Letter to my OB.

[WonderWild]

The one who performed my son's circumcision. Let me know what you think or if you have any suggestions to make it better. I feel really good about it though.

Dr. L,

I have been a patient of yours for many years and I had my son with you 4 ½ years ago. I have always appreciated what a nice doctor you are and how you try to make an otherwise unenjoyable experience bearable. The reason I write to you today is to tell you that I have some unresolved feelings of resentment towards you over the circumcision of my son. I of course take part of the blame in the fact that my son was mutilated. I should have researched. The only excuse I can give is that society and the medical community has made it the norm in America so that most people don’t even question it. Most women in the U.S. have only been with or seen men who are circumcised and those men, for the most part, refuse to acknowledge that anything wrong was done to them.

Most of the blame however goes to you. You are the one who performed the cosmetic surgery on my day old son. You are the one who came to me after I had been through 18 hours of labor, 2 days of no sleep in which I was threatened twice with a c-section. (thank you for saving me from that by the way) It was you that asked me so nonchalantly “do you want to circumcise?” I can tell you that it had never even crossed my mind until you brought it up. When they brought my son back to me and I saw the bloody mess you made of his penis I said to my husband “we should not have done this.”

I must tell you the gut wrenching guilt I felt after I learned the truth about this procedure. There are so many other mothers like me who feel the same way. We feel betrayed by our doctors because they didn’t tell us the truth. I urge you to please rethink your stance on circumcision. I beg you to stop asking the question to parents. You need to mention it to parents during a prenatal exam, when they are not exhausted from labor and on narcotics. Tell them that they need to be sure to thoroughly research the subject. Urge them to actually watch a video of the procedure. There are many reputable websites online that offer it for educational purposes. http://www.circumcisionquotes.com/video.html

Lastly, as with most any surgical procedure it is YOUR duty to explain exactly what is going to happen. You would not perform any medical procedure on the mother without first explaining it to her. I know that every visit I have had with you, you have explained every step of the pap smear and vaginal exam. Why did you not explain the circumcision to me step by step? I was horrified when I first saw a circumstraint. I never knew such a thing existed – as quite a number of people don’t. I never knew that the foreskin is adhered to the glans and has to be forcibly separated with a blunt object. So many things I did not know about the procedure and it was your duty to explain it to me. You failed in that duty. Thankfully I have found a supportive online community of intactivists that have welcomed me and tried to help me heal emotionally. Writing this letter to you is one more step in my healing. I have also written an apology letter to my son that I will have him read when the time is right. I pray that he will not suffer from any sexual difficulties such as too tight erections – seeing as how you did not leave any remnants of his foreskin behind.

I urge you to JUST STOP! It’s so completely unnecessary and dangerous. I urge you to join “Doctors Opposing Circumcision” to see how you can help the intact cause. I am open to discussing this at our next appointment. I have put off seeing you for 2 years now because of these feelings. Your reaction at my next appointment will help me decide if I need to find a new doctor. I also need to let you know that I have discovered that my son may have legal recourse against you if he so decides when he is an adult. Thank you for taking the time to read this and I pray that you will take everything I have said to heart.

[Papai]

Thankfully I have found a supportive online community of intactivists that have welcomed me and tried to help me heal emotionally.

I would avoid words like "intactivists" and championing that he join Doctors Opposing Circumcision. It makes it seem like you've become a pawn of the "crazy" "anti-circ" lobby. I think you should make the letter as personal as possible and express your regret and any complications that your son might have suffered, leaving out that you suggest he join DOC.

The important thing is to stress that you did not feel that you were fully informed of the procedure and you are unhappy with the way your son's circumcision came about.

[WonderWild]

Originally Posted by Papai

I would avoid words like "intactivists" and championing that he join Doctors Opposing Circumcision. It makes it seem like you've become a pawn of the "crazy" "anti-circ" lobby. I think you should make the letter as personal as possible and express your regret and any complications that your son might have suffered, leaving out that you suggest he join DOC.

The important thing is to stress that you did not feel that you were fully informed of the procedure and you are unhappy with the way your son's circumcision came about.

Thank you.

[glongley]

Good for you for getting this down on paper. It really is an important part of your healing, but it will hopefully also get this doctor to really think about what he is doing.

