“Listen to your patient, [s]he is telling you the diagnosis.”
Those are the words of William Osler often called the Father of Modern Medicine for his contributions to the development of medical education. I first heard them from the chief of surgery at the beginning of my internship. It is almost always true, the patient is almost always telling you the diagnosis, but listening is harder than you might think. It is especially difficult to hear what patients have to say when those words are not complimentary. One of the failings of the medical professional is that some doctors peremptorily dismiss anything that makes them feel bad about themselves.
Prominent breastfeeding proponent Dr. Jack Newman illustrates that shortcoming in attempting to peremptorily dismiss the piece I wrote for TIME, Why I’m Not Celebrating World Breastfeeding Week. In the piece, I’m serving as a conduit for the anguish that floods my email inbox. So many women are tormenting themselves over “failure” to breastfeed when the benefits of breastfeeding in industrialized countries are trivial.
[pullquote align=”right” color=”#0166be”]When a patient tells you she has crushing feelings of failure and inferiority because of pressure to breastfeed, it is arrogant to tell her that she doesn’t and she would realize that if she had better information.[/pullquote]
Unfortunately, as his response makes clear, Dr. Newman is not listening.
Dr. Newman starts by being fundamentally disrespectful to a colleague … me. His refusal to follow netiquette and link to my piece, his refusal to acknowledge my name, my professional qualifications, and my goal of easing suffering when writing about breastfeeding all speak to fear. What is that fear? It’s the fear that women will find that there IS someone who recognizes the pernicious nature of breastfeeding advocacy; that there IS someone who understands that the “Baby Friendly” Hospital Initiative is a deliberate slap in the face to many devoted mothers; that there IS someone who cares about mothers’ feelings and mental health; that there IS someone who recognizes the cruelty of letting hungry babies cry it out in an effort to “promote” exclusive breastfeeding. Simply put, I have been listening to what women tell me, not ignoring them. If I were Dr. Newman, I’d be afraid of me, too.
But Dr. Newman’s response isn’t inadequate merely because he fails to listen to women.
Dr. Newman acknowledges that, as I wrote, the evidence for the ‘benefits of breastfeeding’ are not well documented and that the studies are flawed, but then insists:
Since when do we need to prove that the normal, physiological method of feeding infants and young children is better than the artificial method, the feeding used made in a factory?
Since always, Dr. Newman. That’s the essence of science. We start any investigation with the null hypothesis (the claim that there is no difference between the two things we are testing) and then we try to disprove it.
Dr. Newman’s statement is actually a two-fer. Not only does it violate a major principle of scientific investigation, but it is also an excellent example of a logical fallacy — the naturalistic fallacy. The naturalistic fallacy is the unwarranted and illogical belief that anything that is natural is better. Hurricanes, earthquakes, and asteroids hitting the earth are natural, but that doesn’t make them good. Heroin, cocaine and tobacco are natural, but that doesn’t make them healthy. Babies starving to death due to inadequate breastmilk is natural, but hardly desirable. Women suffering postpartum depression is natural, but that doesn’t mean we want to exacerbate it.
When presented with information that breastfeeding promotion is causing women (and babies) to suffer, Newman doubles down:
The author bemoans the fact that so many mothers contact her with horror stories about their breastfeeding experiences. I too am upset about all the mothers having terrible experiences. The author blames breastfeeding for these problems, but the truth is that it is not breastfeeding that is the problem. It’s the lack of information, the lack of support from society in general and from health professionals more specifically that is the problem.
You’re not listening, Dr. Newman!
Patients are saying that the flood of information and the way it is presented has made them feel awful. It is the height of medical arrogance to tell a patient that what is hurting her is not really hurting her. If a patient tells you that she has crushing chest pain, you don’t tell her that she doesn’t and she would realize that if she had better information. It is exactly the same with mental anguish, Dr. Newman. When a patient tells you she has crushing feelings of failure and inferiority because of pressure to breastfeed, it is arrogant to tell her that she doesn’t and she would realize that if she had better information.
Newman digs himself in deeper:
There is no question that, with many exceptions of course, most health professionals, including obstetricians and pediatricians, don’t know the first thing about “practical” breastfeeding.
Earth to Dr. Newman! In 2015 the majority of obstetricians and pediatrician are WOMEN, and they know a great deal about practical breastfeeding because WE HAVE DONE IT … unlike you, I might add.
Referring to problems with breastfeeding, Newman claims:
I will state emphatically, these problems could have been prevented had the mothers received good help at the beginning.
You’re not listening, Dr. Newman! Women ARE TELLING YOU that they don’t want your help, they don’t want your pressure, and they certainly don’t want you to tell them that more “help” and more pressure will make them feel better.
Dr. Newman concludes:
The author also suggests that we “push” breastfeeding on mothers. What world does she live in? Formula is being pushed on mothers from day 1 of their pregnancies by formula company marketing, free samples from doctors and in hospital and in the mail. Bottle feeding images everywhere. Breastfeeding should at least have equal time, but it doesn’t.
I’m living in the real world in 2015, Dr. Newman; you appear to be mired in the 1950’s. Breastfeeding initiation rates are above 75%. That’s the MAJORITY, Dr. Newman. Breastfeeding images are everywhere, in blogs, on Facebook, in mainstream media. Breastfeeding women are everywhere, in restaurants, in workplaces, any place where women congregate. Sure, some people don’t like the public visibility of breastfeeding, but that just proves the point that it’s everywhere. It’s difficult to take lactivists seriously when they make claims that are so obviously untrue.
It’s time to listen to mothers, Dr. Newman. Your arrogance is in believing that you, the doctor, know better than they what they are feeling and experiencing. That’s paternalism and it’s ugly.
