Ditch the doc?
October 4, 2011 3:02 PM   Subscribe

Am I wrong to want to ditch my doctor for this?

A few months ago, I ran out of my birth control pills (Tricyclen Lo, which I hated) and decided to try something else. After exploring my options, I eventually settled on a Mirena IUD. I went to Planned Parenthood and they referred me to a young female GP who does IUD insertions. During the initial consultation, we had a frank discussion about the possible pros and cons of the procedure and the device. A week later, I had it inserted and all was normal. Went back for a followup a month later and all was (and still is) normal. I'm glad I went for it.

Today, I went to my regular GP to get a prescription refilled. I mentioned to him that I had gotten an IUD because I thought it was pertinent information for someone writing me a prescription for antidepressants (and especially since the birth control pill he had prescribed for me had made me pretty wacky emotionally).

He looks at me and said something along the lines of "Who on earth did you get an IUD from?" I told him Planned Parenthood had referred me to another doctor. He was visibly unimpressed. He gave me what felt like a lecture about how I could have an ectopic pregnancy and end up infertile and how he would never, ever implant an IUD in someone who "hadn't had her family yet" (This was after I told him I didn't plan on having kids). He shook his head and said he couldn't believe someone had done that. Then he said (in an equally unimpressed tone) that I didn't need to go to Planned Parenthood and could have gotten a referral from him. This was all said in a disapproving dad sort of way.

I was pretty pissed off when I left his office. He made me feel as though I had made an irresponsible decision regarding my health. I felt like I had been judged. He has been my doctor since I was six years old, although I have seen him very infrequently in adulthood, especially in the last few years since I have taken to going to our excellent local Planned Parenthood for pap smears and STD testing.

Am I wrong to want to ditch my doctor over this? Or am I being oversensitive?
posted by futureisunwritten to Health & Fitness (45 answers total)
Best answer: You have a right to expect your physician treat you like an adult. In my experience, doctors who treated you when you were a child are less likely to view you as an equal once you gain majority (indeed, I find that doctors often fail to treat you as an equal, even without that history).

All things being equal, I'd find another doctor. He's just a service provider.
posted by Admiral Haddock at 3:07 PM on October 4, 2011 [25 favorites]

Your doctor works for you. If he's done something to make you uncomfortable then you have every right to fire him and hire someone else - preferrably someone who respects your personal decisions.
posted by elsietheeel at 3:08 PM on October 4, 2011 [9 favorites]

Best answer: Yup, I'd find another doctor over that. If he'd instead had a "OK, you were aware of risks x, y, and z, right? And we need to take that into consideration going forward in these ways" conversation with you, that'd be fine - or even a "Hmm, I don't know that doctor and want to make sure everything was done properly, I'd suggest x or y test to make sure you're in good shape." As it is, it sounds like his professional ego is more important than your health or autonomy.

(If you liked the GP who did the insertion, why not go to her instead? Sounds like that was a good experience.)
posted by restless_nomad at 3:10 PM on October 4, 2011 [6 favorites]

Best answer: Ditch the doctor and find one who doesn't give you condescending, borderline-misogynistic, paternalistic lectures.
posted by mudpuppie at 3:10 PM on October 4, 2011 [21 favorites]

You have every right to ditch your doctor when his/her approach is not what you're comfortable with. He sounds uninformed and judgmental and I would have ditched him too. Also, when it comes to your ladybits, stick with your GYN (or in this case your local PP), who has more information regarding your personal sexual health, than your GP.
posted by dayintoday at 3:10 PM on October 4, 2011 [1 favorite]

how he would never, ever implant an IUD in someone who "hadn't had her family yet"

This is a super common in the medical industry. Doctors and surgeons are very wary of doing anything that could screw up your ability to have kids. Even if you know you don't want kids and have told them until you're blue in the face. They still are hesitant. They're worried about lawsuits coming down later on for them making you unable to have kids that you now want.

