Is this unethical doctor behavior?
December 10, 2013 12:53 PM   Subscribe

Sorry in advance for the moderate dose of TMI... if IUDs and lady doctors eek you out, read no further.

I am a woman in my late twenties living in NYC. I am pro-choice. Today I went to get an IUD inserted, and my doctor refused to conduct the procedure upon finding out I had had very recent unprotected sex with my long term boyfriend (despite my pregnancy test coming out negative). Her grounds for refusing were ethical: In the eventuality I later found out that I was in fact pregnant, having an IUD removed during early pregnancy might actually prevent me from carrying the hypothetical baby to term.

When I told her there was no chance of me wishing to carry the pregnancy to term, she told me I might change my mind, and that by inserting the IUD at this moment, she would be preventing me from making a future choice. She told me she had seen countless women change their mind and that I had to trust her professional experience. I told her that it would be absolutely disastrous if I changed my mind, and knowing this, I was willing to risk it. But her refusal was final, and I didn't continue to fight it because I realized that if I had to purchase a second IUD, it would come out of pocket (vs paid for by insurance).

I am pretty disturbed by this experience, and I don't know what to make of it. She was otherwise an excellent doctor, very sex positive, young, understanding.

Should I change doctors?
posted by qzar to Health & Fitness (52 answers total) 3 users marked this as a favorite
posted by thereemix at 12:57 PM on December 10, 2013 [15 favorites]

I really don't like the way she phrased her argument, and it does sound like you'd be happier with a different physician. I know I would switch after this experience.

BUT, in her defense, is it possible that you had unprotected sex so recently that a pregnancy test wouldn't be able to detect it? If so, I can kind of understand why some doctors might be wary of inserting an IUD under those circumstances.

Again, I don't think she expressed this very well, and I would switch doctors if this happened to me.
posted by schroedingersgirl at 1:00 PM on December 10, 2013 [3 favorites]

DTMFA - you know you and she apparently doesn't. It sounds like her own hang up and she's projecting it on you. Don't need it or her.
posted by tilde at 1:01 PM on December 10, 2013 [5 favorites]

Not unethical. Perhaps a little too CYA for your taste, in which case you're welcome to find another doctor. But no guarantee they wouldn't say the same thing. Pretty sure no ethical doctor is going to insert an IUD for a patient who may currently be pregnant.

The thing is, it's actually true that removing an IUD during early pregnancy is a risk. And your doctor can't know that you wouldn't change your mind. Which creates potential liability for her.

Unfortunately, hypothetical "but I would totally never..." accounts don't reduce her liability in this situation.

That said, did she say that she would NEVER insert an IUD for you, or that she couldn't do it until X future date wherein she would feel more confident that you are not pregnant?
posted by Sara C. at 1:03 PM on December 10, 2013 [28 favorites]

In my experience, Planned Parenthood told me it is standard to not insert an IUD within 2 weeks of unprotected sex because of STDs and possible pregnancy complications that can put you at risk when your body is adjusting to the IUD. Like, greater possibility of infection and/or tubal pregnancy.

That said, it sounds like she got the advice right but the reason wrong. With all kinds of moralizing that was totally unnecessary.

Drop her.
posted by whimsicalnymph at 1:03 PM on December 10, 2013 [17 favorites]

Were you told ahead of time that unprotected sex would prohibit insertion of the IUD?

I would only be annoyed if I had NOT specifically been told at the time I booked the appointment unprotected sex was a deal breaker.

I can see the doctor's point that the IUD can create complications and agree with her decision, but you absolutely should have been informed about the no sex requirement before the appointment.

Sorry if this is not exactly the answer you wanted.
posted by jbenben at 1:04 PM on December 10, 2013 [3 favorites]


She didn't refuse you an IUD outright, correct? She's just asked you to reschedule for 3 or 4 weeks hence, yes?

Other than this particular issue, you feel that you have a good rapport with her? That she takes your concerns seriously, that she doesn't blow you off as in "my knowledge and opinion are superior to yours"?

Was she quite clear that she would be willing to perform an abortion for you in the event that you do turn out to be pregnant, no further hoops to jump through?

