Friday, May 16, 2008

It's not about you

Morag, of Mama Mid(Wife) Madness, has read my recent post and written an open letter entitled I have no fight with you (now cached here) in response.
I am a student midwife, and I am human, and as a person I feel savaged and hurt by your attacks. I have done nothing to deserve such unbridled hostility.
From the title to the last paragraph it demonstrates one of my most common criticisms to direct entry midwives: "It's not about you. It's about the patients!"

Let's look at this from HER point of view. The patient hired your preceptor to support her and to manage any unanticipated complications of labor. One of those unanticipated complications occurred, a life threatening complication at that, and your preceptor handled it all wrong. She made not one, not two, but at least 4 serious errors in judgment, any one of which could have led to the death of the patient, and may have led to permanent injury of the patient (it is too early to know yet).

Did the patient deserve to be treated wrong? No! Is it acceptable to ignore that the patient's life was further endangered because your preceptor did not know what she is doing? No! Is it acceptable to pretend that this did not happen and allow this woman to go out and do it again in the future when it might actually kill someone? No!

You, of course, are not necessarily in a position to know what was done wrong, but you SHOULD find out; at a minimum, someone should tell you. You should not walk away from that incident believing that it was handled correctly or that it is the way that you should handle it in the future. The fact that you wrote about it the way that you did indicates that you took away precisely the wrong lessons from what could have been an excellent teachable moment. This is one of the serious deficiencies of the preceptor system in direct entry midwifery. If your preceptor is incompetent, you will learn to be incompetent, too. Morag, you need to know and you deserve to know that your preceptor did everything wrong.

I do not set out to hurt your feelings, but frankly, when it comes to taking responsibility for the life and death of others, your feelings shouldn't even be involved. The mere idea that you would refuse to read my criticism because you might not like it is frightening in the extreme. If your feelings are going to be hurt by learning something that you don't like, you should find another line of work. It is your OBLIGATION to read and learn from any relevant criticism. If you cannot intellectually defend what you or your preceptor are doing, then you need to study more, read more, learn more.

Morag continues:
I have no idea what it is you are trying to prove, only that you will ultimately be unsuccessful.
I think it is pretty obvious by now what I am trying to prove. I am trying to show that direct entry midwives are grossly undereducated and grossly undertrained. They are dangerous and they should not be providing care to anyone. Unfortunately, I have more than enough examples to draw on to make my case.
I have done you no wrong. Please leave me alone.
I have no fight with you.
How do you know you have done no wrong? Did you even bother to investigate the specific errors that I pointed out? Don't you owe it to this patient and to future patients to learn to do the right thing, not just one of a few things that you know how to do? Morag, it is not about you, and you are committing a very serious error if you think it is. It is about the patient. Her wellbeing must come before your feelings. That is your ethical obligation and you cannot meet it if you refuse to learn from what happened.


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