PARADIGM SHIFT: MOVING TOWARD ACCESS IN EVERY OFFICE

Abstract

Dehlendorf and Grumbach should be commended for their recent piece on medical liability insurance for abortion care in family medicine.1 Their work highlights that family medicine physicians are uniquely positioned to provide early abortion care to their patients. Medication abortion and first-trimester aspiration abortion are skills that family medicine physicians can easily incorporate into their practices as a service to their patients. As mentioned by Dehlendorf and Grumbach, it is estimated that 44% of women have an abortion sometime during their life.2 This fact makes early abortion relevant to all primary care physicians, but especially to family medicine physicians, who have clinical training in obstetrics and gynecology. Additionally, in the more rural parts of the United States, family medicine physicians are often the only physicians in town. In the 87% of US counties that do not have an abortion provider, family medicine physicians could be the answer to this unmet need.3 Anthony McWilliams, left, and “L” Lawrence Warren, right, participate in the 2nd Annual Stand Up and Represent National Black Gay Pride march in the West End section of Atlanta, GA, on September 2, 2002. Photograph by Ric Feld. Printed with permission of AP Images. Currently, only 2% of abortions are provided in private doctors' offices.3 The majority are performed in specialty abortion clinics. Patients are often referred to these specialty clinics from the gynecologist or primary care doctor who diagnosed their pregnancy. This is the current model of abortion care in this country. Imagine however, if first-trimester abortions were available in the majority of primary care practices. The paradigm of abortion care in the United States could be fundamentally altered, and the negative stigma of abortion could be lessened. Family medicine physicians have other advantages beyond their physical proximity and training skills: the ability to provide continuity of care and make use of the acquired trust of their patients. In times of crisis, primary care physicians have a unique opportunity to intervene to effect positive change as a result of the relationship they have built with their patients.4 Delivering abortion care in the primary care setting has the potential to improve postabortion family planning and contraceptive services, such as patient selection of intrauterine devices or other highly effective contraceptive methods. Better contraception means fewer repeat abortions, and that is a goal that almost everyone can agree on.5