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

[Alarae]

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...

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

@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?

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!?

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.

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.

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

Hope you recover well, Hotter.

Let's compare this to other medical conditions.

Sorry, but what medical condition is contraception treating?

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?

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

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.

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 😜

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.

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?

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.

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 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.

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.

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.

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!

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.

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.

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.

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

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!

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.