Do doctors actually tell their patients they "cannot have children"?
November 15, 2013 6:37 AM Subscribe
In my life I've heard a number of stories from women who claim to have been told they could not have children... who then proceed to have children without intervention. Sometimes, this is an extremely welcome development, other times, very much the opposite. Saying something like "you will not be able to have children" with such certainty seems like an extremely irresponsible thing for a medical professional to say to a patient and so I have a bit of a hard time believing that doctors say it, at least in any case where it is at least physically possible for someone to conceive.
So, do doctors actually say this, or do you think they are saying one thing and patients are hearing another thing entirely?
So, do doctors actually say this, or do you think they are saying one thing and patients are hearing another thing entirely?
Doctors say stuff that isn't necessarily true all the time.
I was told I likely wouldn't be able to run again or walk without a brace due to some surgeries I had. Bupkiss. I can run, jump and walk just fine. The doctors were surprised. The thing is that the way the body regenerates is different for everyone. What the doctors say might be true for most people but there are always a few flukes.
I've known women who've gotten pregnant despite being told they could never have children by their doctors. It definitely happens.
posted by manderin at 6:45 AM on November 15, 2013 [1 favorite]
I was told I likely wouldn't be able to run again or walk without a brace due to some surgeries I had. Bupkiss. I can run, jump and walk just fine. The doctors were surprised. The thing is that the way the body regenerates is different for everyone. What the doctors say might be true for most people but there are always a few flukes.
I've known women who've gotten pregnant despite being told they could never have children by their doctors. It definitely happens.
posted by manderin at 6:45 AM on November 15, 2013 [1 favorite]
at least in any case where it is at least physically possible for someone to conceive.
But they don't. They tend to say this to women for whom it isn't possible for them to conceive: they have blocked tubes or do not ovulate or have fried their eggs with chemo or have structural problems like significant fibroids. A tiny, tiny percentage of women will get pregnant anyway.
posted by DarlingBri at 6:47 AM on November 15, 2013 [1 favorite]
But they don't. They tend to say this to women for whom it isn't possible for them to conceive: they have blocked tubes or do not ovulate or have fried their eggs with chemo or have structural problems like significant fibroids. A tiny, tiny percentage of women will get pregnant anyway.
posted by DarlingBri at 6:47 AM on November 15, 2013 [1 favorite]
Best answer: Yes, they do. I was told I was not ovulating and my husband's sperm was too low and other things wrong with it that there was no way I could get pregnant without medical intervention.
Guess what happened? I got pregnant as soon as I'd quit my job with free health insurance. No I did not ever go back to that doctor.
posted by Marie Mon Dieu at 6:49 AM on November 15, 2013 [2 favorites]
Guess what happened? I got pregnant as soon as I'd quit my job with free health insurance. No I did not ever go back to that doctor.
posted by Marie Mon Dieu at 6:49 AM on November 15, 2013 [2 favorites]
Best answer: I suspect that there are probably women who have complicated and difficult health/reproductive situations who simplify, when pressed, to "the doctor said I can't have children" even though the doctor said something more like what telegraph describes. I - did I want children - would most likely have huge difficulty conceiving; I have told people that I "pretty much can't have children" because it is the short version and it gets them off my case. I'm sure that for women who want children and would definitely have huge difficulty conceiving, it's much easier to tell people "the doctor says" than to listen to the "did you try cutting out gluten and taking up neo-platonic meditation? My cousin did and she got pregnant right away" stuff that you get otherwise.
I'm sure there are also plenty of women who really simply can't have kids and are straight-up reporting what the doctor told them.
Just in case: if someone does tell you, in social circumstances, that "the doctor said she can't have children", I assume you're not going to use the answers in this thread to press her on that point.
posted by Frowner at 6:52 AM on November 15, 2013 [30 favorites]
I'm sure there are also plenty of women who really simply can't have kids and are straight-up reporting what the doctor told them.
Just in case: if someone does tell you, in social circumstances, that "the doctor said she can't have children", I assume you're not going to use the answers in this thread to press her on that point.
posted by Frowner at 6:52 AM on November 15, 2013 [30 favorites]
Best answer: My friend Donna and I laugh at all the "Miracle Babies" we know. These are born mostly to our friend's children.
In this instance, I think some young women are just dramatizing their conceptions, but it is a thing.
YMMV.
posted by Ruthless Bunny at 6:54 AM on November 15, 2013 [4 favorites]
In this instance, I think some young women are just dramatizing their conceptions, but it is a thing.
YMMV.
posted by Ruthless Bunny at 6:54 AM on November 15, 2013 [4 favorites]
Yes, they do. This happened to the mother of my son. She had an abdominal hernia, and while patching that up they noticed she had some deformation of her ladybits* and so she couldn't have kids. She's had three, now.
Incidentally, after I broke my femur in a bad accident, the doctor told me that odds were pretty good I'd never run and pretty good I would have trouble walking for life. I made a more or less full recovery.
So, yeah, doctors can make mistakes. Frankly, If a doctor is going to be wrong, I prefer them to be wrong in this way.
*I forget the exact diagnosis unfortunately - it was a long, long, time ago. It was pretty dire, though. She was very upset after she had been told.
posted by Pogo_Fuzzybutt at 6:54 AM on November 15, 2013
Incidentally, after I broke my femur in a bad accident, the doctor told me that odds were pretty good I'd never run and pretty good I would have trouble walking for life. I made a more or less full recovery.
So, yeah, doctors can make mistakes. Frankly, If a doctor is going to be wrong, I prefer them to be wrong in this way.