I can see how in her mind she acted in a professional and ethical manner. I think this sounds like a complete hassle for you, in terms of having to reschedule, but I'm not sure this is DTMFA territory yet.
posted by vignettist at 1:06 PM on December 10, 2013 [5 favorites]

a negative pregnancy test means there's no pregnancy, and no choice to make. taking into account schroedingersgirl's latent pregnancy point, would this doctor be willing to insert the IUD in a week or two after a conclusive pregnancy test showed negative? if not, she's a nutball.

this is how you learn that some things you don't even tell your doctor.
posted by bruce at 1:06 PM on December 10, 2013 [2 favorites]

you wouldn't remove the IUD in early pregnancy, iirc. Sometimes they come out with the baby...

She could have been worried about STIs...either way, if she or her office staff hadn't informed me of this "rule" and wasted my time, I'd be pissed.
posted by the young rope-rider at 1:06 PM on December 10, 2013 [1 favorite]

Wow. I would certainly change doctors. Her attitude strikes me as insulting and not based on the facts of your situation.

You may already know this, but IUDs are often used as a form of emergency contraception that is effective up to five days after unprotected sex. That is, if put in up to five days after sex, it can stop an egg being fertilised or a fertilised egg implanting in the uterus. So, depending on how recently you had sex, the risk of later discovering you were pregnant might have been very low.
posted by daisyk at 1:06 PM on December 10, 2013 [11 favorites]

Yes, it's unethical doctor behavior, and I think you should report her.

IUDs are actually an excellent method of emergency contraception-better than pills because they provide ongoing contraception:
posted by Violet Hour at 1:08 PM on December 10, 2013

ehhh. when i had my IUD inserted a few years back, i had to jump through a lot of pregnancy test hoops. like 2 blood pregnancy tests - 2 weeks before insertion, 2 days before insertion. it was really annoying, yes, and even though i absolutely abstained from sex for like 3 weeks or whatever, it made me feel like my doctor didn't trust me to not have sex.

but my doctor informed of the no-sex thing before i even started the process so i was prepared for it. maybe your doctor didn't?

as a whole, u.s. doctors are still a little weird about IUDs, in my opinion, and that can cause differing experiences for women.
posted by kerning at 1:13 PM on December 10, 2013 [1 favorite]

It is not unethical to refuse to perform a medical procedure that might threaten a theoretically feasible pregnancy. Some doctors won't. It could happen and you could sue.

But I would personally roll my eyes so hard that I'd go elsewhere. She should have given you pre-op instructions regarding unprotected sex.
posted by Lyn Never at 1:13 PM on December 10, 2013 [2 favorites]


I go to Aster OB/Gyn. Dr. Fahmy is the absolute best and totally non judgmental. He inserted my Mirena AND gave me a shot to the cervix so I wouldn't feel the insertion. It took five minutes.
posted by roomthreeseventeen at 1:14 PM on December 10, 2013

I'm in the medical field. I don't think this doctor was unethical. There are people who really do change their minds about wanting to keep the baby after they find out they're pregnant, even if before getting pregnant they were absolutely certain they wouldn't keep the baby. Your doctor was acting based on her prior experiences, and she understood that it could be a very emotional thing.

The doctor was acting in your best interest. Perhaps she didn't communicate this in the most effective way possible, but it sounds like your doctor was just being firm and responsible.

It's understandable that you feel a bit shaken or disturbed from this incident, and it is a hassle to reschedule your appointment, but I wouldn't change doctors over this.
posted by gemutlichkeit at 1:14 PM on December 10, 2013 [7 favorites]

The doctor was acting in your best interest.

This is patronizing and offensive. The only person who gets to decide what is in my best interest is me.
posted by Violet Hour at 1:15 PM on December 10, 2013 [15 favorites]

I was not informed of the no-unprotected sex rule prior to insertion. I also foolishly figured the withdrawal method was effective since every single one of my long term relationship friends use it. When i confronted her about not being told in advance, she told me that she had assumed I was still on the pill since it had been prescribed to me at some point many months ago.

I would 100% understand if she was refusing me the procedure because it jeopardizes MY future health should I be pregnant, or because it's foolish to have to get it done once again post-termination. I explicitly asked her if there were any health risks for me if I chose to terminate, and she said it would only jeopardize my health if I chose to have the baby. I told her I would absolutely choose to terminate. Even if she is right about me potentially changing my mind, the whole reason I take birth control to begin with is so I don't have to make those choices because they are not financially feasible for me at this time. If in theory there is no health risk should I chose to abort, that should be MY choice not hers. This feels like that heartbeat rule. We're in NYC for crying out loud.

