Separation of church and medical care?

May 13, 2007 7:34 AM

The school nurse called my best friend a slut! Well, not exactly, but darn close.

My (24 yo) best friend attends a large public state university in Kentucky. She recently went to the campus health clinic to get some birth control pills, and the nurse taking her history asked how many sexual partners she'd had. The answer was ten, and the nurse immediately grabbed my friend's hand and said "oh, honey, if you ever need someone to talk to, I'm here for you. Having that many sexual partners usually means there's a problem in here (indicating her heart)"
My friend was outraged and insulted, and upon completing her appointment, immediately asked to speak to the director of the health clinic. The director said she didn't see the problem and that she agreed with the nurse, that ten sexual partners at the age of 24 was unhealthy from a physical standpoint-and from a moral standpoint, ten sexual partners at any age was unconscionable.
This is a public school, not a religious school. My friend wants to know if the nurse broke any laws or any medical code of ethics with her moralizing, and where she should take her complaint next (school newspaper? university president? My friend is not afraid of publicity, she doesn't care who knows how many people she's had sex with).

posted by Wroksie to law & government (68 comments total)

I don't see any laws or ethical codes broken there... Writing something to the school newspaper is probably a decent idea, but don't expect a whole lot to come of it. The freedom to express outrage in a newspaper over apparent moral judgments is the same freedom that allows the nurse to make those moral judgments in the first place.

Unless the nurse refused to treat your friend, or failed to keep her medical information confidential, there's nothing that she's done wrong in a substantive sense.

Reflexive outrage probably would accomplish little here. You friend should just go on living her life as she sees fit, and not care what others think.
posted by modernnomad at 7:51 AM on May 13, 2007 [1 favorite]

Sorry, not feeling any outrage here. The nurse didn't bring up church, she wasn't passing out pamphlets for Abstinence only groups. Instead, she has a moral code that makes her feel that someone who has multiple partners has emotional problems. At least she didn't call her a sinner and suggest she was going to hell.

Can you both accept the fact that she was trying to be helpful? That she's probably had numerous young girls who've been victims of rape and abuse come through her doors and she was reaching out in case your friend was also a victim of abuse.

I'm more concerned with the director's viewpoint that ten sexual partners at any age is unconscionable. If you need to direct your energy somewhere, I'd spend some time making sure that your school clinic is making birth control, emergency birth control, and abortion counseling available. The director's views may be trickling down to the everyday care that other women are receiving there.
posted by saffry at 7:53 AM on May 13, 2007 [2 favorites]

I'm not too sure what sort of legal leg she has to stand on. Publicity would probably lead the clinic to deny (at worst) or "discipline" (at best) the nurse in charge.

In effect I believe they would argue the nurse/director have the right and freedom to express an opinion.

My $0.02 would go towards saying tell her to forget it and go on living her life as she pleases.
posted by gadha at 7:55 AM on May 13, 2007

I experienced something very similar when I was in college (STDs + multiple partners = much eye rolling at health services) as did many of my female friends. While I think it's unprofessional of the school nurse, I don't think it's terribly unusual. Your friend is normal and the school nurse telling her she isn't reflects more poorly on the school nurse than on your friend.

If she wants, a strongly worded letter to the school paper might help her vent a little, but she does risk opening herself up to the ire of people who come at the issue from the same direction as the school nurse. I don't even get why your friend thinks there is a religious aspect to this; lots of people get moralistic about other people's sex lives without necessarily coming at it from a religious perspective.
posted by jessamyn at 8:00 AM on May 13, 2007

Wow. For what it's worth I find that incredibly offensive, and if you have any recourse I would definitely pursue it.

Most of the replies you'll get here will be from men, who may not really understand what it is like to be on the receiving end of this kind of judgement. It's not right and she shouldn't just pretend it's okay.
posted by loiseau at 8:01 AM on May 13, 2007

I think it is a problem when medical professionals respond like this. For one thing, getting a response like this can make someone uncomfortable about telling the truth to the nurse or doctor the next time ("How many sexual partners have you had?" "Um...three?") which can compromise care. The nurse can have any opinion she wants, but she ought to have just said, "OK," and written down "10" on her little chart. If the nurse was concerned, she could have asked an open-ended question inviting the patient to talk about any discomfort she had about her sexual activity: "Are you comfortable with your level of sexual activity? Do you feel safe with your partners?"

IANAD, but a friend who is says that doctors need to be able to hear anything without strong reactions, in order for patients to be able to be completely honest and get the appropriate care. I don't know how actionable a nurse's failure to behave appropriately is, but I would consider at least a follow-up letter explaining how these kinds of reactions can compromise care.
posted by not that girl at 8:02 AM on May 13, 2007 [15 favorites]

Loiseau, nobody is saying it's not offensive. What was said was that despite it being offensive, it's not illegal. So please spare us the plaintive whine of "anyone who's not advocating lawsuits must be a man and therefore incapable of understanding."
posted by modernnomad at 8:06 AM on May 13, 2007 [6 favorites]

I suggest you do what I did when I went to Bellevue's emergency room to get treated for what I knew was mononucleosis, only to have the doctor try to convince me that it was probably actually HIV: you never go back there, and you warn your likeminded friends not to go back there, but otherwise move on with your life with a reinforced perspective as to how incredibly ignorant people can be in sensitive moments.