*I forget the exact diagnosis unfortunately - it was a long, long, time ago. It was pretty dire, though. She was very upset after she had been told.
posted by Pogo_Fuzzybutt at 6:54 AM on November 15, 2013
Mod note: One comment deleted. Guys, we need to stick to the question of whether doctors tell people they cannot have children, and not wander into "some people lie about not being able to have kids" territory, etc. Thanks.
posted by taz (staff) at 6:56 AM on November 15, 2013 [2 favorites]
posted by taz (staff) at 6:56 AM on November 15, 2013 [2 favorites]
"Can't have children" can also be used two ways. There's "it's not physically possible, or it's extremely unlikely that a woman will conceive and carry to term". There's also "It is not physically possible, or it's extremely unlikely, that a woman will conceive and carry to term without unusual physical damage to herself."
There are women with health problems who are physically capable of conceiving and perhaps carrying to term, but it's a bad idea for them to do so--sometimes the risks of major complications or health problems are much higher for them than for other women. These women may also not feel like communicating all of the above details to their conversational partner, so "Can't have children" it is. (In this case, their own health or medical science may later change enough to make childbearing safer--or they may get pregnant anyway and take chances, which may or may not turn out all right for them in the end.)
posted by Hypatia at 7:03 AM on November 15, 2013 [6 favorites]
There are women with health problems who are physically capable of conceiving and perhaps carrying to term, but it's a bad idea for them to do so--sometimes the risks of major complications or health problems are much higher for them than for other women. These women may also not feel like communicating all of the above details to their conversational partner, so "Can't have children" it is. (In this case, their own health or medical science may later change enough to make childbearing safer--or they may get pregnant anyway and take chances, which may or may not turn out all right for them in the end.)
posted by Hypatia at 7:03 AM on November 15, 2013 [6 favorites]
My best friend's fiance was told that she'd only be able to have children with medical intervention after surgery. She's currently expecting her first, unplanned child.
I find it odd to assume women would do this to purposefully deceive or that they must be misunderstanding what they've been told. It feels a bit misogynistic, to me. That being said, it's likely that doctors genuinely believe this to be the case given the information they have at a point in time.
I assume that the anecdotal commonality of all this has something to do with the fact that a woman who believes her chance of getting pregnant is 0% is much less likely to use birth control--if, say, her reproductive system is actually working normally, then there would be a much higher chance of accidental pregnancy for her than there would be for women using condoms or the pill.
posted by PhoBWanKenobi at 7:03 AM on November 15, 2013 [11 favorites]
I find it odd to assume women would do this to purposefully deceive or that they must be misunderstanding what they've been told. It feels a bit misogynistic, to me. That being said, it's likely that doctors genuinely believe this to be the case given the information they have at a point in time.
I assume that the anecdotal commonality of all this has something to do with the fact that a woman who believes her chance of getting pregnant is 0% is much less likely to use birth control--if, say, her reproductive system is actually working normally, then there would be a much higher chance of accidental pregnancy for her than there would be for women using condoms or the pill.
posted by PhoBWanKenobi at 7:03 AM on November 15, 2013 [11 favorites]
Doctors I've met go to great lengths not to say anything as definitive as this. Rather, in my experience, they far prefer to talk in terms of probability. Fertility specialists, rather than general practitioners, also openly acknowledge there is a substantial margin of error where fertility is affected by multiple factors, no single one of which is definitive. In that respect, fertility is still quite an immature area of medicine. A pernicious by product of that is all the woo books and guilting around pregnancy.
Of course, colloquially, statements which stress very low probability can and do get translated into definitives either in the retelling or at some point in the explanation of the diagnosis. E.g. "The doc basically said I can't have children" or after a doc has given so lengthy explanation of a diagnosis and its implications, it is natural for a patient to lead the question: I.e "does that mean I can't have kids?" to which the answer may be more definitive than the preceding explanation.
posted by MuffinMan at 7:09 AM on November 15, 2013 [1 favorite]
Of course, colloquially, statements which stress very low probability can and do get translated into definitives either in the retelling or at some point in the explanation of the diagnosis. E.g. "The doc basically said I can't have children" or after a doc has given so lengthy explanation of a diagnosis and its implications, it is natural for a patient to lead the question: I.e "does that mean I can't have kids?" to which the answer may be more definitive than the preceding explanation.
posted by MuffinMan at 7:09 AM on November 15, 2013 [1 favorite]
Best answer: So, do doctors actually say this, or do you think they are saying one thing and patients are hearing another thing entirely?
Some combination of both. Doctors are learned professionals and are trained to integrate multiple diagnostic factors into probabilities. But like everyone, they have a tendency to speak as if the most likely option is the only option. Some of this is deliberate, in that the most unlikely options are usually the most unpleasant, and it's frequently not even worth bringing up remote possibilities. But some is just shorthand ingrained by practice, as patients aren't trained to deal with probabilities the same way that doctors are.
So a very, very likely conversation would be something along the lines of this:
"Mrs. Jones, I'm sorry, but with your condition it's unlikely that you'll ever be able to have children. The risk to you and the baby would just be too great."
"Doctor, are you saying that we can't have children?"
"It certainly looks that way."
Note that the doctor did not strictly say that this woman would never carry a child to term, but that it would not be unreasonable to walk away with that impression. That's what happens when you condense a multi-factoral, technical diagnosis into a single, non-technical sentence. You leech out nuance.
Note also that if a doctor says that X is the most likely outcome and X doesn't happen, that does not mean that the doctor was wrong. Not at all. It just means that what actually did happen is improbable. If something is 90% likely to happen, but does not, that's perhaps mildly surprising but hardly a miracle. But if it's 90% likely to happen, one can perhaps be forgiven for saying that it will happen, especially if one doesn't actually have the precise numbers.
