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?

@godmum56

Reminding people that blind adherence to requests from medical professionals is not necessarily clinically advisable and that there are reasons other than stubbornness isn't really so far off topic it deserves censure.

When I was at Uni in the early 80s this was the case then. This was with an old male GP. I would have hoped that things would have moved on since then.

@Doggydreaming

So they think it is ok to coerce you into a medical procedure by witholding contraception? That is beyond fucked up. Make a complaint.

Yeah this. That's appalling. Please complain. I'm a Practice Nurse, this isn't ethical.

@WonderfulYou

I’ve never heard of this although I need blood pressure checks every few months before I’m allowed my pill but this seems pretty extreme.

I do think smear tests should be mandatory but I struggle to see the relevance between the pill and a smear test.

You think smear tests should be mandatory?

Whilst it sounds coercive, yabu for not booking a smear as you are now eligible. I had them from 18 as per guidance then

@Namechangeforthis88

Tip I'd like to broadcast far and wide, when the nurse offered me the option of holding the speculum myself it made a massive difference. Please ask for this at your smear test.

That said, no one should be coerced into any medical treatment, least of all a smear test.

That's an interesting idea. Did you put it in or just hold it once the nurse had it in position? I do smears and haven't ever thought of this, though I'm not sure how it would work as usually have to reposition it several times to get an adequate view. Always looking at ways of making it easier for women though, so definitely willing to give it a try! I do offer left lateral position (lying on your side with legs together and knees bent), which some women find more comfortable but a lot of nurses never use.

@betwixtlives did you miss the personal opinion based on data from outside of the UK part of my post? Because that's all you need to know.

Your "stubbornness" comment smacks of not believing women have the capability to make an informed decision.

@gogohm

Whilst it sounds coercive, yabu for not booking a smear as you are now eligible. I had them from 18 as per guidance then

What?! You're allowed smears when you're 25. OP is 25 and shes booked one.

@gogohm

Whilst it sounds coercive, yabu for not booking a smear as you are now eligible. I had them from 18 as per guidance then

And also, they're not mandatory.

@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.

So if your sister does have cancer then you'd like her to be refused treatment?

[quote NumberTheory]@godmum56

Reminding people that blind adherence to requests from medical professionals is not necessarily clinically advisable and that there are reasons other than stubbornness isn't really so far off topic it deserves censure.[/quote]
sorry I don't understand? I don't think I did say this?

@godmum56 and @NumberTheory Thank you.

@hoomans

I don't take the combined pill I take the mini pill.

If you can afford it just buy Lovima over the counter. It’s the mini pill desogestrel. I used to get cerazette or cilest from doctors but Covid made it a pain to get seen so I just buy over counter now. Few basic questions online and it’s delivered.

My sister's GP told her he wouldn't prescribe her the pill unless and until she had a smear test. She meekly agreed. I was livid on her part and suggested she complain - she didn't want to cause trouble. It is not valid consent.

@godmum56

sorry I don't understand? I don't think I did say this?

You quoted me and the clinical rationale I posted for refusing a smear and had a go about rationale being irrelevant and castigating me for being off topic.

So yes, I think you did say that.

@hoomans

The nurse has also booked me in with her for the smear test. I might follow it up further. Do they have quotas or anything on how many women they get to do them?

Yes, payment is linked to percentage uptake so the practice earns money for hitting targets (QOF points). Which actually makes it worse because they aren't even coercing you into an intimate procedure for your health, they're doing it for their funding. Men don't have to put up with this shit!

@RagzReturnedUnwrapped wow that has really surprised me, makes sense why did the same to me then!

Yes, payment is linked to percentage uptake so the practice earns money for hitting targets (QOF points). Which actually makes it worse because they aren't even coercing you into an intimate procedure for your health, they're doing it for their funding.
Men don't have to put up with this shit!

I always wondered if that was the case.
Years ago, I had an emergency GP appointment as my mental health was terrible and I wanted to try different medication. It was difficult enough to get words out when shaking and crying, but my (male) GP thought the time between me trying to find the right words on how I was feeling was a good time to talk about smear tests.
I refused to see that GP again.

@XenoBitch

*Yes, payment is linked to percentage uptake so the practice earns money for hitting targets (QOF points). Which actually makes it worse because they aren't even coercing you into an intimate procedure for your health, they're doing it for their funding. Men don't have to put up with this shit!*

I always wondered if that was the case.
Years ago, I had an emergency GP appointment as my mental health was terrible and I wanted to try different medication. It was difficult enough to get words out when shaking and crying, but my (male) GP thought the time between me trying to find the right words on how I was feeling was a good time to talk about smear tests.
I refused to see that GP again.

There are loads of incentives like this. If you're ever asked about smoking or alcohol consumption those are other things we get paid for collecting data on. Weight, for obese patients is another one as there is money per patient on the 'obesity register' but people are removed from it if no weight in 5 years.

Of course, in the wider scheme of things these targets do what they are meant to - improve uptake of screening and collect data that will be used either for individual health or population level intervention and funding decisions etc. Which is good. But on a practice level basis, it can feel like box ticking and that we're just here to meet targets rather than deliver care.

There used to be points/payment for number of people on Statins for example. Which financially incentivised prescribing. That has gone thankfully.

Maybe change doctors or put in a complaint to avoid getting her again. You can get the pill in other ways (sure I saw an ad for one called Hanna or similar, no need for prescription) but it would be a good idea to get a smear.

[quote NumberTheory]**@godmum56

sorry I don't understand? I don't think I did say this?

You quoted me and the clinical rationale I posted for refusing a smear and had a go about rationale being irrelevant and castigating me for being off topic.

So yes, I think you did say that.[/quote]
oh fair enough....I think that rationale is off topic. Its never ok for a health care professional to use the threat of witheld treatment to coerce someone into having an interrvention that they don't want. The topic here is not whether or not women should have smears but whether they can/should be coerced into having them. The whole point of capacity is, as I have said, that people should be able to make wrong or bad decisions and no part of that should depend on whether other people agree with that decision.

@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.

I don't think I've have read anything so shocking in a very long time - disgraceful

to add....I think its very easy for threads like these to get derailed into circumstances when such coercion is ok and circumstances when its not...and for adults, that is not right.

@RagzReturnedUnwrapped something just made sense to me!
I had a terrible injury in my ankle and leg a few years ago, couldn't walk for months and am waiting on my third surgery now. So you can imagine I was in a lot of pain at the time. I slipped using my crutches one day and put my foot down (was non weight bearing), I was in a lot of pain so went to minor injuries for an X-ray.
Was sitting for hours waiting, finally I get called by a nurse so followed her up the corridor with difficulty, she took me in a room to ask me how many units of alcohol I drank a week. I asked her what that had to do with my injury and she said they asked everyone so I answered (around 4, she seemed disappointed). She then sent me back out to the waiting room!
I've often thought how inappropriate it was for her to be pulling people from a waiting room who needed medical attention to take a bloody survey!

How would making smear tests MANDATORY work exactly??
Would women be fined? Taken to court? Forcibly taken to a drs and pinned down?