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“If you are not at the table, then you are on the menu.”

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

While the origin of this quote is debated, I find that it sets the scene perfectly.  The point is that you need to be engaged to have a say in the process.  I frequently use this phrase when discussing issues related to women’s health and LGBTQ care when government officials or other people in power try to dictate how I practice medicine.  In less than a year, various entities in the Texas government have tried to dictate this at least three different times.  There just is not enough space in my exam room for all of us.  And sadly, I feel that they are only just getting started.

I consider practicing medicine to be a profound privilege, and it is one that is only obtained after many years of hard work, study, and usually a huge financial commitment. For those who do not know, I did not come to medicine straight out of college.  I chose to pursue studies in ballet and pre-medical course work while getting my undergraduate degree, then followed my passion to an opportunity to teach and dance professionally.  After a few years, I decided it was time to go back to the pursuit of a career in medicine.  However, I did not get there the first try and had to make a further commitment to improve my application to get into medical school the second time.  Having studied ballet in college, I definitely felt a little out of my element in medical school.  I still recall a time when a professor in a small group learning session referred to me as the “lowest common denominator” due to my nontraditional background.  Despite this, I continued in my studies to obtain the title of Doctor of Medicine.  To practice medicine, however, you do not stop there; you must take the next road in the journey of medical education, and I went on to study obstetrics and gynecology in residency for another four years of training.  So, in total, I have spent 12 years in education to become the doctor that I am today.  That does not include the hundreds of hours of study that one must continue after residency to maintain the privilege of being a doctor as well as to provide the best and most up-to-date care to one’s patients.  Despite all of that, for obstetricians and gynecologists, our field is continually under the microscope for various areas of the care we provide, and outside influences are always trying to tell us how to do our job.

As mentioned earlier, there have been three times when the government of Texas has tried to dictate how I can practice medicine.  On September 1, 2021, Senate Bill 8, prohibition of doing an abortion after a heartbeat is detectable, was implemented.  This has led to many far-reaching consequences that do not have anything to do with abortion, such as concerns regarding management of ectopic pregnancy, management of premature rupture of membranes before viability, and lethal fetal anomalies not identified until 18–20 weeks.

“I consider practicing medicine to be a profound privilege, and it is one that is only obtained after many years of hard work, study, and usually a huge financial commitment.”

On December 2, 2021, Senate Bill 4 became effective, further placing non-evidence based restrictions on medication abortions as well as requiring physicians and healthcare facilities to report complications that occur from medically induced abortions. This essentially forces physicians and healthcare facilities to report our patients who are already going through a challenging time.  In addition, we must justify the use of the same medications used for abortion when used for other medical reasons and sometimes delay the care for patients in the process.  

On February 18, 2022, the attorney general of Texas wrote an opinion letter equating transgender care with child abuse.  This was followed by a letter from the governor on February 22, 2022, to the Texas Department of Family and Protective Services, asking them  to “conduct a prompt and thorough investigation of any reported instances of these abusive procedures in the state of Texas.”  While these are officially opinions only, they have led the transgender community to fear seeking evidence-based care. Furthermore, some physicians and healthcare entities who provide this care have shut down or halted the care of these patients.  These opinions have further isolated an already at-risk population from the care they need and deserve. 

We have all trained, studied, and worked too hard to let those who have not done the same dictate the care we provide.  Would we allow outside influences to decide who gets cancer treatment or cardiac care based on the opinion of a person without proper medical education and training?  The truth is, no, we would not accept that.  Unfortunately, when it comes to the issues of reproductive health and LGBTQ care, an attitude of “that does not affect my practice, so I do not need to say anything” is taken.  Yet, there are far-reaching implications that we must consider.  No matter your opinion on any of these issues, we as physicians need to fight back on these interferences in the patient-physician relationship.  I will continue to provide the evidence-based and compassionate care that my patients deserve.  I will also continue to bring myself to the table of advocacy, so that neither my practice nor my patients end up on the menu.  

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