Just as sort of FYI/perspective sort of thing.
posted by royalsong at 3:11 PM on October 4, 2011 [3 favorites]

A stern warning about something like blood pressure or cholesterol is one thing. A sanctimonious, presumptuous lecture about your fertility (after you've made it clear you don't plan on having kids) is uncalled for, and you would be entirely justified in finding another doctor.
posted by usonian at 3:12 PM on October 4, 2011

Best answer: He's unprofessional. He's not a gynecologist, and yet he's clearly talking out of his ass about something that's part of the current standard of care for gynecology. He's territorial about you as his patient. He makes you upset and uncomfortable. You're not being oversensitive at all. Ditch him and find a GP who makes you feel respected and comfortable, and isn't working with information and an attitude about BC that's about forty years out of date.
posted by The Master and Margarita Mix at 3:13 PM on October 4, 2011 [4 favorites]

Feel free to get another clinician. Trust is an integral part of the clinician-patient relationship, and if you feel like you don't trust him regarding this part of your health, it's perfectly within your rights to find someone you do trust.

Many clinicians who are established or older don't have the experience (because they fell out of favor in North America and are only coming back now), but they should have the presence of mind to know their limitations and be able to state them without moral overtones. Even saying 'I'm not comfortable putting in IUDs in women who haven't had children' is less judgmental.
posted by cobaltnine at 3:15 PM on October 4, 2011

Am I wrong to want to ditch my doctor for this?

It's not necessary to read beyond that—having a comfortable relationship with a physician you can trust is essential for your health. You can switch physicians for any arbitrary reason when you feel you need to.

That said, I think the physician in question could have treated in this in a much more professional and sensitive way and in this particular example, I would be steamed and looking for another care provider as well.
posted by grouse at 3:22 PM on October 4, 2011 [2 favorites]

This would be an absolute dealbreaker for me. What everyone else said. God.
posted by Specklet at 3:22 PM on October 4, 2011 [2 favorites]

I totally would. I would also probably try to see that doctor that gave you the IUD on the regular, since it sounds like she knows how discuss medical issues without being a judgy jerk.
posted by grapesaresour at 3:22 PM on October 4, 2011 [2 favorites]

This would drive me up the wall -- but how is his care in other areas? If he's been an utterly great doc, I'd just chalk this up to a difference of opinion, keep seeing him and never mention it again. If he's just so-so, then definitely leave. (Just because it can be really, really hard to find a good doc. And if this guy is great in other areas then he may be worth keeping.) But you're definitely not wrong to leave if that's what you want to do.
posted by BlahLaLa at 3:30 PM on October 4, 2011 [1 favorite]

He has facts on his side, and you have every right to look for a doctor more wishy-washy about your opinion, but at the end of the day, why do you go to someone for advice about your own body? For validation, or because they know their business better than you do?

A few years ago, my father's cardiologist "fired" him for continuing to smoke, not losing weight, and generally maintaining a sedentary lifestyle despite years of admonitions to change all of the above. I kept my mouth shut and smiled politely in the interest of keeping the peace, but if/when I eventually need a cardiologist myself, you can bet the farm I'll go to the one that fired my father (young fella, so he might even still practice when I eventually need one).

I'd rather have an asshole who knows his shit, than a salesman full of it.
posted by pla at 3:30 PM on October 4, 2011 [3 favorites]

I would be annoyed but if he's someone you trust enough to talk to about depression and similar issues, that might be a relationship worth maintaining despite this blip (if it is a blip instead of a recurrent thing.)

I have seen this happen multiple times with doctors who are in the same specialty--they get shirty and pissed off when they disagree with each other over ideal treatments/diagnoses or they feel that another doctor is putting their patient in harm's way. It's part ego, part concern, part competitiveness. The professional thing to do is hide this from the patient, and some doctors are better at hiding it than others.

Everyone has bad days, and I would think about whether this was a one-time thing that might be worth rolling your eyes at and ignoring so that you still have a doctor who knows you and your history.
posted by the young rope-rider at 3:32 PM on October 4, 2011

Let's see. He treated you like a child for daring to make your own reproductive choices. He acted like your decision to not have children is a phase that you will grow out of rather than an informed decision. Also his information on IUDs is horribly outdated and seems to be based in some paternalistic notion that women need to be preserved as baby vessels at all costs, even if that means limiting your choices.

posted by katyggls at 3:33 PM on October 4, 2011 [4 favorites]

