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» Got Questions? Get Answers. » SCARLETEEN CENTRAL » Sexual Ethics and Politics » Nurses/Doctors Pushing Pills and Discouraging other methods

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Author Topic: Nurses/Doctors Pushing Pills and Discouraging other methods
atm1
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So over in this topic it came up that quite a few young women have had the experience of being discouraged by their health care provider when they want to choose a method of birth control that isn't the pill. I'm trying to pull the discussion over onto it's own thread.

Over there, I wrote
quote:
I've actually heard quite a few stories from other young women who's doctors, for whatever reason, would not give them a diaphragm. Many said that their doctor questioned their ability to use it correctly and pushed the pill on them.

I was lucky enough to get a prescription without any fuss (though I encountered a pharmacist who wouldn't fill it... and I had to get the manager to make him give my my prescription back...), but I'm beginning to realize that it's pretty common to have problems getting fitted for a diaphragm.

And then MJandDC outlined exactly what I was talking about:
quote:
I don't think it's right for a doctor to question a woman's ability to use a certain kind of birth control correctly, even if it's not a pill. It's not his place. It's kind of an insult really.

My nurse practitioner kept saying how easy the pill is, versus how difficult it is to use a diaphragm. She was really concerned about the idea that you have to plan ahead for intercourse with a diaphragm, and that you can't just go for it when you want it without being prepared. I was like, you are talking to a 24-year-old virgin. I think I have the self-control necessary to take a time-out and head to the bathroom to put a little device in. It was kind of insulting that she thought I couldn't handle that.

She kept saying the pill is foolproof. The thing is, though, I'm not a fool. I don't need a foolproof method. I need the best method for me and my body, and if it requires a little planning and self-control, so be it.

Heather threw in her thoughts too:
quote:
For anyone's future reference, whenever I am going somewhere new for a new diaphragm fitting, I'm just sure to make clear that is what I need when I am making my appointment. Some providers are not prepared to fit them, so to save myself a headache, I always check in advance.

This kind of experience is SO troubling, I agree. Especially since the pill is hardly foolproof (especially for younger women, whose typical use rates are actually a good deal lower than for those in their 20's). And in agreement with what is being said, absolutely, I find it really troubling when healthcare providers seek to influence patients with their own personal preferences -- not health concerns -- like this. Personally, if I encountered this, I'd be sending a letter.

atm1, I think that'd be an excellent topic if you want to start it. Especially since the "why" of some doctors really pushing hormonal methods -- even when they are methods a patient knows she does not want -- is a pretty big topic with a lot of legs.

So, what do you guys think about that?

Have you ever had an experience where a health care provider did not want you using a certain type a birth control for a non-health reason? (I'm excluding cases of when it's not safe to take the pill, for example).

Why do doctors seem to push the pill on so many young women? How do you feel when they do this?

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September
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Oh, I have had that experience, myself. A while ago, I decided to quit taking the pill and try a non-hormonal method instead. And my gyn (who I already gravely disliked at that point, due to a few other conversations I'd had with her that ended in her patronizing me and basically telling me what was and wasn't good for me) flat out refused to fit me for a diaphragm. She informed me that it wasn't as safe as the pill (thank you, I know this, I researched my options extensively before coming to you) and that it was inconvenient since I had to put it in before intercourse (thanks, already knew that, too, and clearly decided that I could just about handle it).

In the end, after suggesting several different types of the pill to me, and then an IUD (which I'd love to have but cannot afford to pay for), she grudgingly agreed to fit me for a diaphragm. And then promptly refused to instruct me how to properly insert it! Apparently, I could figure that out by myself, there are handy descriptions that come with the diaphragm, and anyway she'd already taken too much time for me and had other patients to care for.

Needless to say, once I had my diaphragm, I never quite felt confident that it was sitting right, and so I never used it. During my next gyn visit (with a different doctor!), I ended up opting for the Nuva Ring, because I just didn't feel good about diaphragms anymore after that experience.

And it's not just me, either. I definitely feel that gyns here are pushing the pill. A friend of mine reacted badly to the hormones, and her doctor tried her on three different prescriptions of the pill before even bringing the option of non-hormonal methods to the table. And what's more, in Germany, state-funded insurance covers the pill for girls from age 16 on. The pill, and no other methods of BC.

