Pro-Life Doctors' Practice Restricted in UK

[mockingbird]

lifesitenews.com/news/uk-pro-life-doctors-banned-from-sexual-and-reproductive-health-specialty-un

I think this is a Catholic news site but if you just want to view the guidelines here and not give them the clicks: http://www.fsrh.org/pdfs/DFSRHFormI.pdf

Basically in the UK, specialists in "Sexual and Reproductive Health" (I am not sure if this is a gynecological specialty, or their name for ob/gyn) are now considered ineligible for certification if they refuse to provide contraception to their patients, including emergency contraception. You are still allowed to conscientiously object to performing abortions as long as you will provide referrals and don't judge your patients (I guess that is to be determined during training?).

Honestly I don't think this is "draconian" as the article suggests. Birth control is now a large part of gynecological practice and I think it has become a vital/integral part of practice. If you don't want to prescribe it pick another specialty. It's just part of the job just like an endocrinologist (hormone doctor) needs to know how to manage diabetes patients, and it is not your place to inflict your beliefs on your patients. If you were the only available gyn in the area, and you didn't provide birth control, that would be placing an undue burden on all your patients who need or want it, i.e. trying to find a TOTALLY LEGAL prescription.

ETA: Last year the US OB-Gyn governing board (ACOG?) came out with a recommendation for birth control to become OTC. I doubt this will go through anytime soon because TEH BABIEZ but I think I would be in favor of that for no other reason, that it would allow people to access it without risking going through a doctor or pharmacist who is against prescribing/providing it.

[Hane]

Last year the US OB-Gyn governing board (ACOG?) came out with a recommendation for birth control to become OTC. I doubt this will go through anytime soon because TEH BABIEZ but I think I would be in favor of that for no other reason, that it would allow people to access it without risking going through a doctor or pharmacist who is against prescribing/providing it.

As someone whose body reacts badly to hormonal BC, I have to admit I'd be worried if it were made available OTC. (I had scary side effects--most likely from clotting--such as ONE leg swelling to twice its normal size and sudden excruciating headaches during sexual arousal at different times in my life when I tried hormonal BC.) I watched my health like a hawk when I was on it and let my doctor know immediately when things went wrong, but what might happen to a girl or woman who was less cautious?

[mockingbird]

As someone whose body reacts badly to hormonal BC, I have to admit I'd be worried if it were made available OTC. (I had scary side effects--most likely from clotting--such as ONE leg swelling to twice its normal size and sudden excruciating headaches during sexual arousal at different times in my life when I tried hormonal BC.) I watched my health like a hawk when I was on it and let my doctor know immediately when things went wrong, but what might happen to a girl or woman who was less cautious?

This is honestly what surprised me about their recommendation. I have also had bad reactions to hormonal bc (other than the one I'm on now; I have to take it because of a hormonal deficiency). The clotting risk is small but pretty serious and there are people who shouldn't take it because of that. Also, with so many different types, I feel like a doctor would be best to help you figure that out (some women do better with the progesterone-only pills, for example). It is a huge headache for me to be able to get my pills though (and that's without a judgy gyn) so I think loosening the restrictions somehow would be good. I guess I should have said, I am cautiously in support of moving it to OTC. I know I read the text of their recommendation and I'll have to find it and see if it addressed any of these problems.

[Mama Mia]

Another concern with birth control being OTC is if women would then have to always pay out of pocket instead of having insurance cover it. I hope if they do make it over the counter they provide a way to use insurance to purchase it, but since over the counter spermicides and condoms and other over the counter medications are usually paid with cash, I don't know if that is doable.

[mockingbird]

Another concern with birth control being OTC is if women would then have to always pay out of pocket instead of having insurance cover it. I hope if they do make it over the counter they provide a way to use insurance to purchase it, but since over the counter spermicides and condoms and other over the counter medications are usually paid with cash, I don't know if that is doable.

That's true. I'm not sure if there is a way to add it to the formulary for everyone if you were to purchase it at the pharmacy or something, since it is supposed to be covered now?

[DGayle]

As someone whose body reacts badly to hormonal BC, I have to admit I'd be worried if it were made available OTC. (I had scary side effects--most likely from clotting--such as ONE leg swelling to twice its normal size and sudden excruciating headaches during sexual arousal at different times in my life when I tried hormonal BC.) I watched my health like a hawk when I was on it and let my doctor know immediately when things went wrong, but what might happen to a girl or woman who was less cautious?

