T O P I C R E V I E W
Member # 36415
posted 12-05-2011 02:55 AM
It's been a while since I've been here. I'm just looking to get some opinions on this. I've tried to research it myself but am getting different opinions everywhere. I live in Australia and have been prescribed birth control pills for the last 7 years. I got the pill initially without having a pap smear however had one about 6 months into taking the pill as I was more or less bullied into it. My doctor now (who is different to the one I was first seeing), after writing them for the last 4 years, has now told me he will not write me any more prescriptions until I agree to a pap smear. Is this legal? I wouldn't have thought anyone could be denied basic medical care like this? Surely it is my right as an informed patient to refuse a medical exam? I also don't understand the correlation between these 2 things: cancer screening vs. birth control. I feel like he's holding me to ransom. Do anyone know for sure if (in Australia) a doctor can refuse to renew a script because I refuse a pap smear? Also: Please don't tell me I should just have one. It's my body, my choice, and I have decided not to have these exams. Thanks for any help provided.
Member # 68739
posted 12-05-2011 09:35 AM
Hi Dolphins_Cry, there are apparently a lot of women who feel the way you do. It is normal to feel that a pap smear is intrusive or embarrassing. I am pretty positive it is legal for doctor's to do this because they are medically obligated to do what they feel is best for the patient. If they want to withhold a medication (especially one that you aren't dependent upon to live) they can. However, you have the option of going to another doctor who doesn't have the pap smear/birth control opinions. I think if you go to a Planned Parenthood that they will prescribe birth control without requiring a pap smear so maybe you want to check with them.
It is your own choice not to have these exams but just do it with the understanding that you can have cervical cancer at any age and most of the time, it is a pap smear that clues people into this because in its early stages, the symptoms aren't obvious. That is why a pap smear is designed to detect abnormal cells well in advance. I want to ask you and urge you really to at least have a pelvic exam. A basic pelvic exam is usually just done with the doctor's hands and you can have one without a pap smear. They check your breasts for abnormal changes as well. These things ARE important to have if you are on birth control and extra important if you are sexually active (most cervical cancers are caused a by sexually transmitted infection called HPV). Birth control causes a lot of cycle changes and it is important to have those changes monitored, birth control can also mask some health conditions as well. I think the connection you are asking about is really more about doctors trying to find a way to get women in for testing once a year by essentially holding your birth control "ransom." That sounds really unfair and mean but it has your health in mind. Most women of course do not like these exams and doctors are trying to find a way to make them have them. This reason is in addition to the reasons I already stated. It isn't that there is an alarming connection between cancer screening and birth control, it is more about circumstances. A women on birth control is of reproductive age, and is or will in the near future be sexually active: both of these things can bring many health issues that need to be monitored. Now there are exceptions. If you are under 21, and are not sexually active, you are probably pretty safe to not have any gynecological exam (assuming you haven't noticed any abnormal symptoms) and most doctors don't push for one in these cases. I didn't have one myself until I was 19 and I was on birth control for a long time before that. I am sure that a volunteer from this site could tell you more about your specific location and the regulations there but I really do not see what they are doing as denying basic medical care. Is it a tad unfair and maybe wrong? Perhaps, but it isn't the same as denying you your blood pressure medicine, especially since you can probably go to another clinic to get your birth control pills anyway. Have you tried talking to this doctor about how you feel? Maybe he can clue you into his intentions in all this and maybe you can reach some kind of compromise? If not, you are simply going to have to go somewhere else. Whether you want the exam or not, obviously I don't advise you to go off birth control if you don't want to or if you need it. It is your right as a patient to refuse an exam, you are 100 percent right about that. They cannot make you have one if you don't want it. I am sorry you are having trouble with this. I know the exams are unpleasant but I personally enjoyed the peace of mind they brought me to know for sure that I was healthy. I lost insurance years ago and haven't had one in a long time and I admit I do miss having that peace of mind. We all have our reasons for doing what we do and certainly have a right to them so I suggest you stand up for what you think is best for you
Member # 3
posted 12-05-2011 10:39 AM
I'm not quite here yet today, but it is very common medical best practice with hormonal methods -- and required in many practices, something which can also be a major issue around the protection doctors need from malpractice or having a hand, when it comes to their own ethics, in patients becoming ill -- to require pap smears at a certain point.
This is complex, and I don't think it's about holding BC hostage. Rather, it's mostly about broad healthcare guidelines and practices and practitioners working within them.
