Ob/Gyn Residency and circ??

[KaylaBeanie]

Recently I've made the decision to add a second major, Pre-Med. Well, it's not a major per se, but that's beside the point. Should I decide to go through medical school, there are a few different areas that interest me, Ob/Gyn (obviously) being one of them. I doubt we have a large abundance of doctors on here, but does anyone know if it's mandatory (officially or unofficially) to do circs during residency? Quite obviously, I would not want to do one (nor do I think obgyns should, but that's neither here nor there). I imagine that you can't be forced outright to do something, but I would worry about the internal politics involved (severing ties, pissing off attendings, etc) that could come from such refusal. Does anybody know?

[PatioGardener]

I'm not sure about the USA, but in Canada a physician or surgeon is only responsible to make sure that their patients receive the medical advice/procedure they need - they are not responsible for delivering it. The example most often used is abortion. A doctor is not required to perform an abortion, or even to refer a patient to an abortion clinic. However, the doctor legally must refer the patient in a timely fashion to another doctor who will make the referal.

I have no idea how circumcision would fit, as it is seen as an elective procedure here in Canada, similar to breast augmentation.

Here newborn circumcisions (a rare event when not for religious reasons) tend to be the relm of (aging) pediatricians. I don't know any OBs who do them.

[PuppyFluffer]

I would think that you could take a consciousentious objection. I think doing it as soon as possible in your education would be a good idea.

[Greg B]

I am not in the medical profession, but from the discussions I have read here and elswhere on this topic, my impression is that you could make a case that you do not need to do it. I seem to remember one person going through the training and avoiding it.


Regards

[KaylaBeanie]

Originally Posted by PuppyFluffer

I would think that you could take a consciousentious objection. I think doing it as soon as possible in your education would be a good idea.

What exactly is a conscientious objection? I know the definition, but not in this context.

Thanks for the quick input guys. Hopefully in the next 6-8 years, the rates drop even lower and it's less of an issue. While oncology is my top choice at the moment, I would hate for circ (pesky cosmetic surgery) to potentially stand in the way of becoming an Ob/Gyn when OB's shouldn't even be TOUCHING penises, much less hacking them up . It still blows my mind that doctors specializing in female reproduction and genitalia are allowed to circ. It goes to show that $$ really does talk.

[glongley]

There have been some articles recently in the medical literature about doctors' rights to conscientious objection in the medical context (i.e. refusal to participate due to moral objections), e.g. this one from the AAP:

http://www.ncbi.nlm.nih.gov/pubmed/19948636

Search Pub Med fro "conscientious objection" for more.

Also, last year I believe the Federal Dept of Health and Human Services reaffirmed the right to conscientious objection in facilities that receive federal funding, geared mainly to abortion and sterilization issues, but of course there are other issues that might lead a health professional to have moral objections, like a Jehovah's witness to hanging blood products, or of course like performing medically unnecessary amputations on non-consenting patients as in the case of circumcision. For more info see:

http://www.hhs.gov/ophs/programs/policy/conscience.html

I personally know of residents who have chosen to refuse to do circumcisions, so it is possible, but there is likely to be flak or harrassment. (Doubt if the same kind of harrassment would go on for someone who had a moral objection to some of the other issues I listed above - but somehow objecting to circumcision is not given the same kind of respect yet). On the other hand, if you really know your stuff and are willing to speak out, you can be a voice to educate your fellow trainees and attendings.

Conscientious objection is a huge piece of where we need to go with changing the medical mindset about circumcision. Doctors need to be educated enough to realize there is an ethical problem, and then they need to be supported and empowered to act on that ethical position in their training and workplaces. The more who refuse to do circs, the fewer circs there will be, and the more the paradigm shifts.

Please PM me if you would like to talk further. I have some other information that might be helpful for you.

Gillian RN

[glongley]

Also wanted to mention that circumcision position statements of the British Medical Association and the College of Physicians and Surgeons of British Columbia directly address and support the right to conscientious objection by physicians.

https://www.cpsbc.ca/files/u6/Circum...nfant-Male.pdf [2009]
http://www.bma.org.uk/images/Circumc...m41-147277.pdf [2006]

Also, Doctors Opposing Circumcision has a summary statement on Conscientious Objection:

http://www.doctorsopposingcircumcisi...ionleaflet.pdf

Gillian

[KaylaBeanie]

Awesome, thank you SO MUCH for that Gillian! With 47 states allowing the moral objection, I'll just have to make sure I don't land in one of the 3 unprotected states. I hope to move out west anyhow, where the rates are fairly low...my only real concern is cutting ties with other doctors and superiors by refusing, but I'm not letting it concern me at the moment since we have no idea what the climate will be like in 8 years when I get out of med school.