People have bad reactions to all kinds of things that are OTC. What you do is see your doctor for guidance, or avoid products you aren't sure about. I have several medication allergies and more reactions, and it's a hassle to go to a doctor for little things, but I still favor people being able to get this stuff OTC.

My insurance covers anything that's OTC at the prescription rate of $5, or $10 for name-brand, if a doctor writes a prescription for it. This is an incentive to see a doctor before taking something.

[ViolaSebastian]

Having them be prescription only is also a good way to insure that women are getting their annual pap smears/pelvic exam, so there's that, too...

[mockingbird]

http://www.acog.org/Resources_And_Publi ... raceptives

Here's the ACOG recommendations if anyone is interested.

They said studies have shown women do fine with a checklist of who should not use BC, thought side effect rates were similar to other OTC pills, and they also stressed that a pelvic exam is not required for getting birth control and making that a requirement or acting like it is could be an access barrier in itself. One thing I thought was interesting was studies showing women who were able to buy many packs at a time (vs. the insurance limit) had a better compliance rate.

[DGayle]

Having them be prescription only is also a good way to insure that women are getting their annual pap smears/pelvic exam, so there's that, too...

That kind of oversight gets to be patriarchal. You can only get birth control if you get your yearly paps even of you opt out, and to make sure you remember, since you can't be trusted, your birth control will be held hostage. Getting birth control shouldn't require letting someone else make a medical decision for me that has nothing to do with the birth control itself. Birth control isn't dangerous because of not having a pap, or safer for having one. The only way they're connected at all is by both involving my private parts, but only barely. Birth control impacts the endocrine system and my hormones affect my uterus.

Edit: I don't know why this showed up a couple hours after mockingbird's post. I posted it before dinner.

[Mama Mia]

That kind of oversight gets to be patriarchal. You can only get birth control if you get your yearly paps even of you opt out, and to make sure you remember, since you can't be trusted, your birth control will be held hostage. Getting birth control shouldn't require letting someone else make a medical decision for me that has nothing to do with the birth control itself. Birth control isn't dangerous because of not having a pap, or safer for having one. The only way they're connected at all is by both involving my private parts, but only barely. Birth control impacts the endocrine system and my hormones affect my uterus.

Edit: I don't know why this showed up a couple hours after mockingbird's post. I posted it before dinner.

I agree. I do get concerned though with some of the very serious side effects that can occur from hormonal birth control though, especially if young girls were able to get it OTC. On the other hand I don't know that seeing a Dr. Makes them any more likely to be on the look out for serious side effects. I think maybe easy to understand warnings /side effects listed and making birth control over the counter and covered by insurance would be the way to go, if they could find a way to keep it covered or at least very cheap if it's over the counter.

I also think having free contraceptives available at school and community clinics would be very useful.

[Brightonbelle]

UK here.

this is an intetesting one. We already have the MAP available OTC in the uk (although you have to pay - it would free through one's GP). The only thing that bothers me about this is knowing the great lengths the nurse at my surgery went to to ensure I was on the right BC pill. Would a pharmacist be able to do that? OTOH, pharmacists often have more up to date training than GPs on the latest drugs available as it's their specialism so perhaps this could work.

re: that article, it's my understanding that doctors can object to performing abortions but not referring. I could be wrong,but that's my understanding of our system here. Patients are entitled to a second opinion on the NHS too.

[DGayle]

I agree. I do get concerned though with some of the very serious side effects that can occur from hormonal birth control though, especially if young girls were able to get it OTC. On the other hand I don't know that seeing a Dr. Makes them any more likely to be on the look out for serious side effects. I think maybe easy to understand warnings /side effects listed and making birth control over the counter and covered by insurance would be the way to go, if they could find a way to keep it covered or at least very cheap if it's over the counter.

I also think having free contraceptives available at school and community clinics would be very useful.

A lot of girls can't go see their doctors whenever they feel like to get a prescription. Even teens are in school during a lot of office hours. So is the better alternative really to tell them no birth control without a prescription?

Taking birth control does affect our hormones, but why is this the one area we shouldn't be allowed to decide for ourselves when it's completely fine for people to make the decision to smoke cigarettes, which causes cancer and heart disease so often that cigarettes are a bigger killer of women than breast cancer? If someone doesn't want to talk to a doctor first, that should be her choice. If your concern is minors restrict birth control to 18+ and accept that you're making it harder for teens to prevent pregnancy. I don't know that anyone under 13 should be allowed to buy any medications at all though, and usually they don't.

