Unethical comment from doctor.

amother

Sat, Apr 29 2023, 9:39 pm

amother Yolk wrote:

I've been trying to pinpoint what bothered me about this, and I think it is the point that the OP is so vague about what is involved. She obviously has access to the internet, since she is here, so I would have expected her to do some personal research after the appointment with the genetic counselor.

She is right that when both parents are carriers for the same BRCA mutation there is a 25% risk of each baby conceived having Fanconi's Anaemia. That is not the same as a 25% risk of each child born having it. The vast majority of these foetuses die within the early weeks of pregnancy. (Not that repeated miscarriages are a desirable outcome, either.) The actual statistics are around 1 in 130,000 live births. This is from all mutations causing it, not just the BRCA genes.

Approximately 1 in 40 askenazi Jews carry a BRCA mutation. If the OP's husband is a carrier, there is likely to be some family history. She didn't say anything about that, so we don't know if there is or not, but without family history the risk is much lower.

Fanconi's Anaemia does carry a high risk of leukemia, but the main problem is the failure of the bone marrow to produce an adequate supply of all types of blood cells, obviously leading to multiple other issues.

All of this information can be found in a few minutes on Google. If her husband went to the doctor with the same information that she presented above, it could be that the doctor wondered how much they had really looked into it. Since it is rare enough fir their insurance not to cover it, it's a very large outlay for minimal risk, and he may well have wanted to be sure they had done adequate research before deciding to proceed.

Even if we barely looked into it , it’s still none of the doctors business to mention the halachic side of it.

amother

Lightyellow

Sat, Apr 29 2023, 9:58 pm

amother Yolk wrote:

Yes, I hinted to this in my posts. Even if the dr wasn’t the most diplomatic, from her post it doesn’t seem op or her husband were sufficiently informed, and religion aside, it IS his job to make sure they have full disclosure and complete understanding of the ramifications of their testing. Running the test otherwise would actually be unethical.

amother

Sat, Apr 29 2023, 10:06 pm

amother Lightyellow wrote:

I knew exactly what I was getting myself into. I did my research and discussed it with my genetic counselor before deciding to go ahead. The doctor he went to is NOT a genetic counselor. It is absolutely not his job to inform him of anything and definitely not his place to mention a Dayan. It is his job to do the bloodwork as asked.

amother

DarkKhaki

Sat, Apr 29 2023, 10:09 pm

I’m surprised so many had doctors lecture them about bc heter. My own frum doctor was totally the opposite. She was encouraging bc and an induction with not so subtle annoyance about my desire to consult a Rav. (I was young and more temimus‘idk then.)

I have also heard of frum obs that discourage against testing for Down syndrome. That made me upset to hear as well.

amother

Pumpkin

Sat, Apr 29 2023, 10:13 pm

amother Dimgray wrote:

My sister had this experience as well. I think a Dr like that should lose their license. She was also strong enough to ignore the Dr but I imagine there were other vulnerable women who were not.

And there we go. Advocating for doctors to lose their license for giving the BC against their better judgment but also asking the woman to please get a heter.
I don't agree with a doctor begging their patient to get a heter, but to want them to lose their license is beyond the pale.

amother

Lightyellow

Sat, Apr 29 2023, 10:19 pm

amother OP wrote:

I have a lot of experience with genetics and genetic testing. As annoying as it was, no doctor aside for a geneticist was ever willing to run any testing for us because they weren’t sufficiently trained. And the Dr always made sure I knew exactly what I was getting into, and potential pitfalls of the testing, even when it was clear I knew more than them. Sorry, but you didn’t seem clear from your posting at all, you seemed confused. It wasn’t professional to couch it in religious terms, but what I’m hearing is him saying have you really thought hard about the practical and ethical ramifications of what you’re doing.

amother

Narcissus

Sat, Apr 29 2023, 10:26 pm

amother Seablue wrote:

I discussed birth control options with a secular Russian doctor in Israel and she said that condoms is one option but the Rabonim usually don't allow it though she can give it to me anyway if that's what I prefer.

I was so uncomfortable. It was really not her place to mention this aspect of Chareidi life.

Honestly, the Rav had not been happy to give me a heter but I decided that I will do what is right for my family and make my own decisions without consulting a Rav again. And there she was talking about Rabonim at a doctors visit.

She meant well but it was not appreciated.