So yes. This absolutely does happen. Sometimes in so many words. I'd say it is very likely that doctors are saying one thing and patients hearing another, but this isn't because patients are paraphrasing or just hearing what they want to hear. They're probably taking a statement which the doctor meant as a simplification of an expression of un-quantified probabilities and just reading it like it reads on its face.
posted by valkyryn at 7:10 AM on November 15, 2013 [10 favorites]
Some combination of both. Doctors are learned professionals and are trained to integrate multiple diagnostic factors into probabilities. But like everyone, they have a tendency to speak as if the most likely option is the only option. Some of this is deliberate, in that the most unlikely options are usually the most unpleasant, and it's frequently not even worth bringing up remote possibilities. But some is just shorthand ingrained by practice, as patients aren't trained to deal with probabilities the same way that doctors are.
So a very, very likely conversation would be something along the lines of this:
"Mrs. Jones, I'm sorry, but with your condition it's unlikely that you'll ever be able to have children. The risk to you and the baby would just be too great."
"Doctor, are you saying that we can't have children?"
"It certainly looks that way."
Note that the doctor did not strictly say that this woman would never carry a child to term, but that it would not be unreasonable to walk away with that impression. That's what happens when you condense a multi-factoral, technical diagnosis into a single, non-technical sentence. You leech out nuance.
Note also that if a doctor says that X is the most likely outcome and X doesn't happen, that does not mean that the doctor was wrong. Not at all. It just means that what actually did happen is improbable. If something is 90% likely to happen, but does not, that's perhaps mildly surprising but hardly a miracle. But if it's 90% likely to happen, one can perhaps be forgiven for saying that it will happen, especially if one doesn't actually have the precise numbers.
So yes. This absolutely does happen. Sometimes in so many words. I'd say it is very likely that doctors are saying one thing and patients hearing another, but this isn't because patients are paraphrasing or just hearing what they want to hear. They're probably taking a statement which the doctor meant as a simplification of an expression of un-quantified probabilities and just reading it like it reads on its face.
posted by valkyryn at 7:10 AM on November 15, 2013 [10 favorites]
Response by poster: In reference to PhoBWanKenobi above, the latter part of your response is why I think there is a difference between telling someone they won't likely walk again without assistance and telling someone they won't be getting pregnant without assistance. The patient in the first case isn't going to go out of their way to prevent walking, they want to walk. In the latter case, this assumption cannot necessarily be made.
In a roundabout way, I actually happen to exist because my grandmother was told by a doctor that she could not get pregnant and then ended up having my mother. I have to say that one of the reasons for my question is wondering if Doctors as a group actually still say stuff like that.
posted by Feel the beat of the rhythm of the night at 7:15 AM on November 15, 2013
In a roundabout way, I actually happen to exist because my grandmother was told by a doctor that she could not get pregnant and then ended up having my mother. I have to say that one of the reasons for my question is wondering if Doctors as a group actually still say stuff like that.
posted by Feel the beat of the rhythm of the night at 7:15 AM on November 15, 2013
According to my wife, who works with couples looking into adoption, yes. Doctors definitely do tell patients they can't have children.
posted by Thorzdad at 7:16 AM on November 15, 2013
posted by Thorzdad at 7:16 AM on November 15, 2013
What valkyryn said. There are two things at work here:
(1) (Most) medical professionals communicate in terms of probabilities drawn from population-level statistics. So they might say something like 'there is a 95% chance that you won't be able to have children." That means that 95% of individuals with your condition aren't able to conceive, but 5% are. Many people interpret this as "you can't have children." Exchanges like the one valkyryn describes also happen. Finally, physicians may overplay the unlikelihood of a rare event in order to prevent patients from having false hope.
(2) There is also a bit of confirmation bias at work here. You hear about the (rare) instances when someone is told that they can't conceive and does. But this must be compared to the many more times someone is told they can't conceive and they don't.
posted by googly at 7:21 AM on November 15, 2013 [1 favorite]
(1) (Most) medical professionals communicate in terms of probabilities drawn from population-level statistics. So they might say something like 'there is a 95% chance that you won't be able to have children." That means that 95% of individuals with your condition aren't able to conceive, but 5% are. Many people interpret this as "you can't have children." Exchanges like the one valkyryn describes also happen. Finally, physicians may overplay the unlikelihood of a rare event in order to prevent patients from having false hope.
(2) There is also a bit of confirmation bias at work here. You hear about the (rare) instances when someone is told that they can't conceive and does. But this must be compared to the many more times someone is told they can't conceive and they don't.
posted by googly at 7:21 AM on November 15, 2013 [1 favorite]
I know women who were told it was highly unlikely they'd ever have children. In one woman's case, she had fibroids and endometriosis and a whole host of other reproductive-organs-related issues. She did end up conceiving and delivering a "Miracle Baby", but she got pre-eclampsia and the baby had to be delivered something like six weeks early because all of the mom's organ systems started to shut down. Mom and the kid are OK now (save for the kid having bad lungs), but mom is not planning on doing pregnancy ever again.
I think sometimes it is not just delivered as a statement of fact but a strong recommendation.
posted by Anonymous at 7:23 AM on November 15, 2013
I think sometimes it is not just delivered as a statement of fact but a strong recommendation.
posted by Anonymous at 7:23 AM on November 15, 2013
valkyryn: So yes. This absolutely does happen. Sometimes in so many words. I'd say it is very likely that doctors are saying one thing and patients hearing another, but this isn't because patients are paraphrasing or just hearing what they want to hear. They're probably taking a statement which the doctor meant as a simplification of an expression of un-quantified probabilities and just reading it like it reads on its face.
