Practise nurse withholding the pill without a smear test? (TITLE EDITED BY MNHQ)

[hoomans]

I've just been for a pill renewal appointment with the practise nurse at my GP. I turned 25 last month so have only just come onto the smear screening radar and she informed me that the new rules mean that she can only supply a weeks worth of contraception until I have a smear test and if I continue without having one they will refuse to prescribe it altogether. Surely they can't do this? I haven't declined and I've booked an appointment to get it done but surely this shouldn't be the case?

@Maray1967

I was told this in the 1980s when I first went on the pill. Thought it was bizarre then. So my first penetrative experience was with a speculum - lovely.

Yep me too. A male doctor who also insisted on doing an extensive breast examination too. No female nurse escorting either. He shooed them out of the door. I was 16 so didn't question it, but was terrified. He did it again 3 months later when I went back for my 2nd 3 month supply.

@WonderfulYou

What about women who are rape victims? What about women with vaginismus? What about women who simply don't want a potentially painful, invasive procedure?

And what happens if they get cervical cancer. The procedures are going to be a hell of a lot worse and way more invasive than a smear which takes a couple of minutes.

My sister has always refused to have a smear test.
She now has all of the symptoms but won’t go and get checked. She is just going to have to wait until it gets worse which is absolutely ridiculous.

I have to have regular smears as I have HPV/abnormal cells.
I know that if I refuse and I get ill, my next procedure will be a lot worse - painful and invasive, as well as life threatening.

Nobody on this thread is saying smears aren't useful, that's not the point. The point is that you shouldn't be railroaded into having one, or in fact any routine health care test unless you want one. A woman being told to lie down and take her knickers off so she can be given contraception is not OK.

Cue someone else posting - they let me keep getting the pill with no checks and now I've got cervical cancer.

I think it's quite right to do this. If you don't like it you can buy it over the counter at a chemist without a script.

To the PP asking about women who refuse smears - if a person has legal capacity to make decisions, if they have all the information about the risks and benefits and they decide not to go ahead that's it, there's no argument, the test doesn't get done.

I let my folks know that they are always welcome to.come back and I will check in with them about the smear when I see them but at the end of the day the choice is theirs.

Just get the smear. Why anyone would say no to something that can save your life is completely beyond me. Yes, it’s not the most pleasant thing ever, but neither is cancer.

@ElectraBlue

Complain. There is no such rule.

This is what some surgeries do to try to bully women into having smear tests to make their testing quota/get more money in.

This should absolutely be challenged and reported.

Yes.

Yep me too. A male doctor who also insisted on doing an extensive breast examination too. No female nurse escorting either. He shooed them out of the door. I was 16 so didn't question it, but was terrified. He did it again 3 months later when I went back for my 2nd 3 month supply.

I too have had some dodgy examinations over the years to get my pill prescribed. 'Routine' examination is a green light to dodgy (and inept and out of date) doctors. That's why we have clear guidelines these days.

A woman being told to lie down and take her knickers off so she can be given contraception is not OK

Very well said.

I think it's quite right to do this. If you don't like it you can buy it over the counter at a chemist without a script.

So you think it's ok to force a woman to have an invasive medical procedure so she can access contraception through the NHS?

I'm finding it quite scary that some women seem quite happy for other women to be forced into uncomfortable and sometimes painful procedures

I had a copper coil fitted when I was around 28. I hadn't had my smear test yet because I believe 25 is too young (personal opinion based on data from outside of the UK, you do you etc etc). Whilst I was up on the bed, legs akimbo and ultimately very vulnerable the Nurse announced she'd get my smear done at the same time, as she was grabbing the brush. Luckily I am not shy and told her I didn't want a smear. She did seem confused, questioned why, I was resolute in my decision. She didn't do the smear, just fitted the coil.

Forcing someone to have a procedure against their will is abhorrent. Withholding treatment for a condition based on that is abhorrent.

@WonderfulYou Your posts are abhorrent and show you have no empathy whatsoever.

@acatcalledjohn

I had a copper coil fitted when I was around 28. I hadn't had my smear test yet because I believe 25 is too young (personal opinion based on data from outside of the UK, you do you etc etc). Whilst I was up on the bed, legs akimbo and ultimately very vulnerable the Nurse announced she'd get my smear done at the same time, as she was grabbing the brush. Luckily I am not shy and told her I didn't want a smear. She did seem confused, questioned why, I was resolute in my decision. She didn't do the smear, just fitted the coil.

Forcing someone to have a procedure against their will is abhorrent. Withholding treatment for a condition based on that is abhorrent.

@WonderfulYou Your posts are abhorrent and show you have no empathy whatsoever.

What was your rationale behind refusing a smear when you were already having a more invasive procedure done? Did you say no out of stubbornness?

I had this happen to me with HRT. My GP refused to renew my prescription.

I was petrified of getting smears after a bad experience, and at that point in my life could not muster the courage.

So I stopped HRT.

That was bad enough and I felt awful.