As to the why, I am not sure. Maybe gyns feel most comfortable with it because it's easy to prescribe (no pesky exams for fitting or insertion), and because it's been around the longest. But whatever it is, it's definitely worrisome.

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-joey
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"The question is not who will let me, but who is going to stop me." -Ayn Rand

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atm1
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I do think that it's important for doctors to point out that things like the diaphragm aren't as effective, and I encountered that too. But I will agree that there's a big difference between "You know that this is significantly less effective than the pill, right?" And "This is so much less effective than the pill that I doubt you can use it right and you'll probably get pregnant."

One thing that at least my gyn told me when I got mine was that I *should* come in once I had my diaphragm to make sure that it fit right, since sometimes measuring alone isn't 100% correct. She had me put it in and take it out in her office, because she wanted to make sure I could do it right, like any responsible doctor would.

I never thought that I'd feel so lucky for having a doctor respect my wishes (the initial conversation about it went something like: "I want a diaphragm." "You know it's less effective than the pill, right?" "Yep, but I want a non-hormonal method to back up condoms." "Oh, well, then this is perfect for you!"). She wasn't 100% excited about a diaphragm (she mentioned that she had friends who got pregnant while using them), but she definitely understood why I wanted it and called the pharmacy to yell at them when they wouldn't fill my prescription.

I guess there's just a big difference between many health care providers who treat patients like smart people who understand what they want and providers who take an "I know everything and you don't so you should just listen to me."

When I got my wisdom teeth out when I was 16, the doctor totally refused to acknowledge my statement of "I've had bad experiences with vicodine, and I refuse to take it." Even my mom was there saying "My daughter won't take vicodine, so there's no use in giving us a prescription." He told my mom to fill the prescription anyways, because I'd want it in the end. I was perfectly happy with ibuprofen and ice, like I knew I would be (and my mom respected me enough not to fill the prescription). Basically, the doctor didn't trust the fact that while he knew more about how people generally react to a procedure, I knew more about my own body, pain tolerance, and how I react to medications than he did. Even though that experience had nothing to do with sexual health, I think it's a good illustration of that attitude: "I'm the doctor, I know everything, so I'm not going to listen to your needs/wishes."

I think that problem is often compounded when the doctor is talking to a young person, and, often, women (some of the moments I've been most proud of my mom is when she's yelled at doctors because they're patronizing either her or me).

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Heather
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I want to mention that this does not just happen to young women: I'd say that this is an issue with women period, unspecific to any given age group.

One tough thing to know is that pharmaceutical companies are BIG business, and court doctors and healthcare providers like nobody's business. At the clinic I also work at, for instance, before we shut the door on pharma reps, they would literally come to the clinic and leave food, chocolates, presents as....well, bribes for us to give away their samples and prescribe their products. So, that kind of thing is some of what drives this bus, alas.

Too, some doctors are simply better than others at not projecting their own personal biases or experiences on patients. I'd also say that, unfortunately, laziness likely has some influence. Some docs just get set in the way they do certain things, what drugs they use and prescribe, and just couldn't be bothered to make adaptations.

So, I'd say a lot of this is just sorting out good docs from lousy ones, which, obviously, sometimes takes trial and error and can be a real pain in the bottom.

(FYI, the pill hasn't been around the longest at all. Diaphragms have actually been around far, far longer, in the states and Europe, for around 100 years. The pill wasn't even put in for FDA approval until the mid 1950's. Diaphragms were, in fact, what Margaret Sanger was first distributing when she started her work. And versions of cervical barriers as a whole go back thousands of years.)

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Heather Corinna, Executive Director & Founder, Scarleteen
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atm1
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I don't think my sentence was clear in that I do think that it happens to many women. The worst I've seen is actually how doctors have been treating my grandmother, who is still a very active woman and is completely capable of understanding and having a say in her treatment. She said that a lot of the problems got resolved once my grandfather started going to appointments with her--only now doctors tend to talk to him more... though her wishes are respected more...


Also, I would find it interesting to see if relationships to pharmaceutical reps is in any way correlated to how often doctors prescribe the pill (or refuse to prescribe a diaphragm).

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NonStraightAnswers
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Joey: In terms of why the pill might be covered when other types of birth control aren't, theoretically at least it could be a misapplication of the fact that some women are prescribed the pill for health reasons other than birth control (i.e. to minimize ovarian cancer risk, or for women with irregular cycles to reduce menstrual pain, risk of anemia, etc.). That being said, it probably has more to do with the reasons mentioned above.