I just want to emphasize this. Based on my professional and personal experience with many doctors, it is unlikely that they would speak in such absolute terms as "You cannot have children", but their carefully qualified message gets simplified, either intentionally or unintentionally, by their patients. In my case, my wife and I didn't think we wanted any children after our first one, and when a medical situation arose that made future pregnancies much less likely and potentially more dangerous, we just decided to tell family and friends who ask about it that we "can't have any more children" even though it might be technically possible.
posted by Rock Steady at 7:25 AM on November 15, 2013
I just want to emphasize this. Based on my professional and personal experience with many doctors, it is unlikely that they would speak in such absolute terms as "You cannot have children", but their carefully qualified message gets simplified, either intentionally or unintentionally, by their patients. In my case, my wife and I didn't think we wanted any children after our first one, and when a medical situation arose that made future pregnancies much less likely and potentially more dangerous, we just decided to tell family and friends who ask about it that we "can't have any more children" even though it might be technically possible.
posted by Rock Steady at 7:25 AM on November 15, 2013
You hear about the (rare) instances when someone is told that they can't conceive and does.
Totally. And with a population north of 300 million, rare things happen all the time. Hell, there's like a 175 million to one chance that you'll ever win the lottery, but somebody does almost every month. The probabilities we're talking about here are a lot higher than that. Even something that is one in a thousand could happen hundreds of times per day in a population large enough.
posted by valkyryn at 7:29 AM on November 15, 2013 [2 favorites]
Totally. And with a population north of 300 million, rare things happen all the time. Hell, there's like a 175 million to one chance that you'll ever win the lottery, but somebody does almost every month. The probabilities we're talking about here are a lot higher than that. Even something that is one in a thousand could happen hundreds of times per day in a population large enough.
posted by valkyryn at 7:29 AM on November 15, 2013 [2 favorites]
Friend was told due to endometriosis & fallopian scarring that she had less than 10% chance of getting pregnant. So she got lazy with the BC and a year and a half later...
I haven't heard a 'you can't ever have children' diagnosis. If you didn't have a uterus or something major like that, then maybe they would make a definitive statement like that.
posted by St. Peepsburg at 7:31 AM on November 15, 2013 [1 favorite]
I haven't heard a 'you can't ever have children' diagnosis. If you didn't have a uterus or something major like that, then maybe they would make a definitive statement like that.
posted by St. Peepsburg at 7:31 AM on November 15, 2013 [1 favorite]
Another anecdote for yes, this still happens. Fourteen years ago, I was told that one of my ovaries was probably non-functioning, but "they left it in anyway" (this was after a large cyst had torsioned and burst), and considering the scarring on the other one, "it's likely you'll never have children". I have endometriosis.
FWIW, I have not yet had children.
Anecdotally, I also have a few friends with endometriosis who have been told "you cannot have children" in more absolute terms. None of them have had children either, in spite of at least two of them wanting children dearly and trying for them.
posted by fraula at 7:32 AM on November 15, 2013
FWIW, I have not yet had children.
Anecdotally, I also have a few friends with endometriosis who have been told "you cannot have children" in more absolute terms. None of them have had children either, in spite of at least two of them wanting children dearly and trying for them.
posted by fraula at 7:32 AM on November 15, 2013
Best answer: There's at least one pretty common diagnosis (look up Polycystic Ovarian Syndrome or PCOS) which often leads to infertility or at least trouble conceiving, but not always. There's no way for doctors to know whether or not there are fertility implications for a particular woman until she tries to get pregnant.
There seem to be a couple of ways doctors deal with this. Some can actually explain, in a sensitive way, what the deal really is. Some say something like very vague and pessimistic like "You will probably have trouble getting pregnant" or "It's very difficult for women with PCOS to have children." For some patients of these pessimistic and vague doctors, this could be really upsetting news, and even if they understand "I probably will have trouble getting pregnant, but it might actually be fine" intellectually, they could still feel "I can't get pregnant, ever" in the gut. (This was my experience, until I did a pile of extra research--not everyone does the research, so it's totally understandable to come away from a pessimistic, unclear doctor like this with an understanding that doesn't account for all of the unknowns of this condition.)
And finally, there do seem to be some doctors out there who say "You can't get pregnant" to women with this condition. This is indeed incorrect in many cases, but PCOS is not very well known or understood (even though perhaps as many as 10% of women have it!). Lots of women report their doctors having a lot of difficulty diagnosing PCOS, and it kind of follows that if some doctors are not very familiar with it, they might not do a perfect job of explaining the uncertain nature of its effects on fertility. I know of several women with surprise baby experiences who specifically have PCOS.
posted by snorkmaiden at 7:34 AM on November 15, 2013
There seem to be a couple of ways doctors deal with this. Some can actually explain, in a sensitive way, what the deal really is. Some say something like very vague and pessimistic like "You will probably have trouble getting pregnant" or "It's very difficult for women with PCOS to have children." For some patients of these pessimistic and vague doctors, this could be really upsetting news, and even if they understand "I probably will have trouble getting pregnant, but it might actually be fine" intellectually, they could still feel "I can't get pregnant, ever" in the gut. (This was my experience, until I did a pile of extra research--not everyone does the research, so it's totally understandable to come away from a pessimistic, unclear doctor like this with an understanding that doesn't account for all of the unknowns of this condition.)
