Am I right to be annoyed by this?
December 9, 2017 4:32 PM   Subscribe

Twice in the last couple of years, I've been asked a particular question at my doctor's office, which infuriated me. Am I right, or am I overreacting?

So at two different appointments -- one my GP, one the gynecological nurse practitioner (both at the same facility) -- this went down between me and the nurses who do your initial pre-doctor stuff. Both were standard check-up appointments, with no particular tests scheduled or pressing problems to be addressed.

I'm in my 50s and have been going to this facility for decades, and the nurse has my chart in her hands. Here's how it goes down:

Nurse: (after weighing me, taking my temp, checking my blood pressure) Is there any chance that you are pregnant?

Me: No.

Nurse: How do you know?

Me: (looking at her blankly) I just know.

Nurse: But *how* do you know?

Me: Uh...

So this is what infuriates me. I feel like there are several specific questions she might have asked me, depending on what information she is trying to get from me. For example:
"Are you in menopause?"
"Do you have an active sex life?"
"Do you engage in penis-in-vagina sex?"
"Do you understand how birth control works?"
"What kind of birth control are you using?"
"What was the date of your last period?"
"Are you heterosexual?"

I find it so, so infuriating that she leaves me to just sort of cast about in my head for the answer she's looking for. It feels vaguely humiliating -- perhaps to have to answer, "I haven't had sex in X days" or "My partner is infertile" or "I'm a lesbian" or "I went through X rounds of fertility treatment to get pregnant one time and so it's vanishingly unlikely that I'm pregnant now without that" or "We use condoms and they haven't broken."

I've prepped myself for an appointment I'm having next week. I plan to answer, "Why do you need to know?" with the same tone that Frozone's wife uses in The Incredibles. But I'd love to know if this is normal, and if I'm overreacting.
posted by BlahLaLa to Health & Fitness (70 answers total) 7 users marked this as a favorite
 
My immediate question would be, "Why do you ask?" Like... are they just making up random questions, or is there a result on the chart that's weird that they're trying to find an explanation for?
posted by clawsoon at 4:37 PM on December 9, 2017 [7 favorites]


I don't think you're overreacting. It's a really unnecessary question, for the reason you are aware of: it's a stand in for like 10 other potential questions. In my case, there's no way I could be pregnant, because I'm trans. Am I supposed to say that when they ask me that? It's invasive in the worst possible way.
posted by lilies.lilies at 4:41 PM on December 9, 2017 [7 favorites]


They absolutely need to know. Here are my thoughts on a previously; probing your answers is fair and reasonable.

"How do you know?" is the least assumptive and most inclusive way to get the information you medical practitioner needs to deliver healthcare to you.
posted by DarlingBri at 4:44 PM on December 9, 2017 [106 favorites]


I get DarlingBri's line of reasoning but both things can be simultaneously true: It's invasive and offensive to you, and they don't care because they need to cover their asses. I feel like this is true for a whole lot of our medical system. I don't know what the answer is, but if it helps, I feel the same as you.
posted by HotToddy at 4:51 PM on December 9, 2017 [9 favorites]


The nurse has a fixed amount of time. Asking "how do you know" and receiving a direct answer is a lot faster than "do you have a uterus? > yes > menopausal? > no > sexually active? > yes > PIV? > yes > birth control? > yes > what kind? > condoms > last period?" etc.

Is there a wording that would satisfy you, other than the lengthy question tree? I'd mention it to the doctor, or the nurse manager.
posted by AFABulous at 4:55 PM on December 9, 2017 [19 favorites]


Just to be clear, I'm totally fine with the general question of "Is there any chance you could be pregnant today?" It's the post-"no" probing, with its total non-specificity, that annoys me.
posted by BlahLaLa at 4:58 PM on December 9, 2017 [4 favorites]


The medical significance of knowing you're not pregnant varies depending on why you're not pregnant. Asking you individually about the 20 different reasons you might not be pregnant that they might care about is a) a waste of time and b) likely to be even more cisheteronormative, agist, invasive, etc. Instead, they're asking you a single generic question that could apply to any person.

If this is a long-standing condition, one that isn't likely to change over time, you could ask them to note it prominently in your chart and not ask you in the future, but they aren't going to re-read your whole chart every time they do an intake interview, either, so that's not necessarily going to work.
posted by jacquilynne at 4:59 PM on December 9, 2017 [24 favorites]


The thing is, the nurse does not want to know ANY of the potential follow up questions you suggested. The nurse just wants to know "is the reason you think you are not pregnant a legitimate reason that a medical professional would agree with (eg. I'm not sexually active, but could be any number of other things), or a reason that seems logical to you but that a medical professional would not agree with ("I've been douching with baking soda"). Your answer, "I just know", in fact REQUIRES further probing because it suggests that maybe you just think you would, in fact, magically know if you were pregnant. If you want to be convincing but private, you could say, "it's not medically possible for me at this time."
posted by Ausamor at 5:07 PM on December 9, 2017 [99 favorites]


"Can you be more specific?" or "Can you ask that another way?"

Or you could go to town with "How does anyone really know anything?" and when she goes blank, say "I know where babies come from, and I'm not pregnant. Do you have any further questions on that?"
posted by Sunburnt at 5:08 PM on December 9, 2017 [9 favorites]


I’ve been asked many, many times if I could be pregnant at my ob/gyn, even though I went through premature ovarian failure at 16 and have been on HRT of one kind or another since I was 20 (birth control pills until recently). In some cases, the “Could you be pregnant?” question came after they’d just read through my chart to get any updates.

I figured it’s a combination of autopilot and general “duh”. Maybe it’s the physician’s assistant equivalent of asking someone if it’s for here or to go when they already said “to go”, I dunno. But I agree that it’s irritating as fuck to a) ask the question in such a way as to seemingly quiz the clearly grown woman if she knows how babies are made, and b) ask it even when the answer is provided in the fucking chart!
posted by Autumnheart at 5:08 PM on December 9, 2017 [3 favorites]


I think this question is so infuriating to many of us because it comes down to feeling that our medical care providers don't trust us. How do I know I'm not pregnant? Because the last time I had PIV sex with a person who produced sperm was in 1985. And also because I no longer have a uterine lining. And yet I routinely give urine samples for pregnancy tests before procedures that involve radiology, or before taking certain meds.

