Saturday, October 14, 2017

'A third of people get major surgery to be born': why are C-sections routine in the US? | Life and style | The Guardian

Carmen Walker didn't realize how bad things had gotten until she heard her doctor's voice from across the operating room: "I'm going to try to save her uterus."

Walker had delivered her first child by caesarean section, so when she became pregnant a second time, doctors didn't think twice before scheduling another. And then another and another. Now, giving birth to her sixth child, she was experiencing the consequences: placenta accreta, a condition which is linked to multiple C-sections and can result in fatal bleeding.

Caesarean sections have saved the lives of millions of infants who might have otherwise been killed or permanently injured during difficult births. But in the US, the rate of caesareans has increased so much over the decades that the surgery has been transformed from a life-saving intervention into a procedure performed as a matter of course during one in three US births.

In 2015, the latest year for which the Centers for Disease Control has data, the share of births by C-section was 32%. The World Health Organization has suggested that the rate should not be higher than 10% - 15%, while other experts have suggested it should not be higher than 19%. The last time the US's rate was that low was during the 1970s.

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Friday, October 13, 2017

Why I Almost Fired My Doctor - The New York Times

I always liked my primary care doctor personally. He routinely welcomed me to his office with a cheery hello and a smile. We asked about each other's children. We often discussed our respective exercise regimens, running in his case and pickup basketball in mine. For more than 20 years, we even confided about our ambitions as writers.

But I often questioned his judgment in medical matters.

Take, for example, the time my neck bothered me. I complained to him about frequent soreness and stiffness – probably a result of spending hours planted in front of a computer. He suggested I obtain a neck brace to wear while working. "Is that necessary?" I asked him. No, he said.

At no point did he ask me where my neck hurt, or how much, or how often. He never physically examined my neck, nor instructed me to turn my head in order to observe my range of motion. He neglected to propose I do specific exercises to rehabilitate my neck or get a new chair or just take frequent breaks from sitting at a keyboard.

Rather, he advised me to see an orthopedist or physiatrist. He also printed out some medical journal articles about neck problems for me to read, all well over my head.

Some time later, my annual physical revealed my overall cholesterol level to be borderline high. "I should probably put you on a statin," my doctor said. "I could prescribe Lipitor." "Would that be necessary?" I asked him. No, he said.

"It's a trend that reflects the state of medicine today," Dr. Danielle Ofri, associate professor of medicine at NYU Langone Medical Center and author of "What Patients Say, What Doctors Hear," told me. "Physicians are so risk-averse they prescribe medications as a default and reflexively refer patients to specialists. It's systemic."

What to do? After all, this was my health here. As a lifelong recreational athlete and fitness enthusiast, I'd entered my 60s healthy, but eventually – inevitably – my age would catch up with me. Was I going to risk my longevity to avoid hurting my doctor's feelings? I needed a physician I respected and trusted. Should I stick with the status quo or take a hike?

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