That said, if she had only advised me to wait for ethical reasons, I wouldn't be this put off. But she refused to conduct the procedure. She did however agree to reschedule me.
posted by qzar at 1:19 PM on December 10, 2013

I would absolutely change doctors, if nothing else because the way she worded her argument, however valid it may be, would rub me the wrong way. I too would have preferred to have been warned about the no-recent-sex requirement.

One note for whoever said a negative pregnancy test = no pregnancy.... if only it were that simple. Pee-on-a-stick pregnancy tests are rarely accurate until at least 10-12 days after ovulation. If the unprotected sex happened a few days prior, that'd be too soon for a test to be positive. A blood test takes a few hours to come back from the lab, and the way OP worded her question it seems like she wasn't in the office quite long enough for that.
posted by hungrybruno at 1:20 PM on December 10, 2013 [1 favorite]

Okay, I meant that in her mind she was acting in what she believed to be the patient's best interest. Just because the patient doesn't agree with the doctor's decision does not mean that it's necessarily time to switch doctors. I would switch if the doctor showed an actual lack of competence, you had bad rapport with her or just felt like you couldn't communicate effectively with her in general, if she was unprofessional... but not if you disagreed with her medical judgement.
posted by gemutlichkeit at 1:21 PM on December 10, 2013 [5 favorites]

There are some doctors who will only insert an IUD during your period for this reason. Negative pregnancy tests only cover pregnancies that can be detected - there's a window of about two weeks before a test is 100% reliable and a false negative is much more common than a false positive.

Definitely a pain for you, but not unethical from a medical POV. Maybe try rescheduling when you're due for your next period.
posted by sonika at 1:22 PM on December 10, 2013 [2 favorites]

gemutlichkeit: her judgment was ethical not medical. Her ethics, not mine. She wanted to give me the opportunity to have a pregnancy, even though I have already made my choice. She made a call based on her own ethics over mine.
posted by qzar at 1:24 PM on December 10, 2013 [3 favorites]

There are some doctors who will only insert an IUD during your period for this reason.

Some doctors recommend insertion during your period because it can be easier due to the cervix being slightly open. I would be appalled if a doctor required a period as "proof" of not being pregnant--which it isn't, anyway, as decidual bleeding isn't uncommon after conception.
posted by Violet Hour at 1:27 PM on December 10, 2013 [5 favorites]

She made a call based on her own ethics over mine.

Well then, there's your answer. It sounds like you will not trust her judgement after this.
posted by vignettist at 1:27 PM on December 10, 2013 [5 favorites]

You do sound fairly disturbed and unsure if you should trust your doctor, so if this is the case, I would switch. Communication with your doctor matters a lot and it would not be worth compromising any of your future healthcare due to poorer communication/lack of trust.
posted by gemutlichkeit at 1:30 PM on December 10, 2013 [2 favorites]

[Folks, asker included, I know this is kind of a tough subject but this needs to stay a focused question-and-answer thing, not a discussion or argument about the topic. Please keep it constructive and answer-oriented.]
posted by cortex (staff) at 1:36 PM on December 10, 2013 [1 favorite]

You should change doctors if you feel that this exchange has left you unable to trust your doctor to take care of you and to work with you to protect your health and well-being.

That said, while it sounds as though the way she communicated it with you was not ideal, the care your doctor provided to you was not unethical. There are a lot of CYA, standards-of-care type stuff that doctors do that has nothing to do with whether they trust you or whether they want to do something you've asked them to do. Other people have done a great job of covering some of those concerns above, but I'll also point out that getting pregnant with an IUD inserted, or having an IUD removed while pregnant, seems to carry risks to you other than miscarriage. Dr. Google tells me that ectopic pregnancy (which can threaten the life and health of the mother) and long-term or permanent fertility problems can result. Your doctor should have explained to you if she had those concerns, but I don't believe that it's unethical for a doctor to delay a procedure in order to alleviate those concerns where the delay will not harm the patient. Your doctor made both an ethical and a practical judgment, and although IANAD, I think your doctor made a reasonable decision under the circumstances.

The failure rate of the withdrawal method is about 18%. That means that for every hundred couples who use withdrawal as their method of birth control for a year, 18 of them will be pregnant within that year. Again, IANAD, but I suspect you'd be hard-pressed to find any doctor who would insert an IUD for a woman in your situation. However, I think you could fairly easily find a doctor who is better at communicating with you in advance what you need to do before medical procedures and better at explaining to you the ways in which she can and can't help you.

