GoodmanBrown

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I am on an outpatient adult rotation right now, and we had a younger woman come in for a random complaint. I noticed she had had a miscarriage a few months prior, and as part of the visit, I asked about the miscarriage. As part of the conversation, she revealed the pregnancy was not planned and that she was not on any birth control.

I didn't go into any birth control options then, but I brought it up with my resident when I presented the case. I asked if we could discuss birth control options when we both went in to see the patient. He said that we couldn't because this clinic was part of a Catholic hospital, and it wasn't allowed.

I respected his say, but I think this is bull**** and borderline malpractice. I have no say in this now, but once I have prescribing power, I would definitely risk reprimand for prescribing OCPs. I mean, the smartest thing I intend to do is not put myself in that kind of situation, but I just wanted to see what others thought about the situation.
 

Blue Dog

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If you're in a Catholic hospital, discussing or prescribing contraception is off-limits, unless you're looking to get fired. It's not malpractice, either, so don't worry about that. The patient made the decision to come to a Catholic facility for her healthcare. The Church's position on contraception is common knowledge.

FWIW, you can discuss natural family planning. Most doctors don't know much about it, however.

http://www.americancatholic.org/Newsletters/CU/ac0685.asp
 

brats800

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Also, when I was at my Jesuit medical school, the hospital didn't have any patients on "birth control" but there sure were a lot of women on OCPs to control their heavy periods and to help their acne... ;) They also were able to have the discussion re: birth control but had to refer out for things specifically not allowed.
 

VA Hopeful Dr

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Also, when I was at my Jesuit medical school, the hospital didn't have any patients on "birth control" but there sure were a lot of women on OCPs to control their heavy periods and to help their acne... ;) They also were able to have the discussion re: birth control but had to refer out for things specifically not allowed.
Bingo
 

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Just because a woman isn't on birth control and hand an unplanned pregnancy doesn't mean she wants to be on birth control. How do you know she would have welcomed any "counseling" on birth control options? Did she tell you the pregnancy was unwanted or merely unplanned? The two are not necessarily the same. Did the patient ask you about OCP? Do you know anything about this patient's religious belief?

As someone who embraces Christianity (though I'm not Catholic and am not personally opposed to birth control), I can tell you that many religious people truly feel like their values are under attack in today's society. Popular culture and "conventional wisdom" preach non-judgementalism, but in reality, when people make decisions based on their religious beliefs, they are often judged for it. I recall a woman on one of my rotations with end stage cancer who withdrew a DNR after a visit from her pastor, who suggested that if she didn't do everything possible, she might go to hell. There was a LOT of eye rolling and disgust for her decision expressed by all the docs involved (not directly to the patient, but to each other, test) I can't imagine the same reaction to, say a Muslim male who would request not to be seen by female doctors- If I rolled my eyes or complained about that, I'd be reprimanded for being judgmental.

I imagine OP doesn't mean to be judgmental, but his/her remark does smack of being judgmental. If we are going to preach non-judgmentalism, it needs to be applied in ALL settings. The hallmark of being non-judgemental is how we handle those whose we disagree with.

Ultimately, we are all free to choose what type of setting to work in. We are free to choose a facility that most closely matches our values. So are patients. As others have said, if you don't want to be in a place that doesn't believe in birth control, don't work in one. And I'd suggest you not do residency in one, either.
 

henge

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many religious people truly feel like their values are under attack in today's society
Many secularists feel their values are under attack too. We live in a diverse society where lots of people--secular and religious--hold views that others--secular or religious--find offensive.
 

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Many secularists feel their values are under attack too. We live in a diverse society where lots of people--secular and religious--hold views that others--secular or religious--find offensive.
Offense is never given, only taken.
 
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GoodmanBrown

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Just because a woman isn't on birth control and hand an unplanned pregnancy doesn't mean she wants to be on birth control. How do you know she would have welcomed any "counseling" on birth control options? Did she tell you the pregnancy was unwanted or merely unplanned? The two are not necessarily the same. Did the patient ask you about OCP? Do you know anything about this patient's religious belief?

