Conscientious refusal or not?

LegacyUser

Hi guys....
I'm a regular contributor to the forums but I've decided not to log in due to the personal nature of the post.
My girlfriend (non-national) went to her local GP recently looking for a certain type of birth control pill.
The GP (female) refused to give her her perferred choice of pill because she is 35 citing various reasons, that are totally acceptable if a certain lifestyle/medical history is present.
But the GP neglected to carry out any tests or look for information regarding her lifestyle/medical history. She is extremely fit, active and does not smoke. She understood that certain risks are associated with taking the pill of her choice and fully accepted them.
She left the doctors surgery close to tears!
My question is threefold:
1) Can the GP make this decision without carrying out any tests or looking for a personal history?
2) Can you advise if it's worth placing a complaint against the GP or is it a waste of time?
3) Is it best to just go to another doctor?
All advice is greatly appreciated.
Regards,
Annoyed.

username123

Im not sure why you felt the need to mention that your gf is a non national or that the GP is female.

Unless you yourself are a doctor I suggest you leave the medical advice to the professionals. However, if you are unhappy with a medical opinion you are free to go to another doctor. Like anything else, you will get doctors who prefer certain treatments/drugs/methods etc...

I dont wish to comment on your understanding of a particular pill which you do not name, but you have left out an important point that is taken into consideration when GPs prescribe the pill.

To answer your 3 questions specifically:
1) Can the GP make this decision without carrying out any tests or looking for a personal history?
You cannot say what was in the doctors head and what factors influenced the decision so say yes, because if asked to explain the reasoning Im sure the doc would make a valid case. Dont forget you pay for a doctors OPINION. Important distinction that.

2) Can you advise if it's worth placing a complaint against the GP or is it a waste of time?
Complaint about medical advice? Id ask another doctor first - see above. The original doc could still validly argue she felt risk factors were too high.

3) Is it best to just go to another doctor?
Yes.

daisybelle2008

OP, it is quiet amazing that you are ‘annoyed’ and your girlfriend close to tears. That is a total overreaction IMHO. The GP acted very responsibly. Just because your girlfriend ‘accepts’ the risks doesn’t mean the GP is going to ignore years of medical training and say grand so take what you like.
I have no idea what ‘tests’ you think could be done to accurately predict clots, if she takes a flight that is another risk factor as well as her age. Maybe you are using the internet for your medical ‘expertise’? But I for one would be happy if my GP advised my age put me at risk and prescribed a lower risk pill.
So you are basically asking if it is a good idea to complain a doctor for not wanting to take risks with your girlfriend’s health, even to she is happy to take risks? Do you not think there are bigger medical travesty’s taking up resources, than your girlfriend not being able to prescribe her own pill?
Seriously, if she got a pill that suits her age, then move on from this. I am sure if God forbid your girlfriend had a problem, you would be claiming the GP ignored the risks.
Also how is it relevant that your girlfriend is non-national and the GP female, what’s that got to do with it? You obviously believe something or why mention it?

username123

I forgot to ask - did the doc suggest or recommend some other method of birth control? It would be strange if the doc didnt have an alternative.

LegacyUser

We have a very poor reproductive health care system in Ireland when it comes to contraception choices offered by GP's and its not uncommon for many GPs to have limited knowledge of all contraception options out there. I've seen this happen with non Irish friends who are use to being able to have a much more open conversation with their doctors over reproductive health care choices. In my area there are maybe 9 GPs but only 1 is qualified to offer the coil as a contraception choice. It's not likely that the GP was offering a poor service to your GF but that they aren trained and use to the Irish limited understanding of contraception and use to the average Irish persons inability to have open and frank discussions about their sex life and reproductive choices.

LegacyUser

certain types of pill are simply not recommended for women over 35 regardless of medical history tbh, your gf may have been prepared to accept the risk but that doesn't mean the doctor was prepared to accept the risk of prescribing something they felt would put a patient at unnecessary risk.

The obvious solution would be for your gf to simply get a second opinion.

I'm a bit baffled as to why you gf would be so upset at simply being told a medication was unsuitable for her?

Did the doctor suggest one of the many alternative types of contraception available to your gf? mini-pill, patch, implant, coil, injection? If so perhaps she should consider using the method recommended to her instead of risking her health on something deemed unsafe for her to use?