Im sorry you have an upsetting experience but know that lots of women would appreciate getting this info. Not every young woman getting married knows this.

amother

Clover

Sat, Apr 29 2023, 10:28 pm

Didn't read the responses but I honestly don't see what he did wrong. Your Jewish Dr is Jewish you should have just responded "I hear you Dr thank you for the info but this is our decision and we are moving forward with it." And Good Shabbos.
I understand that testing positive is scary but even scarier is that u and ur DH don't seem to be on the same page here. Why would your DH call you from the Drs office and have the Dr speak with you why couldn't your DH just tell the Dr thank u for the info and move on. Your DH isn't a minor that needs permission from a parent before he does any testing. Did the Dr tell your DH I can only test you if I get your wife's concent? If yes then sure Dr is not only unethical but also crazy. Seems to me your DH would like to consult with daas Torah and needed the Drs help to persuade you.
I think the reason this bothers u so much is bc really you know that you should consult a ruv otherwise you would have not gotten so worked up about it.
I'm sorry your going thru this. Wishing you the best of luck on this journey.

amother

Sat, Apr 29 2023, 10:34 pm

amother Clover wrote:

Didn't read the responses but I honestly don't see what he did wrong. Your Jewish Dr is Jewish you should have just responded "I hear you Dr thank you for the info but this is our decision and we are moving forward with it." And Good Shabbos.
I understand that testing positive is scary but even scarier is that u and ur DH don't seem to be on the same page here. Why would your DH call you from the Drs office and have the Dr speak with you why couldn't your DH just tell the Dr thank u for the info and move on. Your DH isn't a minor that needs permission from a parent before he does any testing. Did the Dr tell your DH I can only test you if I get your wife's concent? If yes then sure Dr is not only unethical but also crazy. Seems to me your DH would like to consult with daas Torah and needed the Drs help to persuade you.
I think the reason this bothers u so much is bc really you know that you should consult a ruv otherwise you would have not gotten so worked up about it.
I'm sorry you’re going thru this. Wishing you the best of luck on this journey.

My husband knew exactly what was happening and we were on the same page. He called me because I was caught off guard. Just like I was.

amother

Banana

Sat, Apr 29 2023, 10:43 pm

amother OP wrote:

This is completely untrue. We take the hipcratic oath of do no harm. Just because a patient asks for something, I am in no way obligated to order or prescribe it. You make it sound like he is obligated to provide you with a script for the genetic testing just becaue you are paying him for the visit. In fact, he doesn't have to do anything, especially if he feels there are potential second and third order effects of knowing the results that you may have not considered. Part of the calculus is to consider the patients psychosocial and cultural background which he seemed to do in your case.

amother

Banana

Sat, Apr 29 2023, 10:47 pm

amother Lightyellow wrote:

This totally. In fact, if he didn't and the results caused psychological harm to you, ypu could of potentially had grounds to sue him becaue he didn't sufficiently inform you. He is the one who takes all the legal risks by being the one who is ordering the test and is therefore obliged to have a lengthly discussion with you.

amother

Banana

Sat, Apr 29 2023, 10:55 pm

amother OP wrote:

Part of the calculus is to consider the patients psychosocial and cultural background which he seemed to do in your case.[/quote

Pushing is inappropriate but asking is totally in line with medial ethics. If I had a Johavas witness who needed blood products and I was under the impression that they may not understand what they need I may find it appropriate to ask if they consulted with their religious leader.

amother

Carnation

Sat, Apr 29 2023, 10:56 pm

amother Clover wrote:

This seems on point.

OP, I get the sense that you're resisting (I don't want to say rebelling against) the norms and expectations of your community, in particular, having a large family and going to a Dayan for guidance. It sounds like you want to do things "your way." This is making the doctor's inappropriate statements particularly triggering for you.

I wonder if even the decision to have your husband tested is partially motivated by your desire to stop having children.

amother

Sat, Apr 29 2023, 10:56 pm

amother Banana wrote:

Part of the calculus is to consider the patients psychosocial and cultural background which he seemed to do in your case.

He didn’t just mention it. He had an agenda and pushed it onto me. he strongly suggested that I shouldn’t do the test. Mentioning the ramifications is one thing. Mentioning the lor or Dayan or rav is completely inappropriate.

amother

Sat, Apr 29 2023, 10:57 pm

amother Carnation wrote:

I didn’t say I wanted to stop having kids. I said that if I did not want to have more kids it wouldn’t be the worst sin in Torah.

amother

Banana

Sat, Apr 29 2023, 11:03 pm

amother OP wrote:

That is exactly what he he is supposed to do and in fact he probably wrote this exactly in the medical note in case he ever gets sued by you by not liking the results!!!!

I would write something such as " had a robust conversation about the potential negative repercussions of the genetic test such as..... In light of the above risks, I strongly discouraged the test until the patient confers with his rabbinic guidance considering they are orthodox Jews."

amother

Powderblue

Sat, Apr 29 2023, 11:04 pm

amother Lightyellow wrote:

Exactly
Most pcp’s don’t want to order genetic testing because it is beyond their scope to interpret certain results.
I had a discussion with my pcp about getting tested for mfthr mutation post mc. She suggested I get tested for it but didn’t want to order it because of above and had me ask my ob for it.

amother

Whitewash

Sat, Apr 29 2023, 11:11 pm

amother Lightyellow wrote:

Most pcps won't even run this kind of testing because they're not qualified to interpret the results and counsel appropriately. Which is probably why he gave the lecture. He's not used to doing this kind of thing and not equipped to counsel properly, before and after.

This is my thought, the dr should have just refused to do the testing. It’s not in his wheelhouse. The end. Instead he decided to make it weird by calling op and ended up offending her.