Favorites from this week

Officially fall, y'all. The political scene is really firing up, pumpkins are at the farmer's markets, and apple cider is a-brewing. Oh, and my pick'em team is doing really well. Some awesome stuff came through my email this week, and I again share my favorites with you below....Recognizing Conscience in Abortion Provision - Lisa Harris in the New England Journal of MedicineThis article is a beautiful description of why the definition of conscience is important, and how when one's conscience leads down a path, that does not mean that another's path is done without conscience. Abortion provision is no exception: providers working with women who are debating, deciding, and moving past pregnancy termination are some of the most passionate, kind, and conscientiously-motivated people I have ever met. Please visit the site above for the full piece and for the reference list."The exercise of conscience in health care is generally considered synonymous with refusal to participate in contested medical services, especially abortion. This depiction neglects the fact that the provision of abortion care is also conscience-based. The persistent failure to recognize abortionprovision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by conscience to provide abortion services, contributes to the ongoing stigmatization of abortion providers, and leaves theoretical and practical blind spots in bioethics with respect to positive claims of conscience — that is, conscience-based claims for offering care, rather than for refusing to provide it...Whether or not abortion provision is “conscientious” depends on what conscience is. Most ideas of conscience involve a special subset of an agent's ethical or religious beliefs — one's “core” moral beliefs. The conclusion that abortion provision is indeed “conscientious” by this standard is best supported by sociologist Carole Joffe, who showed in Doctors of Conscience that skilled “mainstream” doctors offered safe, compassionate abortion care before Roe. They did so with little to gain and much to lose, facing fines, imprisonment, and loss of medical license. They did so because the beliefs that mattered most to them compelled them to. They saw women die from self-induced abortions and abortions performed by unskilled providers. They understood safe abortion to be lifesaving. They believed their abortion provision honored “the dignity of humanity” and was the right — even righteous — thing to do. They performed abortions “for reasons of conscience.”...Recognizing only negative claims of conscience with respect to abortion — or any care — is a kind of hemineglect. Health care workers with conflicting views about contested medical procedures might all be “conscientious,” even though their core beliefs vary. Failure to recognize that conscience compels abortion provision, just as it compels refusals to offer abortion care, renders “conscience” an empty concept and leaves us all with no moral ground (high or low) on which to stand."...Too Many Young Women Have No Idea How Contraception Works - Doug Barry in JezebelI can't tell you the number of young women I saw this week who believe they are infertile and thus do not use contraception. This article, and the referenced poll, are spot-on. Correct explanation and ensuring understanding weighs on the shoulders of providers and guardians. Fellow providers: figure out how to explain it, make sure they understand, and possibly follow-up in 1-3 months to review use and appropriateness of the method for each woman. If the woman made the effort to come to the office, ask for birth control, they deserve our effort to make sure they have it right!"Thanks to a prevailing climate of misinformation when it comes to how the Swiss timepiece that is the female reproductive system actually works, a distressing new poll from Contraception In America revealed that two in five women flat out did not use birth control or skipped doses of oral contraceptive pills because they were not sexually active, or believed they were infertile much the same way an ancillary character in a zombie movie might, despite all evidence to the contrary, believe that he or she is somehow immune to a zombie bite. Babies are zombies — this is what we've come to...The newest study of birth control ignorance polled 201 physicians and 1,000 women within a wider age range, 18-49-year-olds, and found that 55 percent of women between the ages of 25 and 29 believe that their unplanned pregnancy was the result of a contraceptive failure. This, in fact, turned out not to the case — these unplanned pregnancies were actually the result of user error, such as skipping birth control doses, or respondents being misinformed about their fertility or sexual activity...The biggest takeaway from the poll? Young women aren't getting the access and education to contraception that they need to make informed decisions, and that really needs to change like on the double."...Switching Contraceptives Effectively - Jane Grody in the New York TimesSimilar to the article above, much of the onus of this issue rests on the provider prescribing the method and explaining its use, switching, or quitting and planning to return to fertility. I have had a number of patients in visits having been told one thing by their general practitioner that is very much not the case, related to their fertility, their contraceptive method, and their return to fertility. Important to read up on! The Reproductive Health Access Project (RHAP) has a wonderful resource for switching methods. "Women choose to switch with surprising frequency. In a national study of contraceptive switching rates, researchers at the Battelle Centers for Public Health Research and Evaluation concluded that “many women are probably dissatisfied with their experiences with particular methods.” With discontinuation rates as high as 90 percent for some methods, the researchers found that 40 percent of married women and 61 percent of unmarried women in the study had switched methods over two years.Disturbingly, the researchers also found that “about one in 10 women choose to abandon contraception altogether, even while they are at risk of an unintended pregnancy.”Most women get their contraceptives from family doctors and health clinics, not from gynecologists who are presumably well-informed about the choices and able to help women select a method, or two methods, best suited to their circumstances. Without proper guidance on how to make these changes safely, gaps often occur in contraceptive protection that can result in an unintended pregnancy."...Hands-Only Cardiopulmonary (CPR) Campaign from the American Heart AssociationI realize I'm late to the game on this campaign and this video, but just caught it on TV this week and love it. I do, however, wish they hadn't used women's breasts as part of getting the message out in this video. The AHA's video on hands-only CPR is available here. ...Two items related to my general dislike of the assigned and assumed power of white coats, when worn by any student practitioner. Mostly I dislike the use of white coats and subsequent misunderstanding regarding the level of student, intern or resident and the care of patients who would otherwise not know to question who their provider is, their level of education, and what role they play in that patient's care. Disclose yourselves, students, and prove how great you are with your approach, your mind, and your kindness, not your white coat.#whatshouldwecallmedschool is a Tumblr page where med students share their frustrations. This one expresses annoyance at being confused for a nurse practitioner instead of a medical student. I realize it is supposed to be derogatory, but instead I see it as awesome in the world of patients understanding that nurses are also studying to be practitioners. Ah, the times they are a-changing. YES.This YouTube video, I'm Diagnosin'. Creative lyrics, fun video. To me it emphasizes a couple of things: 1) over-studying can cause people to really use all the parts of their brain, including the creative parts, 2) everyday people, ahem, everyday people with personalities who may be cocky or derogatory toward women or who think of medical procedures as "cool" are admitted to medical school (and nurse-practitioner school, for that matter), and become practitioners who may care for you or your family, so think about providers as people and not all-powerful beings, and 3) first-year medical students typically do not provide direct patient care, and this video only further confuses people who do not know that....Global Nursing Caucus - November 12th in Boston, MANurses run healthcare in many international settings, particularly in Africa. Discussing the role of nursing education, practice, and research is vital to the profession as a whole and global health work overall. "We are pleased to announce that registration for the first Global Nursing Caucus Seminar is now open! The seminar will be held Saturday November 12th on the Boston University Medical Campus, Heibert Lounge, from 8am to 4:30pm.Topics to be covered:

• Introduction to the Global Nursing Caucus
• Mechanisms and Structures Underlying Global Health
• Education and Research in Nursing: Global Initiatives
• Nursing in Resource Constrained Settings
• Increasing Nursing Visibility

Keynote Speaker: Manzi Anatole is a Rwandan nurse working with Partners in Health. He will describe his work developing a mentoring program to strengthen the quality of nursing care at rural health centers in Rwanda and the challenges that he faces.Registration is at http://globalnursingcaucus.eventbrite.comPlease feel free to share this information with any interested colleagues or friends and e-mail us with any questions at globalnursingcaucus@gmail.comWe look forward to seeing you November 12th!"...