And finally, there do seem to be some doctors out there who say "You can't get pregnant" to women with this condition. This is indeed incorrect in many cases, but PCOS is not very well known or understood (even though perhaps as many as 10% of women have it!). Lots of women report their doctors having a lot of difficulty diagnosing PCOS, and it kind of follows that if some doctors are not very familiar with it, they might not do a perfect job of explaining the uncertain nature of its effects on fertility. I know of several women with surprise baby experiences who specifically have PCOS.
posted by snorkmaiden at 7:34 AM on November 15, 2013
Things like this do happen, yes. But in my experience, between doctor visits with older family members way back when, and my own doctor visits now, it happens less with younger doctors, who have heard all the same "horror" stories - younger doctors tend to temper their advice and answers to questions (in deference to their lawyers' advice, imho), whereas older doctors tend to have more of that "I am all-knowing" type of attitude, and dispense their opinion as if they sit at the right hand of God.
This is one reason why "get a second opinion" is such common advice.
posted by vignettist at 7:34 AM on November 15, 2013
This is one reason why "get a second opinion" is such common advice.
posted by vignettist at 7:34 AM on November 15, 2013
I was told from age 15 on that I wouldn't be able to have children, only once saying "but medicine is advancing all the time so don't lose hope." It affected my self-esteem (barren in a big-catholic-family environment), my relationships and, once I was married, our schedule for "trying." I got pregnant the first month we tried, and then again with my second while the first was still nursing.
posted by headnsouth at 7:37 AM on November 15, 2013 [1 favorite]
posted by headnsouth at 7:37 AM on November 15, 2013 [1 favorite]
Also, keep in mind that anecdotes from generations trying to conceive pre 1990s-ish may not reflect the situation today. The first successful IVF procedure wasn't until 1979. Medical interventions and diagnoses are more available and more refined/successful today than back then. So a statement of "it's very unlikely that you'll conceive without medical intervention" today may have legitimately been "you can never have children" back then due to the available medical technology and knowledge. Someone who might die from a vaginal birth may have been advised to never conceive in the days before safe c-sections were available.
posted by melissasaurus at 7:41 AM on November 15, 2013 [2 favorites]
posted by melissasaurus at 7:41 AM on November 15, 2013 [2 favorites]
Best answer: I just want to emphasize this. Based on my professional and personal experience with many doctors, it is unlikely that they would speak in such absolute terms as "You cannot have children", but their carefully qualified message gets simplified, either intentionally or unintentionally, by their patients.
Quoted for emphasis. As somebody whose work requires precise use of language I find that noticing and processing the finer distinctions and using language that is precise enough is one of the hardest things for my trainees to learn. All of my trainees have university degrees. I would expect this to be even more pronounced for medical professionals, dealing with people with varied levels of education, especially when talking about emotive subjects such as fertility.
posted by koahiatamadl at 7:55 AM on November 15, 2013 [1 favorite]
Quoted for emphasis. As somebody whose work requires precise use of language I find that noticing and processing the finer distinctions and using language that is precise enough is one of the hardest things for my trainees to learn. All of my trainees have university degrees. I would expect this to be even more pronounced for medical professionals, dealing with people with varied levels of education, especially when talking about emotive subjects such as fertility.
posted by koahiatamadl at 7:55 AM on November 15, 2013 [1 favorite]
Also, keep in mind that anecdotes from generations trying to conceive pre 1990s-ish may not reflect the situation today.
And also keep in mind that back in the day doctors were gods and what they said, you believed. That's why my mother never took me to a different gyno when I was growing up, and it never occurred to me to see another one before I was actually pregnant. These days patients are not only encouraged to get a second opinion from another doc, they're expected to do research on their own, and they have any number of forums and support groups and etc. to glean more info from.
posted by headnsouth at 8:04 AM on November 15, 2013 [4 favorites]
And also keep in mind that back in the day doctors were gods and what they said, you believed. That's why my mother never took me to a different gyno when I was growing up, and it never occurred to me to see another one before I was actually pregnant. These days patients are not only encouraged to get a second opinion from another doc, they're expected to do research on their own, and they have any number of forums and support groups and etc. to glean more info from.
posted by headnsouth at 8:04 AM on November 15, 2013 [4 favorites]
I would expect this to be even more pronounced for medical professionals, dealing with people with varied levels of education
A bit yes, but patient populations reflect gen pop pretty much right on the money, so "varied" in this case mostly means "only 40% ever went to college, and only 30% have a degree".
If you're used to explaining subtle technical probabilistic diagnoses to an audience that mostly hasn't even taken a single college course and has only the vaguest understanding of gross anatomy, it can be pretty easy to simply slide into a default mode of assuming that they're not going to get it even if you did put forth the effort. It's not a bad assumption most of the time.
This is not a justification, as physicians have an ethical and professional duty to do their best to make sure that patients understand what's going on. That means putting forth the effort every time, even when it's futile. But it should serve to explain why these misunderstandings seemingly happen so often.
posted by valkyryn at 8:06 AM on November 15, 2013 [2 favorites]
A bit yes, but patient populations reflect gen pop pretty much right on the money, so "varied" in this case mostly means "only 40% ever went to college, and only 30% have a degree".
If you're used to explaining subtle technical probabilistic diagnoses to an audience that mostly hasn't even taken a single college course and has only the vaguest understanding of gross anatomy, it can be pretty easy to simply slide into a default mode of assuming that they're not going to get it even if you did put forth the effort. It's not a bad assumption most of the time.
