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!

Doctors can refuse to have involvement with terminations/contraception if that is against their beliefs (religious or ethical).

Yes, they can: they can resign. No-one forces them to remain a doctor, and if they don't like the job, they should get a different one.

In other news, if you don't approve of nuclear weapons, don't get a job working on Trident.

"Conscientious Objection" applies when conscription is involved. No-one is forced to become a doctor, and they knew the score when they took the job.

I'm curious, if these GPs will not prescribe certain medications, or treat patients for certain things, would they then be paid the fee for seeing the patient? Or does both that GP who refused to treat the patient, and the next GP that the patient has to see get paid the fee?

I'm sure about to make myself very unpopular but I don't refer people for terminations. This is not a moral judgement on anyone or a religious objection and is something I have spent many hours thinking about and is based on my knowledge and training in embryology. Of course I always discuss with women who request a termination what their options are, what a termination may involve, what support they have and what support they may need afterwards. I would also always make sure they would be able to see a colleague very quickly in order for the forms to be done. I would like to stress that I completely believe that every woman should have control over her own body and am pro choice, it's just that I am not comfortable with ending life in the same way I am against euthanasia (although I am not saying the two are the same.) as if happens this situation does not usually arise in the area where I work as the way the service is arranged all women are referred to a clinic for counselling prior to a final decision being mad and I have no issue with that. I also think it's unfair to say I should have chosen another job- there is no branch of medicine that is free of ethical dilemmas and yes, while we are here to provide a service to the public, we are people with hearts and minds and experiences too, not robots and I am sure that you would all agree that a good doctor is one with empathy and compassion.

I should also add I happily prescribe contraception and have additional training to fit coils and implants so my patients have the broadest range of options available.

MidniteScribbler- that is not how GP payments work. A surgery will be paid around £60-70 a year per patient on their list regardless of whether the patient has no medical problems and sees their HP rarely or has very complex needs and sees their GP every other day and is on lots of medication-there is no fee. Interestingly, contraception is not something GP surgeries have to provide, it is not in their contract, but most do because they recognise it is a key part of family medicine and if so they are given additional funds to provide the service.

Poppyred, I struggle to understand how compassion and empathy = making a patient aware of your moral judgment of their wishes. You say you don't refer "people" (let's get real here, women) for terminations because you don't feel comfortable with "ending life". Forgive my ignorance, but I thought you were referring, not actually doing the procedure yourself

Im not making a moral judgement- you're ascribing that motivation to my actions. I am not telling patients that I think they are wrong (I don't necessarily think they are) but what I am saying is that there is enough doubt in my mind as to what a fetus can or cannot experience to make me uncomfortable with being involved in the process. The argument regarding whether I am performing the actual procedure is too simplistic- is only the person who pulls the trigger responsible for deaths in wars?

You sign up for the army, you sign up to kill people. You sign up to become a doctor, you sign up to facing a side of doctoring that may not be comfortable for you.

And you may not be saying to the patient "I don't refer for terminations because I feel personally uncomfortable with your choices", but to say you're not judging is also too simplistic. People evaluate their feelings about choices and act accordingly. But choosing to be barrier to a service (and whether or not you help them find another doctor, you are still actively being a barrier), is ascribing a feeling about their actions to your behaviour. And if you think your patient isn't feeling judged, you're being incredibly naive.

My (and other people's) opinions on this may make you feel uncomfortable about your choices, and if so, I think that's a good thing, as you need to shake the idea that you are Switzerland in this. You are part of this patient's journey, either by helping them or hindering them, and I personally don't think the latter comes under empathy and compassion. You cannot stand apart from this process like you have no involvement one way or the other - it doesn't work like that.

Poppyred85 but you ARE making a moral judgement whether you intend to are not. By saying that you are uncomfortable because you don't know the implications for the foetus you are in turn making a judgement on the person asking for one. By choosing the life of the foetus over the quality of life and sometimes the life itself of the woman involved you are judging her. Because you are the person who holds the key to the referral you are making the decision for the woman and removing her right to make a perfectly legal decision.

Thankfully in my case I was able to speak up and ensure I accessed the treatment myself, I worry about woman who are unable to do this.

You sign up to become a doctor, you sign up to facing a side of doctoring that may not be comfortable for you.