(On Preview): The more you update the thread, the more it seems as though you're looking for our permission to act on your discomfort with this doctor. You don't need our permission. Just like deciding whether to stay in a romantic relationship, or deciding whether to have sex with someone, or deciding what color socks to wear, you can make whatever decision feels right to you, and you can make that decision for any reason or no reason or just because you feel like it. You deserve to have a doctor you feel as comfortable with as possible, and it sounds as though this doctor isn't that doctor for you. So, absolutely, go find a doctor you love!
posted by decathecting at 1:39 PM on December 10, 2013 [18 favorites]

Not unethical. Being a doctor requires making a lot of judgment calls and she can't substitute your judgement for her own. But it sounds like she might not be a good fit for you - you can and should definitely shop around for a doctor you like and/or feel is more compatible with you.
posted by cessair at 1:40 PM on December 10, 2013 [4 favorites]

I'm a doctor. I think calling this unethical is very extreme of you. I can see why you're annoyed that you were inconvenienced, but the fact is that she's willing to do the procedure on a future date. She didn't want to do it today because she felt it was too risky. That's her decision to make. Doctors are not required to perform any procedure on a patient just because they want it and say they accept the risks. The physician must also feel that it is reasonable to perform the procedure, not just the patient. You can't have elective surgery when your blood pressure is out of control, even if you think that's really inconvenient and you say you don't care if you have a stroke and you're willing to accept the risk.

It's not "her ethics over yours" - it's her professional judgment, and she's allowed to use it. And you're allowed to go see someone else if you don't like her attitude/perspective/communication skills.

Did you consider that even though she's young and sex positive, she might also be anti-abortion? For those who consider abortion to be wrong, it is not considered ethical in this country to force them to provide people with emergency contraception if they feel uncomfortable with that. It is acceptable for physicians to refuse to provide services that would terminate a potential pregnancy, although they should be willing to provide a referral to another physician who would do so. It's not clear if this was part of her reasoning.

If there was a lab on site, she could have gotten a quantitative hCG done on the spot that would have given a definitive answer to the pregnancy question - because "a negative pregnancy test means there's no pregnancy" is not accurate when you're talking about home urine pregnancy tests - it all depends on the day post-ovulation that the test is done and whether your urine was concentrated enough to detect the hormone, etc. But this would have delayed you by at least an hour which probably wouldn't fit into her schedule anymore. So the negative pregnancy test at home is not definitive, and I think postponing the procedure to a later date was reasonable.

the whole reason I take birth control to begin with is so I don't have to make those choices because they are not financially feasible for me at this time.

Look, you've got to be aware at this point that the withdrawal method is not an effective method of birth control. I don't think this argument holds water - what you did wasn't responsible if you didn't want to get pregnant.
posted by treehorn+bunny at 1:42 PM on December 10, 2013 [43 favorites]

She made a call based on her own ethics over mine.

Doctors get to have their own ethics and opinions. It is not unethical for them to abstain from providing you services if they don't want to.

It doesn't even read to me like she said "I don't believe in giving abortions" or something. None of us were there, but if she said "I know you say you don't want a baby, but trust me, I have had this exact conversation with a number of smart, informed young women, and have done the procedure, and have seen them change their minds, and it has broken my heart, and so now I only insert IUDs when I know to a metaphysical certainty that the woman is not pregnant" perhaps the sentiment would be different. None of us have any idea what was going on in that exam room.

By all means, don't go back. You don't have a right to compel her to do anything, and it's not a breach of ethics for her to abstain from doing what she doesn't want to do. But it is a service industry and you can shop around for whatever you want. I am strongly pro-choice myself, and have supported Planned Parenthood (off and on) for a couple of decades.
posted by Admiral Haddock at 1:45 PM on December 10, 2013 [7 favorites]

But she refused to conduct the procedure. She did however agree to reschedule me.

So reschedule the procedure. I fail to see the problem here. Your doctor can't insert the IUD if she believes you may be pregnant. Having unprotected sex risks pregnancy. Not taking birth control pills she prescribed risks pregnancy. Using the withdrawal method in lieu of contraception risks pregnancy.

The bottom line is, your feelings aside, your doctor has to actually practice medicine. That's what her job is. Her job is not to be your friend or cosign your sexual choices.