As someone who embraces Christianity (though I'm not Catholic and am not personally opposed to birth control), I can tell you that many religious people truly feel like their values are under attack in today's society. Popular culture and "conventional wisdom" preach non-judgementalism, but in reality, when people make decisions based on their religious beliefs, they are often judged for it. I recall a woman on one of my rotations with end stage cancer who withdrew a DNR after a visit from her pastor, who suggested that if she didn't do everything possible, she might go to hell. There was a LOT of eye rolling and disgust for her decision expressed by all the docs involved (not directly to the patient, but to each other, test) I can't imagine the same reaction to, say a Muslim male who would request not to be seen by female doctors- If I rolled my eyes or complained about that, I'd be reprimanded for being judgmental.

I imagine OP doesn't mean to be judgmental, but his/her remark does smack of being judgmental. If we are going to preach non-judgmentalism, it needs to be applied in ALL settings. The hallmark of being non-judgemental is how we handle those whose we disagree with.

Ultimately, we are all free to choose what type of setting to work in. We are free to choose a facility that most closely matches our values. So are patients. As others have said, if you don't want to be in a place that doesn't believe in birth control, don't work in one. And I'd suggest you not do residency in one, either.
I'm all for people being 100% free to make their own choices. You're right; I did not ask the woman if she wanted OCPs or if the pregnancy was unwanted. The EMR listed her religion as a non-Catholic faith, and when I asked if she was trying to get pregnant, she said "No, it was kind of an accident." So, I'm making an assumption there.

Where I get judgmental is when people push their beliefs on others. You and BD both state that the patients are choosing to get their care at a Catholic institution. While this is literally true, I think necessity is driving a fair number of my patients to go to the nearest, cheapest option available to them. I don't think they are in any way saying, "This Catholic clinic will practice medicine in a way that upholds my faith-based value system." as they walk through the door. So, yeah, it ruffles my feathers a good bit when we ignore important aspects of a patient's health because it offends a bunch of celibate, old men in Rome.

And as a final note, yeah, I would definitely never go to residency at a place that didn't let me give my patients effective birth control options.
 

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it ruffles my feathers a good bit when we ignore important aspects of a patient's health because it offends a bunch of celibate, old men in Rome..
Catholicism is the largest Christian denomination worldwide. It reaches far beyond the boundaries of Rome.

http://www.religionfacts.com/christianity/denominations/catholicism.htm

Few people realize that until 1930, all Protestant denominations agreed with the Catholic Church's teaching condemning contraception as sinful. The Anglicans caved in first, bowing to social pressures, and others soon followed.

http://www.catholic.com/tracts/birth-control

As for "ruffling feathers," you might try a little harder to respect the beliefs of others if you expect them to respect yours. You're a doctor, not Martin Luther.
 
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Catholicism is the largest Christian denomination worldwide. It reaches far beyond the boundaries of Rome.

http://www.religionfacts.com/christianity/denominations/catholicism.htm

Few people realize that until 1930, all Protestant denominations agreed with the Catholic Church’s teaching condemning contraception as sinful. The Anglicans caved in first, bowing to social pressures, and others soon followed.

http://www.catholic.com/tracts/birth-control

As for "ruffling feathers," you might try a little harder to respect the beliefs of others if you expect them to respect yours. You're a doctor, not Martin Luther.
1) I completely respect the beliefs of Catholics who feel contraception is against God's dictates for them. I would never try to coerce a Catholic woman into using birth control if it was against her religion.

2) The interaction I'm referring to was between a non-Catholic physician and a non-Catholic patient. The clinic we were in is part of a large, non-religious non-profit. The associated hospital was originally Catholic, but is now part of this conglomerate. The vast majority of funds used to operate the hospital and clinic come from private insurance, Mediare, and Medicaid. A minority comes from Catholic sources. As such, it would appear to me that the Catholic institution is inserting itself into an interaction in which is has no right to. So, who's really not respecting whom in this instance?

