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To not understand why I have to talk to a nurse before I can book an appointment for implant removal?

(172 Posts)
Alarae Mon 25-Mar-19 15:44:57

Considering I want it out to start to TTC?

Rang up my local GP today to book an appointment for removal, only to be told my the receptionist that I need to speak to the nurse first, and then she might schedule an appointment for me.

I don't see why I should need a conversation considering my reasons? Understandable if someone wanted it out for other reasons such as concerns on side effects, recent implantation etc but even then if someone wants something out why should someone be trying to convince me otherwise?

Just a bit annoyed as the earliest telephone appointment is in 10 days, and then who knows how long it will take to actually get an appointment considering only one person holds the clinic!

I can't even go to a walk in clinic as I need a GP referral for that in my area because I am not 25...

Alarae Mon 25-Mar-19 15:45:38

Sorry about the format, I did type in paragraphs but they disappeared when posted!

3ChangingForNow Mon 25-Mar-19 15:46:25

Because you are a woman and stupid of course. They have to check you know what you are doing hmm

Traveler001 Mon 25-Mar-19 15:47:14

Yabu, you’re a mere woman, how would you know what is right for your own body? Silly girl.

ILoveMaxiBondi Mon 25-Mar-19 15:47:22

That’s ridiculous! What a waste of NHS resources to make you go in for a chat rather than just using that appointment to have it removed!

Tolleshunt Mon 25-Mar-19 15:49:07

Because you are not allowed autonomy over your own body when it comes to long-acting contraceptives. Some HCPs believe they have the right to make you continue to have it in your body, even if you don't want it.

Sound ridiculous? Check out the threads on Mirena removal on here.

kaytee87 Mon 25-Mar-19 15:49:09

Yes, silly woman. You must be lectured first. They might want your husbands permission too wink

JohnnyMcGrathSaysFuckOff Mon 25-Mar-19 15:50:37

Because the nurse knows best, of course! Silly girl.

TeeniefaeTroon Mon 25-Mar-19 15:51:48

They tried to get me to do the same. I ended up booking into the the family planning clinic at my local hospital and they removed it without any queries.

dietcokemegafan Mon 25-Mar-19 15:54:03

I'm a female GP and clearly believe in female autonomy. But about half the women who come to have their implant out are doing so for a reason that doesn't exist and they often change their mind when given the facts. So if double appts for removals are in short supply, it's reasonable to triage them.

frugi Mon 25-Mar-19 15:54:25

Is there another family planning clinic you could potentially drive to? Lots are drop in and would be able to do this for you. Sounds like a waste of everyone’s time.

Inde96 Mon 25-Mar-19 15:55:12

I went to a sexual health clinic to have mine removed as it was affecting my mental health. The person who removed mine responded with "Well, if you get pregnant, you'll certainly be depressed then".

kaytee87 Mon 25-Mar-19 15:55:15

@dietcokemegafan but op wants to ttc.

TheInventorofToasterStreudel Mon 25-Mar-19 15:56:32

I had to have a private conversation with the nurse before I had my coil out and she was really aggressive "why do you want it out?" "well, are you on folic acid?" "Is your husband?" (???!!! I kid you not!)

We are both in healthcare.

Grace212 Mon 25-Mar-19 15:57:56

sorry to hear this OP

I could use the Mirena as an alternative to the pill but I am suspicious....there seems to be a lot of attempting to pressure women to choose it - cheaper? - and then from what I hear from friends, if you want it removed it's a hassle.

if it's causing side effects, it seems to involve virtually having a row with the GP or nurse or whoever.

it does all boil down to "women can't possibly make a choice without being hassled".

Tolleshunt Mon 25-Mar-19 16:01:08

You may act properly, dietcoke but there are plenty of GPs who don't. Check out the many threads on here from women who have reported suffering known side effects of the Mirena or implant, and yet have been poo-pooed by HCPs, who have failed to follow the patient's request for removal.

beeRB Mon 25-Mar-19 16:02:32

Oh this made me so annoyed when I rang my GP I didn't bother. I contacted the local sexual health (GUM) clinic instead and saw them that week and got it removed.

A much easier experience and I now only use the GUM clinic for contraception related appointments- the ridiculous wait and unnecessary appointments at the GP's was infuriating.

I also find the staff at the GUM clinics seem very happy to get to speak to a sensible adult who knows what they want with regards to contraception and TTC smile

YouSayRisottoIsayRisotto Mon 25-Mar-19 16:08:43

I got the lecture when I had mine out.

They've paid for it so they want there money's worth I guess hmm

I was also given a lecture at the post natal checkup because I said dh would be getting the snip.

Apparently this was unacceptable and I was given the hard sell for the Mirena Coil, which I made very clear I didn't want. Left with an appt for the coil. hmm

After 3 kids and years on bc why would dh take some responsibility for our fertility?

Cancelled the next day when I wasn't so out of sorts.

When dh went first his first appt to discuss vasectony he basically got talked out of it/denied one and told it would be better if he used something else (a wife on the coil most likely).

The second time I came with him and let all three dc loose in the GP office.