The gmc allows doctors to opt out of the terminations. Doctors do not sign up to this aspect of medical care when they start training. Anyone who thinks they might not wish to be involved with terminations is not obliged to.

PurpleDaisies, I'm not debating the legality of the doctor's position. But since these doctors in question are throwing around their sense of "ethics", I think it's "ethically" wrong to start shoehorning your personal beliefs into a service someone is legally entitled to (for reasons I have already stated).

Purpledaisies Like Ten has said it's not about the legalities, it's about why people who have these views are allowed to go into the very strains of medicine where they will
be responsible for these procedures. Ethics and religion are separate issues, where either of them stop someone doing their job properly that someone needs to find a position where it is not an issue.

Outcomes for children in care are (shamefully) disgraceful in this country, yet as a social worker if I didn't "ethically" agree with putting children in care I would find myself sacked pretty quickly.

Surely it depends on tone. If a doctor smiled sympathetically at me and said that they didn't deal with these forms for termination but would get a colleague who could help me (like Poppy says) I would be fine with that. I probably wouldn't gene be aware of the reason.

Surely you do want Docrors to think about things and question things even if their conclusions are different to yours. I don't have a problem with a GP being anti-contraception either I only have a problem with a 45 minute wait and an implied judgement. I accept though that I am a middle-aged woman and firm in my own values and not a vulnerable teenage girl who may feel powerless and judged - and that this does make a difference.

The opinions expressed on this thread do not make me uncomfortable- you assume that I have not already considered the impact my feelings in this could have on my patients and what that could mean for my ongoing relationship with them were I to be in that position. You seem to be basing your judgement in that on the idea that GPs don't actually care about the relationship with their patients and at least for myself and the GPs I know that is not the case. The position I am in with this now is not the one I was in when I chose to become a doctor, and indeed a GP. It is based on my experiences while training and my own experience as a mum and after a lot of reflection and difficult thinking. Do you think it would be better if I stopped being a GP altogether and wasted the time and money spent on my training (not just by me but by you all as tax payers?) would it better for my other patients if I stopped practicing altogether or are you saying that doctors should be forced to do something they don't want to because that is what society demands? I think we are all aware of examples where this has had horrific consequences. I should also say that the point about refusing to refer in the case of life threatening problems, the law and the GMC is quite clear- there can (rightly) be no exemption on the grounds of conscience if a woman's life is at stake- at least in the UK outside of NI.
In terms of being a barrier to a woman making a legal decision then as the doctor objecting has a duty to ensure the woman is referred to a colleague as quickly as possible then there should be no barrier.
Again I think I should point out that actually for me in the real world this is not an issue because of the way services are designed women are referred for counselling prior to deciding what they want to do and I have no issue with this at all.

Had a similar experience when a number of years ago I went to the doctor to be referred for a termination. I was in the process of leaving an abusive marriage and unfortunately I was given an appointment with the locum. I explained the situation and that I would not have been physically, mentally or financially able to bring another child into the world. She spent the full 10 minute appointment telling me that I already had two children so there was "no reason" I should have a termination.

In the end after very strenuously defending my decision (not what I needed at the time) she gave me the paperwork to take to the clinic. It wasn't until I took it in that they told me the referring doctor hadn't signed it. Not sure how I'd not pieced it together before but at that point the penny dropped that she had obviously objected to the termination on some kind of religious or ethical basis and that's what all the conversation had been about not that she was concerned that I would regret the decision etc. What annoys me looking back is that she didn't at least declare that the "advice" she was giving me was based on her own beliefs not medical fact.

I always though before this that GPs were like the BBC and had to be impartial. Like others have said thank goodness I wasn't a terrified 16 year old.

My mistake ten I didn't get you were talking about ethics from the bit of your post I quoted.

I agree with calloh that tone makes all the difference. Doctors aren't obligated to participate but they absolutely do need to be compassionate and non judgemental in how they handle it.

To be honest while I was bleeding and waiting for someone to find a doctor who would do my op the experiences of that doctor as a parent would have meant diddly squat to me.

Just as an update today I have made a complaint to the surgery. I accept (although disagree) that the doctor was able to do this but it was badly handled and I feel that reception should have made me aware that he could not do this appointment. I have also complained that the doctor gave me all the options/information then td me afterwards that he wouldn't do it on ethical grounds. We will see what the outcome is!

