Five insights from the op-ed, written by Benjamin E.Y. Smith, MD, faculty member at the Fort Collins family medicine residency at Fort Collins, Colo.-based UCHealth Poudre Valley Hospital:
1. To understand how medical schools are teaching future physicians to discuss abortion, Dr. Smith and colleagues assessed interviews with 74 students in their last year of medical school who were planning to specialize in obstetrics and gynecology. The findings are published in Social Science & Medicine.
2. Over half of the students in the study used the term “elective” to differentiate some abortions from others.
“This piqued our interest because ‘elective’ has a very specific — and confusing — medical meaning,” Dr. Smith explained. “Within medicine, ‘elective’ describes procedures that can be scheduled in the future and differentiates them from procedures that must be performed immediately.”
“Elective” does not imply anything about the procedure’s value or importance, Dr. Smith said. “Indeed, a lifesaving surgery should be called elective if it doesn’t need to be done today. Using this framework, the vast majority of abortions performed in the United States are appropriately categorized as elective.”
3. But outside of medicine, “elective” means voluntary or optional. Nearly all the students who used the term “elective” in the study interviews did not understand the difference and used its nonmedical meaning. “They inappropriately juxtaposed ‘elective’ and ‘medically necessary,’ and used ‘elective’ to describe abortions they considered to be sought for ‘social’ or ‘convenience reasons,'” Dr. Smith wrote.
4. No students questioned their nonmedical use of the term, and many said this use of “elective” was reinforced by their educational environments, Dr. Smith said. Some students said medical school teachers ignored or glossed over elective abortion during lessons. Other students said that unless they went to certain clinics on certain days, they would only be exposed to what were deemed medically necessary abortions or, more often, no abortions at all.
“Categorizing any abortion as unnecessary or unacceptable, especially when couched in co-opted medical jargon, is egregiously unprofessional,” Dr. Smith wrote. “It places patients at risk of inferior treatment, and is also squarely at odds with standards set by the American College of Obstetricians and Gynecologists and other specialties that provide reproductive healthcare.”
5. Medical schools must immediately set formal standards for how to discuss abortion with patients and with colleagues, Dr. Smith said. Medical schools then must expand reproductive health experts’ roles in developing clinical experiences around abortion.
“Medical schools have a responsibility to ensure that future physicians appreciate the health impacts of safe and legal abortion care, regardless of political efforts to change its legality,” Dr. Smith said. “Their future patients’ lives depend on it.”
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