We left with an appt. grin

Wantmyflipflops Mon 25-Mar-19 16:20:02

As @beeRB said you don't have to go to the GP to get it removed. Sexual Health Clinics will do it as will FAmily Planning Clinics if you have a local one. I got my implant removed the day I called the GUM clinic...

MsHopey Mon 25-Mar-19 16:20:08

I always thought it was standard to discuss the procedure, sign off any paperwork and just have a general discussion. It didn't seem a very big problem in the grand scheme of things.

I was quite surprised when my DH phoned up for a vasectomy and was given an appointment for the operation right there and then. No consultation appointment or paperwork.

YouSayRisottoIsayRisotto Mon 25-Mar-19 16:23:42

The removal barely counts as a 'procedure' honestly. Nothing to discuss.

I've seen threads where people say they did it themselves. (Not suggesting op do that though!)

AliceAforethought Mon 25-Mar-19 16:25:52

Seems very unreasonable. Fair enough if it’s because you’re wrong attributing side effects to it or something, but when you’re ttc? An annoying waste of time.

My GP took mine out after a brief discusson.

frugi Mon 25-Mar-19 16:26:59

Removing your own mirena would be easy. Not sure I’d fancy removing my own implant without any local anaesthetic, but maybe I’m a wimp.

AliceAforethought Mon 25-Mar-19 16:27:46

I've seen threads where people say they did it themselves. (Not suggesting op do that though!)

Yes I’ve seen this. Someone said they took a Stanley knife to it shock

anniehm Mon 25-Mar-19 16:29:45

You requested it to be put in, you knew how long it lasted. As you are requesting removal early then it's right and proper they explain the process and check that you want to come off contraception, they don't want to be paying for something else!

BlackAmericanoNoSugar Mon 25-Mar-19 16:34:46

I was just wondering about self-removal. They are pretty close to the surface, aren't they? I was thinking some local anaesthetic cream and a scalpel would do it, probably no more painful than a bad splinter.

I bet if you said "it can't be that hard to do it myself" to a nurse who was trying to refuse a removal that you would get a removal appointment without further comment.

longtimelurkerhelen Mon 25-Mar-19 16:35:51

@YouSayRisottoIsayRisotto

The second time I came with him and let all three dc loose in the GP office grin

Release the children. (maniacal laugh) grin

InsertFunnyUsername Mon 25-Mar-19 16:36:50

I had a nightmare trying to get my implant removed after it had "run out" I even attempted to remove it do not advise!!

It took me taking a day off work and sitting in a sexual health clinic to get it removed, have you rung your local clinic? Might have better luck!

longtimelurkerhelen Mon 25-Mar-19 16:38:39

Fair enough if you have to have a chat with the nurse first (just to make sure you know your own mind angry ), but why not then have it removed at the same appointment?

Makes no sense. It's a waste of time for both of you and you would need to take time off work twice.

InsertFunnyUsername Mon 25-Mar-19 16:39:58

Sorry just read about the clinic!

agnurse Mon 25-Mar-19 16:41:04

They probably want to check with you to see why you want it removed.

Let me explain.

Obviously, you want to remove yours to TTC. But some people may want them removed for other reasons (e.g. side effects). This is why it's important to speak to someone about why you want it removed. They want to be sure that you understand the risks and benefits of having it removed, and if someone isn't planning a pregnancy right away, they want to be sure that she is aware of how to prevent one.

YouSayRisottoIsayRisotto Mon 25-Mar-19 16:41:23

@longtimelurkerhelen

I could have asked for a tenner while I was there as well. He just wanted us OUT. grin

KatnissKringle Mon 25-Mar-19 16:46:00

That's mad! I just made an appt and got mine out, no fuss. And I'd had it in less than a year so I expected some questions but the GP just cracked on and whipped it out in no time.

Alarae Mon 25-Mar-19 17:03:27

I fully understand scheduling a chat for people who have other concerns such as side effects, worries etc, but I don't want to swap to another contraceptive. Unless they are going to try and talk me out of TTC, I have absolutely no idea what they want to talk to me about? As others have mentioned, it's just a waste of time in my circumstances, since I'll have to make sure I'm far from the office to discuss it privately. I'm sure the nurse could do better things with her time then talk to me.

Unfortunately the nearest walk in clinic to me doesn't provide contraception services to over 25s without a GP referral, which means I might as well just take the nurse call as the wait for a GP is even longer.

Looks like I'm just going to have to travel further out to a family clinic that allows walk ins without needing a referral or for me to be younger hmm

pinegreen Mon 25-Mar-19 17:10:21

if someone isn't planning a pregnancy right away, they want to be sure that she is aware of how to prevent one.

Jesus wept. This level of condescension towards women is the reason I get my pill privately online, after a GP harangued me for 10 minutes over how to take it properly at the ripe old age of 34, no kids, and 15 years on the pill. Plus various fending off conversations trying to point me towards the implant (which I will never have).

Meanwhile, blokes who need a bit of help getting their todger upright can walk into any pharmacy and walk away with Viagra, no questions asked.

Grace212 Mon 25-Mar-19 17:21:45

pine so glad you said that - that example is one that annoys me immensely - adverts for Viagra everywhere but dog forbid a woman decide what meds/hormones etc do or don't go in her body.

OP it's worse to delay with side effects in some ways - the woman might be feeling awful.