Another possible answer both for that and for the original question is that society in general and especially doctors are inclined to think that things which have been created and tested by the academic/scientific/medical establishment are superior even if "lower tech" methods have been working for many people for years. Compounding that is the fact that historically that establishment has been predominately male so a woman, as part of a group that's been excluded from Knowing What's Best, is particularly likely to be dismissed when trying to challenge that paradigm. In case it's not clear, I'm not advocating the rejection of medical science, just the idea that treatments that alter the body are inherently and universally better than those that work with it.

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bluejumprope
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I hope I'm not going off topic, but there's a lot here I find interesting. I've never been on birth control, but I've been to several doctors for migraines and encountered many of the same issues. Because of the severity and frequency of my migraines, my neurologist wanted to put me on a daily preventative pill, which I was opposed to for many reasons (similar to the reasons a woman might not want to be on hormonal birth control), and she was completely unwilling to listen to me. I've finally found a somewhat unconventional way to manage my migraines and have them less frequently, but the doctors were absolutely no help. Also, the contempt I've encountered from MDs for taking alternative/holistic approaches has been ridiculous.

quote:
Also, I would find it interesting to see if relationships to pharmaceutical reps is in any way correlated to how often doctors prescribe the pill (or refuse to prescribe a diaphragm).
Here's an article, not about birth control, but explaining some of the power of drug marketing:
How drug companies keep tabs on physicians

This thread makes me think a lot about "For Her Own Good" by Barbara Ehrenreich and Deirdre English. Have any of you read it? There's a whole lot in there which I think is relevant.

I found these quotes:

"Healing was female when it was a neighborly service, based in stable communities, where skills could be passed on for generations and where the healer knew her patients and their families. When the attempt to heal was detached from personal relationships to become a commodity and a source of wealth in itself--the business of healing became a male enterprise."

"While the female lay healer operated within a network of information-sharing and mutual support, the male professional hoarded up his knowledge as a kind of property, to be dispensed to wealthy patrons or sold on the market as a commodity. His goal was not to spread the skills of healing..."

[ 01-22-2009, 03:56 PM: Message edited by: bluejumprope ]

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without tenderness, we are in hell. -Adrienne Rich

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atm1
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I have heard that some medical schools have started offering classes on alternative approaches, because there are more and more studies that show they make a difference.
Sometimes, though, a doctor just needs a personal experience with something. When I was a kid, I had a pretty severe medical problem for which the only "cure" was an invasive bone-graft surgery. After six months of accupuncture (designed to help my body adapt to what's wrong, instead of actually fix it), all of my symptoms were gone. The specialist who I had been seeing (who only encouraged alternative treatments when it was looking like our insurance company wouldn't cover the $50,000 procedure), was truly amazed, and started recommending that his other patients try similar things before surgery.

One of the things that I do feel happens all the time in medicine is a sort of doctor vs. body mentality--the solution to a problem with the body is to fight it with outside solutions. This is often the case with birth control (change hormones to prevent pregnancy instead of simply using barriers; use hormones to get rid of moderate cramps instead of encouraging heating pads, tea, and exercise; etc), and also with a world of other medical problems as well. Also, framing medical treatment in this way, doctor vs. body or disease, completely removes the living, breathing patient from the discussion. My accupuncturist was a huge help in teaching me to learn how to listen and respond to my own body--in how to manage pain, how to control tense muscles, and how to allow "positive energy" to flow through my body.

I think this also fits with the "healing as commodity" idea bluejumprope brought up: it's often treated as more "male," ie full of competition (be it commercial or against bodies themselves).

(and don't worry about keeping this "on topic": I'm finding all of this discussion--both about personal stories and about the abstract problems--really great and I certainly hope I'm not the only one who reels that way. Take this whatever way you want!)

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NonStraightAnswers
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The idea of a doctor vs. body mentality really seems spot on, though I'm glad to hear that your specialist was so open to having that mentality changed! My sense is that the issue is compounded for women, though, due to a more general distrust of the natural woman's body (I'm thinking of things like the expectation that all women shave, previous decades' push by government authorities for women to bottle feed instead of breast feed babies, etc.). Thoughts? Examples of distrust of the natural man's body? A desire to point out that not all bodies fit neatly into the categories of "man" and "woman"?
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