It always helps me cope with it when the practitioners are apologetic and clear about it: "I know it's annoying to be asked to give a urine sample, but it is routine for us to protect us from liability." When there's a tone of voice that sounds mistrustful, or an implied or explicit, "You can't possibly know for sure," that's when I really get my hackles up. I get that they're covering their asses, but they can also express sympathy, support, and trust at the same time.

"Why do you need to know?" is actually a good question to ask. If they're just asking because it's the next question on the checklist, then for heaven's sake they should let it go. If they're asking because you're taking a medication that is contra-indicated during pregnancy, or, as in my case, because there's about to be extended radiology around that part of my body, that can feel more legit. Your nurse's question, "How do you know?" is infuriating because, in my experience, whatever answer you give, they may very well argue with or use as a jumping-off point for an informational lecture you don't need. Some months ago, I was condescendingly told that it is still possible to get pregnant while going through menopause. Yes, thanks, I know.

Also, "How do you know?" may invite or require you to give information you're not comfortable giving, about your level of sexual activity, your sexual identity (do I feel like coming out to this person right now?), and so on.

To me, it makes such a difference whether the person asking (or sending me off to the bathroom to pee in a cup) seems to recognize that this is invasive and probably unnecessary. If they're asking me to cooperate with them in this small way to complete a bureaucratic and legal requirement, well, fine. If they're telling me I can't know my own body and its history so I have to pee in a cup because I'm not to be trusted, well, fuck that.

I have also found that the wording of the question makes a big difference. My doctor's office asks me, "Do you have any reason to think you might be pregnant?" which is a very different question, to my ears.

So: yes, it's infuriating. But in my view there's a lot that medical professionals can do to convey their respect to their patients while asking these kinds of questions, and I wish more of them would give some thought to that.
posted by Orlop at 5:10 PM on December 9, 2017 [25 favorites]


Your “perhaps to have to answer” examples are exactly what they want to hear. They want to know what the source of your certainty is, knowing (almost surely based on experience) that some people are ridiculously uninformed about signs and situations that they would consider to be “knowing” they aren’t pregnant. “Because we use the withdrawal method” or “Because I had a period three weeks ago” or “I’m pretty sure the condom hasn’t broken recently”. That would lead to a “Ehhh let’s just do a test just to be sure”. But any of yours would probably satisfy them.

Like so much in medicine, it’s probably a liability thing.
posted by supercres at 5:10 PM on December 9, 2017 [20 favorites]


You are interpreting “How do you know” as -“Oh, really, now? Tell me more about your sex life...”

They likely mean, “How do you know,” as a version of: “What evidence leads you to feel confident that you’re not accidentally or unexpectedly pregnant?”

How you answer THAT question does matter a lot because you’d be surprised by how many folks really don’t know the ins and outs, er, as it were, of procreation.
posted by pinkacademic at 5:15 PM on December 9, 2017 [50 favorites]


It's because the have to ask and a surprising number of people do not understand how pregnancy works. If you're at the ob-gyn this seems like the least invasive thing they do so I guess it seems like a strange thing to be annoyed about. I think replying "I'm 50" or "I don't have a uterus" is probably what they're looking for.
posted by fshgrl at 5:25 PM on December 9, 2017 [14 favorites]


I say, "No, my husband had a vasectomy." That seems to squash things. Though I'm personally not annoyed by question. I've had enough bullshit questions and disbelief from doctors dealing with chronic illness that this is very low on my list. And agreed, people are idiots. They may very well say "There's no way I'm pregnant because I burned a special candle when we had sex." Your clinic has no idea until you tell them.
posted by Crystalinne at 5:45 PM on December 9, 2017 [13 favorites]


Yes, this is infuriating; yes, there are legitimate reasons why they ask. Yes, they should be utterly polite and slightly apologetic in tone if/when they press you on details.

*technically anyone could be pregnant, just like anyone could be a lizard person. But generally nurses don’t want to get in to deep discussions of possible-world semantics. They are generally following protocols made by people who are not idiots and want to benefit gross public health. My humble suggestion is to Grin and Bear it, just like you would any other medical best practice that is also a pain in your metaphorical (or literal!) ass.
posted by SaltySalticid at 5:51 PM on December 9, 2017 [1 favorite]


Yes, it's infuriating and insulting. It feels like a pop quiz, and the implication is, "Because maybe you're wrong, you idiot..." THERE ARE OTHER WAYS TO ASK THIS. I like the answers mentioned above: "It's not medically possible" and/or "How does anyone really know anything?"
posted by unknowncommand at 6:03 PM on December 9, 2017 [1 favorite]


(I once told the doctor "because I have toddler twins", and she left it at that.) but seriously I know several women who are intelligent professional women who turned out to in fact be pregnant, when they thought it was impossible. Including women who had previously needed fertility treatment, and one who thought she was through menopause.
posted by Valancy Rachel at 6:05 PM on December 9, 2017 [26 favorites]


Another angle on what everyone else is already stating so well:

I never get the “but are you suuuuuure you’re not pregnant?” follow-up, and it’s either because (a) I’m 35 and nulliparous in a region where most folks breed much earlier and/or (b) my job/education/other demographic factors give providers some sort of confidence that I wouldn’t underestimate my chances of a surprise pregnancy.

This is flattering, but potentially hazardous; providers should not assume “oh, this patient says she is not at risk for condition X, I’ll take her word for it because stereotype Y.”

For the sake of patients with less access to information than you have, please assume good faith. Maybe even be grateful if no one in your clinic is assuming certain groups of people are smarter about biology than others.

You can always short-circuit the exhaustive line of questioning by explaining WHY you’re sure (“I only have sex with women” or “I had a pituitary tumor and I’ve never hit menarche” or “I’m a nun, and I’ve been celibate since 2009” or whatever.)