Chucklecheeks1 Mon 25-Mar-19 17:21:53

I went to the FEmale GP last week to ask for a referral as my ablasion didn’t work as should. My periods are heavier than they were before and with horrid side effects. I was offered the ablasion after years of trying all other hormonal and non hormonal contraceptives.

She spent ten minutes trying to pursuance me to get the mirena as I was obviously over exaggerating thr side effects from the last time I had it fitted. She ignored that hormonal contraception gives me permenant periods, that my womb tilts and that coils don’t stay put. All the reasons the specialist decided on an ablasion in ther first place. She knew better.

I asked to see another GP who read my history and refered me straight away. I’m sick of justifying myself simply because I’m female.

Grace212 Mon 25-Mar-19 17:24:50

agnurse

your response made me ponder again - is this all a ploy by the NHS to get women to go private because it's such a hassle?

I've had the implant "promoted" to me endlessly as well. If it's cheaper, I wish they'd just say so.

PolPotNoodle Mon 25-Mar-19 17:25:09

How odd. I had mine out at a sexual health clinic, had to sit around for a bit waiting but it was done same-day. Same when I had my coil out. I don't recall being asked if I was super duper sure about it.

Tolleshunt Mon 25-Mar-19 17:29:10

Totally agree, Pine. The level of patronising, paternalistic bullshit is really something.

2019sucks Mon 25-Mar-19 17:36:24

Oh god I had this - do you mind me asking how old you are OP?

I booked an appointment to get mine removed as we were also TTC, I was 24 at the time. Then had a letter saying I had to talk to the GP first, and the GP said basically TTC was the only reason they would remove it. I’d actually struggled with it for a long time, it massively affected my mental health, periods, appetite and libido and when I went to ask for removal due to this I left with a prescription for the pill on top of the implant to “balance out my reaction to the hormones”.

I can’t understand how they think they have so much control over a foreign object in a woman’s body.

agnurse Mon 25-Mar-19 17:38:00

Some people honestly have very strange ideas about how to prevent a pregnancy. Here are some of the ones I've heard about:

-You can't get pregnant standing up
-The Pill keeps working for several months after you stop taking it (it can take some time for fertility to return, that's true, but there's no guarantee)
-You can't get pregnant on your period
-You can't get pregnant your first time
-You can't get pregnant if you douche afterwards
-You can't get pregnant if he doesn't ejaculate (news flash: the pre-ejaculate can contain sperm)
-You can't get pregnant on a weekday, only on the weekend

It's incredible how misinformed some women are. Obviously, this is slightly different, but I have heard of women who thought babies were born through the urethra. They honestly did not know that you have two separate orifices down there. Then, too, even with the Pill, there are some women who aren't aware of things such as potential serious side effects, or even the fact that if you're on certain antibiotics the Pill won't be effective.

2019sucks Mon 25-Mar-19 17:38:07

Sorry the reason i asked your age is because the GP said as I was under 25 they needed to speak to me before “agreeing” to remove it!

FairfaxAikman Mon 25-Mar-19 17:42:09

* I bet if you said "it can't be that hard to do it myself" to a nurse who was trying to refuse a removal that you would get a removal appointment without further comment.*

I pretty much did do this. Nurse didn't believe me when I said the end was catching on clothes or DS running his hand up the inside of my arm was causing me pain. I ended up telling her it would be less bother to cut it out myself as the pain would only be short-term.
She agreed to remove it after that.

Graphista Mon 25-Mar-19 17:43:52

Medical sexism reinforced by "incentives" to promote LARC and once they're in if they're removed "early" the GP surgery can lose that "incentive"

Seriously tons about this on mn and in the press generally (but not making major headlines which it bloody well should be doing!) it's a scandal, both in terms of not acting in patients best interests and in wasting Nhs resources

"Let me explain." Wow! You couldn't be more patronising if you tried!

To Agnurse and the GP - you may act ethically but there's a hell of a lot of primary hcps who are not particularly wrt to LARC.

https://www.mumsnet.com/Talk/amii_being_unreasonable/3402449-Aibu-to-ask-you-to-tell-me-your-experiences-of-being-dismissed-by-medics-as-a-sick-woman-I-promise-to-listen

Tolleshunt Mon 25-Mar-19 17:46:11

agnurse those are not reasons to deny removal. Or make patients jump through the hoops, double appointments, long delays etc. If s woman rescinds her consent to Larc, it should be removed ASAP, regardless of what the HCP thinks of her reasons.

2019sucks that's awful. Did you complain?

ThinkOfAWittyNameLater Mon 25-Mar-19 17:46:58

Do not attempt to remove it yourself. My mirena cool became... entangled... and needed to be cut out sad

I absolutely hate the attitude some HCPs have about contraception. They need to decide if they'll "let" you take it out?! F off. My body, my choice.

My husband went for vasectomy and Dr was asking about my contraception. DH pointed out it was none of his business and irrelevant. Came home with date for the snip.