This is not a justification, as physicians have an ethical and professional duty to do their best to make sure that patients understand what's going on. That means putting forth the effort every time, even when it's futile. But it should serve to explain why these misunderstandings seemingly happen so often.
posted by valkyryn at 8:06 AM on November 15, 2013 [2 favorites]
Also, sometimes women will say "the doctor said I can't have children" because saying "after months of trying, the doctor performed a procedure wherein she inserted a cannula into my uterus which sprayed radio-opaque dye all through my Fallopian tubes; this revealed a terrible blockage on both sides. We explored the possibility of remedying the condition through surgery, but when the surgeon opened me up, she found that my endometrial material had leaked through the ends of my Fallopian tubes, enrobed my ovaries with scar tissue, and adhered my uterus, bladder, ovaries, and intestines into one indistinguishable mass. Conception of our own children would require hours of delicate microsurgery, followed by months of unpleasant drugs and painful, invasive application of the most advanced fertility techniques currently available to medicine, with an approximately 20% success rate and at an out-of-pocket cost of close to a quarter million dollars" is kind of a downer for a cocktail party.
posted by KathrynT at 8:23 AM on November 15, 2013 [30 favorites]
posted by KathrynT at 8:23 AM on November 15, 2013 [30 favorites]
Also, sometimes women will say. . .
There is, of course, also that. Sometimes it's not the doctors who are the ones doing the paraphrasing. Sometimes the patient knows quite well what is going on and is either giving you the short version or just doesn't want to talk about it.
posted by valkyryn at 8:38 AM on November 15, 2013 [1 favorite]
There is, of course, also that. Sometimes it's not the doctors who are the ones doing the paraphrasing. Sometimes the patient knows quite well what is going on and is either giving you the short version or just doesn't want to talk about it.
posted by valkyryn at 8:38 AM on November 15, 2013 [1 favorite]
A friend of mine got married. He and the wife were told flat out that she could not have children. They planned their life accordingly, buying a one bedroom apt in Hamilton Heights. And she got pregnant, near the age of 50. It was completely unplanned. They have a beautiful, healthy boy named Ethan.
posted by computech_apolloniajames at 8:57 AM on November 15, 2013
posted by computech_apolloniajames at 8:57 AM on November 15, 2013
My mother had 2 successful pregnancies (my two older sisters) and then had a miscarriage. Her doctor told her after her miscarriage that she would not be able to have any more children. 14 years later, I came along. My parents where sexually active throughout those 14 years, so the doctor was right for a long time before he was wrong.
posted by hworth at 9:19 AM on November 15, 2013 [3 favorites]
posted by hworth at 9:19 AM on November 15, 2013 [3 favorites]
Of course some doctors don't parse their words carefully, just like other people. Plus they may have different opinions about the prognosis. My wife was told she couldn't get pregnant naturally but she did. In our case I don't recall whether the fertility doctor said can't, likely can't, probably can't, or whatever, but it's not hard to imagine one doctor saying it one way and another saying it another.
posted by Dansaman at 9:35 AM on November 15, 2013
posted by Dansaman at 9:35 AM on November 15, 2013
After I had a miscarriage two separate doctors informed me that I wouldn't be able to have children. One indicated the probability (vanishingly small), the other, my second opinion, simply stated it wasn't possible. If someone asked me, I would say, "the doctor said I can't have children" because it cuts to the chase in a semi-uncomfortable topic.
posted by marimeko at 9:48 AM on November 15, 2013 [1 favorite]
posted by marimeko at 9:48 AM on November 15, 2013 [1 favorite]
My aunt was told she can't have children because she has endometriosis and she can't. She tried an expensive procedure once or twice to conceive, but it didn't take and there was no assurance that it ever would. So she and my uncle just made peace with living without kids. Now she has past child-bearing age and never got pregnant. So doctors do say this, and sometimes they are correct.
posted by AppleTurnover at 10:57 AM on November 15, 2013 [2 favorites]
posted by AppleTurnover at 10:57 AM on November 15, 2013 [2 favorites]
My story: doctors told us it was very likely impossible to conceive and they were absolutely right.
"We can't conceive," was met with way too much extra questioning and way too many anecdotes and suggestions from friends and family. You could say it's a very touchy subject for me. We left friends behind because of it. While we grieved, we got next to no support.
So yes, our doctors said it to us -- it was both of us, oddly enough.
It was sad news with a very happy ending. Our most awesome kids were adopted. Everything comes as it should, but the journey is different for everyone.
posted by mamabear at 11:24 AM on November 15, 2013 [4 favorites]
"We can't conceive," was met with way too much extra questioning and way too many anecdotes and suggestions from friends and family. You could say it's a very touchy subject for me. We left friends behind because of it. While we grieved, we got next to no support.
So yes, our doctors said it to us -- it was both of us, oddly enough.
It was sad news with a very happy ending. Our most awesome kids were adopted. Everything comes as it should, but the journey is different for everyone.
posted by mamabear at 11:24 AM on November 15, 2013 [4 favorites]
I don't recall whether I was told I would not, or whether I was told it was a very, very unlikely chance. I believe it was the latter.
But I find your followup interesting in that most doctors assume women DO want kids until told otherwise (and then sometimes after). My doc was immensely relieved that we were not having a very emotional disappointing conversation once I basically said "yay" in response.
posted by pixiecrinkle at 11:50 AM on November 15, 2013 [1 favorite]
But I find your followup interesting in that most doctors assume women DO want kids until told otherwise (and then sometimes after). My doc was immensely relieved that we were not having a very emotional disappointing conversation once I basically said "yay" in response.
posted by pixiecrinkle at 11:50 AM on November 15, 2013 [1 favorite]
Some doctors screw up - but keep in mind when someone tells you their doctor said "X", one round of the Phone Game has already occurred. Maybe their doctor said, "It's very unlikely - less than a 10% chance."