In other words, treat it like a particularly bad customer service experience. If you're the sort that explodes these sorts of experiences into as big a deal as possible, that's a perfectly valid reaction, but know that you've basically learned the lesson already (not to go there) and can pretty much leave it at that.
posted by hermitosis at 8:09 AM on May 13, 2007

I would be angry, as well, and I would consider pursuing that anger simply because the director of the clinic at a state-funded clinic at a state-funded school is allowing religion-based morality influence patient interactions. I shudder to think what would happen if a young woman came in asking for, say, a referral to an abortion provider, or even the morning-after pill. The nurse was out of line. Your friend sounds quite brave, and I think she should write to the school newspaper about what happened and encourage other students to go to the local Planned Parenthood (if there is one) or local county health department for their sexual health needs instead of the campus clinic. I don't know how their funding works, but if it's based in any way on the number of patients they serve, losing a significant number of them could cause them financial problems that might make them change their tune.
posted by cilantro at 8:09 AM on May 13, 2007 [1 favorite]

Well, I'm a guy, and I find that outrageous. A health professional has no business judging you on a moral basis.
posted by Malor at 8:10 AM on May 13, 2007

I tend to agree with the nurse.

I agree that the nurse may have been out of line in her professional role by saying so.

I also think there is a possibility the nurse was acting out of genuine compassion, not judgment.

She could certainly complain to the the school, and the nurse may be told "Well, you are the nurse, not their friend or counselor, so knock it off." And that's about it.
posted by The Deej at 8:11 AM on May 13, 2007

"oh, honey, if you ever need someone to talk to, I'm here for you. Having that many sexual partners usually means there's a problem in here (indicating her heart)"

Should the nurse be allowed tell people who've only slept with 5 people: "Oh, sweetie, if you ever need to talk to someone, I'm here. Having only had 5 sex partners usually means there's something wrong with you."

IANAL, but to me this doesn't seem to be a matter of opinion, it's a presented as statement which can be verified or not. I have no statistics to point to, but I'd wager that a large sample of people with 10+ sex partners would show no greater percentage of people with emotional problems than a large sample of people with less than 10 sex partners. Are medical professionals allowed to say things that aren't true?
posted by 23skidoo at 8:13 AM on May 13, 2007

Can you both accept the fact that she was trying to be helpful? That she's probably had numerous young girls who've been victims of rape and abuse come through her doors and she was reaching out in case your friend was also a victim of abuse.

Why is the fact that she's had ten sexual partners any more suggestive of abuse, than if she'd had three, or if she'd had one? If anything, more sexual partners could be considered a sign that she is "comfortable with her sexuality" (I hate that phrase, but it seems to fit here).

There are several things offensive about this:
(1) The fact that the medical professionals switched into "judgment mode" concerning your friend's sexuality, when there was no sign that her number of sexual partners had had any deleterious impact on her health. (I say that, to contrast this with doctors who justifiably caution patients about smoking, drinking, or obesity.)
(2) The fact that the medical professionals' understanding of sexuality seems to be stuck in the nineteen-fifties. That should give your friend pause.
(3) The fact that, when aware of your friend's outrage, the doctor apparently made no apology.
(4) The fact that these people are working at a large state university (not a religious school) where there are likely a lot of men and women who have had numerous partners.
posted by jayder at 8:14 AM on May 13, 2007

Jessamyn - the reason I assumed that this was religious moralizing (and this part was my assumption, and not my friend's), as opposed to the non-religious kind, is because I attended the same university and even grew up in the small town where's it's located. It's Jesus-central. There are at least a hundred churches in a county of less than 20,000 people. The whole county was completely dry until 2001. I would bet my life that a middle-aged nurse in that town who is morally opposed to someone's sex life is morally opposed to that sex life because she is a born-again Christian. But there is, I suppose, a teeny-tiny chance that she's just a jerk, in general, and it has nothing to do with Jesus
posted by Wroksie at 8:23 AM on May 13, 2007

The idea that having averaged less than two sex partners a year since becoming sexually active (assuming she did so in her late teens) is in any way unconscionable, is itself unconscionable. Where is a college woman supposed to find a college man who is interested in a serious long-term relationship? I'm generalizing, but a lot of college guys are looking to have as much sex as possible with as many different women as possible. I'd say an average of several months is quite good for a college relationship.