Lavenderice I don't understand how the views of the GP before you were referred could have had an effect on what happened after you were treated unless you were bleeding beforehand, in which case we're not talking about the same thing but maybe I've misunderstood your post in which case I'm sorry.

Slightlyconfused I think that's perfectly reasonable.

poppyred

You seem to be basing your judgement in that on the idea that GPs don't actually care about the relationship with their patients
I never said that. My point, I suppose, is that I don't really care whether they have a "relationship" with their patients or not. GPs are there to give access to other, more specialised medical procedures, give me medicine that will help my health issue, and dispense advice along mandated by a professional body. They can give me their opinion, if they like (as women, men, parents, whatever), but they ARE NOT entitled to prevent me getting treatment I want / need if I am legally entitled it and there is no medical reason why I should not have it.

are you saying that doctors should be forced to do something they don't want to because that is what society demands?
No, I'm saying they should be forced to do something they don't want to because the law says they are the doctor and I am the patient, and if I am entitled to something the law says I can have, and there is no medical reason for me not to have it, no more discussion is required.

I think we are all aware of examples where this has had horrific consequences.
Do enlighten me on cases where doctors were forced to do something legally-allowed and medically-safe and it had horrific consequences for the patient.

as the doctor objecting has a duty to ensure the woman is referred to a colleague as quickly as possible then there should be no barrier.
By saying you cannot do this, you are immediately causing doubt and an obstruction. Unlike other posters I disagree that tone of voice is vital here (although it is important). For some vulnerable women any barrier, however brief, can be frustrating and / or traumatic.

Again I think I should point out that actually for me in the real world this is not an issue because of the way services are designed
Then I'm not sure why you even mentioned it. Except that we're not just talking about terminations, we're talking about access to medicine. And there have been at least 3 examples on this (possibly more) of women who have actually had a delay or issue getting medicine / treatment they require "in the real world", due to doctor's personal views. So, yeah.

Lavenderice, are you saying that there was a doctor available, but who wouldn't agree to the operation?

Ten
Are you a lawyer by any chance?
Love your line of questioning.
I'm also keen to read the answers.

Haha Ihatethecold not a lawyer (or anything close to it), just very passionate about this issue, which I see as a basic healthcare AND women's rights issue. I really think letting your personal views affect your professional work is a slippery slope. Too many people think it's infringing on their human rights to make them do something they don't want to do. Nope, it's called "a job". If what you're being asked to do is legal and in line with the expected duties of your job, then it shouldn't be up for debate.

If a customer services associate in a shop was asked to dissect a frog, they are perfectly within their rights to refuse. If a doctor is asked to prescribe legal and safe medication that they disagree with, IMO they shouldn't be allowed to refuse.

Rightly or wrongly, this does happen. I have a major issue with 'Christian' GP practices (of which there are many) who don't have any GPs who refer for terminations, who hold prayer meetings in the surgery, and who DO NOT make it explicit to their patients that this is the case.

This is what the GMC says, in any case.

"Personal beliefs and medical practice (2013)

1. In Good medical practice * we say:

15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: a. adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient b. promptly provide or arrange suitable advice, investigations or treatment where necessary c. refer a patient to another practitioner when this serves the patient’s needs. 48. You must treat patients fairly and with respect whatever their life choices and beliefs. 52. You must explain to patients if you have a conscientious objection to a particular procedure. You must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs. If it is not practical for a patient to arrange to see another doctor, you must make sure that arrangements are made for another suitably qualified colleague to take over your role. 54. You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress. 57. The investigations or treatment you provide or arrange must be based on the assessment you and your patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options. You must not refuse or delay treatment because you believe that a patient’s actions or lifestyle have contributed to their condition. 59. You must not unfairly discriminate against patients or colleagues by allowing your personal views† to affect your professional relationships or the treatment you provide or arrange...

1. In this guidance, we explain how doctors can put these principles into practice. Serious or persistent failure to follow this guidance will put your registration at risk.

Footnotes * General Medical Council (2013) Good medical practice London, GMC. † This includes your views about a patient’s or colleague’s lifestyle, culture or their social or economic status, as well as the characteristics protected by legislation: age, disability, gender reassignment, race, marriage and civil partnership, pregnancy or maternity, religion or belief, sex and sexual orientation."