I went to ask for referral for sterilisation. They asked why DH couldn't just have the snip. I said he was welcome the make as many babies as he likes but don't want any more in my body. It's me that is permanently damaged from 2 (much adored) babies, not him and I want reassurance that it can never happen again. Got my referral.

agnurse Mon 25-Mar-19 17:58:03

Tolleshunt

I didn't say they were reasons to deny removal. Rather, my point is that it's all about informed consent. If a woman has a mistaken idea about how to prevent pregnancy, is her decision that she doesn't want to keep her coil or implant truly an informed one? (That said, I do think two appointments is a bit excessive. One should be sufficient for teaching and removal.)

Let's compare this to other medical conditions. Would you not suggest that if a patient wants to stop a medication, they should contact their provider?

Tolleshunt Mon 25-Mar-19 18:08:34

As far as I was aware, agnurse, legally there is only a requirement on a HCP to ensure fully informed consent before prescribing meds/carrying out a procedure. Patients are at liberty to discontinue treatment at any time, and don't need a HCP's permission to do so.

Re your specific example, no I wouldn't usually feel I needed to ask a HCP whether to stop treatment in most circumstances. If I did, I could easily make an appointment myself.

That said, in the context of an ongoing relationship between HCP and patient, I can see that the HCP may feel a duty of care to ensure the patient is informed before discontinuing. I wouldn't be upset about that in itself, provided there is no delay in removal, and the HCP agrees to remove, even if they don't agree with the patient's reasons. As you say, no reason a quick check on this can't be done at the appointment to remove.

Some of the egs given on this thread, and others, though, go far beyond that.

Graphista Mon 25-Mar-19 18:09:05

Would you not suggest that if a patient wants to stop a medication, they should contact their provider?

Not when it's contraception no! It's not medically necessary, it's not harmful to stop using and frankly your attitude is infantilising and bordering on supporting state control of women's fertility!

There isn't anything like this level of control or patronising and condescending bollocks about any other medication

iolaus Mon 25-Mar-19 18:12:57

I'd go to a sexual health clinic and they will , in most cases, do it on the day - by the nurse

However they do tend to a) ask you why you want it out - if it's for bleeding they will give you additional meds to stop that, if it's for conception, partners had a vasectomy etc then just take out

but also b) they feel it work out ease of removal as if it's deeper or at a stranger angle than normal they need to have done additional training to get it out - so they would make you an appointment with the correct person

Could it be a misunderstanding and the receptionist actually meant 'don't speak to the doctor, you need an appointment with the nurse first as she can take out the majority of them and save the doctors appointment'

Verynice Mon 25-Mar-19 18:13:52

@dietcokemegafan
Interested to hear these reasons that don't exist?

VeronicaDinner Mon 25-Mar-19 18:18:04

@agnurse

So your first thought is Oh she must be so dumb she thinks a baby is going to come out of her pee hole? And you are a health care professional?

Notwotuknow Mon 25-Mar-19 18:21:08

I had issues getting the mirena removed. It was really affecting me (I suffered lots of unpleasant side effects and it hadn't stopped my bleeding), so I asked for it to be removed. Although I'd had it in for abt 2 yrs, my consultant refused to remove it. Saud they wanted me yup try other things first and if that didn't work then they'd remove whilst I was already under anaesthetic as an ablation would be the next step (so they'd kill 2 birds with one stone).
I really didn't want to wait that long, but they weren't interested.

After all, I'm just a woman and it's only my body, but what do I know!?

Hotterthanahotthing Mon 25-Mar-19 18:23:44

I had a hysteroscopy today and have been asked for my lady 3 appointments to have the marina as part of hrt,today I caved.Luckily they couldn't do it so mysure now booked and no doubt more badgering.

Tolleshunt Mon 25-Mar-19 18:24:45

Did you complain Not?

My advice to anybody coming up against a refusal would be to say something like: 'I am putting you on notice that I no longer consent to have this device in my body. Are you refusing to remove it?'

If you can get out a pen and paper and go to write down their answer, so much the better.

I'd be very surprised if the intransigence continued.

Hotterthanahotthing Mon 25-Mar-19 18:25:06

Sorry,had a GA so button hitting a bit off.

Tolleshunt Mon 25-Mar-19 18:29:35

Hope you recover well, Hotter.

kaytee87 Mon 25-Mar-19 18:30:37

Let's compare this to other medical conditions.

Sorry, but what medical condition is contraception treating?

agnurse Mon 25-Mar-19 18:30:54

VeronicaDinner

I have heard from a woman herself that she thought this was true. I've heard from another nurse of women (who had had children themselves) who thought this was true.

It's not that they were stupid. It's rather that they didn't understand how their bodies worked as it had never been explained to them. Sadly, many women are very poorly informed about the function of their own bodies. I'm not saying that every woman would believe that. Rather, I was illustrating a point. If I were in the position of having a woman who was asking to have her implant removed, I'd be having a sit-down with her to explore her options. Why does she want the implant removed? If we have a method for getting the side effects under control, is she interested in trying that and keeping the implant? If she is TTC, that would be an opportunity to discuss pre-conception care (e.g. good nutrition, folic acid supplementation, etc.). If she is not TTC, is she aware of alternative options for preventing pregnancy?

It's not that we assume people are ignorant. It's rather that we want to ensure that they are fully informed. What I like to do is check with the patient - what do you know? What do you want to know?