I doubt another doctor would handle this situation differently.
posted by Sara C. at 1:47 PM on December 10, 2013 [10 favorites]

No, I don't think this is unethical. In fact, I don't even think this is was an abnormal experience. Change doctors if you want, but I do not think any medical professional would insert an IUD under the conditions you described.

However, you seem determined to see this as wrong and unethical, and you don't need my permission to change doctors.

Also you owe it to yourself, and future doctors, to keep your doctor in the loop about your birth control choices.
posted by sm1tten at 1:51 PM on December 10, 2013 [6 favorites]

Your doctor can't insert the IUD if she believes you may be pregnant.

I repeat, IUDs are a safe and effective method of emergency contraception, meaning they can and should be inserted AFTER unprotected sex to prevent pregnancy.
posted by Violet Hour at 1:53 PM on December 10, 2013 [3 favorites]

I dunno...If I was a doctor and my patient insisted they were not pregnant because they use the -withdrawal- method during very recent unprotected sex, I would've reacted the same way your doctor did and cancelled the procedure in order to ensure safety and a greater chance of success for the procedure later.
posted by stubbehtail at 2:00 PM on December 10, 2013 [10 favorites]

I would change doctors. There are lots of other sex-positive, accomplished, and great doctors out there who will give you treatment and advice based on your medical situation only rather than involving their impressions of your likelihood of changing your mind about a hypothetical situation. As other commenters have pointed out, possible very early pregnancy does not mean you can't have an IUD inserted. In fact, IUD insertion is used as emergency contraception.

I would have accepted reasons that were medically-based for her refusal, but that doesn't sound like what she told you were her reasons. Her reasoning sounds paternalistic and minimizes what you told her directly and clearly you would do in a case where you were pregnant. The risks she outlined to you all hinged on you changing your mind about a pregnancy and she overrode your own statements about what you would do in favor of what she imagined you might do. I would not be ok with that.

I have a hunch that she's anti-choice. That's fine. But, if she's a physician who has anti-choice beliefs and her job requires her to deal with the reproductive health of women who may have different beliefs, I think that it's her responsibility to disclose that at the beginning of the relationship, not when she is refusing your IUD insertion.
posted by quince at 2:03 PM on December 10, 2013 [2 favorites]

To the folks who are implying that I must want to get pregnant if I am so sexually reckless, know that this line of reasoning is aggressive and unkind, not to mention irrelevant to the questions I posed.

IN SUM: I agreed with my doctor's call for practical reasons this morning, and especially now that I know it could hurt my health if I was pregnant and aborted. I didn't and don't agree with her reasons, which at the time were explicitly and solely predicated upon the idea that I'd want to KEEP THE BABY. I learned in this thread that her professional calls can be based on hypothetical ethics or personal moral code, which I honestly wasn't sure was legal. I will ask her what her stance is about abortions -- a good question to ask your GYN I now realize! -- and if she is pro-choice, I will have a talk with her about this and see if we can clear up this misunderstanding.

I very much appreciate all your feedback. Thank you for all of your varied opinions. Cortex -- sorry if we got off topic in any way.
posted by qzar at 2:21 PM on December 10, 2013 [1 favorite]

I got the impression you thought maybe she had an anti-abortion vibe. I'd say, given you've labelled her as sex positive, that it might be worth looking at what she said through a pro-choice lens -- she found unethical to remove a possible choice from you, when the alternative is simply wait two weeks. You stated that you would never take that choice. But her ethical quandary was that it would be HER who would be taking the choice away, not you, if she did the procedure. It doesn't mean she's judging your choice to abort or not, just that the options are so different in their outcomes -- (1) wait two weeks or (2) take away a future freedom of choice from a patient.

Also, I can see being in a professional situation where someone says with all possible certainty and conviction they'd never change their minds...and then they do. That could be problematic for her and possibly lead to legal complications.
posted by girlpublisher at 2:37 PM on December 10, 2013 [6 favorites]

The bottom line is that doctors can't rely on "oh no but I would never..." as important information as to whether they should perform a procedure which could negatively affect the patient's health. It's not really about you, or about sex, or about babies, or about what your doctor thinks of you as a person. It's about standards of care, protecting your patient's health, and, on a certain level, covering her own ass from the malpractice suit that could result if you did change your mind, no matter how unlikely that is to happen.
posted by Sara C. at 2:57 PM on December 10, 2013 [11 favorites]

If you're performing what could technically be an abortion, it is important to know that beforehand, so you can monitor the situation. It's not without risks, I don't care if you're calling it emergency contraception or not. That changes everything in real world terms.