This is a bit like getting IDed when you think you’re obviously well past legal drinking age, or a store clerk wishing you “happy holidays” rather than hazarding a guess at which ones you celebrate: it’s probably more about applying unbiased standards or general legal ass-covering than anyone’s actual impression of you. Getting offended is exhausting and pointless.
posted by armeowda at 6:06 PM on December 9, 2017 [58 favorites]


I think it is harder to get mad about this after a lot of contact with people who would say in response, "I know I can't be because I always jump up and down afterwards" or worse. the reason medical people sometimes sound like they are delicately and indirectly asking if you are an idiot who doesn't know where babies come from is because they don't know if you are and they need to find out. and guessing about how informed you are based on your manner and appearance and vocabulary and assumed class position is worse than just asking everybody.

invasive questions are enraging, most particularly if you're there for some procedure or medication and they order a just-in-case pregnancy test anyway, because why even ask in that case. but if the answer is " because I use reliable birth control, reliably" or "because I am not physically capable of getting pregnant" I would let them have that information, since both could be relevant to general health and treatments for unrelated conditions.

in her early 70s people were still asking my mother for the date of her last period. I guess because there's a standard form they were looking at and you just have to ask all the questions on the form. she liked to make a big production of calculating how many years since 1980-whatever, multiply by twelve for how many months, carry the one.... this was just to annoy the doctors and it got the job done. they always said yeah, yeah, I get it, but never seemed sorry for asking. later, she started just saying it was sometime in the 20th century, did they want her to go home and check her files. so I would not expect this kind of thing to stop anytime soon.
posted by queenofbithynia at 6:07 PM on December 9, 2017 [26 favorites]


I kind of enjoy rewarding invasive questions with really direct, TMI answers when I'm in a certain kind of mood. "I have not had sex since the Obama administration" is the sort of answer that halts any further probing in that direction.

I do understand why they ask, and I know I'm far more well-informed about The Facts Of Life than most with my background, and my minor annoyance does not outweigh the ramifications of someone not realizing they are pregnant because we have such shitty, inadequate sex ed - so I try to be chill about it. I have had college-educated people say the most dumb-ass things about sex in front of me .. I would not want to assume in their position, either.
posted by bunderful at 6:14 PM on December 9, 2017 [3 favorites]


I can see how it's annoying but it's one of those questions females get asked at the doctor their entire life from 14 on. So many things necessitate covering their ass by asking that question. I don't think they're trying to annoy you or humiliate you, or push a button, or distrust you. It's just on their list.
posted by katypickle at 6:15 PM on December 9, 2017 [4 favorites]


Yes. On its face it is an insulting question that denies your intelligence and bodily autonomy.

That said ... you can also see where it's an imperfect question that is meant to be inclusive enough that it fits everyone, and is also meant as a leading question that is a first step down a decision tree.

It's much more likely that they chose this question for good enough reasons than bad ones, so.
posted by Dashy at 6:17 PM on December 9, 2017 [2 favorites]


I know several women who are intelligent professional women who turned out to in fact be pregnant, when they thought it was impossible. Including women who had previously needed fertility treatment, and one who thought she was through menopause.

Yes, this. It's possible to genuinely believe you're not pregnant, and in fact still be pregnant, so the question "how do you know" is an attempt to ferret out the validity (for lack of a better term) of your statement that you're not pregnant. Some (many? most?) women who say they're not pregnant are reliably accurate in their assessment because (for example) they don't have a uterus/are postmenopausal/have not had PIV intercourse in [X amount of time]/etc. But not every woman who states that they're not pregnant is this reliably accurate in their assessment, hence the "how do you know" question in order to make sure.

It's not an insult, it's an acknowledgment of the (neutral, objective) fact that sometimes people are mistaken when they self-report these things.
posted by the return of the thin white sock at 6:18 PM on December 9, 2017 [10 favorites]


Oh, and. For a non-medical analogy, here’s this:

When I got laid off from my job of seven years (now five years ago), HR put everyone through the same exit-interview battery they used for voluntary resignations. Dozens of us were getting RIFed at once, and we all had to answer a straighfaced HR rep who asked, “Why are you leaving your job at Dipstick Incorporated?” It was truly insult-to-injury-level absurd, but most of us understood it wasn’t the HR reps’ idea, and their asking didn’t mean that they thought we were all too stupid to grok the layoff process. They just HAD to do it, and it made things less painful for everyone if we just said “I’m getting laid off because Corporate wants to relocate administrative operations to Denver.”

It didn’t teach them anything about most of us, but maybe it reassured them that Weird Bob from Revenue actually understood he didn’t need to come back on Monday?
posted by armeowda at 6:26 PM on December 9, 2017 [4 favorites]


Annoying but bog-standard. So much so that the same insurance company that paid for my hysterectomy and ovarian cancer treatment still paid for all the pregnancy tests ER doctors gave me whenever I came in needing X-rays or with unexplained abdominal pain. Nowadays, whenever the nurse asks, "Any chance you could be pregnant?" I just head them right off at the pass with, "No; I had a hysterectomy in 2005."
posted by The Underpants Monster at 6:29 PM on December 9, 2017 [4 favorites]


Dude, it's a nurse. She is only asking you questions, not judging you on your lifestyle. Just answer the question. It's medical, not political.
posted by Marie Mon Dieu at 6:40 PM on December 9, 2017 [28 favorites]


I actually think "how do you know?" is potentially less invasive than most of your options, because it allows you to explain it the way you want. If someone is in menopause, a lesbian, and hasn't had sex for nine months, she could decide which of those facts she wanted to announce in the hall.

You ask why they don't just ask the question they're really getting at, but I think that what they really want to know is whether you're pregnant. I think if they wanted to know "are you sexually active?" for instance, they'd just ask that. But yes, it can definitely feel insulting and intrusive if handled poorly.
posted by salvia at 6:45 PM on December 9, 2017 [16 favorites]


I think it is harder to get mad about this after a lot of contact with people who would say in response, "I know I can't be because I always jump up and down afterwards" or worse. the reason medical people sometimes sound like they are delicately and indirectly asking if you are an idiot who doesn't know where babies come from is because they don't know if you are and they need to find out. and guessing about how informed you are based on your manner and appearance and vocabulary and assumed class position is worse than just asking everybody.