3) Almost all sexually-active, Catholic-identified women have used birth control at least once and more than half use it regularly.1 Most Catholics think it's morally acceptable2, and I suspect that most Catholics would start using some form of birth control the moment Vatican Council III says it's okay. (Those who aren't already.) It's not the Catholic everyman driving this stance, it's the Vatican leadership.

4) Religions update their beliefs to reflect society not infrequently. Slavery was once biblically justified by many religions, and now it's not. The ownership of wives is another good example. I'm sure I can find more if you'd like. Religions that don't adapt and change to society's values will become irrellevant and die off. Further, the Vatican's stance hurts people. Unwanted pregnancy is a big deal anywhere it happens, and condom use is an important STD prevention in areas of the world where it really matters.
 

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The interaction I'm referring to was between a non-Catholic physician and a non-Catholic patient.
Doesn't matter. Their house, their rules.

The clinic we were in is part of a large, non-religious non-profit. The associated hospital was originally Catholic, but is now part of this conglomerate. The vast majority of funds used to operate the hospital and clinic come from private insurance, Mediare, and Medicaid. A minority comes from Catholic sources. As such, it would appear to me that the Catholic institution is inserting itself into an interaction in which is has no right to.
The hospital's financial situation is irrelevant.

Almost all sexually-active, Catholic-identified women have used birth control at least once and more than half use it regularly.
That doesn't make it OK in the eyes of the Church.

Religions update their beliefs to reflect society not infrequently.
But, the Church hasn't, in this case.

You don't have to agree with another's beliefs in order to respect them. If you can't handle that, you shouldn't work in a Catholic hospital.
 

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If she wanted OCPs or another form she would have asked. You'd then get her to say that she had some menorrhagia. At least, this is what I saw for the most part in these situations.
 

henge

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Their house, their rules.
Well, that's the issue, isn't it? I have no reason to believe that the hospital in this case is not complying with the law. But would you still say "Their house, their rules" if a religious hospital, based on its religious dogma, refused to treat Muslims or treated whites before blacks in the ER?

Aside from getting paid huge sums of money from the government through Medicare and Medicaid, hospitals benefit from tax exemption, the ability to attract tax deductible charitable contributions, the ability to issue tax exempt bonds to raise capital, etc. In exchange for trillions of dollars of cash and subsidies, the government imposes all sorts of rules on hospital. Clearly, it is not as simple as "Their house, their rules." Sometimes, he who pays the piper calls the tune.
 

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Well, that's the issue, isn't it? I have no reason to believe that the hospital in this case is not complying with the law. But would you still say "Their house, their rules" if a religious hospital, based on its religious dogma, refused to treat Muslims or treated whites before blacks in the ER?
That would be discrimination, and there are laws against that. There are no laws mandating that anyone provide contraception, Catholic or not.

Aside from getting paid huge sums of money from the government through Medicare and Medicaid, hospitals benefit from tax exemption, the ability to attract tax deductible charitable contributions, the ability to issue tax exempt bonds to raise capital, etc. In exchange for trillions of dollars of cash and subsidies, the government imposes all sorts of rules on hospital. Clearly, it is not as simple as "Their house, their rules." Sometimes, he who pays the piper calls the tune.
Write your congressman.
 

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That would be discrimination, and there are laws against that. There are no laws mandating that anyone provide contraception, Catholic or not.
True but there are laws that protect individuals who speak freely in this country, especially in the context of the doctor-patient relationship. So while a physician who works in a Catholic hospital system may not perform abortions, give out condoms, insert IUD's, write a prescription for OCPs, (their house their rules), physicians have every right to talk about contraception and family planning (this is America) and refer the patient to the appropriate venue where those things can be discussed and acted upon as appropriate (standard of care).