It is important to get across what is on your mind about this, while at the same time doing it in a way that the doctor stays receptive to your message. Usually it is a good idea to revise and sleep on your writing a few times, and keep tweaking the parts that may evoke defensiveness on his part.

I think you have done a really great job laying out the main points of how it affected you, how it makes you feel about him, and what you would like him to do. Here are a few points that seemed problematic to me, with my comments:

"I of course take part of the blame in the fact that my son was mutilated. "

I always feel that the use of the term mutilation is going to automatically put up defensiveness in people being confronted with this for the first time. I'd revise the sentence to avoid such a highly charged word in the very first paragraph.

"Most of the blame however goes to you. "

I would soften this with an "However, I feel that..." rather than a direct accusation.

"It was you that asked me so nonchalantly 'do you want to circumcise?' I can tell you that it had never even crossed my mind until you brought it up. When they brought my son back to me..."

What else did he tell you or not tell you about it, that can be used to show him how inadequate his "informed consent giving" was?

"Urge them to actually watch a video of the procedure. There are many reputable websites online that offer it for educational purposes. http://www.circumcisionquotes.com/video.html"

I would omit any links here. He knows what one looks like, and he may find grounds to criticize whatever version you direct him to, rather than sticking with the point that parents need to know what is involved, and that there are video resources available on the Web.

"I never knew that the foreskin is adhered to the glans and has to be forcibly separated with a blunt object. "

Blunt object makes me think of getting hit over the head with a rubber hose or a baseball bat. You could just refer to "separated with a blunt probe."

"Thankfully I have found a supportive online community of intactivists that have welcomed me and tried to help me heal emotionally."

I think the word "intactivists" will mean next to nothing to him, and will put up red flags in his mind about crazy people filling you with misinformation. You might just say "online community of like-minded parents..."

"I urge you to join 'Doctors Opposing Circumcision' to see how you can help the intact cause."

I think again this might arouse defensiveness. He is very far away from even thinking about "the intact cause". I'd say the first goal is to get him to acknowledge that he caused you distress, that he needs to change his informational approach, and that he needs to educate himself about the harms of circumcision. Joining DOC and becoming an intactivist is too much of a stretch at this point. If you try to get him to change too radically, he will not hear the rest of what you have to say.

One other thought, I think it is always a good technique when offering criticism to "sandwich" the negative stuff between some positive comments at the beginning (such as your various expressions of appreciation) and the end (such as your ending with a thank you). You might also want to say one more nice thing about him or his practice, just so the threat of a potential law suit in the future is not the last taste in his mouth.

Thank you so much for writing this letter. The more doctors that hear this kind of feedback from the mothers they serve and the boys they have cut, the more will educate themselves and think about what they are actually doing, and the more will eventually lay down their knives.

Hope this is helpful. Gillian

[Papai]

I agree with glongley's suggestions.

But I wouldn't even mention about the online community of like-minded parents. Trust me, doctors immediately throw up red flags when they hear you've done anything online.

[WonderWild]

Thank you all so much. These are great suggestions and I have made some changes. Keep them coming. I will post the final draft before I mail it out. Hopefully by the end of the week I'll be done tweaking it. I've already been working on it for a month.

[bluetoes]

Originally Posted by Papai

But I wouldn't even mention about the online community of like-minded parents. Trust me, doctors immediately throw up red flags when they here you've done anything online.

Good point. While I consider myself perfectly normal there really are a lot of cranks out there

[kldliam]

Thankfully I have found a supportive online community of intactivists that have welcomed me and tried to help me heal emotionally. Writing this letter to you is one more step in my healing. I have also written an apology letter to my son that I will have him read when the time is right. I pray that he will not suffer from any sexual difficulties such as too tight erections – seeing as how you did not leave any remnants of his foreskin behind.

I urge you to JUST STOP! It’s so completely unnecessary and dangerous. I urge you to join “Doctors Opposing Circumcision” to see how you can help the intact cause

I don't think that you should make any threat about any future lawsuit. I don't know what purpose it serves here & it wont go over well at all. Your message will get lost. You know your son has this option and that is all that matters. I would also use the words "genital integrity" supporters instead of "Intactivists". Most people have no idea what an Intactivist is. I would avoid telling him anything at all about the internet. People are very dissmissive when you start talking about the internet. I too would also urge you not to encourage him to join DOC at this point. IF he is receptive to this letter, you can tell him that this organization exists in person and that you urge him to check it out.