Of course, if your friend had been a man, chances are the nurse would have simply rolled her eyes, muttered something about how boys will be boys, and given her a prescription, even if he'd had fifty partners.

There is a simple solution to this problem: get the hell out of Kentucky as soon as possible.
posted by kindall at 8:23 AM on May 13, 2007 [1 favorite]

Nothing is more offensive to me than when medical professionals pull these shenanigans and prescribe their own morality.

I agree 100% with cilantro; a few letters to the campus newspaper and the campus administration are in order.
posted by porn in the woods at 8:26 AM on May 13, 2007

any medical professional dealing with sexually active adults should know better than to morally judge people seeking HEALTH advice and not SPIRITUAL advice.

as mentiones, they not only potentially compromise that person's healthcare, but also scare off others who may need help but don't want to be embarrassed or shamed.

i would be outraged and write a letter of complaint to the medical licensing board of that state.
posted by wayward vagabond at 8:35 AM on May 13, 2007

Hermitosis, don't you think it might be a little difficult to "not go back there" if you're a student depending on the (usually free) health care provided to students by the university?

I think the nurse was well-meaning, but out of line. This is in the buckle of the Bible-belt...she probably thought she was doing the girl a favor by not couching her words in religious terms.

The administrator was also out of line...he hadn't even examined her. Once again, his words were also probably well-meant.

The fact is, neither opinion said anything about her medical condition. A letter to the editor or anyone else probably won't do any good in such an atmosphere. A federal lawsuit, perhaps yes...if any medical or human-rights violations occurred, which in my layman's opinion weren't.
posted by lhauser at 8:36 AM on May 13, 2007

If it's Jesus-central, why are you so surprised, even if it's a public school? Is this just pent-up frustration?
posted by smackfu at 8:38 AM on May 13, 2007

I think it was unprofessional and perhaps outdated, but it sounds like the nurse was trying to be helpful in the way, misguided as it might have been, she knew how. Can your friend look at it that way instead of being angry? It seems like she was actually trying to be kind.
posted by walla at 8:50 AM on May 13, 2007

I can't help you with the outrage but my advice is: never answer that question again. It's nobody's business but your own. I get asked all the time and I just say, 'None of your business' or 'Fuck off' or 'Only an insecured bastard would count' or whatever. Never give a number--no one asks that question without the intention of judging you--not health professionals, lovers, friends. Keep it to yourself.
posted by dobbs at 8:52 AM on May 13, 2007 [1 favorite]

Well, if you go to an uber-liberal college, they'll basically accuse you of lying if you tell them you're a virgin, so you can't win either way.

("Denies ever having sex" was the exact phrase written in my file, if I recall correctly.)
posted by Lucinda at 8:52 AM on May 13, 2007 [3 favorites]

insecure
posted by dobbs at 8:52 AM on May 13, 2007

She recently went to the campus health clinic to get some birth control pills, and the nurse taking her history asked how many sexual partners she'd had.

Perhaps a dumb question, but why does the nurse even need to know how many partners she's had?

And woulda polite "That's personal information" head this off at the pass?
posted by Brandon Blatcher at 8:53 AM on May 13, 2007

For whatever its worth, I (a male) had a similar experience when I went in for a check-up a few years ago. In the course of conversation I told the doctor I was soon to be moving to another city to live with my girlfriend (now wife), only to be given a stern lecture about the evils of cohabitation before marriage. I found it annoying, and never did go to that doctor again, which seemed to me the logical course of action to take under the circumstances.

I can easily see why your friend was offended (the nurse, if anything, should have kept her concern limited to whatever health risks are associated with being sexually active with multiple partners), but I'm not sure I see some great reason she (your friend) needs to "Do Something" about it. Chalk it up to the "you get what you pay for" file and move on. The more time your friend spends obsessing about this is the more time she's letting this nurse rent space in her head. Let it go as the ignorant comment of an uncouth woman.
posted by The Gooch at 9:01 AM on May 13, 2007

I think a "Wait, does my dad count?" would be a great way to head this off at the pass.

It wasn't illegal. However, it was more than a jerky move. When a healthcare professional issues a lifestyle judgment of this nature, it harms doctor-patient relationships everywhere. One of the reasons that people tend not to seek treatment for STDs, sexual dysfunction, and so forth, is precisely this kind of attitude. It's only a short hop from here to the "I won't give you the morning after pill, it's murder!" kind of histrionics.

Healthcare professionals are the automotive mechanics of the human body (and they've cheerfully made it that way). I wouldn't tolerate this kind of crap from my car mechanic ("Oh, so you drive to Tuscon, hunh?"), a nurse shouldn't get away with it, either.
posted by adipocere at 9:02 AM on May 13, 2007

This sounds shitty and unprofessional.