The pill just isn't suitable for everyone, it can have some very serious side effects tbh and as a woman there's no way in hell i'd be prepared to risk taking something that a doctor felt put me at such a risk that it would be negligent to prescribe. If anything I'd have more faith in a doctor who took responsibility for my personal health than one who prescribed something like it was a box of smarties just because it was the most widely used drug and most people had no adverse reactions.

Neyite

lostcharms wrote: »

Hi guys....
I'm a regular contributor to the forums but I've decided not to log in due to the personal nature of the post.
My girlfriend (non-national) went to her local GP recently looking for a certain type of birth control pill.
The GP (female) refused to give her her perferred choice of pill because she is 35 citing various reasons, that are totally acceptable if a certain lifestyle/medical history is present.
But the GP neglected to carry out any tests or look for information regarding her lifestyle/medical history. She is extremely fit, active and does not smoke. She understood that certain risks are associated with taking the pill of her choice and fully accepted them.
She left the doctors surgery close to tears!
My question is threefold:
1) Can the GP make this decision without carrying out any tests or looking for a personal history?
2) Can you advise if it's worth placing a complaint against the GP or is it a waste of time?
3) Is it best to just go to another doctor?
All advice is greatly appreciated.
Regards,
Annoyed.

1. What tests do you feel should be done when getting the contraceptive pill? In my 20 odd years on the pill, taking my blood pressure, a breast exam, and the occasional smear test is all that has been tested. Do you even know if the pill in question is one that is issued in Ireland? At one stage the pill I was on was withdrawn from the UK market for a time due to scaremongering, yet in Ireland was still prescribed.

2. Its a waste of time. The GP has their reasons for having preferred contraceptives they recommend, and while you may have some basis for complaint if they were irresponsible, it sounds very much like they erred on the side of caution. What can you complain about, realistically? That the doctor didnt give you a particular drug you wanted? You dont have a leg to stand on there - anymore than if I wanted a doctor to give me a supply of morphine for no reason other than I used it in another country or whatever. It sounds like the doctor told your girlfriend why she would not prescribe that particular pill, so its not like the doctor left her clueless. And I'm not sure why a grown woman would be reduced to tears over a run of the mill GP visit?

3. Just go to another doctor. But be prepared for the fact that you may get the same answer. After all, the GP has seen far more patients on the pill than you or your girlfriend, and have more experience of side effects.

HeyThereDeliah

Are you suggesting she refused because your GF is non national or for personal beliefs?

On what grounds could you report her? She gave her professional opinion.

Your GF is an adult, why was she in tears? She should go to another doctor but I am surprised the doctor did not offer her an alternative pill.

Ickle Magoo

Not all doctors share the same views or are prepared to take the same risks - I don't believe there is any illegalities in that, especially in the greyer areas such as prescribing a particular contraceptive to someone in a high risk group when alternatives are available.

If your girlfriend isn't happy with the service she gets, then as with any other service, she is free to take her custom elsewhere and get a second opinion. I don't think you have any reason to be angry or your gf to be in tears because a medical professional insisted on following industry recommendations to the letter.

I had a male GP refuse to support me in going for a VBAC - I don't believe it was anything to do with his gender or my nationality rather he was refusing to be complicit in the inherent risks...so I wouldn't say it's even unusual for a GP to refuse to prescribe pharmaceuticals/procedures based solely on the preference of their medically unqualified patient.

All the best.

Katy89

OP, what is the exact reason, the GP refused this pill to your GF?
the GP should have given specific reasons why she can't use this pill, not just her age as I havn't heard of anything that women in their mid thirties shouldn't take the pill at all.

has yor girl friend a special health conditon on which the GP decided to not describe this pill?
or is it these pill in itself which the GP means is a risk factor?

sorry, I think it's not clear from your original post so I'm a bit confused here, means some more information would be necessary to judge wether the GP was unreasonable or not.

John Mason

my Doctor has refused me my preferred choice of contraception because i am over 35, higher risks of clots.

its a pain in the nads but tbh i would rather change and be alive.

I am not sure what tests you wanted the Doctor to give her, but i have never had any tests done for contraception .