Member # 35643
posted 12-05-2011 03:58 PM
My understanding is that your doctor is within their code of practice to require physical examinations and smears before prescribing contraception, if they are concerned about your sexual health. At the same time, it is your right as a patient to change doctors.
I am sure you can find another doctor who will prescribe contraception without requiring a smear. NoName mentioned Planned Parenthood above- your equivalent organization in Australia is the Family Plannning Association. It is a good idea to discuss with a nurse or doctor there anyway as they can confirm their position on this situation using up-to-date national reproductive health guidelines. Particularly if you have decided not to have smears long term, have you considered getting the HPV vaccine (Gardasil) which protects against main strains causing both warts and cervical cancer? FPA can do that for you. [ 12-05-2011, 03:59 PM: Message edited by: eryn_smiles ]
Member # 3
posted 12-05-2011 04:18 PM
(Just an FYI with Planned Parenthood, so those in the US know, their usual rule with this is that they will provide contraception prescriptions for one year without a GYN exam and pap, and if patients want them continued, they will need to have those exams.)
Member # 36415
posted 12-06-2011 12:47 AM
Thanks for the responses.
I went to the clinic today and the doctor wrote me a script but without any repeats and told the receptionist to tell me I can't have any more without the pap. I told her to please mark on my record that I am an informed patient refusing to have this test and I would appreciate it if I didn't get harrassed everytime I phoned/came to see a doctor. "You've sprained your wrist? - better get a pap smear!" She told me she couldn't do that and it was a requirement for the test to be done if I wanted BC and she wasn't very happy when I asked her why that was when the World Health Organisation states that a pap smear is not necessary to be prescribed BC. So then she brought out the Practice Manager who's favourite line was, "It's at the discretion of each individual doctor". So I asked her finally just to clarify, "So when I next call for my prescription can I again expect to be threatened with 'no pap, no pill'?" "It's at the discretion of each individual doctor." I feel like writing an angry letter. I bet their male patients don't get harrassed to have prostate exams. Just to clarify: - I have had the Gardasil vaccines - For the last 9 years I have been in a monogamous relationship - The only other person who I have been with was my rapist (12 years ago) but: - I had a pap smear 6-7 years ago and it was normal - I am no longer having sex and won't be for the foreseeable future I also am aware that there is a 1% incidence of cervical cancer vs a 15-20% false-positive ratio with these tests which often lead to unnecessary biopsies and colposcopies that can damage the cervix. It's not like I'm just "embarrassed" to have one - I have made an informed decision. But apparently doctors and their practice managers don't think too highly of patients who advocate for their own healthcare. Whatever. Thanks for letting me rant. Guess I'll be on the hunt for a new doctor.
Member # 1679
posted 12-06-2011 10:03 AM
Have you tried asking about whether they would be willing to do an exam but not the actual PAP test? As Heather said, quote: I'm not quite here yet today, but it is very common medical best practice with hormonal methods -- and required in many practices, something which can also be a major issue around the protection doctors need from malpractice or having a hand, when it comes to their own ethics, in patients becoming ill -- to require pap smears at a certain point. This is complex, and I don't think it's about holding BC hostage. Rather, it's mostly about broad healthcare guidelines and practices and practitioners working within them. It is complicated. Part of it really is about liability. Especially in first world countries where litigation is common and costly, care providers tend to be antsy about not conducting screening tests. There are certainly other providers and practices who will release patients from their care or refuse to prescribe other types of medications without screening tests (specific to the med or general). Given the links (be they increasing risks or decreasing them) with estrogens and certain cancers (especially for patients with certain histories), many care providers do feel like it's an important test. You may be able to find a care provider who will prescribe for you for as long as you wish without an exam, if it's not policy in their practice to do so.
You sound like a very health literate individual who is making an informed decision. But please understand that (to a greater or lesser extent based on what the norm is in your area) a highly informed patient is the exception. In the US, for example, I've seen estimates that only around half of all adults could be classified as health literate (being able to access, process, understand, and act on basic health information, essentially). While I agree that it would be great if providers were able to assess the level of each individual patient somehow and for folks who are super informed have different rules, it's just not as easy to get that done as it sounds (also, the legal difficulties are still going to be there). I understand what it is to be an informed patient and be frustrated with guidelines. I've been there myself. But it is also important for you to understand it from the provider's perspective. It's practical and safe (both in terms of patient outcomes and legal ramifications) for them to have guidelines to which they adhere. [ 12-06-2011, 10:19 AM: Message edited by: KittenGoddess ]