However, when the question is asked a different way (How many partners have you had in the past 6 months?) it's a standard part of the algorithm for assessing relative risk of contracting STDs. That is an important part of dispensing sexual health care to sexually active young adults. It's not judgmental to have a discussion about sexual safety with someone who has come to your clinic for reproductive services if they say they've had five partners in six months.

(And "denies" is standard medical notation for patient self-report of anything. It does not imply disbelief.)
posted by OmieWise at 9:06 AM on May 13, 2007

While it's unlikely a legal issue, it most certainly is an ethical issue. Establishing a precedent that any woman who comes in for birth control pills -- that is, takes responsibility for her reproductive life -- is going to get lectured by the nurse for having sex is a large obstacle to ask women to face, especially if the school's in a heavily religious area, where women are likely getting the same public, out-loud judgments stuck on them all the time.

It discourages the most at-risk students from getting effective birth control and from getting medical care. "Do no harm" is not being followed in any way here; these sorts of judgments do active harm.

I'd write to... probably anyone who would listen. The campus paper. Various local or national feminist groups to get a letter-writing campaign going from whomever picks it up. I'd keep the religion aspect out of it, just focus on the harm it does when women assume their morality will be called into question simply for seeking health care. (And Planned Parenthood, when I was volunteering there, really had that as one of their main tenets, that women should be able to seek comprehensive health care without worry of being judged or given misinformation. Maybe contacting someone in PR or media relations at your local clinic and seeing if they have any ideas?)
posted by occhiblu at 9:09 AM on May 13, 2007 [2 favorites]

It's only a short hop from here to the "I won't give you the morning after pill, it's murder!" kind of histrionics.

This happened to my girlfriend and I when I was a freshman in college. My condom broke and we went to see the morning after pill to avoid pregnancy. I was quite the struggle and the nurse that ultimately gave my girlfriend the pills gave her a disgusting lecture on her loose morals and the religious origin of life.

What we did was keep working up the ladder at the hospital until we reached someone that was sympathetic, or at least agreed that it was unprofessional. My girlfriend got an apology from the nurse and that was that. I know your friend went above the nurse, but is there anyone farther up the chain to complain to?
posted by Falconetti at 9:13 AM on May 13, 2007

Well, if you go to an uber-liberal college, they'll basically accuse you of lying if you tell them you're a virgin, so you can't win either way.
Reminds me of college when the nurses attributed everything to being hung over, even if I didn't drink at the time.

I would also go the newspaper route. I dunno about yours, but out college newspaper fed off stuff like this. It also gave the staff something for a week or so to put in the comments section.
Also, calmly tell them I'm not answering that question in the future. After all, who would have known the nurse would respond how she did?

And I don't get the spiteful responses advocated here where a few gentle words would suffice. They really won't solve anything. If anything, it'll piss off the nurse (you can be sure she'll bitch to other people about what you said) which will be more detrimental to the health care you receive than any question they might ask. And if you're like most college students, you'll have to go back to the same clinic due to the cheap/free care you receive.
posted by jmd82 at 9:14 AM on May 13, 2007

(And "denies" is standard medical notation for patient self-report of anything. It does not imply disbelief.)
posted by OmieWise

I can confirm that. I just saw my own medical record lately in the course of treating an injury, and was immediately taken aback at the phrase "denies being a smoker." Then I realized, yes, all they can do is report what I say. Although I have seen other records which just record it as "non-smoker."

Reading your own medical record can be unnerving, because the doctor records his/her impression as soon as you walk in. Of course, everyone else makes immediate judgments as well, but they don't usually put them in writing!
posted by The Deej at 9:18 AM on May 13, 2007

Did she get her prescription?

If not, then lawyer up.

Otherwise grow a thicker skin or move somewhere that has more like minded people.

The director sounds like a dick, but that alone isn't illegal. If you presented the problem as you did here (with one well-meaning, if misguided sentence from the nurse and a whole lot of attitude) I'm sure he just wanted you out of his office, or was provoked by your outrage to give you something to really bitch about.

I'm sorry you're 24 and still getting bent out of shape by words. Move on. Be happy. Fuck.
posted by Ookseer at 9:27 AM on May 13, 2007 [1 favorite]

a large public state university in Kentucky

ITS KENTUCKY! What do you expect?

Alright thats the easy answer.

The legal answer (IANAL, btw) flows like this:

1. The nurse is (possibly, depending on the relationship the clinic has with the school) a state actor.

2. The Supreme Court decided long ago that that the government can not interfere with the distribution of contraceptives.

3. If this went to court your friend's lawyer would have to persuade the court that this nurse was creating an environment which prevented your friend from exercising her right to obtain reproductive services (in this case, birth control.) And that the state, via the nurse, was responsible for building this barrier.

Its a stretch to say the least whether your friend has any standing (proof of damage.) She could argue that she was so hurt and offended that she felt that she could never return to that clinic again for reproductive services... but thats a stretch.