Very much this. Make friends with a nurse/PA and you will hear the most amazing stories of people who thought they couldn't be pregnant because they'd been on top or used Summer's Eve or something. And, remember, the risk they are trying to avert by asking a question--unnecessary and unintentional harm to a fetus--is not exactly trivial. Also, I'd rather be asked "How do you know?" than to have the nurse/PA run through Twenty Questions that may elicit a lot of information that's more delicate. Imagine being trans without bottom surgery, for instance, and being run through a bunch of questions that assume the existence of a vagina and uterus.

Honestly, while I'm not exactly filled with love and trust for the medical establishment as a whole, going to the doctor and then complaining about invasive questions about your body seems to be missing the point a bit. They're really not asking because they give a damn about your sex life or because they're hoping to catch you out on ignorance of some aspect of reproductive biology. You've come to them with some question or issue about your body, even if it's just "is everything in order?", and they're trying to get a complete picture.
posted by praemunire at 7:21 PM on December 9, 2017 [20 favorites]


Years ago I had a friend that was an Xray technician, a surprising number of people think they couldn't possibly be pregnant but are unexpectedly so. Saying No to a Nurse when asked this question isn't the hard no you might think it is from their POV. They've had so many false no's given to them by this point, they need to know why you think you can't be pregnant & that the reason isn't you had sex standing up.
posted by wwax at 7:33 PM on December 9, 2017 [10 favorites]


They may be asking how you know you're not pregnant because a surprising number of women are pregnant and even go to term without knowing.

My father had a woman who worked for him who went into labor without knowing she was pregnant. Two times. If a doctor had asked her whether she was pregnant the day before she gave birth should would have said "no". I also have an ER doctor friend who says this is a regular occurrence at his hospital (and generally not a happy one).

So I would cut your health care providers some slack. They're just trying to take care of you.
posted by Winnie the Proust at 7:47 PM on December 9, 2017 [6 favorites]


Other folks upthread have covered the good reasons for the questions. I have found that "It's very unlikely because of [99% unlikelihood], but not impossible" has shut down further inquiry unless I'm about to have a procedure that needs that last 1% of certainty. I think "impossible" creates more questions than "very unlikely", so if you find the follow up infuriating you might want to try that.
posted by tchemgrrl at 7:52 PM on December 9, 2017


I’m taking a medication that can cause birth defects, and I’m way past menopause. When I first started taking it, I had to fill out six pages of forms about pregnancy. Every month when I get a refill, the pharmacist has to read a spiel about how I shouldn’t get pregnant or give my meds to women of childbearing age. Every six months, I have to take a quiz about pregnancy over the phone. It irritates the shit out of me. But one of the pharmacists apologized, saying he knew I was well aware of the information, but he had to read it to me. I was really grateful to him for acknowledging that. I do understand that health care providers can’t assume you know anything, but there are ways to show a little humanity. Just saying something like, “I’m sorry, but I have to ask” goes a long way.

I’m sure in my case that fear of a lawsuit drives this, and that could be part of it for you as well in that they have to be really sure you know you’re not pregnant. And as many have noted above, some women really don’t understand how their bodies work.
posted by FencingGal at 8:47 PM on December 9, 2017 [7 favorites]


This might help you see the humor in the absurdity instead of getting annoyed. How is prangent formed?

Warning: I had to explain to my doctor why I laughed when she asked me this after watching this video.
posted by fshgrl at 9:02 PM on December 9, 2017 [8 favorites]


With anything medical-related, the doctors and nurses are the ones obligated to meet your needs, not the other way around. Ask them why they need to know, and don't answer unless they give a satisfactory answer.
posted by Aleyn at 9:34 PM on December 9, 2017


I've found it helpful to respond to similar questions with something like, "Could you give examples of what kind of answer you're looking for?" or "If you tell me why you're asking, it will help me know what kind of answer to give."
posted by amtho at 10:21 PM on December 9, 2017 [10 favorites]


It may be an important question to ask for all the reasons given above, but I don't think it's out of place to be frustrated when professionals whose profession relies on interacting with people don't have the awareness to realize how the question might make their patients feel or the professionalism to try to mitigate those feelings.
posted by trig at 10:54 PM on December 9, 2017 [1 favorite]


I think that question is probably the least invasive means of obtaining an answer from you. I get how it could be upsetting, but I think it's kind of an inclusive way of asking.

As a teen, I was asked by an x-ray room nurse if there was a chance I could be pregnant. I paused and then said yes. And she went into full panic mode and ushered me out of the room and started asking me a ton of questions. I was baffled and asked what was wrong. She got mad and said I couldn't have an x-ray if I might be pregnant. I then replied with various statistics and how, even then, I wouldn't be continuing with a pregnancy, but that any sexually active straight teen had a chance of being pregnant and yet I had no reason to THINK I was pregnant, but, yes, there is ALWAYS a chance. She was NOT impressed and I was pretty ticked off that my answer was considered annoying or confusing, when there was no way she would get away with that question on a biology exam.
posted by shockpoppet at 11:21 PM on December 9, 2017 [14 favorites]


I'm male. My doctor has never asked me how I know 'for sure' anything about my health. It's taken for granted that what I say is true - my weight, how much I drink, whether I smoke or not, and so on. I don't see why it isn't like this for you, and I see why it infuriates you.
posted by obiwanwasabi at 1:07 AM on December 10, 2017 [14 favorites]


That is incredibly obnoxious, you are right. I have never been asked "how do you know?" Unless you are about to undergo some kind of treatment that is specifically contraindicated for pregnant women, it's an unnecessarily insulting and invasive question. If you're looking for the Internet's permission to change practices over this, go for it. If it were me, I very well might.
posted by phoenixy at 2:33 AM on December 10, 2017


"How do you know" makes perfect sense. In 1986, I had a bad case of pelvic inflammatory disease and needed surgery. Post-surgery, I was informed I was sterile and could never have children. So my husband and I had unprotected sex for years knowing there was zero percent chance of conception.

About five years later, after feeling sick for weeks, I was asked this same question, explained I'm sterile and can't have kids, and was pretty goddamned surprised to discover I was pregnant.

I "knew" because a doctor told me I couldn't have kids. That doctor was wrong. These days, I can tell my doctor that I know because I'm 5 years into menopause and not having sex.
posted by yes I said yes I will Yes at 2:50 AM on December 10, 2017 [10 favorites]


I'm male. My doctor has never asked me how I know 'for sure' anything about my health. It's taken for granted that what I say is true - my weight, how much I drink, whether I smoke or not, and so on. I don't see why it isn't like this for you, and I see why it infuriates you.