I thought it was a great letter. I agree with Glongley: sleep on this one for a week or two. Put it down, go back to it with a fresh mind, then put it down again and repeat.

[zinemama]

I agree with the pp who suggested not using "mutilated" in the very first paragraph. That would stop him reading right there.

Instead, "I of course take part of the blame that my son was subjected to unecessary cosmetic surgery."

I would also omit the part about the supportive online community. I think for most doctors, laypeople + internet = wackos.

I'd also suggest shortening it quite a bit, and keeping the focus less on how circ = bad and more on a doctor's responsibility to fully inform. I'd keep it very personal, and skip a lot of the generalities about circ, and stick to your story, your feeling of betrayal that you were not informed, that he did not describe the procedure to you nor let you know it wasn't necessary. You might mention that you have met perfectly normal, intact children and now realize your son was born fine as is, but again, I'd skip the lecture, threat of suit, and call for him to get radical.

He's an individual; you're an individual. I think by focusing on your story, his actions (or lack therof) and the relationship you have as doc and patient, you'll be a lot more effective.

[WonderWild]

Originally Posted by zinemama

I'd also suggest shortening it quite a bit, and keeping the focus less on how circ = bad and more on a doctor's responsibility to fully inform. I'd keep it very personal, and skip a lot of the generalities about circ, and stick to your story, your feeling of betrayal that you were not informed, that he did not describe the procedure to you nor let you know it wasn't necessary.

Which parts do you feel are generalities?

Thanks for the suggestions. I am going to take out the "mutilated" part and the "internet" part.

[~Megan~]

I think you should move the part about legal recourses to a new place or leave it out entirely. It comes off as a threat. And threats do not open minds.

[eepster]

The PPs have made many good suggestions, but the thing that struck me was how you thanked him for supporting your not wanting a c-section.

To me it seems like a hypocracy on his part. He believes his patients shouldn't be coerced into unnecessary surgeries when they give birth, but yet when they are but a day old he solicits unnecessary surgery.

I might say:
"While I appreciated your helping me to avoid the unnecessary pain and trauma of having a c-section, I wish that you had done the same for my son and not solicited for him to have an unnecessary surgical proceedure."

If anyone gets what I'm saying but can word it better please do.

[Fyrestorm]

I think I would also mention in there the questionable ethics of soliciting cosmetic surgery, especially on an infant.

[Quirky]

I too think it's great, and think that the best part is focusing on informed consent. I also would drop the lawsuit part, at least until you make sure you have every last scrap of documentation of your records out of his office, the hospital, and the insurance company.

You might even quote from the AAP's (wishy-washy) statement on circumcision:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

ACOG has signed on to this statement IIRC.

Yay you for having the courage to let him know how you feel!

[GoodMomma]

Good letter! I might steal it to send to my previous OB! Not really, I wouldn't do that but it's a perfect letter and sounds like a lot of what I'd write in my own. I think you did a good job!

[KBecks]

I''m going to suggest a few edits. I think your letter should be shorter and more focused. Your draft is great for getting your thoughts out and a release of your feelings about circ. Now it's time to get focused on persuading the doc to change.

I'm concerned that the letter puts the doc on the defensive too much, you want him to become a partner, and so the doc needs to be treated as one. It also comes off as very emotional. Unfortunately, a doc will be more likely to be persuaded by facts. I want to write a letter to my OB and here are the points I plan to make

* circ is medically unnecessary
* a foreskin is beneficial (short list of benefits of foreskin)
* circ is damaging (description of what is lost to circ)
* circ side effects - (short list / many not known until maturity)
* parents are not given adequate information to consent
* human rights - consent should belong to child

And here are my call to actions
* please consider eliminating circ from your pratice
* please offer greater caution to parents about dangers, what is lost when the foreskin is removed, and possible side effects so they may be more fully informed
* if you still choose to offer circ, please provide adequate pain relief and continued pain relief / care instruction to parents (I'm not sure if I should even suggest what to do if they keep offering it, but I think that would be helpful to people. I also wonder about telling them about loose circs being better, but I worry about that because of the re-circs that sometimes result from it.)


OK, I think your letter needs much more information and much less emotion. I think releasing the emotions is very helpful for your healing, but it will turn off the doctor to your message. On the contrary, compelling information may help persuade the doctor to reconsider offering the procedure.