PinkDaffodil2 Mon 25-Mar-19 18:31:44

Sexual health clinics will generally take it out on the day because they tend to operate a very different appointment system to GPs, so if you decide to keep it (which loads of women do in my experience) it doesn’t matter as the clinician can see a walk in patient instead with the extra time. In a GP setting a removal will generally be a double appointment with a GP which is a very valuable resource. If 20-30% of women change their mind after speaking with the nurse then that’s much more efficient for the practice (though I appreciate not more efficient for patients!). I’m training to be a GP and working in a GUM clinic at the minute and it’s really interesting to see how the different systems deal with similar presentations.
Obviously some people’s experiences aren’t just due to this though and it’s horrible the attitudes some HCPs have! I hope our generation of GPs does better x

HeadsDownThumbsUpEveryone Mon 25-Mar-19 18:35:14

I'd be having a sit-down with her to explore her options. Why does she want the implant removed? If she is TTC, that would be an opportunity to discuss pre-conception care

So you would treat the women like an idiot then? I presume that the vast majority of women who wish to TTC know about pre-contraception care, if they don't I'm sure even the most lacking in intelligence could google what is recommended for women TTC. You honestly don't need to waste an appointment to discuss eating healthily and taking folic acid.

It is almost impossible to get any form of appointment at my GP surgery even with a Nurse. If they are wasting their time having chats with grown women about common sense issues then I'm beginning to see why I can never get an appointment.

Samind Mon 25-Mar-19 18:35:28

I remember going to sexual health clinic about getting implant in and the woman kept trying to get me to have the coil in. Literally bullet point information and leaflet to take home to read even though I'd booked another appointment to get my old implant out and new one in. Must be a finance thing. I agree though what do we know about contraceptives or what's good for us or what we'd like to put in our bodies. I had to get mine out though as the implant sent me ott horomonal 😜

Ilovelala Mon 25-Mar-19 18:36:06

We do follow the same process though 9/10 times we will remove it in the same appointment, we don't tell patients we will do it 100% because the abuse we receive if we couldn't do it on that day is not worth it for us.

Consult is done beforehand because it is not financially effective to pay a doctor or implant fitter/remover to do your consultation too, especially if it's not suitable on the day. We rather a doctor do a procedure every 20 minutes than 1 an hour. It's about ensuring everyone gets their contraception in a timely manner.

Tolleshunt Mon 25-Mar-19 18:37:15

Out of interest, PinkDaffodill, how much training have you been given on patient autonomy, fully informed consent, Beauchamp and Childress, managing conflicts of interest between financial incentives and patient best interests/autonomy?

Do you have any views as to how a GP could arrive at a conclusion that they should deny removal of LARC despite the request of a patient that they do so?

agnurse Mon 25-Mar-19 18:39:55

HeadsDown

Again, not every woman knows about pre-conception care. Again, I'd be asking if that is something she would like to explore.

Wellness visits are a time when health care professionals SHOULD be doing health promotion with patients.

It's not that we assume that you don't know, it's rather that we have a professional responsibility to make sure you DO know. It's a covering-our-butts thing.

As a nursing instructor, we teach our students that you MUST ensure that your patient knows about the side effects of their medication. I do suggest to them that it's helpful to find out what your patient already knows. Once you find that out, then you'll know if you have additional teaching that you need to do. I had a patient once who had been put on Flagyl for BV in pregnancy. She was really worried about this because she had come across something that said Flagyl could cause cancer. What we had to explain to her is that this was a very remote possibility, and that actually, her baby was at far greater risk from the BV than from what we were using to treat it.

The point is that we can never assume health literacy. If I, as a nurse, gave a patient a medication and didn't ensure that they knew about the side effects because I just assumed they did, and they suffered serious harm, I could be held liable for not educating them. It's a professional responsibility.

PixiKitKat Mon 25-Mar-19 18:42:39

I had to threaten to rip mine out if they wouldn't do it for me! The side effects were awful and their solution was to try give me the pill to take at the same time! I didn't want that and just wanted it out but they convinced me to give it another few months claiming it'll settle down hmm I finally got it out after 9 months of a being on my period almost constantly and feeling tired all the time even after 12 hours of sleep.

They try to convince me to try it again everyone I refill my pill but I say no as it was so awful last time.

agnurse Mon 25-Mar-19 18:44:46

Tolleshunt

I don't insert or remove coils or implants as part of my practice, but if I did, I would first ask why the patient wants to remove it. I'd explain that it's not that I'm saying I won't take it out, but rather I want to help them explore their options. Is it creating problems for them? What problems is it creating? Is there a way to fix those problems, and, if so, would they prefer that we fix the problems rather than taking it out?

It's not about swaying their decision or refusing to remove it. It's rather about ensuring that they are fully informed about ALL of the options before they make a decision. Otherwise, it's not really informed consent, is it? Not to mention that if they're experiencing problems such as potentially very serious side effects, we need to actually report those. Even if the side effects aren't serious, if they aren't something that's already documented as being a side effect, it's something I as a clinician would want to know so that I can let my future patients know as well.

HeadsDownThumbsUpEveryone Mon 25-Mar-19 18:48:04

Again, not every woman knows about pre-conception care. Again, I'd be asking if that is something she would like to explore.