Being offended is not sufficient legal standing and it sounds like your friend wasn't denied birth control... so basically it sounds like the nurse did nothing illegal per se.

Are there ethical questions? Sure. But that doesn't mean squat. Kentucky is a conservative state. The community sets its own standards for ethics, norms, and mores. In this case the burden of ethics is on your promiscuous (and I mean that strictly in a non-judgmental, technical sense) friend, not the community.

Your friend and her ten previous sexual partners are outside the "norm" for the region where she is attending school. This is a fact which your friend will have to accept with the knowledge that as long as she continues to have plurality of sexual partners in a region where doing so is taboo she will continue to occasionally run into resistance to her... ahem... "fun loving" nature.
posted by wfrgms at 9:40 AM on May 13, 2007

To me, 10 partners by 24 could be percieved as high (especially by older generations) but it also seems like the nurse was doing her job - maybe not very elegantly but she was offering support. Having 10 sexual partners at that age could be indicitive of emotional problems or it could be indicitive of a casual attitude to sex, which is fine but how would you feel if your friend had cold/flu like symptoms and the nurse told her to have a lemsip - when it could in fact be meningitus.
I really dont think the nurse meant any harm or was being judgemental, she perhaps just needs a few lessons in tact.

I do agree the director was out of line and a complete asshat. Saying 10 is too many in a lifetime is pushing it a little.
posted by missmagenta at 9:48 AM on May 13, 2007

How many partners have you had in the past 6 months?

Hmmm...maybe that was the question the nurse thought she was asking? 10 sexual partners in 6 months would be an awful lot.

But seriously: this was assholeish behavior on the nurse's part, but responding with legal action or public anger is also a bit assholeish. Give the nurse a little of the old "other cheek" medicine. Have the woman go to the nurse and say something along the lines of:

I appreciate the sentiment of what you were saying the other day [even if you don't], but I don't like what it suggested or implied. I felt like you were judging me and it made me feel less comfortable about coming to this clinic in the future, and made me feel that it isn't safe to be open and honest with you about any personal issues that might come up. I'm sure I'm not the only one who feels this way, and you should keep this in mind if you want to have a clinic that is open and useful to the students at this college.

If you frame this as a separation of church and state issue, and make this into a battle of issues, it will only cement in her mind (and of those who are likeminded) attitudes about those who are different. If you frame it in terms of "here's how I was upset by this behavior and here's how it may negatively affect your relationship with the students" then she may be more receptive.
posted by Deathalicious at 10:05 AM on May 13, 2007 [1 favorite]

I'm really flabbergasted at some of these answers. The girl is 24!! Assuming she waited as late as 19 to start having sex, that means she only had 2 sex partners per year! If that qualifies as slutty in someone's book that person is living on a different planet than I am.

And for those who say the nurse was just being a jerk, she was, but she was also creating an atmosphere that could lead other women to avoid care when they need it.

I would suggest getting involved at your local Planned Parenthood or other organization devoted to the sexual well-being of students. You may not be able to do anything about the campus health office, but you could create an atmosphere of openness that will let other women on campus know that if they're ever denied care because of something like this they have other options.
posted by MsMolly at 10:18 AM on May 13, 2007 [1 favorite]

Yes, the judgment of too many sexual partners by the nurse is certainly unprofessional and unsettling. But what is really more disturbing is she implied your friend had some kind of psychological disorder (i.e. "problems in [the heart]") where no codified indicator was present. That is what is called malpractice these days.
posted by dendrite at 10:38 AM on May 13, 2007

10 sexual partners in 6 months would be an awful lot.

Um, no, one hookup every two and a half weeks hardly seems to qualify as "an awful lot." Hell, if they were all healthy, fun, respectful and mutually casual encounters, I'd say it would be downright enviable.
posted by poweredbybeard at 10:43 AM on May 13, 2007 [1 favorite]

University of Kentucky, right? If so, I go there:

She should go to Women's Place in Frazee hall. Also, email Carrie Bass at the UK Feminist Alliance. They will know what to do.
posted by phrontist at 11:01 AM on May 13, 2007 [1 favorite]

ITS KENTUCKY! What do you expect?

Lexington and Louisville (the only two towns with big state universities) are both pretty liberal (by middle american standards) actually. We've got ample wingnuts on either side.
posted by phrontist at 11:04 AM on May 13, 2007

You're right, that was completely out-of-line.
But there isn't anything worth doing about it, ASSUMING that the moralizing is in addition to rather than in lieu of the services she went there to get.

Imagine being that nurse. Imagine being her, living the life she thinks a person should live. Do you want that? No? Then who cares what she says?
posted by Methylviolet at 11:10 AM on May 13, 2007

The nurse's response is so inappropriate as to border on malpractice. It doesn't matter how many sex partners the woman had or what the nurse or anyone else thinks of it; delivering a judgmental opinion is not an appropriate part of health care under any circumstances.