This is totally aside from any moral or ethical issues. It is impossible to know whether the doctor's practice, insurance or her hospital would revoke her privileges / has otherwise forbidden performing abortions. According to the AMA's ethics board, formally a doctor has the right to refuse to perform any act that could be considered abortion. In real world terms, what you were asking her to do had the potential to cause an unbelievable amount of administrative problems and in theory could destroy her career, even if she was amenable to the procedure.

From the standpoint of either formal medical ethics, practical applications or evidence-based clinical perspectives, it is difficult to disagree with what the doctor decided to do.
posted by hobo gitano de queretaro at 3:19 PM on December 10, 2013 [2 favorites]

I believe it is likely that she phrased things poorly. This is actually something that may be prohibited by her malpractice insurance carrier (ask me how I know in memail if you're interested), for exactly the reason she states. It's that many women do end up wanting to keep a baby. It's not about her ethics - it's that she can be sued if one of her patients does end up wanting to keep the baby even though they swore up and down that they didn't. Even if unsuccessful, these suits cost money. It's not necessarily an ethics call on her part to point out that you may want to keep the baby even if you say that you don't. It can be a professional opinion.

It may also be that she's found - in her experience - that the easiest way to explain the variety of reasons that she can't insert an IUD after unprotected sex is explaining it that way. Often medical providers have learned (at great length) how to approach things with the greatest chance of success.

In the end - if you have been happy with her in general this is probably something that's worth working past. One of the things we pay doctors for is their professional judgement. And in the end, she's the one that would be held liable if something went wrong when she went against her professional judgement and inserted the IUD. Being legally liable for a pregnancy is a pretty big deal. It's something that a whole lot of women's health providers have experience with - either directly or through a colleague. It's a whole bundle of no fun for anyone, and it does make people behave more conservatively about certain things (like this!) than their patients would want.
posted by stoneweaver at 3:27 PM on December 10, 2013 [7 favorites]

Look at this from her point of view - you told her you wanted birth control pills, and then you changed your mind and stopped using birth control. You told her there was no chance you were pregnant based on a home pregnancy test.

IUDs, if I understand correctly, are a plan b for up to 5 days after unprotected sex. However, if you had unprotected sex 9 or 13 days ago, for instance, you would be out of the five day window and still not able to trust a home test.
Nothing in the original post or follow-up made me think you want a baby now, or ever. However, it does sound like you feel judged. I think she judged you as a client who needed to be told about professional standards. She offered to reschedule. What else could she do?

Changing doctors is an option, but I don't think a responsible physician would do anything differently.
posted by Lesser Shrew at 3:34 PM on December 10, 2013 [1 favorite]

Not unethical, and standard practice at my local very sex-positive and pro-choice clinic. You are instructed not to have unprotected sex for a certain period before IUD insertion (you should have been informed of this, obviously), otherwise the appointment is cancelled and rebooked. If the patient is pregnant already it can't be used for emergency contraception, and there was no way of knowing 100% if you were or not. The doctor isn't going to rely on hypothetical situations rather than safely rescheduling you.
posted by ghost dance beat at 4:05 PM on December 10, 2013 [3 favorites]

Some background... I didn't casually change my mind about birth control pills, I wanted something more effective. The doctor and I planned the switch to an IUD together. Her office failed to properly order the IUD and gave me incorrect status updates whenever I followed up, resulting in a 3 week delay. My 6-refill birth control prescription of course ran out, and her office failed to renew after many, many, many calls from me and my pharmacy. I could have found another doctor or kept calling her, but there is only so much time in each day, so yes, I gave up. I elected to ask my long term relationship girlfriends how they handled their birth control, and took their word for it thinking it would "tide me over" for three weeks. This was unwise, I whole heartedly agree. I am shocked that none of them have gotten pregnant in the 5-9 years they have been with their partners. I had unprotected sex the day before yesterday, while I was on my period, which I still was on today when I went in for the procedure.