As it is, a lot of people don't read the ingredients, and take a couple extra-strength Tylenol with a heavy dose of NyQuil, not realizing they're OD'ing on acetaminophen. The solution isn't to start putting that stuff on the prescription list, but to have warnings, and then realize that sometimes people just don't care and that it's their choice.

A lot of times, doctors prescribing birth control just decide on one to write up. They don't really know which ones each woman will respond negatively to until it's tried. A woman gets it, and if she doesn't feel well on it, she'll bring it up with her doc, who will try another. Since we have such a heavy roll in this, why couldn't we do that for OTC? X makes me nauseated, so I'll try Y. Give us women, yourself included, a bit of credit, and trust that we can be trusted to make out our medical decisions. As far as medical decisions go, this is a minor one, and it's a lot safer than certain non-medical things a large chunk of the population uses.

[DGayle]

UK here.

this is an intetesting one. We already have the MAP available OTC in the uk (although you have to pay - it would free through one's GP). The only thing that bothers me about this is knowing the great lengths the nurse at my surgery went to to ensure I was on the right BC pill. Would a pharmacist be able to do that? OTOH, pharmacists often have more up to date training than GPs on the latest drugs available as it's their specialism so perhaps this could work.

re: that article, it's my understanding that doctors can object to performing abortions but not referring. I could be wrong,but that's my understanding of our system here. Patients are entitled to a second opinion on the NHS too.

But if someone doesn't feel safe going it alone, they can still see a GP. If someone doesn't want to see their GP, they can do it on their own.

The important thing is women there have the CHOICE.

[OkToBeTakei]

But if someone doesn't feel safe going it alone, they can still see a GP. If someone doesn't want to see their GP, they can do it on their own.

The important thing is women there have the CHOICE.

Yes morning after pill is OTC. Also yearly cervical smears are not necessary unless you are in a high risk category, also pelvic exams are wholly unnecessary full stop in an otherwise healthy female. This is not a routine examination in the UK and is one I suspect is tied up with money in the US if used as routine.

Also as the OP said a doctor can choose not to perform an abortion but absolutely can NOT refuse to refer a patient. As all abortions have to be regulated via the NHS either in an NHS hospital or an NHS approved/mandated clinic then it would never really be a problem.

I agree DGayle. I'm not sure of the availability of OTC medicines in other countries but in the UK it would be quite easy to kill yourself through ignorance of OTC medication. It's very difficult to tell if you are going to have an adverse reaction to a common compound used in cough linctus. Pharmacists here are very highly trained and most now have consulting rooms for minor ailments and can prescribe antibiotics when appropriate, which is not indiscriminate in the UK. A GP has no more way of telling which BC may or may not suit a female just through the act of examination (obviously triggers such as high BP or family history need to be examined) I don't think this is something a pharmacist can not undertake. They tend as mentioned to have a better understanding of the differences in indivudual medications/newer ones/compounds and would probably be more helpful for somebody trying to find one that suits.

Most folks I know just put their BC on repeat, some for years. GP's will review periodically but they do that for all long term meds. I get a yearly review because my diclofenac for muscle pain is on repeat.

[Arete]

So the birth control pill is NOT OTC in the UK, the morning after pill is OTC. Did I understand that correctly?

There are new guidelines for PAP frequency in the US. Without certain risk factors, it is now recommended the test be performed every 3 years.

[Mama Mia]

A lot of girls can't go see their doctors whenever they feel like to get a prescription. Even teens are in school during a lot of office hours. So is the better alternative really to tell them no birth control without a prescription?

Taking birth control does affect our hormones, but why is this the one area we shouldn't be allowed to decide for ourselves when it's completely fine for people to make the decision to smoke cigarettes, which causes cancer and heart disease so often that cigarettes are a bigger killer of women than breast cancer? If someone doesn't want to talk to a doctor first, that should be her choice. If your concern is minors restrict birth control to 18+ and accept that you're making it harder for teens to prevent pregnancy. I don't know that anyone under 13 should be allowed to buy any medications at all though, and usually they don't.

As it is, a lot of people don't read the ingredients, and take a couple extra-strength Tylenol with a heavy dose of NyQuil, not realizing they're OD'ing on acetaminophen. The solution isn't to start putting that stuff on the prescription list, but to have warnings, and then realize that sometimes people just don't care and that it's their choice.