In addition, unless the nurse is certified to deliver psychologic counseling, she has made an offer ("oh, honey, if you ever need someone to talk to, I'm here for you") to deliver care that is well outside her scope of practice.

The campus health practice may have a patient relations or risk management department that would be responsive to these valid concerns. If not, I suggest at least filing a complaint with the state boards that certified the nurse and the medical director as fit to practice.

You might also pursue legal action, but with the current shortage of medical care in Kentucky, plus the likelihood of finding an activist religious-right judge on the bench, that course would be likely a waste of time.
posted by ikkyu2 at 11:18 AM on May 13, 2007 [3 favorites]

i would write up on op-ed and submit it too your school paper
posted by Flood at 12:37 PM on May 13, 2007

University of Kentucky, right?

Can't be. Can't be UofL or EKU, either. Could be Morehead, Murray or Western, though.
posted by dilettante at 12:44 PM on May 13, 2007

I think the proper response should of been "Eight were women so they don't really count. Nobody's ever had a baby fist." I feel sorry for any girl who gets told she is a slut by this woman who isn't as confident in herself as your friend. I would write a letter of complaint or possibly see your dean of students. These people could be scaring off women who are in need of their services and that's not right.
posted by Foam Pants at 1:08 PM on May 13, 2007

It's Murray State University in Murray, Kentucky, for those who are wondering. (it's in the Western tip of Kentucky, quite close to the Tennessee border)
posted by Wroksie at 1:18 PM on May 13, 2007

I would have your friend write letters to the licensing boards that licensed both the nurse and the doctor she spoke to. Explain in unemotional, factual terms what happened, using the exact words spoken by the people in question wherever possible and explaining how she believes these people's actions were unprofessional and violated the guidelines and/or the breached the clinical relationship. If the medical center on campus has a director, you may want to send a copy of these letters to that director, just to let her/him know that you are reporting her/his staff for potential professional misconduct.

All of this can be done anonymously, although she should be aware that the doctors on campus do talk to one another, so they may already know who she is. This shouldn't, in an ideal world, lead doctors to treat her any differently the next time she seeks medical treatment, but doctors are only human, and they do get upset, so if you let the campus health center know that you have written letters to state medical boards, some people may be angry.

Then, I would try to forget it and move on. Because as sucky as this is, your friend probably doesn't want to get into a huge on-campus battle over this, and it probably wouldn't do any good anyway. If your friend is still feeling upset about this, I would urge her to channel her energies into activities that will help people whose lives are held hostage to these sorts of points of view or who have been sexually victimized. Join a group dedicated to safe, legal access to contraception and reproductive rights here in the US and around the world. Become a rape crisis counselor. You have a lot of positive energy here, and I think you can use it for something a lot more productive than writing letters to your college paper.
posted by decathecting at 1:34 PM on May 13, 2007

You have a lot of positive energy here, and I think you can use it for something a lot more productive than writing letters to your college paper.

But that's pretty much exactly what "joining a group dedicated to safe, legal access to contraception and reproductive rights here in the US" would entail -- working to raise awareness that (1) this kind of judgmental crap is happening, (2) that it's affecting the local population, and (3) that women shouldn't have to put up with it.

Wroksie's friend obviously has enough confidence to fight back. Other students on campus may not. By speaking up against students being treated in this way on her campus, Wroksie's friend shows other students who may not have that courage that it's ok to be angry about this type of treatment, and that this judgmental crap shouldn't keep them from seeking health care anyway. It's a way of letting the campus know that the fault lies with the campus health center, not with the women who the campus health center has labeled unworthy of proper medical care.

If this nurse has pulled this crap once, it's hugely likely she's pulled it other times. Raising awareness on campus that this is happening is helpful for all the other women who heard this from the nurse and decided that they weren't worthy of seeking birth control, or any health care, from anyone.
posted by occhiblu at 2:09 PM on May 13, 2007

does anyone under the age of 30 do intimacy? commitment? self respect? conversation? just how out of touch am I?

Nobody under the age of 25 knows what they want in a mate, although they think they do, so they are happy to go full steam ahead into physical intimacy only to find out a few months later that it's not going to work, so they break it off and try again with someone else. They are so sure they have figured it out this time that again, they go full steam ahead into physical intimacy... and the cycle repeats.

Part of growing up is figuring out what you really want. Part of figuring out what you really want is trying a bunch of different things and seeing which you like. This includes relationships with various kinds of people.

As I said earlier, getting a college-age male to stand in one place long enough to have any kind of monogamous relationship with him is something of an accomplishment in itself; one doesn't need to be berated for "only" having managed it for several months.

It is entirely possible that you are quite out of touch.
posted by kindall at 3:56 PM on May 13, 2007

I tend to agree with not that girl. Professionals (doctors, nurses, lawyers) are generally expected to keep personal reactions private.