At the risk of stating the obvious, the medical stakes if you're inaccurate in reporting your weight vs. if a woman is inaccurate in reporting the likelihood of pregnancy simply aren't comparable. Numerous procedures, vaccinations, and medications can be harmful to fetal development. Additionally, numerous symptoms can have drastically different implications if a woman is pregnant vs. not pregnant.

I mean, turn the question around: if a woman presents with abdominal pain and says she's not pregnant when she actually is, the results could be literally catastrophic if the doctor or nurse doesn't ask the follow-up question to ascertain how accurate her self-reporting is.
posted by the return of the thin white sock at 2:58 AM on December 10, 2017 [17 favorites]


I have to ask this question often - and (particularly if the answer will affect my prescribing or differential diagnosis) will ask this follow up question +/- if the woman would be willing to take a pregnancy test.

To address your point about why the follow up question is not more specific - from my perspective I am not interested in those specifics. I do however genuinely want to know why you are sure you're not pregnant.
Your case is a little different because it's a regular checkup - but say your answer is "because I have a mirena" and you have abdominal tenderness - I'd be worried about an ectopic. With the same signs and an answer of "I'm not sexually active" I would think differently.

Nthing that your healthcare practitioner will have met many women who are sure they are not pregnant who are, in fact, pregnant. If I don't confirm this and you have an adverse outcome it leaves me legally liable. I would also find it very difficult to move past such a potentially catastrophic and easily avoidable mistake.

I think you are absolutely correct, however, that this could and should be asked with more tact.
posted by bored_now_flay at 4:07 AM on December 10, 2017 [13 favorites]


I'm having a hard time thinking of a way to ask that as an open-ended question any better. You don't want to ask a series of yes/no questions if there's any way not to. You want the "explain" kind of questions, because that's when you hear the shit you'd never think to ask.
posted by ctmf at 6:44 AM on December 10, 2017 [4 favorites]


"I went through X rounds of fertility treatment to get pregnant one time and so it's vanishingly unlikely that I'm pregnant now without that," is why someone close to me didn't realize she was pregnant with her second kid until her second trimester. Also I think that's where the second kid in the family I babysat for as a teen came from. This happens enough to be A Thing, as others in the thread have pointed out.

Basically, some of the reasons people think are *iron-clad* for why they are not pregnant are more convincing than others. I'm not sure there's a better way to get at it than asking an open-ended question.
posted by mskyle at 6:53 AM on December 10, 2017 [1 favorite]


Adding to the chorus at this point, but - I was once given a pregnancy test in the ER despite the fact that I told them (the truth) that I had literally never had sex with a person who produces sperm and hadn’t had any sex at all in months. I was very annoyed at the time. (I didn’t need an X-ray, but I had fainted unexpectedly and they were trying to rule out pregnancy as a possible cause).

A few years later I was discussing it with a friend who is an OB/GYN, and she told me several stories of patients who swore up and and down that they couldn’t be pregnant, but were. I remember she had one patient who said she had never had sex, turned out to be pregnant, and continued to insist that she had never had sex and couldn’t be pregnant - which was only slightly unusual because of the denial post-pregnancy confirmation. She’s had many patients who say they couldn’t possibly be pregnant but upon a positive test say “oh well, there was that one time, I just wasn’t counting it because [reasons].” My friend believes that the women are not lying to her on purpose - they actually, truly believe that they couldn’t possibly be pregnant due to some combination of denial and ignorance - mostly denial.

It is frustrating when you are for-real 100% sure that you couldn’t be pregnant to be asked, but given the above, I understand why it’s necessary. [Some] people are unreliable narrators, and doctors don’t have a way of knowing who is and who isn’t, and the stakes can be very high.
posted by insectosaurus at 6:57 AM on December 10, 2017 [11 favorites]


Agreeing that, while it's annoying, if they really need to know whether you're pregnant, the quickest and most direct way to confirm that is to ask how you know you aren't, rather than asking a series of questions about possible reasons you wouldn't be.

The surgeon who did my hysterectomy told me that she'd had someone who asked about getting pregnant AFTER having the surgery, so that's why she had to tell me that I wouldn't be able to get pregnant without a uterus in there.
posted by ernielundquist at 7:23 AM on December 10, 2017 [4 favorites]


People sometimes do not know basic anatomy stuff. I just had a cis woman friend ask me if I get periods because I've had bottom surgery as a trans woman. I have friends who thought they were infertile because they had been married 14 years without kids and had been told by many doctors they couldn't have kids. They now have two.

I think it would be nice for nurses to just skip to the part where they explain this. But, I can see why they do it this way.
posted by odinsdream at 7:33 AM on December 10, 2017


If I don't confirm this and you have an adverse outcome it leaves me legally liable.

I mean, it really is mostly this, right? And all the other reasons listed above are valid and logical. But in this day and age, it often seems like women don’t get fair treatment in a medical setting. It can feel like the medical profession doesn’t care much about us at all at times beyond if we are carrying a fetus. And our health is really only a consideration while carrying a fetus insofar as the health and viability of the fetus is sound. And if you are anything other than a slim, white, heterosexual woman in the middle class or “better” then you might not even get that. So all this can be true and reasonable and the question also feel belittling and beside the point.

I guess the trick is to answer as dispassionately as possible and try to keep your eyes on the prize - quality care for the reason you came in. Don’t let them distract you.
posted by amanda at 7:50 AM on December 10, 2017


I am an MD. I can see how you might find this question invasive or tactless. But, as you are enlisting the help of a healthcare provider, it is their job to know everything that pertains to your medical care. I agree with all that's been said about the efficiency of this nurse's question, why it is important for your healthcare, and why it is vitally important NEVER to assume anything when caring for patients.

When we ask questions like this, we are not trying to be nosy or judgemental. We are asking because we cannot take anything for granted, especially when treatment decisions could potentially have devastating consequences for a fetus. It is our responsibility to be thorough, and to that end, the "how do you know?" followup question is perfectly reasonable.

