As ob/gyns, we care for patients with a variety of gynecologic and reproductive health issues that can be emotionally charged and intensely private. Although gynecologic health issues are medical issues as are headaches or sprained ankles, the extent to which individuals want to talk openly about them varies. In our offices, patients share their fears, their pains, and their hopes, and discuss their sexuality, their gender identity, and their sexual behaviors. We talk with preteens about puberty, with teens about their periods, with women who are excited to be pregnant, and with those who are not. We talk to women who have never told anyone about a past sexual assault. We talk with women who are facing infertility or the need for a hysterectomy. Our patients know we will listen to and treat them with dignity and provide accurate health education that enables them to be a partner in their health care decisions.
Three recent pieces of legislation highlight a threat to the physician-patient relationship. The proposal of laws that interfere with this complex and intimate relationship is a step too far. These pieces of legislation illustrate this overreach by the state: dictating medical care for transgender adolescents (Arkansas and 18 other states),1,2 mandating medically inaccurate information about abortion (18 states),3 and requiring resuscitation for newborns with fatal diagnoses (New Hampshire).
As Frank Bruni pointed out in his recent New York Times op-ed column, politicians are currently demonizing trans people in a new culture war, similar to the way in which they vilified gays and lesbians, charging that gay marriages would somehow undermine straight marriages.4 Politicians, including former President Donald Trump, assert that trans equality would “destroy women’s sports.”5 This is a political strategy that ignores the realities of the patients in our offices. It ignores the transgender individual who has found puberty blockers to be immensely helpful or the trans persons who had previously been suicidal when attempting to fit in to a gender-binary world. It ignores the parents who have wrestled with their child’s affirmed gender identity, done extensive research and reading about the issue, and who love their child and support therapy and potentially medication to help alleviate their child’s gender dysphoria. It ignores our medical judgment and recommendations after we have listened to the patient and their parents. It ignores the expertise of our colleagues in endocrinology, psychology, adolescent medicine, adolescent gynecology, urology, and social work who work with transgender youth. As Bruni describes, these lawmakers are stunningly arrogant, and are “getting between physicians and patients.”4
Gender Affirming Care For Minors Endorsed By Several Professional Organizations
As many state legislatures across the U.S. introduce or have in process bills that could directly impact the physician-patient relationship and how treatments are administered, several professional organizations issued position statements.
In its statement, the North American Society of Adolescent and Pediatric Gynecology stated that it has nearly 470 members consisting of physicians, advanced practice providers, nurses, and professional health care trainees. “Our mission is to provide multidisciplinary leadership in education, research and gynecologic care to improve the reproductive health of all youth, inclusive of children and adolescents who are gender diverse.
We advocate for the provision of unrestricted, unbiased and evidence-based practice of pediatric and adolescent gynecology. We stand with national medical organizations supporting comprehensive care of adolescents and the confidential relationship between patients and their physicians.1 We support the positions that `physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of punishment. Patients, their families and caretakers in partnership with their physicians, not policymakers, should be the ones to make decisions about what care is best for them.’”1
The other organizations included the American College of Obstetricians and Gynecologists; the American Academy of Family Physicians; the American Academy of Pediatrics; the American Psychiatric Association; and the American Osteopathic Association.
Reference
- Frontline physicians oppose legislation that interferes in or penalizes patient care. American Academy of Pediatrics. April 2, 2021. Accessed April 26, 2021.https://services.aap.org/en/news-room/news-releases/aap/2021/frontline-physicians-oppose-legislation-that-interferes-in-or-penalizes-patient-care/
It is not controversial to agree that our obligation as physicians is to care for our patients in a way that best meets their needs. We should also agree that legislatures do not have a role in dictating specifics of medical care. The Coalition to Protect the Patient-Provider Relationship is comprised of nonpartisan, nonprofit organizations united in the “opposition to inappropriate interference in the relationship between a patient and health care provider.”6 Member organizations include the American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Medical Association, American Medical Student Association, American Medical Women’s Association, American Nurses Association, American Osteopathic Association, American Public Health Association. The coalition states that “patients deserve accurate information, high-quality care, and the treatment options that best meet their needs. Physicians and other health care providers should be able to follow the best medical science and training based on available evidence, and adhere to their ethical obligations.”6
It’s not just in areas of women’s health that we must protect that relationship. Other health and safety issues for which politicians are passing laws that stand between us and our patients include gun safety and environmental hazards. Resources for clinicians include a report, “Politics in the Exam Room: A Growing Threat,” by the National Partnership for Women & Families, National Physicians Alliance, Natural Resources Defense Council, and Giffords Law Center to Prevent Gun Violence.7 According to ACOG’s policy statement on legislative interference with patient care, medical decisions, and the patient-physician relationship, “laws should not interfere with the ability of physicians to determine appropriate treatment options and have open, honest, and confidential communications with their patients. Nor should laws interfere with the patient’s right to be counseled by a physician according to the best currently available medical evidence and the physician’s professional medical judgment. ACOG strongly opposes any governmental interference that threatens communications between patients and their physicians or causes a physician to compromise his or her medical judgment about what information or treatment is in the best interest of the patient.”8
When state legislators try to come between our patients and us, we must speak out strongly. We must not let politics trump science or interfere with our hallowed patient relationships. Our patients must be able to rely upon us to provide appropriate and confidential care, based on science and our medical judgment.
References
1.Legislative tracker: anti-transgender medical care bans. Freedom for All Americans. Accessed April 13, 2021. https://freedomforallamericans.org/legislative-tracker/medical-care-bans/
2.Cox C. As Arkansas bans treatments for transgender youth, 15 other states consider similar bills. USA Today. April 8, 2021. Accessed April 13, 2021. https://www.usatoday.com/story/news/politics/2021/04/08/states-consider-bills-medical-treatments-transgender-youth/7129101002/
3.An overview of abortion laws. Guttmacher Institute. Updated April 1, 2021. Accessed April 11, 2021. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws
4.Bruni F. Republicans find a cruel new culture war. New York Times. April 10, 2021. Accessed April 11, 2021. https://www.nytimes.com/2021/04/10/opinion/sunday/transgender-rights-republicans-arkansas.html
5.Ennis D. What Donald Trump’s transphobia really means for women’s sports. Forbes. February 28, 2021. Accessed April 13, 2021. https://www.forbes.com/sites/dawnstaceyennis/2021/02/28/what-donald-trumps-transphobia-really-means-for-womens-sports/?sh=3fac76545e66
6.About the coalition. Coalition to Protect the Patient-Provider Relationship. Accessed April 13, 2021. http://www.coalitiontoprotect.org.
7.Politics in the exam room: a growing threat. National Partnership for Women & Families. October 2015. Accessed April 13, 2021. https://www.nationalpartnership.org/our-work/resources/repro/politics-in-the-exam-room-a-growing-threat.pdf
8.Legislative interference with patient care, medical decisions, and the patient-physician relationship. ACOG. Updated July 2019. Accessed April 13, 2021. https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2019