It was inappropriate and borderline offensive. Not illegal, though.
posted by yclipse at 4:05 PM on May 13, 2007

I agree with the advice of sending straightforward letters to medical boards and the dean of students. The judgment from the nurse was way out of line and could point to problems with getting adequate care without turning students away on campus, and that the director not only agreed, but stated that it was too many for a lifetime is appalling. That's not the kind of medical clinic environment a state university should foster.

For people saying it was too many partners, I'd say I agree with kindall -- young people try several relationships before they find "the one". Finding a mate for life is like finding a career you love to do for the rest of your life. How many here have held a dozen or more jobs in several fields before they found the right one? I see little difference as long as people are being safe.
posted by mathowie at 5:10 PM on May 13, 2007

Meh, secks with lots of partners is, you know, kind of dangerous. Wouldn't you want the doctor to say "10 packs of cigarettes is a lot, you should get help" or "10 bucks a day on crack is a lot, you should get help" or, you know, something along the ounce of prevention pound of cure sort of line.

I don't think she was being judgemental nearly so much as she was sad for your friend in her heart. Maybe not her place, but she's a nurse---she's gotten to watch people be sick and die for years and years, normally from preventable things.

How many nasty sorostitues do you know who come to college w/ a dream and leave w/ Gonorrahea?

Now, with that said---it's not her *place* to do that, but IMO go find something else to be offended about, it's not like there's any shortage, at least in this case it was someone concerned with her wellbeing...I'd kind of prefer that to the cold shoulder, naproxen and condoms approach from the medical staff at my college.
posted by TomMelee at 6:54 PM on May 13, 2007

[a few comments removed, stop with the further derail or take it to metatalk]
posted by jessamyn at 7:43 PM on May 13, 2007

More like "10 packs of cigarettes in 6 years usually means there's a problem in your heart."

This nurse was out of line. You can say it's the cultural norm (and I certainly found that it was in Bloomington, IN) but you won't change the culture if you don't make some noise. I agree that she should write just about everyone people mentioned above.

I wish I had done that, now that I think about it. I just rolled my eyes. " And why is it that you feel you need to be having sex with your boyfriend?" Need? What's need got to do with anything? Thank god I grew up hippie!
posted by small_ruminant at 7:48 PM on May 13, 2007

"10 sexual partners in 6 months would be an awful lot. "

I've had that many in a week. This nurse would probably explode in a blinding red mist if she met me.

What isn't clear is what happened afterwards.. did she otherwise provide decent medical care? I hear people say silly things all the time. This *is* still America. People can still say things.
While it may have been offensive to your friend, unless it affected her medical care, I'd just leave it be after telling the nurse that her comment was hurtful. Sounds like she's already complained to the powers that be and nothing is going to come of it.
posted by drstein at 9:32 PM on May 13, 2007

It seems from looking at the medical board site, they aren't going to do much to help you. It looks like you can only file complaints on "serious" violations. I think you would have more luck if you complained to the university.
posted by hazyspring at 9:40 PM on May 13, 2007

Did she get her prescription?

If not, then lawyer up.

It wouldn't make any difference if she *hadn't* gotten her prescription. There's no law that says doctors have to prescribe birth control to everyone who is able to take it or even to anyone at all. They can deny you because they think you are too young or too old to be having sex or because you are or are not married. They don't have to have any reason. The recent discussion in the news has mostly been over pharmacists, not doctors.

It's completely outrageous, and it ought to be illegal, but it isn't.

It doesn't even clearly violate AMA ethics guidelines (although, again, it ought to). Here's a somewhat relevant example case.

I do think your friend should complain to any media outlet who will listen and also on up the ladder to whoever's in charge. Her goal should be to have the nurse and her superior fired and barred from practicing medicine. I doubt she'll get that, though.

The only way we can change this sort of patronizing attitude is to complain loudly when it happens and refuse to put up with it. Make a lot of noise.
posted by Violet Hour at 9:44 PM on May 13, 2007

I think that reporting it to a media outlet is, unfortunately, the fastest way to get labeled "SLUT" that I can possibly think of.

Just think of Bill O'Reilly getting the story:
Now get this folks, a 20 year old college girl at a PUBLIC university, one Firstname Lastname of SoandSo State University, is complaining that the school healthcare professionals unfairly judged her after her request for birth control for multiple partners..."

Shouldn't be like that, but I'm just sayin'---FOIA in this case will NOT be her friend.
posted by TomMelee at 4:41 AM on May 14, 2007

My friend wants to know if the nurse broke any laws or any medical code of ethics with her moralizing, and where she should take her complaint next (school newspaper? university president? My friend is not afraid of publicity, she doesn't care who knows how many people she's had sex with).

I don't know what this would accomplish. Do you think that the community in which you live would find the nurse's actions to be offensive?