[Ron_Low]

conscientious objection

There is no need to take a stance that you are a conscientious objecter. Simply don't amputate healthy normal body parts from healthy normal people.

If someone says to do it, ask what is the diagnosis of defect or patholology that warrants it. Ask what less destructive remedies have ben tried.

In the very worst case, you will insist on writing "no medical grounds for amputation" or similiar in the medical chart and signing it, before letting someone else do it.

[CookieMonsterMommy]

Originally Posted by Ron_Low

There is no need to take a stance that you are a conscientious objecter. Simply don't amputate healthy normal body parts from healthy normal people.

If someone says to do it, ask what is the diagnosis of defect or patholology that warrants it. Ask what less destructive remedies have ben tried.

In the very worst case, you will insist on writing "no medical grounds for amputation" or similiar in the medical chart and signing it, before letting someone else do it.

While I agree that this is completely legitimate, if the OP is concerned with not pissing off coworkers, cheif residents and attendings, this is not the route to go.

There was a resident where I worked last who refused to do circs. The other residents were less than thrilled to "have to" assist/perform the ones she didnt, but she made it through just fine. Afaik, she didn't have any official "conscientous objection" she just explained that she didn't believe in routine circ. She was asked to witness a circ that was done on a toddler due to severe infection/cellulitis of the foreskin by a pediatric urologist (for experience's sake--they'd never have an OB resident perform the procedure and because she agreed that it was medically warrented, she witnessed/assisted--in this case, passed the instruments.

[KaylaBeanie]

Originally Posted by Ron_Low

There is no need to take a stance that you are a conscientious objecter. Simply don't amputate healthy normal body parts from healthy normal people.

If someone says to do it, ask what is the diagnosis of defect or patholology that warrants it. Ask what less destructive remedies have ben tried.

In the very worst case, you will insist on writing "no medical grounds for amputation" or similiar in the medical chart and signing it, before letting someone else do it.

While a helpful perspective, I don't necessarily think this is the best or most professional way to go about expressing my feelings.

Originally Posted by CookieMonsterMommy

While I agree that this is completely legitimate, if the OP is concerned with not pissing off coworkers, cheif residents and attendings, this is not the route to go.

There was a resident where I worked last who refused to do circs. The other residents were less than thrilled to "have to" assist/perform the ones she didnt, but she made it through just fine. Afaik, she didn't have any official "conscientous objection" she just explained that she didn't believe in routine circ. She was asked to witness a circ that was done on a toddler due to severe infection/cellulitis of the foreskin by a pediatric urologist (for experience's sake--they'd never have an OB resident perform the procedure and because she agreed that it was medically warrented, she witnessed/assisted--in this case, passed the instruments.

Thank you for the first hand experience. I just would want to make it through, causing the least amount of friction and not severing any potential professional relationships. I just don't want something like this to potentially make or break my career, should I go this path.

[CookieMonsterMommy]

If it *does* cause friction w/other residents, as it did with the MD I knew, you could always offer to pick up the slack somewhere else...rounding on a few of their patients, doing some charting for them, etc.

[KaylaBeanie]

Originally Posted by CookieMonsterMommy

If it *does* cause friction w/other residents, as it did with the MD I knew, you could always offer to pick up the slack somewhere else...rounding on a few of their patients, doing some charting for them, etc.

That's what I was thinking...by offering to do an undesirable task, that friction would ideally be eased.

[AllieFaye]

Originally Posted by KaylaBeanie

While oncology is my top choice at the moment,

However, it's important to remember that penile cancer is a legitimate medical reason to circ. While incredibly rare - 1 in 1,000,000 - it would be within the practice of oncology. Granted, it's hard to imagine someone having an ethical objection to that type of circ. It also wouldn't be on infants.

[KaylaBeanie]

Originally Posted by AllieFaye

However, it's important to remember that penile cancer is a legitimate medical reason to circ. While incredibly rare - 1 in 1,000,000 - it would be within the practice of oncology. Granted, it's hard to imagine someone having an ethical objection to that type of circ. It also wouldn't be on infants.

To continue this little side track, I'd probably do pediatric oncology. Even if I got the 1 in several millions case where a young boy had to legitimately be circumcised due to cancer, wouldn't a urologist perform it? If not though, and I did get that beyond rare case, I would have no issues doing a circ in that case. It's so, so, so unlikely though, ideally I'll never have to worry about it.

[PuppyFluffer]

Ah, but in this scenario, we're in the realm of medical necessity....a far cry from routine circumcision!