Women don't need to discuss pre-contraception care and if they do I'm sure they can be a grown up and organise, investigate and learn about it as required. Some women might not know but I would wager it was a very miniscule amount that don't, to lump all women into this group is to presume women are not capable of being functioning adults without having their hands held, no one ever sits an adult man down to discuss this stuff.

The point is that we can never assume health literacy. If I, as a nurse, gave a patient a medication and didn't ensure that they knew about the side effects because I just assumed they did, and they suffered serious harm, I could be held liable for not educating them. It's a professional responsibility.

But the Op doesn't want any medication. She wants a contraceptive implant which is not medication removing. It doesn't matter why she wants it removing whether its because she is TTC or that she just wants it out. There is no need to educate her about side effects or lecture her about other forms of contraception. If an adult says they want the implant removing then I don't see how you need an appointment to discuss the issue. There is no discussion needed is her body and if she wants the implant removing then that's the option she should get.

IlonaRN Mon 25-Mar-19 19:03:11

I had to have a consultation with the GP before they would book an appointment for me to have mine out. Luckily I could have a telephone consultation. It went like this:

GP: So, I hear you would like to have your coil removed. May I ask why?
Me: We want to try for another baby.
GP:. I'm so sorry, we'll book an appointment as soon as possible.

She apologized that I had to speak to her first, especially when I pointed out that I had "lost" a cycle of trying due to having to do so, and these are precious when over 40 and irregular anyway!

YouSayRisottoIsayRisotto Mon 25-Mar-19 19:17:54

You can't get pregnant on a weekday, only on the weekend

I'm more concerned about an HCP who believes that actually happened.

Additionally you cannot compare the mirena coil to medication as medication is fixing a medical condition. A mirena coil is altering a healthy body. A healthy body that does not need a mirena coil to function correctly. It is not for the NHS to decide that a woman should be chemically altered so as to be unable to become pregnant.

YouSayRisottoIsayRisotto Mon 25-Mar-19 19:21:03

Basically you shouldn't be able to refuse this request. So a little talk shouldn't be necessary. You dont need to ask permission

She apologized that I had to speak to her first, especially when I pointed out that I had "lost" a cycle of trying due to having to do so, and these are precious when over 40 and irregular anywa
I'd have been furious in that situation.

SwimmingKaren Mon 25-Mar-19 19:24:19

This is one reason I will never have a coil/implant. I’ve known so many women who have had to argue their case in order to get it removed once it’s in and it disagrees with them.

Jenny17 Mon 25-Mar-19 19:26:32

agnurse sounds controlling. Same sort of thing when pushing contraception and or smear tests. If women want to explore options they can ask no?

Graphista Mon 25-Mar-19 19:49:51

Agnurse please answer honestly WHY you would make a woman have to jump through hoops to have removed a medical device that is causing her problems?

Cos frankly I ain't buying what you're trying to sell. This DOES NOT happen with other meds with the possible exception of mh meds (which is a WHOLE other thread!!)

"because they tend to operate a very different appointment system to GPs" they also operate on a very different funding system.

"I’m training to be a GP" please DO read the thread I linked earlier in hopes of NOT being the kind of GP that dismisses women and girls routinely on a number of health issues, not just gynae/family planning matters. Some really shocking stories including a few where the gps dismissiveness had fatal consequences.

I'm gonna say it and it's been a long time coming, it's NOT just patients that are wasting primary care appointments. If such ridiculousness stopped there'd be more appointments available.

"Must be a finance thing" it is, the push to have women on LARC is being financially "incentivised"

"As a nursing instructor" I hope you're teaching your students genuine autonomy of patients and not to be dismissive, however based on your posts here I'm not holding my breath.

If it were REALLY about educating women on pre-conception health why is it ONLY applied to women on LARC? Do you make women who are stopping using the pill, depo or condoms or other short term/self limiting contraception have the same "chat"? Do you refuse to let them stop using those methods until they have?

"If I, as a nurse, gave a patient a medication and didn't ensure that they knew about the side effects because I just assumed they did, and they suffered serious harm, I could be held liable for not educating them. It's a professional responsibility." And yet this is what's happening constantly especially with LARC women are being told they're imagining the side effects, "they'll settle down give it a chance" or "well it's not that bad" - suck it up! That they're not allowed to have them removed within X amount of time - honestly there's a wealth of stories like this on mn and in the press, stories of women having horrific side effects from LARC but being unable to get the damn things removed!

"Not to mention that if they're experiencing problems such as potentially very serious side effects, we need to actually report those" I've read several examples of where this isn't happening again especially with LARC.

If a woman wants LARC removed that's all an hcp needs to know, women shouldn't have to justify and defend such a request EVER!

jacks11 Mon 25-Mar-19 19:51:02

Women don't need to discuss pre-contraception care and if they do I'm sure they can be a grown up and organise, investigate and learn about it as required.

Well, you would be wrong in making the assumption that all women know about contraception/pregnancy/pre-conception care. You, and your friends/relatives etc, may know all you need or wish to know. But many patients don't and a lot of those don't know that they aren't fully/correctly informed. They think they do know all the need to know and so won't seek advice because as far as they are concerned there is no need.

