor broke out into a huge smile, grabbed her shoulder and laughed "Congratulations! Well done, you won't regret it." | |||
Read more: [http://www.dailymail.co.uk/femail/article-453148/Why-I-changed-mind-seconds-I-abortion.html] | |||
===Stop Forced Abortions=== | |||
See [[Stop Forced Abortions]] | |||
Latest revision as of 10:55, 15 November 2016
Deficiencies of Abortion Counseling
- For most women, abortion is a complex decision and has numerous implications as how she sees herself. Is she taking control or losing control over her life? Is she acting morally, or immorally? Responsibly or irresponsibly? Is she good or bad, honorable or dishonorable? Is she betraying her maternal desires or honoring them by putting off being a mother until she is better able to be a good mother? Or is she a mother, already, despite whatever she does, and will she mourn as a mother? All of these are tough questions that many struggle with before as well as after an abortion.
- For most women, abortion is an emotional decision. Emotions and logic may conflict on many levels and emotions may affect the logic. This is one reason so many report great ambivalence. The strength of their opinion for or against abortion can be swayed every day, just by mood, or just by little incidents which tilt the balance one way or the other.
- If abortion is a complex decision, how can counselors give well informed, good advice unless they explore that complexity and help the woman to sort through it. How can you give good advice on a complex, nebulous, emotional issue in just five or ten minutes....especially if you are avoiding asking questions that may "aggravate" the complexity of the issue?
- If abortion is an emotional issue that is often surrounded by ambivalence, isn't it even more vitally important for the physician to bring a cool, unemotional perspective to the table to help the woman in the decision making process to bring as much foresight to the decision as possible? How can a doctor give good counsel without asking good questions?
- Abortion clinics like to pretend that the women who come to them have already thoroughly thought through their decisions. They like to think that their job is not to explore the decision but rather to simply help women to get through the day with as little stress, questioning, and discussion as possible. That's a nice fantasy. And it is also a way of avoiding getting involved in complex, emotional realities.
- If an abortion can have such a dramatic effect on self-perception, isn't it irresponsible for doctors to allow people to rush into it in a state of panic and fear? Especially when young women are being pressured into it by confused parents and boyfriends?
- Arguably, the only other operations that can impact self perception as much as an abortion are a radical mastectomy and a sex change operation. Doctors don't ignore the psychological effects of those procedures. Why should they ignore it for abortion?
Screening For Other Elective Surgeries
Lasik
AFTER PRE-SURGICAL SCREENING, 25% OF PATIENTS IDENTIFIED AS POOR CANDIDATES FOR LASIK
Twenty-five percent of patients undergoing tests for Lasik who are found to be poor candidates for Lasik eye surgery. “Here's the real rub: One in four patients who seeks Lasik and undergoes a battery of pre-surgery testing is deemed a poor candidate. Maybe the cornea is too thin, or the pupils too large, or nearsightedness too severe, or their expectations unrealistic. But it's not clear just how many patients get screened appropriately, and some forge ahead anyway. ‘Some patients are just not a cornea laser eye surgery patient,’ stresses Dr. Kerry Solomon of the Medical University of South Carolina, a spokesman for the American Society for Cataract and Refractive Surgery. ‘There are still other options for them. And some are, quite frankly, better suited to staying with their glasses and contacts.’” (Associated Press, “Tired of wearing glasses? Afraid of Lasik? There are options,” Capital - Annapolis, Annapolis, Maryland, May 11, 2008)
20% - 30%. Percent of Lasik applicants who are rejected. “‘Twenty [percent] to 30% of people who walk in to get Lasik get sent away without it,’ says [Dr. Jayne Weiss, director of refractive surgery at the Kresge Eye Institute, Wayne State University School of Medicine], who chaired the [FDA] ophthalmic devices panel. ‘In my practice, it's closer to 50%.’” (Valerie Ulene, “FDA to study Lasik's long-term effects on lifestyle,” Los Angeles Times, June 16, 2008)
Why should abortion patients automatically be given an abortion when the risks are greater?