But denying contraception on that basis must surely be wrong? On so many levels. I would definitely complain. It sounds like the practice nurse could be improperly applying her own principle to patient.

A discussion of the importance of smears in a sexually active woman is surely the way to go?

My doctor sort of did this me, I went for a pill prescription, she gave it to me but checked my notes and said I’m due a smear, she told me to book it on my way out because next time they wouldn’t give me my prescription! I didn’t book it then as I was starting a new job the next day and knew I’d have to be off work as this was before they had evening clinics etc. 3 months later I called for my prescription and they wouldn’t let me have it til I had booked the smear, I had annual leave coming up so could but I thought their tactics were pretty awful.

I understand the importance of a smear but withholding prescriptions is too far!

I once had a doc who insisted on doing a breast exam in order to prescribe the pill. It was a woman though.

Never had any other clinician who insisted on any kind of exam though. I would complain OP. The nurse probably thinks the benefit of the smear (or the income to the practice) justifies this, but it is coercive and an abuse of her role as a prescriber. And as Tiredan has said, it puts the clinician who does the smear in professional jeopardy, because they'll be (perhaps unwittingly) doing it on someone who hasn't properly consented.

That is very unethical. The pill doesn't increase the risk of cervical cancer so there's no reason to withhold it until you've had a smear. If she refuses to prescribe and you get pregnant she could be in trouble considering there is no clinical reason not to prescribe.

Personally I buy my pill online purely because if I can afford to, why should the NHS pay for it instead, I'm surprised more people don't do this considering how chronically underfunded they are. I definitely think the actions of this nurse warrant a complaint to the practice manager and hope you do so OP.

@betwixtlives
What was your rationale behind refusing a smear when you were already having a more invasive procedure done? Did you say no out of stubbornness?

Caveat: I'm not acatcalledjohn and have never refused a smear, so this may not be her reasoning.

False negatives and the follow up investigation/treatment they require can cause harm. When the risk of cancer is very low smear tests are not necessarily best practice taking all considerations into account. Some experts place younger women (especially now, with the HPV vaccine) in the don't test without other indications camp.

I think it's quite right to do this. If you don't like it you can buy it over the counter at a chemist without a script.

And if they can't afford OTC prices every month? Unwanted pregnancies? Terminations? What about women who take the pill for their periods and aren't or have never been sexually active with a man? No smear, no pill for them?

What invasive procedures should men be forced to undergo before obtaining required medication? Or is it just women who should be coerced & bullied into them?

Capacity guidance & law is there for a reason.

we don't do that at the GP I work for. Try your local sexual health clinic

Practice nurse here.
No new rules as far as I know, not nationally anyway.
I would strongly question this.

[quote NumberTheory]@betwixtlives
What was your rationale behind refusing a smear when you were already having a more invasive procedure done? Did you say no out of stubbornness?

Caveat: I'm not acatcalledjohn and have never refused a smear, so this may not be her reasoning.

False negatives and the follow up investigation/treatment they require can cause harm. When the risk of cancer is very low smear tests are not necessarily best practice taking all considerations into account. Some experts place younger women (especially now, with the HPV vaccine) in the don't test without other indications camp.[/quote]
its doesn't matter what the rationale is. The whole point of capacity and the mental capacity act is that no one had the right to judge someone's choices on the basis of their rationale. I am pro smear...had all mine until I aged out...did my own risk assessment then and decided not to continue.
In any case what is being discussed her is NOT whether or not women should have smears but whether they should be coerced into having them by threatening to withhold an unrelated prescription.

Practice nurse here who takes smears and does contraceptive reviews.

I have never heard of this rule. Make a complaint.

@WonderfulYou

Mandatory? Do you really mean that? Women should be required to undergo an invasive screening test? What do you think should happen to those of us who say no?

Maybe not mandatory but if they refuse the smear tests they should also be refused treatment for cancer caused by HPV.

Who else would you like to exclude from treatment? Smokers for lung and cardiovascular disease, overweight people from diabetes drugs and knee replacements, recovering alcoholics from access to addiction services?

Thankfully we have a society where we provide medical intervention at the point of need and no-one needs to give an ethical justification of why they deserve treatment.

Also, whilst it is true that the vast majority of cervical cancers are caused by HPV infection not all are. How would you suggest deciding?

This is awful. It happened to me in my early 20s, still a virgin but needing the Pill because of extremely heavy and irregular periods. Very patronising older female doctor coerced me into having a smear test before she'd prescribe the Pill again - the smear was excruciatingly painful. Not at the all the bit of discomfort you're led to believe. She also insisted on doing a breast exam straight after so I was totally naked and very vulnerable. It turns out losing your virginity to a speculum can leave bits of hymen round the edges which then, when I eventually did have sex with my now husband years later made it really painful. It then needed surgery to remove those bits before i could have painfree sex and get pregnant. I have never had another smear test and had to have gas and air just to have a vaginal exam during labour because of that GP.

All because some patronising GP wanted to meet her smear test targets.

Please do complain OP and get the nurse set straight about consent. Her next patient might be a vulnerable late teen or young woman who can't stand up to her.