My original goal was to make sure I would never be in a position to be swayed by biological instinct because I cannot afford a baby at this moment. Her refusal to allow me to go through with the procedure on the grounds that I might be swayed despite myself really upset me. I understand that there were other risks involved -- for both myself and for her -- which must have informed her decision, though she didn't mention them. But before posting here, I suspected her of trying to dissuade me for her own reasons, which is precisely why I posted.
posted by qzar at 4:18 PM on December 10, 2013

Based on your update, I would say you should find a new doctor not necessarily only because of the IUD appointment today, but rather because she seems irresponsible more generally. It would be one thing if generally she was providing excellent care but in this one instance failed to communicate well. However, I would be seeking a new doctor just on the failure to renew birth control (seriously, I would be doing that after maybe 2 calls, much less several!). Adding to that the communication problems over ordering/updating you on the IUD prior to the procedure itself, and it's definitely in "find a new doctor" territory.

I'm also confused as to why she would think you were on birth control pills if you'd been asking her for a new prescription and she did not refill it?! Where would you have gotten these pills? This strikes me as someone who is really disorganized (either her personally, the office in general, or both), and that's not something I'd want from a doctor.
posted by rainbowbrite at 4:30 PM on December 10, 2013 [8 favorites]

The thing is, by stating your original goal is to make sure you would never be in a position to be swayed by biological instinct, that is, your goal is to not get pregnant and have your instinct kick in to keep the baby, you are acknowledging that it is a possibility that it might happen. Your doctor is acknowledging the same thing. Unless I'm somehow misinterpreting that statement. I don't think she's unethical at all, I do think her ethics aren't in line with yours. Either way, I would get a new doctor, this is clearly not a good fit.
posted by Jubey at 4:43 PM on December 10, 2013 [3 favorites]

Based on your update, I would absolutely switch providers if my doctor couldn't handle prescription refills in a timely manner. I would have been furious with a 3wk gap in birth control - that the rescheduling of the IUD upset you so much makes much more sense with this info.
posted by sonika at 4:53 PM on December 10, 2013 [4 favorites]

I would not change doctors over the IUD thing, but I'd definitely change doctors over the not getting a refill or "emergency" filler pack of pills.

Regarding her refusal to insert the IUD, I don't think it has anything at all to do with abortion or babies. I think it's entirely to do with her liability as a professional who faces legal liabilities you have likely never thought of and certainly don't consider daily. She has to answer to a licensing board, as well as executive staff and her medical facility, and someone (her, the management, both) is very aware of the costs of liability insurance and the impact of a lawsuit when she inserts an IUD without being certain you are not pregnant. Your insistence that there is no chance you'd carry an unplanned pregnancy to term has no real bearing on her liability in the event she inserted an IUD and you were pregnant and no bearing whatsoever on your medical condition, should you turn out to be pregnant with a newly inserted IUD.
posted by crush-onastick at 4:55 PM on December 10, 2013 [2 favorites]

I got an IUD a few years ago, I had been on the pill for years and had been sleeping with only one person for about as long. Finding a doctor to do it was a huge pain in the ass. I had to contact four doctors before I finally found one that would do the procedure. The first two refused to put an IUD in a woman who had not already had at least one child. The third wanted me to have pregnancy and STI tests every week for a month and a half before he would even consider preforming the procedure.

Finally I called Planned Parenthood. They told me to make an appointment for when I was on my period. I came in and the doctor inserted it with only minimal questions asked (how old are you? etc.).

My point being, doctors in the U.S. have varying opinions about IUDs and pregnancy. I'm not at all surprised to hear that you had an issue, and would not be surprised if you had to hunt around town to find a doctor that will agree with your request. It's very much a YMMV situation.
posted by Shouraku at 5:02 PM on December 10, 2013 [1 favorite]

qzar: "She wanted to give me the opportunity to have a pregnancy, even though I have already made my choice. She made a call based on her own ethics over mine."

I think you may be misreading her motivation and are taking this personally in a way that your doctor did not intend. Put aside your (perfectly understandable) emotional reaction at feeling that you were not believed/trusted, and think about this in a strictly clinical way for a minute.

Pretend you're a statistics robot and you're calculating a risk vs benefit scenario. (Pretend also that you know what the below percentages are.)

- There is a [number]% chance that you may be pregnant.
- Removing an IUD in early pregnancy has a [number]% chance of miscarriage, ectopic pregnancy, preterm birth, or pelvic infection.
- Pro-choice women who intend to have an abortion in the case of unplanned pregnancy change their mind [number]% of the time.

Inserting an IUD right now carries a real chance of causing you a miscarriage, ectopic pregnancy, preterm birth, or pelvic infection; it means your abortion decision would now be under some duress because of that; and at the very least, you would need to her to re-insert the IUD after an abortion.