My specialty is eyes. I routinely ask patients questions about things they may not think are relevant (how their blood sugars are doing if they are diabetic; what their contact lens hygiene is like; what their home/social situation is like; if they've ever had cancer/chemo/radiation therapy; what they do for work), but these questions all have a role in care, whether the patient realizes it or not. I try to ask these questions in a gentle, compassionate, non-judgemental manner, but I still must ask them. If a patient nevertheless thinks I'm nosy, that's their prerogative, and I'll try to explain my reasoning in the limited amount of time I have. But at the end of the day, they've come to me for medical advice, and I'm going to be as thorough as I need to be in order to provide the best, most appropriate care I possibly can.

I hope this thread helps you understand what kind of answer your nurse or doctor is looking for and why they're asking.

One last thing: a few comments here have advocated snarkiness. I emphasize that we as healthcare providers are on your side. Snarkiness only puts up an artificial barrier and makes it harder, not easier, for us to care for you. It promotes a vicious cycle of mistrust snd defensiveness on both sides. The patient-doctor interaction should be rooted in both compassion and objectivity, and clear communication ("I found your question disrespectful because ______") is a thousand times more productive than snark.
posted by aquamvidam at 7:57 AM on December 10, 2017 [23 favorites]


The other month I was an egg donor (my wife is now carrying our first child!) and for 2ish weeks I tested postive for pregnancy.
I ended up in the ER. I had ovarian hyperstimulation, and had a slightly positive dimer which indicated I needed a CT for the slight possibility of a PE. I work in an ER, I understood what was happening but it took moving hell and high water (no, i'm a lesbian, no I don't have PIV sex. I was given an injection of HCG because I had eggs donated. They are in a petridish)

I still had to sign the "I understand that if my fetus is hurt by CT waiver I won't sue" AND wear the special lead vest for pregant women during the CT.

Really, people are wrong about pregnancy all the time. Asking am open ended question allows for them to figure out your reasons quickly and if a pregnancy test is warranted. It also allows them to avoid asking types of questions such as what Do you have sex? Do you wear a condom? And those questions in a computer system can lead to false reasons to test... Yes I have sex and no I don't use a condom. This is true for me as a married lesbain. This would indicate I need a pregancy test when asking me how I know gets to the answer way quicker .


When she asks how you know, there is no right answer just your answer. 'I just know' doesn't allow for her to direct follow up questions or take action so she asked you again. It's a fact she's looking for, not to judge you. There are thousands of answers to that question, some of them are above.
posted by AlexiaSky at 9:33 AM on December 10, 2017 [2 favorites]


If doctors and nurses are right to be skeptical of women who "know" they're not pregnant, then asking them if there is "any chance" they are pregnant is pointless. That's the insulting part, to me.

It seems to me like asking for the first day of your last period, which is what my OB and GP do at nearly every single visit, is a more precise way of getting the information they're looking for without making their patients feel like they are walking into a logical trap.
posted by muddgirl at 9:57 AM on December 10, 2017 [6 favorites]


Even in the UK you’ll be asked these questions, because it’s not just about legal liability, it’s about *moral* liability: The outcomes for various medical treatments and procedures can be drastically terrible for either or both of mother & child for a pregnant woman. No medical professional want to be responsible for those outcomes if they can possibly avoid it.

The reason they ask you to explain /why/ you think you aren’t pregnant is because any specific questions they might ask will completely miss whole classes of reasons why you can’t be pregnant. It’s far more effective (as outlined above) to hear your justification for not being pregnant and process that through their medical experience. You’ve had a hysterectomy? Lets move on then. You think you’re infertile? Maybe we’d better check that out first before giving you the drugs that would leave your potential foetus born without limbs if you’re unlucky with the timing...

For some of these treatments "we use contraception" isn’t a good enough justification for a negative answer to the 'are you pregnant?' question - the chances of the normal methods of contraception failing on a per year basis is about 1% across the population when /used properly 100% of the time/. People who say "oh, we use condoms" (but in reality aren’t conscientious about it, because lets face it lots of people aren’t) get pregnant at 10 times that rate. That’s why the follow-up question is so important: your nurse / doctor wants to hear your justification so they can decide whether to put you in the "definitely not pregnant" box or the "actually might be pregnant" box. It’s nothing to do with you personally & everything to do with how the statistics fall out in the real world.
posted by pharm at 9:59 AM on December 10, 2017 [3 favorites]


muddgirl: Lots of women get bleeding during early pregnancy that they mistake for their period. Unfortunately that’s not a reliable indicator :(
posted by pharm at 10:03 AM on December 10, 2017 [3 favorites]


Pharm: sure date of last period isn't 100% reliable, but asking if there's "any chance" seems zero percent reliable.
posted by muddgirl at 10:12 AM on December 10, 2017


The "is there any chance" question is designed to be followed up with "how do you know," which gets at the REAL info they want, which is: what evidence do we have that you are not pregnant?
posted by gideonfrog at 11:06 AM on December 10, 2017 [2 favorites]


in this day and age, it often seems like women don’t get fair treatment in a medical setting. It can feel like the medical profession doesn’t care much about us at all at times beyond if we are carrying a fetus. And our health is really only a consideration while carrying a fetus insofar as the health and viability of the fetus is sound. And if you are anything other than a slim, white, heterosexual woman in the middle class or “better” then you might not even get that. So all this can be true and reasonable and the question also feel belittling and beside the point.

While I agree in a general sense, I think it is vastly overstating the case in this particular instance. The practitioners (nurses, techs, and primary care doctors) who are most likely to ask these questions about possible pregnancy are often women themselves: about 85% of nurses, 75% of X-ray technicians, and one-third of doctors in the U.S. are women; the percentage of women physicians rises to 46% for internal medicine, 58% for family practice, and 85% for OB/GYN.

All of these fields are becoming increasingly diverse; in nursing, for example, PoC now account for a third of RNs under the age of 40. That said, while the field's 2013 median salary of $66,200 is solid, it's not exactly upper-class.