Consider a similar case:
Florida passed a law that bans physicians (pediatricians) from asking/discussing about guns as anticipatory guidance during well child checks.
(Florida Law Bans Doctors From Asking About Guns
http://abcnews.go.com/Health/Wellness/florida-law-bans-doctors-guns/story?id=13756579)

But, Federal Judge says no, you (the state of Florida) can't chill free speech. Doctors have the right to speak, especially when it is in the context of patient well-being.
(Federal judge bars Florida "don't ask" gun law
http://www.ama-assn.org/amednews/2011/09/26/gvsc0926.htm)

It would be unconstitutional to forbid a physician from talking about something relevant to patient care, and it would not be in the public's best interest to allow a higher body to shut down that conversation.
 
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How is asking if she wants to discuss contraception a problem? Even if you don't want to have the conversation, or the hospital doesn't want to have the conversation, the patient deserves the opportunity for referral.
 

Blue Dog

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It would be unconstitutional to forbid a physician from talking about something relevant to patient care, and it would not be in the public's best interest to allow a higher body to shut down that conversation.
I don't disagree in principle. Personally, I think the government needs to stay out of the exam room. That's a different issue, however, from what this thread originally referenced (Catholic hospitals and contraception), because then you get into the whole issue of the government interfering with religious freedom. These aren't easy issues, which is why there's so much controversy and debate.
 

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The Florida cases regarding physicians asking about guns was in response to the possibility that Obamacare would REQUIRE doctors to ask patients about guns and RECORD THEIR RESPONSES.

This is different from an individual institution, run (at least partly) by a religious organization, expecting that employees adhere to the principles of the organization that runs it.

Not to mention, there is not an inherent right to contraception. There is, however an inherent right to defend oneself.

A patient at the Catholic hospital who wants birth control can be referred to a place that provides it.

When the government requires all doctors to ask about guns and record the answer, patients who wish to keep their gun ownership status private have no other place to go. The only choice is to lie.

Which is why I'm in agreement with Bluedog. The government should stay out of the exam room.
 

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The government should stay out of the exam room.
And so should the "church". I don't understand the difference. Government or church, it's a 3rd party involvement in the doctor-patient relationship, if you want to be intellectually consistent.
 
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Blue Dog

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And so should the "church". I don't understand the difference. Government or church, it's a 3rd party involvement in the doctor-patient relationship, if you want to be intellectually consistent.
As I mentioned previously, churches have constitutionally-protected freedom of religion.
 
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henge

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The Florida cases regarding physicians asking about guns was in response to the possibility that Obamacare would REQUIRE doctors to ask patients about guns and RECORD THEIR RESPONSES.

***

When the government requires all doctors to ask about guns and record the answer, patients who wish to keep their gun ownership status private have no other place to go. The only choice is to lie.
Your statement is flatly and unambiguously false. Obamacare did NOT require doctors to ask patients about guns. In fact, you've got it exactly backward:

'the NRA was also responsible for a provision in the Affordable Care Act. Into this landmark health care law, NRA-backed legislators quietly inserted “Protection of Second Amendment Gun Rights.” This section bans doctors, health care programs, and insurers from “collection of any information relating to the presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property of an individual.”'

Following Newton massacre:

'Among Obama’s executive actions, No. 16 states, “Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes.” This clarification confirms that doctors should continue to practice preventive medicine. But it does not specifically lift the moratorium on data collection of gun ownership in the ACA, which directly affects research on gun violence.'

http://www.slate.com/articles/health_and_science/medical_examiner/2013/02/pediatricians_and_nra_physician_gag_rules_and_the_cdc_aca_and_states.single.html

Here is the actual text of the ACA statute:

"‘‘(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.—
‘‘(1) WELLNESS AND PREVENTION PROGRAMS.—A wellness
and health promotion activity implemented under subsection
(a)(1)(D) may not require the disclosure or collection of any
information relating to—
‘‘(A) the presence or storage of a lawfully-possessed
firearm or ammunition in the residence or on the property
of an individual; or
‘(B) the lawful use, possession, or storage of a firearm
or ammunition by an individual.
‘‘(2) LIMITATION ON DATA COLLECTION.—None of the
authorities provided
to the Secretary under the Patient Protection
and Affordable Care Act or an amendment made by that
Act shall be construed to authorize or may be used for the
collection of any information relating to
—
‘‘(A) the lawful ownership or possession of a firearm
or ammunition;
‘‘(B) the lawful use of a firearm or ammunition; or
‘‘(C) the lawful storage of a firearm or ammunition."

pages 884-885 of the pdf
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
 

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Your statement is flatly and unambiguously false. Obamacare did NOT require doctors to ask patients about guns. In fact, you've got it exactly backward:

'the NRA was also responsible for a provision in the Affordable Care Act. Into this landmark health care law, NRA-backed legislators quietly inserted “Protection of Second Amendment Gun Rights.” This section bans doctors, health care programs, and insurers from “collection of any information relating to the presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property of an individual.”'

Following Newton massacre:

'Among Obama’s executive actions, No. 16 states, “Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes.” This clarification confirms that doctors should continue to practice preventive medicine. But it does not specifically lift the moratorium on data collection of gun ownership in the ACA, which directly affects research on gun violence.'

http://www.slate.com/articles/health_and_science/medical_examiner/2013/02/pediatricians_and_nra_physician_gag_rules_and_the_cdc_aca_and_states.single.html

Here is the actual text of the ACA statute:

"‘‘(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.—
‘‘(1) WELLNESS AND PREVENTION PROGRAMS.—A wellness
and health promotion activity implemented under subsection
(a)(1)(D) may not require the disclosure or collection of any
information relating to—
‘‘(A) the presence or storage of a lawfully-possessed
firearm or ammunition in the residence or on the property
of an individual; or
‘(B) the lawful use, possession, or storage of a firearm
or ammunition by an individual.
‘‘(2) LIMITATION ON DATA COLLECTION.—None of the
authorities provided
to the Secretary under the Patient Protection
and Affordable Care Act or an amendment made by that
Act shall be construed to authorize or may be used for the
collection of any information relating to
—
‘‘(A) the lawful ownership or possession of a firearm
or ammunition;
‘‘(B) the lawful use of a firearm or ammunition; or
‘‘(C) the lawful storage of a firearm or ammunition."

pages 884-885 of the pdf
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Nope. I said the Florida case was about the POSSIBILITY that Obamacare would contain such a requirement. You are correct in that the final legislation did not contain that. But there was discussion about including it. Florida chose not to wait around and see how it turned out.
 

henge

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Nope. I said the Florida case was about the POSSIBILITY that Obamacare would contain such a requirement. You are correct in that the final legislation did not contain that. But there was discussion about including it. Florida chose not to wait around and see how it turned out.
Your explanation is wholly unpersuasive.

Obamacare was effective March 23, 2010. The Florida statute was signed into law on June 2, 2011. The language in ACA was set more than one year before Florida acted. By the time Florida acted, not only did ACA NOT include the language Florida was supposedly worried about, it included language that was the EXACT OPPOSITE of what Florida was supposedly worried about.
 
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If you're in a Catholic hospital, discussing or prescribing contraception is off-limits, unless you're looking to get fired. It's not malpractice, either, so don't worry about that. The patient made the decision to come to a Catholic facility for her healthcare. The Church's position on contraception is common knowledge.

FWIW, you can discuss natural family planning. Most doctors don't know much about it, however.

http://www.americancatholic.org/Newsletters/CU/ac0685.asp
"I find the Catholic church's stance on this issue antiquated and harmful to women. The church should deal with more pressing issues like child abuse by church priests before preventing women from obtaining contraceptives."
 
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