You need to go to a doctor who treats your input in your health decisions as valuable. I had this _exact_ thing happen to me, and when I finally found a doctor who respected my decisions about not having kids, and wanting a Mirena, it was stunning. Find someone who respects you. You're an adult and should be a team member in your own health choices, not a child to be spoken down to.
posted by librarianamy at 3:34 PM on October 4, 2011

Something I forgot above: his territoriality of you as a patient and the fact that he's so openly judgemental of a doctor who is by definition better qualified than him (she's a gyn, presumably, and he's not), means that you can't trust him to coordinate care for you if there's another issue that requires it. You can't even trust him to be a useful junior member of the team, since he's not capable of admitting ignorance and is going to be second-guessing decisions he has no grounds to be second-guessing. Since coordinating care is almost the entire job description of the GP these days, that alone should be a deal-breaker.
posted by The Master and Margarita Mix at 3:34 PM on October 4, 2011 [1 favorite]

He has facts on his side

No, he is wrong.
Intrauterine devices (IUDs) used for contraception do not increase the risk of ectopic pregnancy, and no evidence suggests that currently available IUDs cause pelvic inflammatory disease.
Tenore JL. 2000. Ectopic Pregnancy. Am Fam Physician 61(4):1080–8.
posted by grouse at 3:35 PM on October 4, 2011 [22 favorites]

You are not being oversensitive. He was judgmental, and worse, he seems to believe his personal opinions are more important than keeping up with current medical care standards. That is not what I would want in a doctor.
posted by blacktshirtandjeans at 3:38 PM on October 4, 2011 [1 favorite]

royalsong: "how he would never, ever implant an IUD in someone who "hadn't had her family yet"

This is a super common in the medical industry. Doctors and surgeons are very wary of doing anything that could screw up your ability to have kids. Even if you know you don't want kids and have told them until you're blue in the face. They still are hesitant. They're worried about lawsuits coming down later on for them making you unable to have kids that you now want.

Just as sort of FYI/perspective sort of thing.

That may be true but in this case, he was not the doctor who put in the device. Therefore he had nothing to worry about as regards future litigation. It sounds more like he was having a "Oh noes! A woman who cannot fulfill her destiny as a reproductive factory! Woe!" moment to me.
posted by katyggls at 3:40 PM on October 4, 2011 [2 favorites]

He has facts on his side, and you have every right to look for a doctor more wishy-wash

But he doesn't have facts on his side. He has advice that is 20+ years out of date! That's not what one wants in a doctor!
posted by kellyblah at 3:58 PM on October 4, 2011

She was a GP and, I'm assuming, not a gynecologist?

Either way, there are increased risks with IUDs; however, women should be informed of those risks and allowed to make the decision themselves. Not "allowing" nulliparous women to have IUDs is kinda crappy and paternalistic, but incredibly common.
posted by the young rope-rider at 3:59 PM on October 4, 2011

You are absolutely not "wrong" to feel the way you do. Even if it were a less clear-cut situation, your feelings are your feelings and you have a right to them. But I personally would be shopping for another doctor after such an event. Life is difficult and filled with assholes already. The people I *pick* to be in my life - and to help me take care of myself - should be people who respect my choices and with whom I am comfortable.
posted by bunderful at 4:05 PM on October 4, 2011

Then why do their own product guides warn otherwise?

The product guide you linked says:
Although current data indicate that there is no increased risk of ectopic pregnancy in patients using the ParaGard T 380A and some data suggest there may be a lower risk than the general population using no method of contraception, a pregnancy which occurs with the ParaGard T 380A in place is more likely to be ectopic than a pregnancy occurring without ParaGard T 380A.
Emphasis added.

It seems you are confused by the last part of this sentence, which indicates that a pregnancy that occurs is more likely to be ectopic when an IUD is used than if one is not used. In a year, a woman has an 85% chance of getting pregnant without using birth control, and that 2% of those pregnancies are ectopic. That means she has a 0.2% chance of an ectopic pregnancy overall.

