to be so upset? GP surgery told me I would be removed from their list if I don't have a smear test

[veryworried29]

Namechanging uber-regular here.

I received a text from my GP surgery which said "Please confirm address by phone. If not you will be removed from surgery list."

I rang immediately and was told that if I don't come in for a smear test then I will be struck off the surgery list!

Dh and I have been with this surgery for 18 years and our children since they were born.

I don't feel I need a smear test. We very rarely have sex and when we do it is always with a condom. I have had years of clear smears before me.

I find them horrifically unpleasant, in the same way that some people are phobic about the dentist, infact think I may have a form of vaginismus (sp?) hence the lace of piv sex.

Tbh, it almost feels like I must agree to be raped (sorry for emotive language, but this is how it feels to me) in order to keep a place at my GP surgery.

I cannot begin to describe how upset I am about this. There have been tears.

I'd be grateful if you could bear this in mind when replying ... I know this is aibu, but I do feel I have a genuine aibu to run past you all with this one.

Chunderella I was also thinking exactly that. A very well loved colleague of mine died of cancer recently and she did decline all treatment except I believe some pain management, as it was pretty clear which way things were headed and she didn't want the horrors that go with it :(

Samu the trouble is a lot of people that are very vocal about other people's decisions are only following a pattern from the press and from professionals. There is a distinct lack of transparency and questioning of 'facts' going on. Its unhealthy in itself.

According to this NHS link 99% of cases of cervical cancer are related to HPV.

I think that the nun data may reflect the fact that nuns can have been sexually active before becoming a nun or, probably in a small number of cases, while they are a nun.

Hullo
I work in cervical screening. The HA would not be telling the practice to remove people from their list because you haven't been for a smear test.
What may happen (not saying this is the case with you) is that if people don't attend appointments, haven't been into the GP for ages then they may ask if you still want to be registered there. I don't agree with what the receptionist has said to you and writing to the practice asking for an explanation sounds very sensible.
Whether you go for screening or not, is up to you. If you have some concerns about attending for screening (physical difficulties etc) then the practice should support you in discussing this with your GP.

Can I suggest searching for "local area team" "screening board" and your area as that should bring up the people who oversee cervical screening in your area who will be interested in what's happened to you, and are independent to the GP practice.

But targets don't take account of your sexual history or your risk factors (like the likelihood of having HPV). They are clumsy things that have either a yes or no box. Doctors that don't meet these targets are penalised or questioned. There is little room for doctors to use their judgment and discuss this with patients. Its just assumed that a blanket approach is the best and only solution.

I think you should add a paragraph to the letter asking them to confirm that they require women to submit to internal examinations in order to remain on the books. It makes what they're requiring extremely clear.

I am an active patient! I'm not there every day because I'm pretty healthy, thankfully, but its not as though I haven't been there for years. I've probably been 3 times in the last 12 months, what with infected insect bites and concerns about my thyroid and what-not.

You're so right revolting - about minimising other womens feelings.

Unfortunately I see a lot of that on these boards - People who simply cannot conceive that an experience or feeling exists unless it has actually happened to them.

I just hope these people don't work within the NHS.

Yes, "I would appreciate a written response to my complaint within xx working days, as well as written confirmation that you are requiring female patients to undergo internal examinations against their consent as a condition of receiving medical care at your practice."

??

You are quite right Revolting Peasant. It is this idea that I am basically being blackmailed into doing something I find very difficult in order to remain eligible for a service which I understood to be my right in the uk. It is an extremely belittling and demeaning experience and part of me feels cowed by it and part of me feels fucking incensed by it.

Please do have a search for the contacts I mentioned earlier, the local area team are part of Public Health England, and the screening team will oversee screening for your area. Although the CCGs oversee the GPs, the LAT are in charge of screening, so should be very interested if this sort of thing is going on. Screening is should be through informed consent.

The OP is an active patient there. She is being bullied. I say this as someone who had CIN2 in the past (loop diathermy for treatment after colposcopy) and whose child died of cancer (we went for the maximum treatment that could be given her, she was too young to be able to consent or not). I chose to have smear tests and, at one point before I was able to change surgeries, went to the FPC/Well Woman Clinic because I disliked how I was treated, and I say this as one who was date raped and does not have issues regarding internal examinations. I am now on a 3-yearly programme, since 12 years have passed with, thankfully, clear tests.

It is wrong to bully a person into having medical procedures they, being of sound mind and educated about the risks of not having it, have chosen to forgo.

OP I have to run off, but for your own self esteem do not consent to a smear test appt made in this manner. Get them to back down on the grounds of behaving totally unethically, then separately see a GP and sort the smears on your terms.

I also actually disagree that you should have to explain your feelings to get an exemption. You are not asking them a favour. It is your vagina and no one touched it without your consent. You don't have to get into very private feelings with the practice manager - no is a complete sentence!

