About this GP

[slightlyconfused85]

Now before I start I generally think Gps are amazing people, I'm not dissing the profession. Today, however, I booked an appointment to get the contraceptive pill after the birth of my 2nd child. I was given an appointment with a locum who explained my options to me, then said he didn't prescribe contraception for ethical reasons. I then had to wait 45 minutes for another gp to be able to fit me in to prescribe this for me. Aibu to think that if the gp surgery is going to have locums that won't do this then they could have let me know on the phone when I booked? I know the receptionist didn't know what I wanted but they could say if it's an appointment to discuss contraception then say and we will find a different GP. Had loads of time wasted today and feeling (probably irrationally) irritable about it!

"Why do their beliefs trump the patients?"

Why to the patient's trump theirs? A doctor-patient relationship should be collaborative, not combative.

In the vast vast majority of situations they don't. But when it comes to whether they personally have to end a human life (as they perceive it) then I think they absolutely should have the right to say no. In that situation they need to quickly and non-judgementally arrange for a colleague to step in.

We're at an impasse. I'm glad the GMC guidelines don't compel doctors to perform those procedures relating to the termination of human life. You obviously disagree ten and I'd suggest lobbying for change to those opt outs since you clearly feel very strongly about it.

Oh, I'm quite wrong am I? Thanks for letting me know! Phew. What a relief.

Your nose and ears analogy is, quite frankly, rubbish, because I'm talking about procedures and medications that are well known, safe and legal.

Again, I don't care what their opinions are. They're doing a job. They should check their opinions at the door.

I've yet to have anyone give me a good reason for why GPs can let their beliefs prevent them from doing their job.

jeff beacuse they are paid to provide a service. It doesn't have to be combative if they, you know, do the job they're paid to do.

recently my sis went to ask for a termination at our local surgery: the gp said "I am disappointed - surely you're old enough to know better!"

Wow. That's absolutely horrendous. Your poor sister. Maybe when she's had a bit of time to recover she might feel ready to complain about the GP? Really unprofessional behaviour.

"They're doing a job. They should check their opinions at the door."

When they start medical school they learn this though; going in they have the knowledge that they can object. It's like any other job - you read the description before you sign the contract. If there are duties you'll object to don't sign the contract.

It's not objecting that you disagree with, it seems, but rather that people who object are allowed into the profession in the first place.

And again I ask - is there not a compromise to be had here? Your opinion is very hardline and potentially prevents the best people from being doctors, overall, just because they object to these practices. It's not stopping people from getting contraception or terminations altogether (which I agree would be madness) so why is it such a big problem for you?

For all the reasons that I have stated and will not state again. I will repeat though, that I'm not suggesting GPs be banned for enforcing their beliefs, I'm suggested they not be given the option to enforce their beliefs. Also, from what other posters have said, "going in they have the knowledge that they can object" - I'm not sure that's accurate.

Some unsolicited advice for you - if you're going to try to debate / "educate" people, dial down on the patronisation and outright telling people "you're wrong". You'll get further. I notice you didn't address the ridiculousness of your analogy, by the way.

Your opinion is very hardline and potentially prevents the best people from being doctors

The claim that people who object to abortion and contraception are "the best people" screams out for "evidence or STFU".

Given the tiny percentage of doctors who adopt this position, their loss from the potential pool of doctors would have no effect whatsoever. Always assuming, of course, that they didn't have a Jonathan Edwards style "here are my unbending religious views, but if you don't like them, I've got others" change of heart.

Personally I think the ethics can be kept out of it. Nobody turns up at their gps saying 'I did a home test, I'm pregnant, refer me for an abortion now' and is immediately booked in for the procedure by that gp there and then. So the gp can easily refer the patient without having to give the slightest indication of their opinion.

I agree that medical personnel should not have the right to object to delivering any legal, medically safe wanted or needed treatment....

With one caveat.... they should not have the right to object to a treatment that was legal at the time they took the job

Case in point - if the UK legalised Assisted Dying, I would support the right of existing medics to refuse to participate, as any other employee in any other role has the right to object to significant job description changes. New admissions to medical or nursing training, however, should not have that choice.

Outside of this, the impact should be on the doctor, not the patient. By definition, there is an imbalance of power in the medic/patient relationship, and therefore, where a medic changes or develops an opinion later in their career that conflicts, the onus should be on the medic to change job roles to avoid the situations they object to, not on the patient to be upset, inconvenienced or even denied treatment to accommodate the medic.

"going in they have the knowledge that they can object" - I'm not sure that's accurate.

It is accurate. Medical students are told this. It comes up in ethics lectures just the same way as all the other issues on ethics, abortion laws, Gillick competency, etc.

I notice you didn't address the ridiculousness of your analogy, by the way.

I wanted to talk about other things but if you insist. My analogy was just to say that not everyone agrees with the same thing. I know it's a flawed analogy.

The claim that people who object to abortion and contraception are "the best people" screams out for "evidence or STFU".

I'm not claiming that. I'm claiming that med school is pretty hard to get into and the people who get are the best candidates, no? And if some of them are objectors doesn't that mean that excluding them on that basis alone would have meant some second choices would have got in?

And also that practices where ALL the GPs object should be flagged as such so you don't register there if you will need contraception.