Like agnurse I see patients whose knowledge is not incomplete, or completely incorrect, and this leads them to incorrect conclusions. Its common, and I'm not being paternalistic or patronising when I say this. I'm not saying patients are stupid. But it really is the case that not everyone knows all about contraception, pre-conception advice and so on. It's also common for patients to take a different path when they have all the information available.

TheShuttle Mon 25-Mar-19 20:42:05

I can understand the OP's frustration and I have met incredibly patronising doctors in my time BUT I have also worked with many people with invisible learning difficulties who definitely benefit from a HCP checking their understanding of any health situation.

MyWeaponofChoiceisWords Mon 25-Mar-19 20:52:35

This is why I refused to have an implant, injection or coil fitted. Nothing on earth would make me be in the position of depending on someone else to remove medication/medical devices from my body.

dietcokemegafan Mon 25-Mar-19 21:19:53

@Verynice - off the top of my head, these are reasons I've been given in the last year, all of these women have been quite happy to keep it after an explanation.

1) I want to get pregnant in a year and I know it takes that long for the hormones to get out of your system so I need it out now

from someone who was in the middle of her final year at uni, for whom a pregnancy now would be a disaster and who planned to rely on her ex-implant for a year after it was taken out. The hormones from the implant are gone within 3 weeks.

2) My periods have stopped and I know that'll mean I can't have children in the future so it needs to come out

periods stopping is a recognised side effect, about which I had counselled her before the implant was fitted, it shows it is working and once she was reminded of that and reassured of the lack of any long term effect on fertility she was fine

3) my boyfriend is away for three months, and I know that hormones are bad for me so I want it out now and in again in three months

erm, would you be doing that if you had to bear the £100 +fitting costs of the new one? And actually it's the lowest dose of any contraception we have and will do you no harm

4) I've been feeling dizzy for three days and I know it's due to the implant so I want it removed

OK, the implant that you've had for two years has suddenly made you feel dizzy now? that seems unlikely, shall we look at why you are feeling dizzy?

I agree that if wanting it out to TTC then maybe a phone appt would do, but to be quite frank the NHS isn't always well funded enough to be flexible.

stayingaliveisawayoflife Mon 25-Mar-19 21:29:37

I hated my implant. After two years I had put on four stone, my pmt was needing to be controlled through medication and I was bleeding for 16 days in a row each month. I paid £150 to have it taken out and back on the injection. Best money I ever spent.

Notwotuknow Mon 25-Mar-19 21:43:59

I tried, but no one got back to me and I didn't have time (or the memory), to keep chasing it up. After almost 3 months of trying to get an appt at my local gum clinic (kept forgetting, or calling when closed or full, etc).
Eventually I managed to get a GP appt to have it removed, after first having a telephone consult with a nurse to check I knew what I was doing and why.
The GP asked if my consultant knew and was ok with my decision to remove the mirena and I lied (by omission) and said that they knew I wanted it removed and I implied that they were fine with it.

So my GP removed it, and then tried to get me on injections/implants,etc, as I must use some form of contraception. I got away by saying I'd think about it.

Absolutely ridiculous situation though.

There's no way I'll ever have something that I'm not in control of again.
At least with a pill I can just stop taking it.

I really hope you get this sorted easily though, OP, and I wish you luck with ttc. flowers

Notwotuknow Mon 25-Mar-19 21:45:36

Sorry, my pp was to @Tolleshunt.

VeronicaDinner Mon 25-Mar-19 22:07:38

@dietcokemegafan

I can't believe someone would refuse for someone to stop unnecessary contraception for three months. I don't care how much it costs. If they don't want to be on contraception, that's the end of it.

stopfuckingshoutingatme Mon 25-Mar-19 22:13:57

I also second women’s health or GUM clinic

I was very impressed by the GUM (less
Happy to visit but that’s another story)

Where are you based OP ? Check the website for them.

Graphista Mon 25-Mar-19 22:21:28

"and will do you no harm" PLEASE tell me as a DOCTOR you don't really believe this is true for all women all the time?!

"but to be quite frank the NHS isn't always well funded enough to be flexible." Then how are EXTRA appointments going to save money?

PaddingtonsHat Mon 25-Mar-19 22:27:41

There are other medications where you have similar conversations about stopping them- anything that has ‘consequences’.
If Mr Smith wants to stop his diabetes meds then that’s his call, but he needs to be informed about potential for kidney failure, blindness and stroke. If people aren’t informed then when the consequences occur, they look for someone to blame. I’m sure there have been cases of contraception being stopped and HCPs being held responsible for subsequent pregnancies.

That being said I absolutely agree that if a woman wants something removed from her body then it should happen ASAP and certainly coils I will remove there and then. Implants are trickier.

Also have lost count of the number of planned pregnancy announcements I have seen not on folic acid or vitamin D. Not all women are informed and for many it doesn’t even occur to them they may need to prepare for a pregnancy.

WeCameToDance Mon 25-Mar-19 22:38:28

Women apparently can't make decisions on their own bodies without being treated like idiots first.
I phoned my GP today for an appointment to get a copper coil fitted. I know what I'm asking for, done my research etc but would they just book the appointment? No! I have to attend something called contraception counselling first and then I may book the appointment. I wouldn't mind but this is on top off the appointment I have already had on the different types of contraception available. 3 appointments to get contraception sorted is taking the piss.

angelikacpickles Mon 25-Mar-19 22:40:50

@agnurse

"if someone isn't planning a pregnancy right away, they want to be sure that she is aware of how to prevent one."