Now let's suppose she's using an IUD. She now has an 0.8% chance of getting pregnant, but since the IUD will block almost all intrauterine pregnancies and some ectopic pregnancies, 12% of the pregnancies that pregnancies that do occur will be ectopic. But still, she will have a decreased risk of an ectopic pregnancy overall of only 0.1%.
posted by grouse at 4:14 PM on October 4, 2011 [3 favorites]

Mod note: Couple comments removed, cool it.
posted by cortex (staff) at 4:20 PM on October 4, 2011

He's an ass with outdated medical knowledge.
Drop him like a two-ton heavy thing.
posted by herrdoktor at 4:22 PM on October 4, 2011

If you've been seeing this doctor since you were six (wow!), at some level he may still view you as a kid. That's a human weakness, not necessarily a professional shortcoming. Now, there's other stuff laid on top that strikes me as Not Cool, but if you otherwise want to keep seeing him, you need to have a little Come To Jesus chat with him and demand that he overcome that habit of regarding you like a child if he wants to continue being your doctor.
posted by adamrice at 4:29 PM on October 4, 2011

You might have shocked him with the news - getting an IUD is a big deal, medically. He might have been surprised that you did something medical without discussing it with him.

However, this doesn't excuse his condescending, patronizing reaction. He should have been a professional about it, and he wasn't. I agree with the others who say that you should find a new doctor - one that doesn't belittle you for making adult decisions on her own.
posted by Elly Vortex at 4:30 PM on October 4, 2011

I have a weird medical condition, and the doctor that is helping me is a professor at the local medical school. At one point, he sent me to another specialist at the medical school. After I met with the doctor, my doctor asked me how it went. I said that it went okay, but the guy seemed very busy and I didn't think that he took me very seriously.

At this point I got a lecture. He said that if I felt any dissatisfaction with a doctor, I should start looking for another one. If I felt that the doctor's views were not 100% in my interest, I should feel no guilt in leaving them.

I can say that I trust my doctor.
posted by Quonab at 4:31 PM on October 4, 2011 [1 favorite]

Joining everyone else in saying to fire the doc. I quit my last doc over a very similar issue. I felt she was judgmental about my Mirena and told me the same things about fertility/pregnancy. She wasn't quite as lecture-y as your doc, but I was done. I didn't want a doc who was providing such out-of-date medical advice. I haven't regretted my decision for a second.
posted by whatideserve at 4:33 PM on October 4, 2011

at the end of the day, why do you go to someone for advice about your own body? For validation, or because they know their business better than you do?

Well, when it comes to IUDs, the OP does know his business better than he does. Which is unsettling; patients should be able to trust their doctors to be up to speed. IUDs aren't exactly newfangled at this point.

I'd ditch him. And I'd either call or write a letter to make it clear why I was no longer his patient, explaining both the outdated medical opinion and the condescension about childbearing. I might make an exception if we had a previously good relationship and I had medical issues that would make it a hassle to find and ramp up a new doctor, but you don't mention any.
posted by orangejenny at 4:42 PM on October 4, 2011

Response by poster: Thanks for your input everyone.

The doctor who did the IUD is a GP and is accepting new patients. She's a 15km drive away but I'm okay with that. Also, as a bonus, I have been to her office three times now and haven't had to wait more than a couple of minutes. My GP's waiting room is always packed and the wait times are long (sometimes hours long). She is professional, well informed, friendly, and close to my age. My current GP is definitely more old school and doesn't usually get up from behind his desk. I went to him to get birth control a couple of years ago and that was the first time I'd been there in about seven years. I went back last year when I was feeling depressed. I told him I'd been feeling blue and he gave me a prescription for Celexa. The whole appointment lasted about five minutes. That said, he has also seen my father through a number of health situations and from what I can tell, Dad is satisfied with his care. The rest of my family seems to like him as well. As a somewhat humorous aside, he calls me by my first name (since my full name is on my medical card) even though I go by my middle name and always have. I was a little floored at his reaction today. In 25 years, I have never found him to be overly friendly, but he has never been unpleasant or unprofessional. I don't think badly of the man, I just don't think he's a doctor whose views are in line with my own.

And yes, there are definitely risks to that little thing sitting in my uterus, and I weighed those risks under the care of an informed medical professional. I remember thinking "Yikes" at a few of the potential outcomes she mentioned, especially when she told me there was a good chance that the procedure would hurt like hell since I hadn't had kids (fortunately for me, it didn't at all). As I said before, she was frank about it. But in a less fearmongering sort of way.