Vent to your friends. Otherwise, as long as she provided you with your scrip, just consider yourself forewarned. Look at getting your prescriptions like going to the DMV.
posted by desuetude at 6:14 AM on May 14, 2007

Sounds like what the nurse said hit close to home for your friend. For some people, 10 partners ever is a lot, let alone 10 partners at 24. Is it possible your friend is mad because part of her, somewhere, thinks the nurse could have a point, or was reminded of things she was taught growing up? I think your friend should take these words and ponder why they made her so mad. If it was because the nurse hit a nerve, figure out why and deal with that issue. If it was just because the nurse is a moron, she should vent to friends, write it off, and forget about it.

My friend is not afraid of publicity, she doesn't care who knows how many people she's had sex with.

Well, she should. Didn't this episode show her that sometimes people judge people unfairly based on this kind of information? Tell your friend not to be rash and do something that could unfairly color others' perception of her for the rest of her life. Anger is fleeting, but Google is forever.
posted by ThePinkSuperhero at 7:17 AM on May 14, 2007 [1 favorite]

I think you friend should just let it go.
Coz the nurse didn't bring up the church or refused to treat her.
She just told that she's concerned about her.
She did something outside her duties, but I don't think it's unethical or illegal.
posted by WizKid at 9:34 AM on May 14, 2007

I think if your friend should go up the chain of the university first - is there a campus ombudsperson? Going straight to the papers is only going to make her look like an attention-seeking jackass if there are other avenues that she could pursue first.
posted by marginaliana at 9:39 AM on May 14, 2007

While it may have been offensive to your friend, unless it affected her medical care

How can a health care provider offend a patient and not have it affect her medical care, now?

Seriously. I'd like to know, because I have a number of patients I find somewhat annoying. Their behaviors aren't consistent with ensuring their own good health, as I see it! I'd love to put them in their place! But I don't; I try not to offend them because I don't believe that's a proper part of the caregiver-patient relationship.

If you can show me a way by which I can offend my patients freely and still not damage that relationship, I'll be eternally grateful! But you won't be able to. Because this kind of behavior is always inappropriate.
posted by ikkyu2 at 10:51 AM on May 14, 2007 [1 favorite]

[removed comment starting with "to pick a fight..." please take fights to email or metatalk.]
posted by jessamyn at 1:45 PM on May 14, 2007

I'm a bit strange, I suppose.

To me, it sounds like the nurse was being compassionate within her belief structure as a medical professional, and offering support if your friend felt she needed it - not saying 'go to church or burn in hell you slut'. A polite 'Thanks, but really, I'm okay' would be an appropriate response, in my opinion.

Sure, it isn't your beliefs, but whatever happened to tolerance of others?

On the other hand, the director was being a jerk. That *was* a moral judgement, and out of line.
posted by ysabet at 6:33 PM on May 14, 2007

What exactly does your friend want? To have them fired? Not going to happen. Disciplined? Again, seems unlikely. Publically humiliated? You might be able to do that with the op ed, but I doubt anything will change their minds. (And your friend did got her meds, no?)

Look, the nurse was trying to be compassionate, and for all you know, she may have found such offers of assistance in similar situations gratefully welcomed.

Finally- consider that your friend might need this nurses help again sometime. Might be kind of awkward if she's called her unprofessional and offensive.
posted by IndigoJones at 6:03 AM on May 15, 2007

"But you won't be able to. Because this kind of behavior is always inappropriate."

It doesn't sound like it affected the level of care at all. Obviously you feel different, so we can just agree to disagree, because I think that you are completely wrong.

Maybe you *should* stand up and risk offending people. But if you think it's "always inappropriate" that's certainly your perogative.
posted by drstein at 7:10 PM on May 15, 2007

I would suggest she write to the licensing board in the State, and emphasize how such moral judgments negatively impact her willingness to speak candidly about personal issues in the future.

Issues like this are very serious, and it's not necessarily just a "Bible Belt" phenomenon. There are a lot of very judgemental medical professionals out there, and I know a lot of people who routinely lie to their doctors because they're uncomfortable.

Being where you are, though, even at the State level you may not get much support. But at least you can know you tried. I wouldn't bother going to the school paper or anyone in the school leadership, I don't think that's really going to produce any significant long-term change; the people with the power are the ones in the oversight/licensing boards. (Although I suppose you could use the newspaper to make other people on campus aware of who to contact at the state oversight level.)

If you do some research, most license-granting medical organizations have some sort of a "quality control" (for lack of a better term) office, which deals with complaints. A single report against a professional probably won't do much, but spreading the word to other people on campus who've been similarly treated might get something done if they start piling up.

I think people are missing the point when they're concentrating on the nurse's intentions. Her intentions, good or bad, are completely irrelevant. The effect -- which was to make the patient uncomfortable, and probably less likely to be truthful in the future, leading to worse care -- is all that matters.
posted by Kadin2048 at 9:56 PM on May 15, 2007