The Clinician Voice Post-Roe: Speaking Up for Standards of Care

The spillover effects of the Supreme Court’s Dobbs decision, which overturned Roe v. Wade, mean that many clinicians face uncertainty regarding which treatment practices are still legal in their state. Likewise, many organizations are still parsing their options for providing care to pregnant patients in urgent or emergent situations, so clinicians are also practicing in environments with rapidly shifting protocols. Accordingly, they may be unsure how to communicate with patients, or uncertain regarding their role in their institution’s planning conversations.

The Doctors Company recently hosted presentations and a panel discussion by three prominent OB/GYNs: Sheila Dejbakhsh, MD, MPH, of Orange Coast Women’s Medical Group; Daniel Grossman, MD, Professor at the University of California, San Francisco, and Director of Advancing New Standards in Reproductive Health (ANSIRH); and Ghazaleh Moayedi, DO, MPH, Founder and Chief Medical Officer of Pegasus Health Justice Center.

The panelists’ discussion addressed questions like: In these volatile conditions, how can healthcare providers advocate for patient safety while mitigating their own liability?

Physicians Have a Role in Planning and Shaping Organizational Culture

State-to-state divides in access to care have grown even more stark following the Dobbs decision. Now, medical professionals in some states are expecting an influx of patients who have traveled across state lines. This brings up immediate practical questions regarding service capacity, but Dr. Grossman proposed considering the planning question first in terms of culture. He says, “I think there are some avenues for big change, hopefully in states including my own, California, where we can actually help with foreseeable challenges or influx of patients. But it is going to take some work. And I think that’s beyond just setting up the infrastructure, but also putting forth a cultural shift or cultural change [from] one that’s more fear-based into something that’s a little bit more structured and prepared for what’s to come.”

As institutions adapt their protocols to changing legal surroundings, physicians in reproductive healthcare bring their clinical expertise to the conversation. Therefore, beyond preparedness in the physical sense, Dr. Dejbakhsh called for “some sort of education around which there is an effective cultural shift. So those people providing the additional support in this process are not looking at this as something to be scared of. I think there’s a huge need to educate not only the physicians and the admin, but also just the entire hospital culture.”

Physicians’ Voices Are Crucial to Preserve Patient Relationships

Clinicians in reproductive healthcare know the importance of establishing trust with patients, but after the Dobbs decision, that process is more difficult in some states. Speaking from Texas, Dr. Moayedi says, “Now we’re moving into an area where patients are afraid to tell their physicians or clinicians the truth about accessing self-managed abortion, having a miscarriage. And we should be concerned that these laws are leading to people needing to lie to us specifically to preserve their own safety.”

All panelists addressed the centrality of the physician-patient relationship to their work, and suggested that these relationships inform physicians’ participation in planning conversations with colleagues at their institutions. Because when physicians must constantly wonder what they’re not being told—or when patients definitely are not disclosing information crucial to their diagnosis and treatment, “It will make it more challenging for us to provide healthcare. It will make it more challenging for us to be trusted,” Dr. Moayedi says. She called on colleagues to step confidently into the role of advocate: “Be open that this moment is one that calls on us to not only serve our patients in the exam room, but to serve them outside of the exam room, too.”

All panelists recognized that it is understandable for clinicians to become overwhelmed by the daily deluge of work with patients. Still, during this high-stakes period, as organizational planning conversations unfold at institutions around the country, Dr. Dejbakhsh says, “It very important that we take a more active role in stepping up.”

Along those lines, Dr. Moayedi described an evolution in her interactions with legal counsel. She addressed the potential for physicians to be afraid to question legal guidance: “I think for me, prior to all this, I really thought the lawyers tell us what to do. Right?” However, she says, “That isn’t actually how these conversations should happen.” Rather, physicians can and should take an active role in speaking from their expertise: “The lawyers bring us legal advice and legal opinions. And we also bring the voice of our community members and the people that we take care of, and the nuance of the science and the medicine.”

Dr. Moayedi emphasizes that collegial respect for legal counsel doesn’t require silence from clinicians. She says, “It’s OK to say, ‘What about this, what about that?’ It should be a back and forth dialogue.”

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.