Additionally, to some people who are effectively math-illiterate (like an ex-girlfriend of mine), they quite literally think "It's very unlikely - less than a 10% chance" is the same thing as saying "It's impossible." So, she and her husband skipped birth control, and - she told me fully expecting me to be utterly shocked, SHOCKED I SAY! - got pregnant. Twice.
Most non=med-staff people really aren't good at relaying medical messages second-hand.
posted by IAmBroom at 11:58 AM on November 15, 2013
Additionally, to some people who are effectively math-illiterate (like an ex-girlfriend of mine), they quite literally think "It's very unlikely - less than a 10% chance" is the same thing as saying "It's impossible." So, she and her husband skipped birth control, and - she told me fully expecting me to be utterly shocked, SHOCKED I SAY! - got pregnant. Twice.
Most non=med-staff people really aren't good at relaying medical messages second-hand.
posted by IAmBroom at 11:58 AM on November 15, 2013
My doctor told me it was "unlikely" I would get pregnant without intervention, and that it was "possible" that even if I did, I would not be able to carry a pregnancy to term. She was wrong on the first count but so far she was right on the second part. She was so surprised when I turned up pregnant that I knew she hadn't given me bad news without really believing it. Why was she wrong? Who knows. People's bodies are weird.
I certainly took her words as "you can never have children" and stopped both trying to conceive and taking precautions to prevent it. The devastating impact of this kind of diagnosis and the wearing-down of months or years of trying to conceive without success leave you looking for SOME kind of definitive answer, even if it's not a good one.
posted by peanut_mcgillicuty at 12:08 PM on November 15, 2013
I certainly took her words as "you can never have children" and stopped both trying to conceive and taking precautions to prevent it. The devastating impact of this kind of diagnosis and the wearing-down of months or years of trying to conceive without success leave you looking for SOME kind of definitive answer, even if it's not a good one.
posted by peanut_mcgillicuty at 12:08 PM on November 15, 2013
I've actually had a doctor who hadn't even examined me yet and hadn't bothered to find out whether or not I cared about children tell me, "You know you probably won't be able to have kids, right?" But he was a dick and I was fortunate to be well-informed enough to not take him at his word and also immediately find another doctor. In my life he's been the exception and not the rule, though, and like everyone else has already said, it's much more common to hear doctors speak in terms of probability than absolutes.
posted by rhiannonstone at 12:27 PM on November 15, 2013 [1 favorite]
posted by rhiannonstone at 12:27 PM on November 15, 2013 [1 favorite]
Happened to my parents about 8 years before they had me. I gather I was quite the little surprise.
posted by fshgrl at 1:43 PM on November 15, 2013
posted by fshgrl at 1:43 PM on November 15, 2013
I know one couple who were told they could not have children and were childless for a few years and then after prayer....well, now they have seven or eight.
posted by St. Alia of the Bunnies at 5:41 PM on November 15, 2013 [1 favorite]
posted by St. Alia of the Bunnies at 5:41 PM on November 15, 2013 [1 favorite]
A doctor told both my parents this. About 10 years of unprotected sex later, I showed up, and no more pregnancies after me. So the doctor was right for a very long time.
posted by Ashlyth at 7:45 PM on November 15, 2013
posted by Ashlyth at 7:45 PM on November 15, 2013
Your phrasing of the question "do doctors actually tell their patients…" or "do they still do this?" suggests that you feel such pronouncements are outdated with our modern medical technology. If only that were the case. Although advances in medicine have allowed many types of infertility to become treatable, we still don't have solutions to every problem.
Take as one example Mayer Rokitansky Kuster Hauser syndrome. In this rare genetic condition, women have a missing or malformed uterus and vagina. As yet, there is no treatment that could allow someone born without a uterus to carry a child, although (as the link notes) having genetic children could be possible via IVF and surrogacy. A doctor who suggested to a patient with this condition that she might be able to carry a child to term would be irresponsible at best.
posted by treehorn+bunny at 8:37 PM on November 15, 2013
Take as one example Mayer Rokitansky Kuster Hauser syndrome. In this rare genetic condition, women have a missing or malformed uterus and vagina. As yet, there is no treatment that could allow someone born without a uterus to carry a child, although (as the link notes) having genetic children could be possible via IVF and surrogacy. A doctor who suggested to a patient with this condition that she might be able to carry a child to term would be irresponsible at best.
posted by treehorn+bunny at 8:37 PM on November 15, 2013
First of all, I have PCOS. It sounds like you or someone you know may also have it. My heart goes out to you/them if that is the case.
The answer is a resounding "YES." I've met plenty of 'soul cysters' on the support board of the same name who've been told this very lie, only to fall pregnant down the road.
Doctors aren't the absolute authorities on everything involving the body. In fact, all of them learn something new every day. They're just human beings. Quite a few of them miss important symptoms and fail to do their jobs properly. They also often make generalized, sweeping statements like 'you'll never have children' that can lead to heartache for their patients or missed diagnosis's that could have saved their patient's lives. They're flawed and can at times be incredibly arrogant and foolish.
I went 18 years with my 'family' primary care physician without her catching on to the fact that I had PCOS- even when I presented her with all of my strange symptoms throughout the years. Her solution was birth control. In other words, she was a bit incompetent and figured she'd just throw some pills at me to 'fix' my 'somewhat common' irregular period 'thing.' That's some expert on the human body!