Besides, I'm much more worried about what the Celexa might do to me!
posted by futureisunwritten at 4:51 PM on October 4, 2011

Best answer: Your doctor handled this really badly, and if you now feel uncomfortable with him, you have every right to go to another doctor. I personally feel that above all else, it's important to have a good rapport with your doctor and that he/she shares your pro-active approach to your health.

Now, I do want to cut the doctor a little slack, because it seems like maybe you had a long-standing relationship with him since you were a kid, and the last thing he knew you were going off with birth control pills and everything seemed fine. Now you're back, and you aren't on the pills, you had a problem he didn't know about with your health, you chose Planned Parenthood instead of him, and instead of the birth control pills he prescribed or trying another prescription, you went in completely another direction and opted for an IUD.

So it's possible that he felt ambushed, and reacted more strongly because he was on the defense about what he had prescribed. That still doesn't mean you should stay with him, and I'd far prefer to go to a good gynecologist for birth control at the very least ( I can totally sympathize with you about the pills, by the way, they used to wreak havoc on my depression, too).

I just thought I'd give you another perspective so maybe you feel a little less pissed off at him, and maybe instead just realize that you have outgrown him and become a better advocate for your own medical care than he is. I had a similar situation with the ob/gyn who delivered my kids; when I realized that he was set in his old ways and unwilling to work with me actively on the problems I was having, even though I liked the guy personally I had to jump ship for the sake of my own health.
posted by misha at 4:52 PM on October 4, 2011 [2 favorites]

Just dropping in to emphasize that the info your old doc gave you was both out-dated (IUDs are fine for nulliparous women) and wrong (there is no increased risk for ectopic pregnancy).

I'm also surprised he gave no more than 5 minutes to address your depression. You might want to consider going through a psychiatrist for your anti-depressants. S/he would give you a far better evaluation to ensure you've got the correct med. If you're not in therapy, you might also like to consider that. A combo of therapy and meds is supposed to give you the biggest boost.
posted by moira at 6:41 PM on October 4, 2011

After reading all the responses and attempting to think about different sides of this, I've got to say dump him and find someone you can work with. He sounds pretty entrenched in his ways. Just because your dad finds him acceptable--one older male to another, perhaps?--That doesn't mean he's someone for you.

Shop around for someone who talks to you as an adult. Everybody has bad days, but his response was disrespectful and misogynistic.
posted by BlueHorse at 7:38 PM on October 4, 2011

Having been to way more than my share of doctors over the last three years, and having encountered both very very bad ones (what OB on the face of the earth yells at a woman 27 weeks pregnant for pre-booking her appointments?) and very good ones, if I encounter a doctor now who treats me like I'm stupid, rather than like the grown adult that I am, it's time to take my business elsewhere. You are not a child, certainly not his child, and his attitude and demeanor were unprofessional, at best.
posted by vignettist at 8:17 PM on October 4, 2011

He is behind on the times, but trying to think of it from his perspective, he probably doesn't insert IUDs at all and probably only knows about them what he learned in his own training, which was a long time ago. GPs have a huge knowledge base to keep up with from pediatrics to geriatrics. So I forgive him for not having the modern info on IUDs, and in a way, it's almost kind of nice that he got upset on your behalf - based on what he knows, the other practitioner wronged you, and he was angry about you receiving what he saw to be improper medical care.

That being said, it sounds like his frustration with the other practitioner was borderline if not clearly unprofessional, and that it came off as frustration towards you personally as well, and that is not justifiable. So I definitely am with all the rest who suggest you get with the new doctor.
posted by treehorn+bunny at 9:10 PM on October 4, 2011 [1 favorite]

Wow--you are way nicer than I would have been. Not only would I have ditched this doctor, I would have walked out in the middle of my appointment, complained to the doctor's practice or hospital (if they are part of either), complained to my insurance company in hopes they would no longer cover this doctor, and posted honest but extremely negative reviews on every MD-rating website I could find. In fact, I bet if you google this doctor's name you will find negative reviews.