A lot of times, doctors prescribing birth control just decide on one to write up. They don't really know which ones each woman will respond negatively to until it's tried. A woman gets it, and if she doesn't feel well on it, she'll bring it up with her doc, who will try another. Since we have such a heavy roll in this, why couldn't we do that for OTC? X makes me nauseated, so I'll try Y. Give us women, yourself included, a bit of credit, and trust that we can be trusted to make out our medical decisions. As far as medical decisions go, this is a minor one, and it's a lot safer than certain non-medical things a large chunk of the population uses.

I believe if you actually read what I wrote, what I said was that I was concerned about the side effects if they are bought OTC, particularly for young teens, BUT that I'm not sure that having to go through a physician necessarily makes it more likely for someone to watch out for/be aware of side effects in any case. I also said that having them available both OTC and at free clinics is preferable. In fact I said clinics in schools, so obviously I am not trying to restrict teen access to birth control. So I don't know why you are acting like I think birth control shouldn't be available except through a Doctor? I do think warnings/side effects etc should be given in much easier to understand language, instead of the minuscule fine print consisting of medical terminology that is given now. So unless you were actually responding to the post at the top of the chain, you are completely wrong about what I said.

[OkToBeTakei]

So the birth control pill is NOT OTC in the UK, the morning after pill is OTC. Did I understand that correctly?

Pretty much.

In order to get a morning after pill, you will have a confidential and anonymous consultation with a pharmacist, which you should be able to do in a private area of the store. If the Emergency Contraceptive 1.5mg Tablet is suitable for you, the pharmacist will be able to supply it and there is no need to go to your doctor (subject to stock availability). However if the pharmacist does not believe that this morning after pill is suitable for you, you may be referred back to your doctor.

Not always free though.

When prescribed by your doctor or family planning clinic on the NHS, the morning after pill would be free. Some local NHS organisations make it available free at pharmacies but this is not always the case.

Birth control pill is free though hence why you require a prescription.

There are moves to allow pharmacies to prescribe apparently as there has been very little if any issues with OTC morning after contraception.

[docmom]

The thing that concerns me most about OTC BC is that insurers here will instantly back off paying for them. I agree the side effects aren't any worse than a lot of other drugs that are already OTC (aspirin would probably not be approved for OTC use nowadays). The other issue is education, particularly of teens, about the proper use of contraceptives. Perhaps if they were available, OTC (and free) in clinics which were easily accessible and came with counseling for first time users...Unlikely in this political climate, but I can dream.

[OkToBeTakei]

So the birth control pill is NOT OTC in the UK, the morning after pill is OTC. Did I understand that correctly?

There are new guidelines for PAP frequency in the US. Without certain risk factors, it is now recommended the test be performed every 3 years.

Sorry did not see your edit. 3 years is the norm here also.

[Khan]

I hated having to go through completely unnecessary pelvic exams just to get my prescription for BC. The bastards in charge really want to publish sluts like me for wanting to avoid pregnancy. More harassment like some states requirement of transvaginal ultrasoundbefore an aabortion is allowed.

[Emkay]

One of the only things I would be concerned about with BC being over the counter is if the patient were on another medication that could have negative interactions with the BC. I know I am on a med that can reduce the effectiveness of my BC, so I am aware of that and take adequate precautions (and will be talking to my dr at my next appt about a stronger BC- any suggestions?). Someone else might not be aware that another med they are on could cause issues.

[Bethella]

What's really ridiculous is when they make you get the Pap/smear before they give you the pill even if you're using it for bleeding/hormone control instead of actually using it for birth control. Never really understood that one.

[Violet]

What's really ridiculous is when they make you get the Pap/smear before they give you the pill even if you're using it for bleeding/hormone control instead of actually using it for birth control. Never really understood that one.

Really??? (UK here!) I've been on various types of contraceptives since my mid-teens (damn heavy periods!) and I've never been asked to have a smear test or any kind of pelvic exam - just getting weighed sometimes and having my blood pressure taken!

[FloraKitty35]

Being a rational person (most of the time) this sounds reasonable to me.

[Bethella]

Really??? (UK here!) I've been on various types of contraceptives since my mid-teens (damn heavy periods!) and I've never been asked to have a smear test or any kind of pelvic exam - just getting weighed sometimes and having my blood pressure taken!

Yep, midwest US, had to get it every year before they would renew my prescription, mostly getting it through the university health clinic and PP. At school it was quite obvious they thought I was lying about being sexually active. Although that has changed now that the recommendation is once every three years and I'm going to a really doctor instead of a clinic.