@pinegreen I agree with you entirely. Nobody but me and my partner cared in the slightest what contraception I was on, if any between the ages of 18 and 31. I managed to not get pregnant at all during that time. Yet suddenly, as soon as I had my first child, it was assumed that I had pushed my brain out my vagina with the baby and forgotten how to prevent a pregnancy.

Tolleshunt Mon 25-Mar-19 23:10:55

dietcoke it may take only three days for the hormones to leave your system, but it can take many months for your cycle to normalise after stopping hormonal contraception, and some women can take a long time to get pregnant after stopping. I hope you also explain this? That way the patient can exercise her autonomy, in possession of all the facts.

Re the patient who was worried about taking hormones unnecessarily for three months. It may be, as you say, that she is misinformed. Alternatively, this could be somebody who is uneasy about taking hormones full stop. It may be that she would be happier to use alternative contraception. Would you explore that as part of the discussion?

I agree with your comments about GP services being woefully underfunded. It can be a nightmare to get an appointment for any reason. Good reason to cut down unnecessary appointments, and streamline processes, I would have thought.

Writersblock2 Mon 25-Mar-19 23:12:28

I ended up having an argument with a GP about the coil. I’d gone back to get my implant removed after its time was up and decided against it and requested the pill. Go massively pushed the coil and asked why I didn’t want it. I told him I didn’t like the idea of something being permanently inside me like that and I had no control over it (also why I didn’t want the implant again). He kept insisting that my feelings were unwarranted. In the end I outright asked how much his incentive was to get a woman to agree to go on the coil. That shut him up sharpish and he backed down.

It shouldn’t take this. If I’d been more shy, less assertive, it could have been a different story. IME it’s exactly the same with smears.

Tolleshunt Mon 25-Mar-19 23:13:29

angelica I agree, I actually burst out laughing at my six week post natal check-up when, at the grand old age of 41, having just had my first baby, I was quizzed as to whether I understood how to prevent a pregnancy! grin

In fairness, the GP, who is generally pretty sound, did have the grace to blush. There was then a hurried moving on to other, more useful, topics.

PanamaPattie Mon 25-Mar-19 23:21:51

Writersblock2 - I agree with you. You need to be tenacious and assertive to make sure you get what you need from a GP. Too much time in a consult is taken up with questions about drinking, smoking, weight, smear tests and long lasting contraception.

JassyRadlett Mon 25-Mar-19 23:30:36

This thread perfectly sums up why I will never agree to contraception where I can’t 100% control it.

FoxFoxSierra Mon 25-Mar-19 23:51:25

My local gum clinic refused to remove my implant as it wasn't put in by them, it seems like that isn't the same rule everywhere but that might be how it works where you are

Dottierichardson Tue 26-Mar-19 00:02:43

One of the stated principles of the NHS is 'informed consent'; if you no longer consent then that should be your choice and yours alone. As for women not understanding their bodies it seems that many GPs are at pains to reinforce ignorance. When I went to the GP with thrush, similar thing happened to a friend, she get referring to 'down there' and was a little taken aback when I said what part of my genitalia are you referring to. GPs can't complain about women's lack of knowledge while endlessly infantilising them.

Frodon Tue 26-Mar-19 00:20:01

I had the implant, it did not agree with me at all. Constant heavy bleeding and extreme mood swings.

I visited three different (male, mistake) GPs in six months begging for it to be taken out. They all waved me off with a nonchalant explanation, that my symptoms would magically disappear and that I should just ride it out.

At month 9, I went back and told them that if they didn't remove it, I would dig it out myself, with whatever implement I had to hand.

They finally took it out after 9 months of hell. It still pisses me off to think about it!

Smotheroffive Tue 26-Mar-19 00:30:18

But about half the women who come to have their implant out are doing so for a reason that doesn't exist

You do think these are silly women then diet that their reasons don't exist confused

I did look to see if anyone mentioned this already, but not spotted it.

It is odd having to justify getting something removed from your own body!!

Speaks volumes that some are resorting to pulling their own coils, or cutting out their implants, gah!! confused

Tolleshunt Tue 26-Mar-19 00:30:18

As if it's perfectly fine to write off 9 months of your life to feeling like that, Frodon. Wtf were they thinking?

Smotheroffive Tue 26-Mar-19 00:33:27

Oh Frodon I am truly shocked at these shit GPS wasting everyone's time and all that suffering.

If that was a man it'd be out no questions asked!!! Only women who have a shit time with periods can understand what hormonal upheaval and continual draining and painful bleeding is like.

PregnantSea Tue 26-Mar-19 01:58:32

I just walked into a local family planning clinic and told them I wanted it out. They did it that day. I wasn't TTC, I was just sick of having 2 month long periods. I didn't bother even attempting to communicate with my GP because the wait time was usually over a month.

Perhaps there's a sexual health/family planning place near you? Worth a shot - would certainly be quicker!

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