The backdoor way to criminalise abortion in the US has been to impose obligations on clinics that offer it that are disproportionate, and to pass legislation that makes malpractice suits much easier and more lucrative. Doctors just give up and either do other things or move out of state. As a result, there are parts of the US where travelling from Dublin to Liverpool looks like a trip around the block.

Most GPs won't accept "out of area" registrations. So if your local practice is staffed by religious extremists, what are you supposed to do? Travel? It sucks to be poor, doesn't it?

GPs who don't want to offer a full range of services aren't forced to work for the NHS: they could just as easily set up as a private, non-NHS GP and serve the three customers that they might have. It is entirely wrong for access to contraception and abortion to be a postcode lottery, dependent on the whim of your local GP and your ability to pay to travel.

jeff

ginnybag To a certain extent I see your point, but I see it in a similar light to the way that medical professionals have to keep up / agree to changes in, say, standard practices in medicine (where a drug, treatment or "way of doing things" was considered safe / better and new research / guidelines shows they need to change). It would be completely wrong for a GP / doctor to say, "Well, stuff the guidelines, I prefer doing things the OLD way because that's how it's always been done!" When they join the profession they know it's an ever-changing animal, and guidelines on assisted dying fall into that remit for me.

Good points pneumometer clap

I'm claiming that med school is pretty hard to get into and the people who get are the best candidates

You appear to have a wildly over-optimistic view of the accuracy of university admission procedures, and the the correlation between entry tariff, degree class and eventual career success.

Can any of the GPs on this thread point us towards any guide to what we can expect from a GP, please?

didyou earlier someone posted GMC guidelines which I were helpful if you're looking for how things stand at the moment.

Ten I see your point with that, too, but I do think there's a significant difference between a change in prescribing guideline recommending one drug over another and suddenly being asked to completely reverse a significant component of the job, and override something that is, in wider society, considered wrong.

I also think there needs to be space to acknowledge that medics are people. Would you take a job where you could have the role changed dramatically at any time, with no right to object, up yo and including personally administering drugs to end a life? More significantly, would you want the UK medical profession staffed only by people who hadn't thought that far ahead, or who had so little moral intelligence that they were completely happy to always just do what someone more senior told them to.

It's a tough call, and do I agree that a GP refusing to prescribe contraceptives, esp. a new GP as it appears to have been here, needs to be, ah, encouraged to find a new branch of medicine to work in. This is standard practice, now, not rare and certainly not new, and not actually all that controversial anymore.

Ten - I don't know what that emoticon is.

I guess that healthcare workers are just lucky you're not in charge then. I think a lot of people would just leave if the ability to force them to do things they agree with was in place. Less people would apply for specialities that would involve euthanasia, for example.

Agreeing to kill someone is very different to agreeing to prescribing scientifically validated and evidence based treatments.

For the record - I'm theoretically pro-end of life choices, though in practice I think safeguarding would be very, very difficult.

Oh, I hear you Pneumo, believe.

If every GP did it would be totally unreasonable!! But I think the rules would change as soon as even 10% started doing this. The thing is the vast majority of the medical profession are totally not judgemental and signed up for that job to help people and not to be awkward! I'm not saying that everyone is understand though. Find me a profession where everyone is nice!

"things they disagree with"

I say that, btw, as someone who actively supports the current call for Assisted Dying to be legalised.

Would you take a job where you could have the role changed dramatically at any time, with no right to object,

I didn't realise that doctors had contracts which precluded resignation.

Every job can be changed at any time. Sometimes that will constitute constructive dismissal. It's for employment tribunals to sort out.

If every GP did it would be totally unreasonable!! But I think the rules would change as soon as even 10% started doing this.

So what would those 10% do in that event? Resign? It seems a very strange principle to have rules which only work so long as only a small number of people avail themselves of them.

And given it's not legal to ask about religion at interview, what would a three-hand GP practice do if it inadvertently employed two such doctors? Would the third have to work a 1 in 1 to provide permanent cover?

jeff It means "Ok, sweetheart, have a biscuit", or in other, less patronising terms, "no comment".

You don't think that the decision to allow assisted dying would be "scientifically validated" or "evidence-based"? That they'd go, "Ok, guys, get out your hatchets and suffocating pillows" as soon as a patient says they want to die? It will be so carefully monitored and treated.

I think the rules would change as soon as even 10% started doing this
So if rule change is inevitable in the event that these objections grow, why should this small percentage be allowed to object now? Because there's only a few and we can "let them get away with it"? Really don't follow this logic.

I guess that healthcare workers are just lucky you're not in charge then.
Mate, a lot of people are lucky I'm not in charge, believe me.

They don't and they could.... and, currently, that would see something like half of all doctors potentially being left with the decision of resign or have no choice but to accept their involvement in assisted dying, when they have said they disagree with it. This would include GP's.

Bear in mind the current 'objection' clause does not allow refusal where a patient will suffer because of it, for AD cases it's inevitable a refusing doctor will see prosecution anyway - no one not suffering would be seeking to die!

Forced against their will to do something not in my contract....that's close to the definition of constructive dismissal, and given the potential numbers involved, that's a disaster for patient care, and very, very expensive for the state.

Hence my point that I would allow existing staff the right to refuse, whilst requiring compliance from New staff.

In this scenario, an existing GP could refuse contraceptive services, but a new one could not - they know it's a part of the job on taking it and should comply. Developing an objection later would see the requirement being for the doctor to change role, not the patient yo lack access to services.