Also, make is less personal for the doc -- the letter emphasizes *you* and *your actions* and this will just put the doc on the defense and not help your cause.

I think sharing your personal feelings is kind of good because it shows the result of circ, but a doc won't change practice based on your feelings, he/she will only change it based on medical evidence, so weight your letter accordingly.

I think your letter is well-written. My problem is that the letter needs to work for your audience (a doctor who has been trained to value and make critical decisions based on logic analysis and outcomes.) Hope that helps.

Good luck!!!

Originally Posted by garrettsmommy

Dr. L,

I have been a patient of yours for many years and I had my son with you 4 ½ years ago. I have always appreciated what a nice doctor you are and how you try to make an otherwise unenjoyable experience bearable. The reason I write to you today is to tell you that I have some unresolved feelings .... over the circumcision of my son.

(the whole 2nd paragraph isn't productive of bringing the doc to your side. I'm sure it was a good vent for you! Use it at that, but don't send it.)

I must tell you the gut wrenching guilt I felt after I learned the truth about this procedure. There are so many other mothers like me who feel the same way. We feel betrayed by our doctors because they didn’t tell us the truth. I urge you to please rethink your stance on circumcision. I beg you to stop asking the question to parents. You need to mention it to parents during a prenatal exam, when they are not exhausted from labor and on narcotics. Tell them that they need to be sure to thoroughly research the subject. Urge them to actually watch a video of the procedure. There are many reputable websites online that offer it for educational purposes. http://www.circumcisionquotes.com/video.html

Lastly, as with most any surgical procedure it is YOUR duty to explain exactly what is going to happen. You would not perform any medical procedure on the mother without first explaining it to her. I know that every visit I have had with you, you have explained every step of the pap smear and vaginal exam. Why did you not explain the circumcision to me step by step? I was horrified when I first saw a circumstraint. I never knew such a thing existed – as quite a number of people don’t. I never knew that the foreskin is adhered to the glans and has to be forcibly separated with a blunt object. So many things I did not know about the procedure and it was your duty to explain it to me. You failed in that duty. Thankfully I have found a supportive online community of intactivists that have welcomed me and tried to help me heal emotionally. Writing this letter to you is one more step in my healing. I have also written an apology letter to my son that I will have him read when the time is right. I pray that he will not suffer from any sexual difficulties such as too tight erections – seeing as how you did not leave any remnants of his foreskin behind.

I urge you to JUST STOP! It’s so completely unnecessary and dangerous. I urge you to join “Doctors Opposing Circumcision” to see how you can help the intact cause. I am open to discussing this at our next appointment. I have put off seeing you for 2 years now because of these feelings. Your reaction at my next appointment will help me decide if I need to find a new doctor. I also need to let you know that I have discovered that my son may have legal recourse against you if he so decides when he is an adult. Thank you for taking the time to read this and I pray that you will take everything I have said to heart.

[eepster]

I need to disagree with KBecks.

I think keeping it about how you feel is important. He has probably seen the facts and dismissed them as unimportant b/c his patients want to circ.

By making the letter about how you feel misinformed and betrayed you will make him see that his attitude is effect his patients satisfaction with him. Which ultimately will have more of an effect than dry facts. Keeping patients/customers happy is more important to most Drs than taking the moral high road.

[Sijae]

Well I for one would leave in the word mutilated. It's how you feel and it's what is true. I don't think softening that word will help him hear how you feel.

I would leave out the part about internet support and the lawsuit part but throw in more description of the facts you didn't know and how horrified you are about them. Putting in the medical details ( that he *should* know) let's him know that you know what you are talking about and putting in the strong emotional words lets him know how you feel.

my .02,
Laura

[KBecks]

To put a perspective on where I'm coming from, realize that you are in essence asking the OB to give up tens of thousands of dollars in annual revenue by discontinuing circumcision services. That is a major business decision, and it won't be an easy decision for any practitioner to make. Plus, the OB may get backlash for ceasing to offer circ to parents who want it.

So, the OB will need compelling reasons why he/she should discontinue circ. Facts and outcomes will be very important. Your emotions are important too, but be careful not to use language that will turn off the doc. You are in essence trying to persuade him/her to radically change his/her business practices, and when you're selling, it goes a lot better when you're nice and easy to work with.

ETA: I have seen data on how doctors make buying decisions, and I hope that will be helpful to this cause.

HTH,
Karen