If you want to opt out then there is a standard form to complete, the practice send it off to the agency that runs the system sending the invitation letters. The practice have to demonstrate they've had a discussion with you about screening. This is because many years ago women were removed from screening "for their benefit" when they weren't given a choice or discussion at all.
The route I've suggested will help to ensure it's properly investigated by an outside body so other people won't have the same experience you've had.

Bela that is really good advice :)

I can't resist coming back on this thread, it's made me so mad!

I hate them haven't had one in at least 8 years and that was at a private hospital prior to endometrial ablasion. I think I might have had one maybe twice at my gp in the 23 years I've been registered. They seem to have stopped sending reminders. Possibly I have been deleted I haven't been there in over a decade.

In order for consent to exist, choosing to opt out should be a legitimate choice that should be respected. I wish that that were the case but threads like this always prove its not regarded as that.

Newspapers and medics are always talking about ways of making more women take up screening. But we should acknowledge and accept a certain percentage for non-uptake, because this is healthy for patient choice and particularly given the nature of the procedure.

I dislike the focus on the fact that women don't go for them simply because they are scared and by implication the best options are that women need to be somehow 'reprogrammed', 'educated' or indeed sedated so they can over come it. Its too simplistic and lacks empathy and understanding.

No where in all this is the fact that women might make an informed choice, that perhaps is due to their anxieties, that on balance screening might not be the right choice for them? It doesn't exist and is consider culturally unacceptable. Women are not allowed within this whole set up to utter the words "no thanks" without being shouted at or guilt tripped or being forced to feel like they need to justify their decision.

Frankly your reasons whether you choose to have a smear are not are none of my business. Its such a personal and intimate decision, yet so many others feel that they have business telling you if you are right and wrong. The only person you should discuss it with, is your doctor, and in order to do so you have to have complete confidence that they have your best interests at heart rather than their own performance targets and that they understand that not taking their advice is a legitimate choice. You can not have that trust in your doctor if they do not allow room for discussion and patient choice.

I do feel that this is being eroded repeatedly across the NHS with such prescribed care pathways for just about every condition. There are always exceptions to the rule as humans are not all the same.

I will Belalugosi, thank you very much for your helpful advice.

And to everyone else ... I am so grateful.

I am going to tweak my email as suggested tomorrow (bit tired to do a proper job on it now).

I don't think I've ever had this much help and support in my 7 years on Mumsnet and I thank you all very much!

I would think its likely the receptionist decided to use her own special brand of persuasion 'for the good of the surgery'.

I know anything about gp receptionists turns into a bun fight, but I do think it's a role that needs an exceptional amount of understanding, boundaries and empathy, yet doesn't seem to work like that in the main for a variety of complex reasons. Some (not all) receptionists seem to regard their job as protecting the surgery / gps against the enemy of the geberal public. This crusading mindset leads to sone pretty shocking behaviour. My gp practice has significant issues with the administration and management, and it's caused me personally huge problems over the years, as a person with a severe and chronic illness. It puts me off trying to get health treatment as you never know what barrage of aggression, obstructive behaviour and 'inaccuracies' the simplest request will be met with. My gp has been known to meet me directly in the lobby to give me/ someone on my behalf a prescription rather than go through reception.

That particular incident had been about reception refusing to give me a prescription of an ongoing drug, which they actually were holding in their hands at the time (!), for a pretend 'pseudo' medical reason which came from the reception not a doctor (& didn't make actual medical sense), then 'lost' that same prescription later in the day, then refused again to give me/ my helper the prescription, and refused to allow me to leave a message/ phone or talk to a gp as 'I'd taken up too much time already today' and I'd have to wait to be given an appointment 2 weeks later to address the issue. The gp was horrified though unshocked when I finally spoke to her. The withdrawal risks of suddenly coming off that medication are minor things like, err, death ... Sorry that's the kind of stuff that happens all the time and I may be slightly riled by it! Ahem.

So in short, if your gp practice is anything like mine, I suspect it isn't anything about a new rule, and everything about over zealous 'persuasion' tactics.

I'm a GP and I'm astounded at this.

Whilst I think you are foolish not to have a smear, I think it is totally your decision. At my surgery we wouldn't dream of removing someone from the list for not having a smear. We would talk to them, and if they still refused we would code them as "smear declined".

I object to you describing me as foolish, but thanks for that input.

Very worried, I think Jacks was saying GPs use the 'relationship with the patient has broken down' line as an excuse for removing patients. It's a get out clause. BUT it is equally true the GMC use refusal to take up cervical screening as a textbook example of when removal of the patient is NOT justified.

Please make a complaint. Pointing out the GMC guidance says this is not permitted. And that informed consent means 'not under duress'.