I actually diagnosed myself. When I was 18 and left home, I set out to figure 'it' out for myself. I knew something wasn't right with my hormones and my body. After googling all of my symptoms and reading a few books, I walked into a private gyno practice and announced that I had PCOS and was there for treatment options. The gyno looked at me arrogantly and asked me if I had been diagnosed, and I told her that I had diagnosed myself. She laughed, thinking, I'm sure, "What a silly ignorant non-doctor," and sure enough, after I forced her to do an internal ultrasound she confirmed that I did indeed have it. Then she proceeded to act like it was her bright idea the entire time and that she'd figured it out. Needless to say I think most doctors are incompetent.
Get a second opinion, see a specialist, do your own research. Take control. Be an advocate for your health. Most doctors will disappoint. But there are a handful of amazing ones. That's my two cents.
posted by OneHermit at 5:06 AM on November 16, 2013
The answer is a resounding "YES." I've met plenty of 'soul cysters' on the support board of the same name who've been told this very lie, only to fall pregnant down the road.
Doctors aren't the absolute authorities on everything involving the body. In fact, all of them learn something new every day. They're just human beings. Quite a few of them miss important symptoms and fail to do their jobs properly. They also often make generalized, sweeping statements like 'you'll never have children' that can lead to heartache for their patients or missed diagnosis's that could have saved their patient's lives. They're flawed and can at times be incredibly arrogant and foolish.
I went 18 years with my 'family' primary care physician without her catching on to the fact that I had PCOS- even when I presented her with all of my strange symptoms throughout the years. Her solution was birth control. In other words, she was a bit incompetent and figured she'd just throw some pills at me to 'fix' my 'somewhat common' irregular period 'thing.' That's some expert on the human body!
I actually diagnosed myself. When I was 18 and left home, I set out to figure 'it' out for myself. I knew something wasn't right with my hormones and my body. After googling all of my symptoms and reading a few books, I walked into a private gyno practice and announced that I had PCOS and was there for treatment options. The gyno looked at me arrogantly and asked me if I had been diagnosed, and I told her that I had diagnosed myself. She laughed, thinking, I'm sure, "What a silly ignorant non-doctor," and sure enough, after I forced her to do an internal ultrasound she confirmed that I did indeed have it. Then she proceeded to act like it was her bright idea the entire time and that she'd figured it out. Needless to say I think most doctors are incompetent.
Get a second opinion, see a specialist, do your own research. Take control. Be an advocate for your health. Most doctors will disappoint. But there are a handful of amazing ones. That's my two cents.
posted by OneHermit at 5:06 AM on November 16, 2013
I was born 9 years after my closest sibling. My parents had been told that they would have no more children, and they accepted that. They did no interventions, just continued to not use birth control. Doctors are people, and people are fallible.
posted by 41swans at 12:27 PM on November 16, 2013
posted by 41swans at 12:27 PM on November 16, 2013
Invariably, it was older (50+), male gynaecologists who told me that I would not be able to have children - three of them, by the time I was 25. One based that assessment on the PCOS diagnosis and my ovarian ultrasounds alone; he told me his conclusion was that I could not get pregnant without medical intervention.
The two others told me that based on the PCOS and a number of other factors, I would never carry a child to term; one of them was the attending doctor during my first miscarriage. I have one of these statements in writing as part of my medical record. I've also had a couple of nurses talk about how I would never have children, as part of their expressions of sympathy. (I remember these because I also remember their reactions when I said it was okay, I don't want kids!)
Other (better) gynaecologists have told me that my bearing children is unlikely, and taken the time to explain that the combination of factors affect the likelihood of my being able to sustain a full-term pregnancy. They have also noted that it's still possible for me to get pregnant, and advised contraception.
Perhaps the older male docs were simplifying things because I was young & female; certainly at least one of them stands out in my memory as a patronising git whose methods and beliefs were outdated. As I've become more assertive and empowered myself as a patient, I've tended to receive more detailed explanations (and ask if I didn't get them!) and less black & white statements. However, I consider it entirely plausible for doctors to say such things; it's just that these days I'd be less likely to stand for it without question.
posted by Someone Else's Story at 3:27 PM on November 16, 2013 [1 favorite]
The two others told me that based on the PCOS and a number of other factors, I would never carry a child to term; one of them was the attending doctor during my first miscarriage. I have one of these statements in writing as part of my medical record. I've also had a couple of nurses talk about how I would never have children, as part of their expressions of sympathy. (I remember these because I also remember their reactions when I said it was okay, I don't want kids!)
Other (better) gynaecologists have told me that my bearing children is unlikely, and taken the time to explain that the combination of factors affect the likelihood of my being able to sustain a full-term pregnancy. They have also noted that it's still possible for me to get pregnant, and advised contraception.
Perhaps the older male docs were simplifying things because I was young & female; certainly at least one of them stands out in my memory as a patronising git whose methods and beliefs were outdated. As I've become more assertive and empowered myself as a patient, I've tended to receive more detailed explanations (and ask if I didn't get them!) and less black & white statements. However, I consider it entirely plausible for doctors to say such things; it's just that these days I'd be less likely to stand for it without question.
posted by Someone Else's Story at 3:27 PM on November 16, 2013 [1 favorite]
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That said, I think a lot of patients take qualified phrases and turn them into absolutes in their memory. So, for example, it's very common for a doctor to say something like "It's unlikely that you will be able to conceive without intervention," or, "Your likelihood of conceiving naturally is X%", or whatever, and if it sounds dire enough, it becomes "I can't have kids."
posted by telegraph at 6:42 AM on November 15, 2013 [9 favorites]