Oh, and i am irish

ash23

My gp wouldn't give me my preferred choice of contraception because of the fact I'd had a c-section and she wasn't comfortable giving me the coil and preferred I went to the local hospital. I thought nothing of it to be honest. If she is worried that she would do more harm than good, then so be it.

We dicussed other options at length, the positives and negatives of each and settled on one that I was happy to try and she was happy to give.

I don't blame the doctor for having her own preferences based on her knowledge, beliefs and experiences. If your girlfriend wants to try another doctor she should. But unless the doctor was very rude or derogatory, or refused to give her any contraception advice at all, then I don't see the problem.
It's a fairly well known fact that certain pills are not suitable for women over a certain age.

username123

Katy89 wrote: »

the GP should have given specific reasons why she can't use this pill, not just her age as I havn't heard of anything that women in their mid thirties shouldn't take the pill at all.

Women over 35 are a higher risk for the pill. Certain lifestyle factors (weight, smoking, exercise) and family medical history can also have an influence, as can previous experiences - it would be very unusual for a doctor to prescribe the pill to a woman over 35 who has never been on the pill at all or who has not been on it for a decade, but if she is already on it and is doing fine then she may be left on it.

Some GPs will not prescribe it at all to women over 35.

To the poster who mentioned the coil, many GPs will refer women on to have it prescribed/inserted because it requires training and they wouldnt have enough of a demand to bother training in it themselves so it is left to medical professionals who specialise in it.

andala

To tell you the truth, I find it a bit strange that contraceptive pills are prescribed by GPs in Ireland, not gynecologists. Usually before being put on the pill one should have hormone levels, liver, blood (including coagulation), cholesterol, sugar and urine tests done as well as general gyn examination.

It's hard to know why your girlfriend was refused the pill since we don't know her medical history. If she feels she really wants to take it, she should see another doctor, perhaps a gyn would be a better choice. I know a lot of women over 35 who are on pills, but, as you know yourself, the fact that many people do something, does not mean it's good for everyone

I'd ask for second opinion and/or look into alternative methods (patches, implant, injection etc)

sam34

andala wrote: »

To tell you the truth, I find it a bit strange that contraceptive pills are prescribed by GPs in Ireland, not gynecologists. Usually before being put on the pill one should have hormone levels, liver, blood (including coagulation), cholesterol, sugar and urine tests done as well as general gyn examination.

a GP can do all the above investigations, if indicated.

there's absolutely no reason why routine contraception cannot be dealt with at a primary care level. referring everyone on to a gynaecologist for contraception would seriously overwhelm an already stretched secondary service.

lostcharms

lostcharms wrote: »

The GP (female) refused to give her her perferred choice of pill because she is 35 citing various reasons, that are totally acceptable if a certain lifestyle/medical history is present.

My question is threefold:
1) Can the GP make this decision without carrying out any tests or looking for a personal history?
2) Can you advise if it's worth placing a complaint against the GP or is it a waste of time?
3) Is it best to just go to another doctor?

There's a reason the pill requires a prescription - it needs to be advised by a doctor. The doctor in question refused and gave various reasons. So basically she perfectly performed her duty as a doctor.
As for your questions:
1) Yes. She's a doctor, she's trained to form an opinion. She doesn't just make up stuff for kicks because she doesn't want to perform tests.
2) Why would you place a complaint? She didn't do anything wrong. If she had refused on the grounds that she didn't feel like it or because she didn't like your girlfriend's shoes, then you could complain. But she refused for valid reasons.
3) Yes, but does your girlfriend really want to when she knows that there are valid reasons not to?

cant log in right now wrote: »

It's not likely that the GP was offering a poor service to your GF but that they aren trained and use to the Irish limited understanding of contraception and use to the average Irish persons inability to have open and frank discussions about their sex life and reproductive choices.

I'd also like to point out that I strongly disagree with this. Sure, there are still some relics practising in some parts, but in general our health service is a lot better than this.

Nonoperational

35 + one more risk factor means you should avoid the combined pill. It would be going against the evidence to prescribe in that situation. The POP may still be suitable. GPs not knowing about basic contraception is nonsense really. It's most likely the GP was being perfectly sensible.

Imagine the thread if the GP prescribed it and the patient had a clot...