In short, the people in medical settings who are asking these questions about pregnancy are rarely, if ever, an entrenched part of the wealthy, white, male medical establishment. More often than not, they are working women who are just trying to provide other women a good standard of care.
posted by the return of the thin white sock at 1:33 PM on December 10, 2017 [7 favorites]


Whatever the rationale was for asking that question, I'd find it disrespectful and would NEVER return to a medical provider who cross-examined me about the validity of an answer I'd already given. This lack of respect is likely to find its way into all aspects of medical treatment.
posted by nirblegee at 5:31 PM on December 10, 2017 [1 favorite]


At the risk of stating the obvious, the medical stakes if you're inaccurate in reporting your weight vs. if a woman is inaccurate in reporting the likelihood of pregnancy simply aren't comparable.

The medical stakes in me telling the truth about smoking would be cancer, and the medical stakes in me telling the truth about home blood pressure readings would be a stroke, the medical stakes in me telling the truth about drug use are too many to count, and the medical stakes about me telling the truth about depression would be suicide. 'No, are you really sure you don't have HIV?' is something no doctor has asked me, ever, and never would, and the medical stakes for that would be death.

As noted above, people can say 'A doctor said I'm infertile' and still be wrong, so the only accurate answer is 'I don't know for sure, and nobody can know for sure, and even if I say 'because reasons' you won't be satisfied, so how about you just cut to the damn chase already and let me know why you think I might be, because that would actually be useful whereas asking a question you already know the answer to isn't?'
posted by obiwanwasabi at 5:41 PM on December 10, 2017 [4 favorites]


Just wanted to add, as an MD, that the answer to "why do you need to know" is not just that a lot of medical treatments are potentially harmful to a fetus. There is no aspect of a woman's physiology that is not affected by pregnancy, from the amount of circulating blood volume, to normal values for blood pressure, to what numbers warrant treatment for iron deficiency or hypothyroidism. I cannot think of a situation when I wouldn't need to know that a woman I am treating is pregnant.
posted by TheLittlestRobot at 8:44 PM on December 10, 2017 [8 favorites]


The medical stakes in me telling the truth about smoking would be cancer, and the medical stakes in me telling the truth about home blood pressure readings would be a stroke, the medical stakes in me telling the truth about drug use are too many to count, and the medical stakes about me telling the truth about depression would be suicide. 'No, are you really sure you don't have HIV?' is something no doctor has asked me, ever, and never would, and the medical stakes for that would be death.

If you lie about being a smoker (for example), it's presumably because you already know that smoking causes cancer, and thus you have some sort of reason to omit this information from your health care practitioner. Further, let's say you're at the doctor and the main symptom you're presenting with is a persistent cough with blood. You will receive the same diagnostic procedures (e.g., blood work, chest X-ray, CT scan, etc.) to determine whether you have bronchitis or pneumonia or lung cancer whether or not you've been truthful about being a smoker. None of these procedures will pose any heightened risk for you as a smoker vs. a non-smoker, so your lying about smoking doesn't have any affect on that score. Now, it's true that if you've lied about being a smoker, then it may delay diagnosis of cancer -- for example, a doctor may order only blood work at first and not an X-ray or CT scan until after those results come in, rather than ordering them concurrently -- but in the end, unless you actively decide to avoid further treatment for months or years, lying to your doctor at a single appointment about being a smoker will not actually affect whether or not you develop cancer, receive a diagnosis of cancer, or receive treatment for cancer.

By contrast, pregnancy immediately alters the options for a range of treatments and medications, which means that the stakes of a missed pregnancy are both varied and significant. For example, pregnant woman should not receive vaccines made from live viruses (e.g., rubella, varicella), and should only receive most other vaccines if there is a significant risk of developing that particular infection (e.g., hepatitis, mumps, rabies, tetanus, etc.). Dozens of other medications are contraindicated during pregnancy, including certain anticoagulants, anticonvulsants, antihypertensives, antipsychotics, retinoids, thyroid drugs, corticosteroids, etc. Administering these drugs during pregnancy can cause miscarriage, congenital malformations, renal failure, fetal growth restrictions, and a host of other adverse affects.

The other side of the coin is that there are numerous steps a pregnant woman can take to help promote a healthy pregnancy. The sooner a woman knows she's pregnant, the sooner she can decide to quit drinking alcohol, start taking prenatal vitamins, take additional precautions to avoid foodborne illnesses, and plan to get a flu vaccine in the second or third trimester.

And it's not just the health of the fetus that's at stake: "In the early 1980s, the national mortality rate from ectopic pregnancy was 1.15 deaths per 100,000 live births; by 2007, it had fallen to 0.5 deaths per 100,000 live births, according to the report. The decline depended heavily on women having access to health care early in their pregnancies." Aside from the fact that early detection and treatment of ectopic pregnancy is crucial in avoiding life-threatening complications for the woman, it's also crucial to help preserve the chances for future healthy pregnancies (if a woman should choose to pursue pregnancy in the future).

Speaking of which: so yeah, let's talk about women's choices when it comes to pregnancy! Millions of women in the U.S. live in states that have imposed restrictions on abortion at 20 weeks (often in conjunction with mandatory waiting periods). A woman who is mistaken in believing that she is not pregnant, but who would choose to terminate that pregnancy, is therefore being potentially deprived of critical health care the longer she goes without learning that she is, in fact, pregnant. Depending on how far along the pregnancy is, a nurse or doctor asking the right follow-up questions may mean the difference between that woman being able to choose an abortion and being forced to carry an unwanted pregnancy to term.

Advocating against health care practitioners asking these sorts of questions on the basis that it's outrageously misogynistic to believe anything other than the idea that all women always know with 100% certainty whether or not they're pregnant isn't actually a feminist position. In fact, in some cases, it's unwittingly the opposite.
posted by the return of the thin white sock at 9:56 PM on December 10, 2017 [8 favorites]


Also, as an OB/Gyn, if you were unexpectedly pregnant I would want *you* to have that startling information as soon as possible. It's not that (all of us, anyway) are treating you as a sacred vessel for the innocent wonderful baby you *must* want...but that if you were one of those women who had implantation bleeding, thought she couldn't get pregnant because some doctor Elsewhere told you you were infertile, and now we catch an unwanted pregnancy before you reach labor unexpectedly, now you have a chance of making it to one of the dwindling counties were abortion is still legal.
posted by eglenner at 10:03 PM on December 10, 2017 [5 favorites]


Thanks for the thoughtful answers and discussion. I highlighted those that most closely seemed to echo the way I've been feeling -- that the lack of tact and specificity in the follow-up question is annoying; that men are never routinely asked to provide evidence for their their answers to the doc's questions; and that at its heart there is no answer -- because if we're all looking for 100% honesty the only possible answer has to be something like "How can anyone ever know for sure?" which is entirely useless in this scenario.

