CHAPTER TWELVE
OTHER DOCTORS

SUPPORTING ABORTION, NOT ABORTION PROVIDERS

Colleagues in the medical community would seem like another logical place to go for group support. The old attitudes against abortionists during the illegal period, after all, were against doctors who were willing to do something illegal. Nowadays, the major medical societies, including the American Medical Association and the American College of Obstetricians and Gynecologists, are firmly in the abortion assembly. They use their lobbying influence and professional credentials to support abortion on demand.

Their enthusiasm for abortion availability, however, isn't matched by enthusiasm for those actually doing them.

The Project Choice survey of abortion doctors asked several questions on this point. Almost 70 percent didn't feel that abortion providers are respected in the medical community, and about 65 percent have felt ostracized. Sixty-one percent had been verbally confronted by an anti-abortion physician, and almost 60 percent perceived their prestige as a physician had been damaged by being identified as an abortion provider. Half felt isolated from the rest of the medical community. A shockingly high portion, 19 percent, said they had been denied hospital privilege because of providing abortions.

These are the feelings of the providers themselves, so there's no way of knowing what can be attributed to a bias against abortion doctors, and what is instead the unadmitted incompetence of the individual answering the survey. The difference may not really be meaningful to the question of support from the medical community, since it would be lacking in either case.

CENTRALIZING

A Time magazine cover story on abortion trends mentioned the fact that abortion has become more and more centralized. Though most doctors are pro-choice, few perform abortions. "Hospitals have also been withdrawing from the abortion business. In the years after Roe was handed down, more than half of all abortions were performed in hospitals. By 1988, 86 percent were done in neighborhood clinics and an additional four percent in the offices of individual doctors. Some hospitals shy away from the procedure because of opposition from potential donors or members of their governing boards. At the same time, because abortion is a relatively simple procedure that doesn't require general anesthesia or the costly equipment of a hospital operating room, groups like Planned Parenthood encouraged the move to clinics as a way to keep abortion cheap and accessible."[1] This strategy, however, causes a problem because clinics are more vulnerable to protests.

Additionally, fewer medical schools are offering training. "Many clinics must go far afield to find a doctor who is willing and able to perform abortions."

Part of this centralization comes from stigma that the potential donors or governing boards won't stand for it. The other doctors in the practice are afraid of losing patients and referrals. But there's a cycle here -- the centralizing makes the stigma worse, too. It certainly gives the impression of distaste.

The idea of low profit mentioned above may sound out of line with the accusations that there are some doctors that are in it for the money, but the difference comes with the assembly-line practice. In any medical procedure where the doctor must deal with the patient face to face, make judgments about what needs to be done, make preparations and deal with each case individually, the low cost would cause a problem. But the normal practice is for others to make all the preparations, and the doctor can actually do six to ten patients within the space of an hour. That makes it considerably more profitable. But it doesn't add to the professional aura that doctors work so hard for.

The Project Choice survey demonstrates further how this dynamic of centralization works. Respondents who said that abortion was 20 percent or less of their practice were separated, then their answers were evaluated on the basis of how they differed from the total group on Social Environment questions. These particular questions were selected because they indicate what an abortion provider perceives his or her image to be within the medical community. The differences were statistically insignificant. The sense of ostracism and lack of respect were the same for those with abortion as a low amount of their practice as for those with abortion has a high amount of their practice.

This encourages centralization. No social benefit for an individual comes from keeping the practice limited. Conversely, those for whom abortion is a small part of the practice can more easily just give it up to avoid that problem.

In his thoughtful book which ponders questions of this kind, Abortion: A Doctor's Perspective, A Woman's Dilemma. Dr. Don Sloan, who's been an abortion doctor for over 20 years, comments on this situation.

The question arises, are we taking this thing too casually? Are we being so cavalier about it as to make a mockery of the institution of marriage and the creation and birth process? We spend more time taking out a patient's splinter or doing a Pap smear than we do over abortion, it seems.
There are abortion mills around -- good ones, to be sure, but mills nonetheless. I guess that was bound to happen. The abortion centers have sprung up, you might say, because we need them. Our hospitals couldn't handle the load, not even with their outpatient surgical units. And in hospitals, regulations and rules are all-encompassing and onerous. So we have these centers where patients are counseled, but don't make the mistake of thinking it's a thorough job. The counseling is less than might be desirable at times.
But on the other hand, where is the time to devote and the energy to expend going to come from, to allocate "enough" to each and every here-today-gone-tomorrow patient? For someone performing abortions, the volume can be so great it's overwhelming. I've sent out tens and tens of thousands of women, and I know so little about so many of them -- most of them. How could I? In a sense, the doctor is only a tradesperson, a technician performing a task, like any other.[2]

This centralization makes the entire industry more vulnerable, and as there become fewer places and fewer doctors, each clinic and doctor left becomes more vulnerable. But if women are being shoved through a "mill", without adequate counseling, then the number of people with seething rage will also grow -- making the clinics and doctors more vulnerable.

Each doctor left also has a higher load, and that increases the likelihood of burnout, which increases the chances of making mistakes. That increases the malpractice suits and the scandals in the local papers.

All this happens even without taking into account the possibility of Posttraumatic Stress Disorder, which if true would exacerbate the problem all the more.

From M*A*S*H, set in a mobile army hospital during the Korean War of the early 1950s, airdate 10/19/73, all doctors speaking:

Hawkeye: Hey, terrific. He's located an incubator. Three of them. It's at the Seven Twenty Eight Evac, in Pusan. A Major Arnold Morris.

Trapper: Jackpot!

Hawkeye: Three cherries straight across. Thanks.

Trapper: Guess where we're going after surgery, Henry?

Henry: Oh? Without my permission?

Hawkeye: Don't we have it?

Henry: Of course, you do. You think I'd let you leave without my permission?

Hawkeye (happily): Ha! An incubator.

Trapper: Three!

Henry: May I remind you both that not everybody you'll meet down there is going to be lovable Colonel Henry Blake.

Hawkeye: What are you trying to tell us, lovable Colonel Edward Blake?

Henry: Just take my advice -- don't show up looking like a couple of freelance abortionists. Shape up.


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