Aug 19, 2015
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Attending Physician
Just started working in a primary clinic and by myself after residency.

I feel obligated to do a preg test on every pre-menopausal woman who walks through the door for fear of litigation. Very likely I will be giving her medications and if not, atleast be renewing her meds from previous providors.
What do the primary care providers out there do?
 

Crayola227

The Oncoming Storm
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Oct 22, 2013
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I'm not qualified to answer this.

My thought, would be that you could document asking the patient quite pointedly about their sexual practices, AS WELL as documenting the details of their last period and intercourse, and BC.

I'm assuming I don't get grilled about this every time I go in because on my med list are OCPs.

Seems like I've been to some clinics where every time the MA or a form asks about last period, and BC.

Most meds if they end up preggo and they got it anyway, it's no big deal and you just stop the med when you find out.

There are certain drugs, like methotrexate, where the rheum ALWAYS does a song and dance about it, even though I'm a doc myself, and he tells me every 3 mos!! But we both know he has to say it so he can document it, not because I need the education.

If you document, and show that you addressed the possibility, you're not liable if the patient is totally full of **** and lied, because you did your due diligence. Some drugs you would not take their word and test them prior to starting.

The other thing, to do malpractice they have to show harm. As I said, most drugs if you stop them when you find out they're preggo, there won't be harm. If there is, again, you need to have done things in such a way it's the patient's fault (didn't tell the truth) and not yours for not thinking of it and addressing it (possibility of pregnancy).
 

chessknt87

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Oct 10, 2007
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Why are all of your women under 40 on medications?

The above post is totally correct though--ask about sexual history/practices, offer counselling on contraception, if they are on a teratogenic medication and no contraception but refuse further counselling document this and that you had that discussion. I cant forsee anyone winning a suit if you document this.
 
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Crayola227

The Oncoming Storm
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Oct 22, 2013
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Why are all of your women under 40 on medications?

The above post is totally correct though--ask about sexual history/practices, offer counselling on contraception, if they are on a teratogenic medication and no contraception but refuse further counselling document this and that you had that discussion. I cant forsee anyone winning a suit if you document this.
Plenty of women under 40 are gonna be walking out with an Rx for an acute condition (abx) or for chronic stuff (asthma comes to mind for some reason), SSRIs, migraine meds, etc etc common crap
 

PlutoBoy

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Nov 19, 2009
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Just started working in a primary clinic and by myself after residency.

I feel obligated to do a preg test on every pre-menopausal woman who walks through the door for fear of litigation. Very likely I will be giving her medications and if not, atleast be renewing her meds from previous providors.
What do the primary care providers out there do?
I check if I'm prescribing drugs that are not safe for pregnancy or ordering imaging that require radiation. I trust the test more than the patient telling me that "there is no way I could be pregnant".
 
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Raryn

Infernal Internist / Enigmatic Endocrinologist
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Apr 25, 2008
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If the patient is not on long term contraception (IUD, s/p tubal ligation, implanon, whatever) and I am thinking of prescribing a medication with teratogenic properties (and I try to avoid them if at all possible) and I'm sending the patient down to get blood/urine labs, I'll add on a pregnancy test. Otherwise, I thoroughly document that I educated the patient regarding possible side effects and she told me there's absolutely no way she could be pregnant and affirmed that ten ways from Sunday before she picked up the medication. Not going to send her down for just a pregnancy test if I don't need any other labs.
 
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PlutoBoy

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Nov 19, 2009
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If the patient is not on long term contraception (IUD, s/p tubal ligation, implanon, whatever) and I am thinking of prescribing a medication with teratogenic properties (and I try to avoid them if at all possible) and I'm sending the patient down to get blood/urine labs, I'll add on a pregnancy test. Otherwise, I thoroughly document that I educated the patient regarding possible side effects and she told me there's absolutely no way she could be pregnant and affirmed that ten ways from Sunday before she picked up the medication. Not going to send her down for just a pregnancy test if I don't need any other labs.
Send her where? Get a UPT.
 
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