I guess my only fallback, other than being prepared to say "Can you ask that another way?" or "Can you be more specific?" is to continue to grow older, until maybe one day, if I'm decrepit enough, the nurse will accept me automatically when I say, "I'm not pregnant." #Crone
posted by BlahLaLa at 10:08 PM on December 10, 2017 [1 favorite]


It seems to me like asking for the first day of your last period, which is what my OB and GP do at nearly every single visit, is a more precise way of getting the information they're looking for without making their patients feel like they are walking into a logical trap.

Sure, but in my own and clearly many women's cases, I could have told them my LMP date and still be pregnant.

Asking "How do you know?" is perfectly reasonable.
posted by yes I said yes I will Yes at 3:06 AM on December 11, 2017 [3 favorites]


I agree that the question can come off as condescending and irritating, but I also can see how asking non-specifically is actually the best practice for letting people talk about their body on their own terms. Rather than subjecting everyone to a standard quiz of items--some of which will feel more or less invasive to people on a completely individual basis--they're asking for the answer that you want to give. I mean, I'd be taken aback if, in order to determine whether I may be pregnant, my doc routinely asked me if I had an active sex life, what kind of sex I was having, if I were heterosexual, etc.

An open-ended question means that you need not give an answer that feels too personal or irrelevant to your doc visit, you can answer very clinically (e.g. "I haven't had unprotected sex with a man") and completely leave off the context (e.g. single w/out current sex partners, a lesbian, going through a rough patch in your marriage, etc.)

On the other hand, if someone were to reply with a reason like "because the last time I had sex was during my period," the provider should step back and do some patient education. Or, what pharm said, above -- it's a good landing point for determining the necessity of follow-up questions. And as TheLittlestRobot and the return of the thin white sock have ably explained, the medical implications are quite different for being mistaken about pregnancy versus reporting smoking or other behaviors.

so the only accurate answer is 'I don't know for sure, and nobody can know for sure, and even if I say 'because reasons' you won't be satisfied, so how about you just cut to the damn chase already and let me know why you think I might be, because that would actually be useful whereas asking a question you already know the answer to isn't?'

I don't want medical professionals "cutting to the chase" of jumping to uninformed assumptions without letting a patient communicate in their own words, no. This is how sexist and racist biases in medical care are perpetuated.
I've seen quite enough of that as a woman.

men are never routinely asked to provide evidence for their their answers to the doc's questions

Never? Not that has been discussed in this particular thread, but out gay men are indeed sometimes asked about their HIV exposure in similar ways, with "how do you know" follow-up questions.
posted by desuetude at 10:11 AM on December 11, 2017 [5 favorites]


Not that has been discussed in this particular thread, but out gay men are indeed sometimes asked about their HIV exposure in similar ways, with "how do you know" follow-up questions.

Yeah, I don't know if this is still the case, but when my friend worked for the Red Cross a few years back, gay men weren't allowed to donate blood. At all. No matter what their status, just in case.

...asking if there's "any chance" seems zero percent reliable.

There are certain circumstances under which a woman does know that there isn't any chance. She may not have been sexually active in a long time, she may lack a part of the necessary anatomy, she may have recently given birth, or she may be well past menopause.
posted by The Underpants Monster at 11:08 AM on December 11, 2017


> There are certain circumstances under which a woman does know that there isn't any chance. She may not have been sexually active in a long time, she may lack a part of the necessary anatomy, she may have recently given birth, or she may be well past menopause.

...or is sexually active but only with women.

When physician's offices go for the "specific question" route, they would often ask if you're sexually active, then ask if you could be pregnant, and if you very confidently say no, they're straight-up confused and would start right in with condescending questions about whether you know how birth control works and how it may not be 100% effective, without pausing to consider the concept of lesbians.

/my actual experience, queer bisexual femme
posted by desuetude at 12:01 PM on December 11, 2017 [2 favorites]


'I don't know for sure, and nobody can know for sure, and even if I say 'because reasons' you won't be satisfied, so how about you just cut to the damn chase already and let me know why you think I might be, because that would actually be useful whereas asking a question you already know the answer to isn't

I don't think this works, because your doctor/nurse probably doesn't think you might be pregnant. They know that you have a better insight into this than they do. They genuinely want an answer - it's not a trick.

"Is there any chance you could be pregnant" seems to be a reasonable starting question because plenty of people answer "yes" - in which case, great - they can do a pregnancy test/rx something not contraindicated in pregnancy/postpone your coil insertion until your next period - etc. If/when you answer no, its reasonable to probe why you think that - so that they don't miss anything.

I wonder if similar questions (which I think are asked to both men & women) would provoke the same irritation. The one that springs to mind is the question of allergies; if someone tells me they're allergic to Penicillin I might indeed ask how they know - answers can range from "I had an anaphylactic reaction" to "my mum said so" to "I feel a bit nauseated with it" - which vary wildly in terms of how they might potentially affect vital treatment with other antibiotics etc. I'd be surprised if in this context follow up questioning was considered to be disrespectful/a form of cross-examination.
posted by bored_now_flay at 3:05 PM on December 11, 2017 [4 favorites]


I personally make mistakes all the time, I misremember things, and I'm a fallible human. Although it's annoying to be asked for corroborating information when I've stated something that I believe is true, and sometimes I know I have to respond, shall we say, assertively if the questioner is being a dope, in some cases (medical questions usually among them), I'll realize that my annoyance is fine but the request is also fine.
posted by amtho at 9:28 PM on December 11, 2017 [3 favorites]


I've never been asked "how do you know," as far as I remember, and I'm a straight, married cis woman who's had two kids and who has doctor's appointments all the freaking time because of an ongoing medical issue (which is not related to fertility). I understand why they'd ask, but I want to be one tiny voice saying it isn't the 100% common experience everyone else seems to be saying it is.
posted by The corpse in the library at 4:12 PM on December 14, 2017 [1 favorite]


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