Okay thanks so much. I’ll email later.

I started posting some things from my paper today. The problem is it is a mess and outdated. I also am not quite sure what people will read and respond to. I get a lot of ideas about what to do but my follow through is not very good. If it is a book for the public, then that would be different than my initial intent. My original intent was just to have enough evidence with me before I met with the head of patient safety at my hospital back in 2011. He had agreed to meet with me. I used to have trouble talking about it so I wanted everything written down.

It was supposed to be a “Clinical History (mine), Causal Analysis (the idea being that errors are predictable and preventable based on systemic factors), and Proposal (what can be done to prevent it).” In the causal analysis, I just go through motivation, lack of informed consent, cause of surgical error — lack of training in techniques, lack of education in anatomy, negligent privileging, etc. I got through the literature and analyze it. Most of what I say is very pedantic. It got very long because I saw so many problems. I was trying to say there is systemic negligence when it comes to female sexual function and vulvar anatomy.

I was going to write a review for Sexual Medicine Reviews, because I was asked, but I have not done that yet. Previously I had the idea to crash the ACOG convention, find OB/GYNs who wanted to help, and then start some kind of online petition or coalition of some sort, but none of them emailed me (even some who said they would), so that was a bummer. I am doing a study at UTSW, but I’m not sure when it’s actually going to happen. I was thinking about getting some kind of 3D digital model made and hosting it on a website. I was thinking about maybe 3D printing a giant vulva for some kind of exhibit. All the detail they show in diagrams for penises could be shown for the clitoris, and I don’t think people are really getting that.

One OB/GYN I talk to thinks that ABOG and ACOG need to be sued. I talked about how problems with the current medical liability system lead to inadequate feedback in my paper, as well as the need to hold professional organizations responsible for the standard of care liable. But this doesn’t happen. I’ve tried contacting lawyers about it, and I was going to try contacting more. The things is that in cases like this, there should be class action against these organizations. It would mean a lot more money and it would lead to actually solving problems if someone could figure out how to do it. I think most of the time errors happen, there are systemic problems behind them, and there are ways to prevent these errors by solving those problems at scale.

Even just the way privileges are often given to doctors who are not trained is a problem. There are a lot of problems with incentives. When my dad gets an application for privileges, he isn’t financially incentivized to look over it carefully. He’s incentivized to just sign it and move on because he isn’t going to be held responsible if they harm a patient. Lack of regulation of in office surgery centers is a problem. It is a problem that I can’t even get numbers for how many labiaplasties in the US are done much less how many people have had bad outcomes. Numbers like this should be easy to access.

There are a lot of stories.

There’s a story about misaligned financial and liability incentives in healthcare. So basically healthcare is a system that doesn’t learn from mistakes.

There’s a story about gender inequality in the approach to female sexual function and vulvar anatomy. This story has been told a lot since the 70s, but things don’t seem to have changed much. A lot of people who write these stories get their facts wrong and add to the insanity, which is why, at first, I though my audience would need to be doctors. But now I think maybe it should be the public, only because of the strength of modern social media.

There is a story about poor information quality. Informed consent is impossible when doctors are not informed. I feel like medical textbooks shoud work like Wikipedia and people should be financially rewarded for their edits and contritbutions. There need to be better incentives systems for ensuring quality in medical journals. There are a lot of scary problems that go on, like in one analysis of medical journals:

“Unfounded authority was established by citation bias against papers that refuted or weakened the belief; amplification, the marked expansion of the belief system by papers presenting no data addressing it; and forms of invention such as the conversion of hypothesis into fact through citation alone.”

There is a story about trauma and what victims need. The way the healthcare system responds to patients who have been harmed is pretty horrible, in ways that increase risks for PTSD, etc.