I've got to say, the best thing you can do with a disrespectful doctor in a non-emergency situation is call them on their disrespect and then WALK OUT THE DOOR, even if (especially if!) it's right in the middle of the appointment. It's unbelievably empowering.
posted by Violet Hour at 10:07 PM on October 4, 2011

I'm leaving my family doctor for the same reason: still treats me like I'm six.

I would also second having a psychiatrist or GP with psychology training oversee your depression treatment, particularly if it's been a long term issue. I know someone who was stuck on a medication that didn't work for her for years, while her GP did no mood assessments and didn't try any different drugs. Six months with a GP who has psychology training - she's had assessments and has been put on a more effective drug - and gets the CBT therapy she needed all along.

GPs can't do everything - they do well with common, everyday things. But reproduction and psychology - I would definitely go to experts for these services.

and yeah - Mirena IUDs are prescribed for nulliparous women all over Europe. Your GP is so behind.
posted by jb at 10:15 PM on October 4, 2011

He is behind on the times, but trying to think of it from his perspective, he probably doesn't insert IUDs at all and probably only knows about them what he learned in his own training, which was a long time ago. GPs have a huge knowledge base to keep up with from pediatrics to geriatrics. So I forgive him for not having the modern info on IUDs, and in a way, it's almost kind of nice that he got upset on your behalf - based on what he knows, the other practitioner wronged you, and he was angry about you receiving what he saw to be improper medical care.

This is why physicians are required to obtain CME credits. And if he doesn't know what he's talking about regarding a sub-specialty, he's not required to spout off about it just to prove that he's your doctor. Blech.
posted by desuetude at 11:14 PM on October 4, 2011

You're not wrong. You should also tell him why you don't feel he's competent to be your doctor anymore.
posted by HFSH at 2:15 AM on October 5, 2011

Best answer: He's not right on the medicine, nor are a number of well-intentioned posters here. His understanding of IUDs is so far out of date that I'd want to dump him on that fact alone. Women's health is a maintainstay of family medicine; if he hasn't kept current on basic contraception, how many other developments has he missed that are just as central to his basic practice?

For the record, the medical evidence is:

Neither of the IUDs on the market today carry any statistically significant risk to health or fertility. Even if you've never had kids. Even if you plan to have kids sometime later. Safe even for those who have a history of ectopic pregnancy.

Ectopic pregnancy is not caused by IUDs, as grouse has pointed out.

There are IUDs are two out of the three top-ranked methods of long-term, fully-reversible forms of contraception. Paragard's effectiveness rate is the same as surgical sterilization. Mirena is more effective than surgical sterilization.

Getting an IUD is not a big deal medically. From a medical standpoint, it is a minor office procedure which takes minutes. (A minority of users experience spontaneous ejection during the first month or two, which sucks, but it too is not a serious health threat issue.)

Upon removal, fertility is restored essentially immediately.

More evidence-based info and myth-debunking from The American College of Gynecologists (2011) The Guttmacher Institute (2008), and the Feminist Women's Health Center (2011).

As long as the provider ran a pregnancy test and STD screen, it sounds like their care was responsible. For your family doctor to leave the impression that IUDs are big!scary!unwise!dangerous! things is ignorant and unprofessional.

God, how I hate the persistency of FUD around sexual health issues.
posted by nakedcodemonkey at 4:10 AM on October 5, 2011 [4 favorites]

Nope, you're not wrong at all. Were this me, I'd ditch this guy faster than... well, it'd be really fast.

You need to be able to have a doctor/patient relationship and you're never going to trust or feel comfortable with someone who blatantly disrespects your reproductive choices. This isn't to say you'll always agree with your doctor, but rather that you need to be able to talk about your decisions without having them belittled.

(I don't know that I would necessarily find it in me to register some kind of official complaint as I really hate confrontation, but it's something that would be useful for other patients if there's a way for you to go on-record.)
posted by sonika at 5:55 AM on October 5, 2011

FWIW, I dumped a gyno for exactly this same reason when I was a kid. When I became sexually active at 16 I asked my GP for birth control. He went on to tell me sex before marriage was wrong. I never went to him again.

In short, DTMFA
posted by Brittanie at 1:58 PM on October 6, 2011

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