We enter every patient encounter with our own unique experiences, judgements, and values, as do our patients. Only when we acknowledge this can we truly connect with compassion.
I enter the exam room and greet her with a warm smile behind my mask; hopefully she can see the smile in my eyes. Neither of us is here alone; we both bring the thoughts, judgments, and expectations of our families, friends, and society.
The nurses have already talked with the patient about the abortion process and what to expect. I stop for a moment, not to look at her, but to see her; this isn’t a skill I was taught in medical school, but one that I’ve developed through my years of helping patients. As soon as I introduce myself, she starts telling me why she needs this abortion. I listen. Some people need to share their stories, while others don’t.
She expects judgment. But it doesn’t matter to me why she, or anyone, needs an abortion. You’re 16, had sex for the first time and are unexpectedly pregnant? I’ll do your abortion. Your baby has anomalies? I’ll do your abortion. You can’t afford another baby? I’ll do your abortion. You want to finish school before starting a family? I’ll do your abortion. You’re uncertain what to do about your pregnancy? My team will work with you to help you reach the decision that is best for you, in your life, whether that’s to continue your pregnancy or to have an abortion.
The recent Dobbs ruling overturning Roe v. Wade in the U.S. was a gut punch to those of us who work in abortion care. This isn’t simply because “the early termination of a pregnancy is a medical matter between the patient and physician, subject only to the physician’s clinical judgment and the patient’s informed consent” (emphasis added) as asserted by the AMA. The Dobbs decision is a direct assault on patients’ reproductive autonomy.
Using clinical judgment is very different from passing moral judgment on anyone’s decision whether or not to continue a pregnancy. As my patient finishes telling me her story, I acknowledge it; I acknowledge her and all that it’s taken for her to get here today. I’m not here to judge her or her reason for needing an abortion. As a doctor, I must acknowledge the experiences, judgements, and values that I bring into the exam room. I understand that these are meaningful and uniquely mine, and that every patient enters the room with their own.
“Shared decision making” is a key component of patient-centered healthcare. The physician is asked to use their clinical expertise to recommend treatment plans that align with patients’ values and preferences. In a strictly factual sense, terminating a pregnancy will almost always be “safer” than continuing that pregnancy to term. Does that mean that I should recommend that every pregnant person have an abortion? No. It means that I should listen, provide expert advice, collaborate and respect the patient’s right to decide.
And with that in mind, I listen to my patient’s story, and I find a way to connect with mutual respect and compassion. And, at the end of the day, I do their abortion.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.