Bariatric Surgery
The use of Personality Inventories in Pre-surgical Psychological Evaluation of Bariatric Patients. Cox S. WebmedCentral plus BARIATRIC AND METABOLIC SURGERY 2015;6(4):WMCPLS00454
- Bariatric surgery has emerged as an effective treatment for long-term weight loss and associated co-morbidities of obesity. However, not every patient who is interested in bariatric surgery is an optimal candidate. Pre-surgical psychological evaluations attempt to identify patients at risk for sub-optimal outcomes following bariatric surgery. Because no consistent guidelines exist for what variables must be assessed during a pre-surgical psychosocial evaluation, many providers remain unsure of how to best identify patients that may be at risk. About half of practitioners include measures of personality in the psychological assessment, yet it is unclear if these measures represent useful tools in predicting surgical outcomes. The current article reviews the evidence regarding commonly used personality inventories in pre-surgical assessment. Literature suggests the MMPI and MMPI-2 demonstrate poor prognostic value in determining outcomes following surgery. The MMPI-2-RF and PAI can be considered possible options to include in assessment, although research has yet to confirm prognostic ability.
Psychological evaluation of bariatric surgery applicants: procedures and reasons for delay or denial of surgery. Obesity surgery. Walfish S, Vance D, Fabricatore AN. 2007 Dec 1;17(12):1578-83.
Dermatologic surgery
Gloster Jr HM, Roenigk RK. Preoperative psychological evaluation. Roenigk and Roenigk’s Dermatologic Surgery: Principles and Practice, 2nd ed. New York: Marcel Dekker. 1996 Jan 23:65-76.
Chemonucleolysis =
Wiltse LL, Rocchio PD. Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome. J Bone Joint Surg Am. 1975 Jun 1;57(4):478-83.
Heart Transplant
Mai FM, McKenzie FN, Kostuk WJ. Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. Br Med J (Clin Res Ed). 1986 Feb 1;292(6516):311-3.
Other medical procedures
preoperative psychological evaluation pretreatment psychological evaluation
Avandia Comparison
Doctors Face Dilemma Over Prescribing Avandia In this NPR interview Daniel Einhorn, a clinical endocrinologist and medical director of the Scripps Whittier Diabetes Institute in San Diego, has quite quotable comments regarding the fact that treatments that look good at first may later be discovered to be problematic and doctors need to be able to reconsider former recommendations:
- "Now we see that we can't always predict the benefits or ultimately the risks of every drug. We need to follow them for as long a time as possible and with as many people as possible and be very critical about our observations. Even a drug that seems safe and seems promising may let you down in the long run."
Don't dump Avandia, diabetes groups urge patients
Panel recommends allowing Avandia to continue to be on the market, despite evidence of risks, since the evidence or risks is not overwhelming.
Avandia is contraindicated in patients with NYHA Class III and IV heart failure. In February 2010, David Graham, the FDA's associate director of drug safety, recommended that Avandia be taken off the market. Graham argued that Avandia caused 500 more heart attacks and 300 more heart failures than its main competitor.
Vioxx, by contrast, was withdrawn from market.
No Regrets
On August 19 People magazine published Kourtney Kardashian's lengthy explanation why she chose not to abort her unplanned baby. Kardashian stars with her sisters Kim and Khloe and other family members on E!'s Keeping up with the Kardashians. Here's what she told People:
- "My doctor told me there is nothing you will ever regret about having the baby, but he was like, 'You may regret not having the baby.' And I was like: That is so true. And it just hit me. I got so excited, and when I told Scott he was so excited. But I think if I had said I'm not going to keep it, I really think he would have pushed me into keeping it...."
Another Case
- He was kind, reassuring. "Anna," he said. "Are you ready? If so, we will give you a little injection in the back of your hand and transfer you to the table. Is there anything you would like to say?"
- "Yes," replied Anna. "I'm really sorry, but I've changed my mind." But instead of being annoyed with her for wasting their time, the medical team seemed to be overcome with a sudden, unexpected euphoria.
- "The doctor broke out into a huge smile, grabbed her shoulder and laughed "Congratulations! Well done, you won't regret it."
Read more: [1]