Postponing the IUD insertion has 0% risk of causing any medical issue. It costs only a little bit of your and your doctor's time for the rescheduled appointment.

Bunch of totally avoidable risks versus waiting a couple of weeks? The ethical thing is for her to postpone your IUD insertion.

She totally fucked up by not telling you about the need to abstain from unprotected sex beforehand, though.
posted by desuetude at 5:09 PM on December 10, 2013 [6 favorites]

It sounds like this delay of the IUD insertion is really just the last straw in an already frustrating relationship for you. Given all that other information, I definitely feel you should change providers. It sounds like her office is disorganized.

I also wanted to add that based on your update, it sounds like you took her discussion with you quite personally - i.e. "I know myself and I would never do that." Don't take it personally. I really feel you on this, because when I wanted to have an IUD inserted back in the day, my provider refused to do it on the grounds that I was not married, unless I went through a battery of STD tests - even though I had been tested already before I got into a long term relationship with my then-boyfriend (now husband). I refused to have the STD tests which I knew to be a waste of my time and money, and she refused to do the procedure. For her, it was a liability thing, I know that, but I hated the implication that I was either lying or cheating on my boyfriend (or he was cheating on me). So I have been there.

But I also have been on the other side of this coin, as a medical provider. And I run pregnancy tests on 99.9% of my patients of reproductive age, regardless of whether they say that they're lesbian, asexual, virgins, menopausal, whatever (pretty much the only thing seen as a guarantee is a hysterectomy). I run drug tests on people who swear they're straightedge. I run drug tests on grandmothers. I do STD testing on almost every patient I do a pelvic exam on, regardless of relationship status. Why? Because people lie to me, and I see crazy things every day, and I don't have time to make a value judgment about the trustworthiness of each patient and/or their partner. It's safer and easier if I just use a standard to protect myself and patients against risks - risks they may not be aware that they have (because their partner's cheating on them) or risks that they may be invested in lying to me about (because they're trying to hide something from their insurance company, trying to save face, or trying to score narcotics). In other words, it's absolutely not personal. It's just the way I do things every day with every patient.

I hope that's helpful. I didn't mean to imply before that you must want to get pregnant - I apologize if it came off that way. I know that people make mistakes and things happen - I've been there, too. I quoted that piece because it seemed like there was some cognitive dissonance between saying that you use birth control so you won't have to deal with these decisions and admitting that in fact, you had recently not used birth control and in fact, could be dealing with these decisions because of that. I mean, you were angry with her for assuming that you were human and fallible, and yet you were also concurrently providing a great example of why human beings are fallible and why doctors make that assumption.
posted by treehorn+bunny at 5:37 PM on December 10, 2013 [15 favorites]

I am also in New York and I would advise getting your IUD put in by someone at Planned Parenthood. They do like 3-10 IUD insertions A DAY. Many other ob/gyn private practices do 2 a year. Seriously.

Experience counts! And Planned Parenthood will tell you up front about no unprotected sex before insertion. AND they won't judge you. Just sayin'.
posted by whimsicalnymph at 6:53 PM on December 10, 2013 [4 favorites]

There are a lot of different things happening here. One is that her office ordered the IUD late. Another is that they didn't re-up your hormonal birth control. A third is that they didn't tell you not to have sex before the procedure.

Then there's the fourth thing, which is that she told you she wouldn't insert the IUD because she didn't trust you to know your own mind. That is pretty aggravating. I find it really frustrating when doctors give me care based on the idea that they know more about my mind and personal history than I do (and if you want to talk about unnecessary, paternalistic medical care, let me tell you it goes totally over the top when you DO get pregnant). I don't think this fourth thing is unethical on her part, and I have sympathy for her point of view -- if she doesn't know you that well, and she's had the experience before of women changing their minds about this stuff, then I can understand her being uncomfortable about inserting the IUD. But it is still frustrating to experience.

Finally, when you combine point 4 with the incompetence displayed in points 1-3, I think I would probably dump this doctor already. You can find someone whose office has its act together -- and you might even be able to find someone who trusts you.
posted by feets at 8:17 PM on December 10, 2013 [1 favorite]

Look, whether her reasons are good or bad it is pretty clear you are now uncomfortable with her. So switch. It sounds like insurance already paid for the IUD--can you just take it to another doctor?
posted by schroedinger at 10:02 PM on December 10, 2013 [1 favorite]

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