dxmedstudent:

I’ve seen a few posts online recently about how terrible it is that doctors insist on pregnancy tests when OP couldn’t possibly be pregnant (because they aren’t sexually active, or are into people who can’t make them pregnant etc), and I can understand that frustration. Really. There’s a lot that could be done better in healthcare, and people aren’t always adequately listened to or involved in their healthcare. It’s frustrating when you have to do a test that you know is useless. And there are huge issues with women not being believed regarding their experience of their symptoms.

But there’s actually a genuine reason for the insistence on pregnancy tests.

When I was a med student, I ended up in A&E with severe abdominal pain. At the time I wasn’t sexually active, and I told the doctor seeing me that. But I agreed to a pregancy test because I knew that they were just doing their job, and there were some serious differentials they had to rule out. This wasn’t personal; they were working according to guidance and hospital policy; any person with a uterus, of childbearing age, complaining of abdominal pain should get a pregnancy test to rule out something like a life threatening ectopic pregnancy. Although it was annoying that I couldn’t just say ‘I am definitely not pregnant’, I knew that whilst I knew this, there was no way for that A&E doctor to be 100% sure this was true.

Because people don’t always tell the whole truth.

This isn’t necessarily a gendered thing; people of all genders don’t necessarily always tell the whole story. There’s still a lot of stigma to sexual activity, and a lot of people aren’t honest with their healthcare providers about things like whether they are sexually active, whether they practice safe sex, whether they take drugs or smoke.Youngsters don’t always want to admit that they’ve been sexually active when they have, perhaps because they fear the doctor will tell their parents, and perhaps because it’s just awkward and scary to talk about it. Whilst it’s understandable that opening up to a stranger about awkward, personal things is difficult, it’s sometimes really, really necessary. I’ve met hundreds of patients who tell me they don’t smoke (but they smell of smoke, carry a lighter and I see them sneak out and smoke by the back entrance), don’t do drugs any more, don’t drink (since they were admitted), always use condoms (but come in with an STI) and it teaches you that people are complicated and nothing should be taken at face value. Unfortunately, there are times when not being truthful could put patients at risk or cost them their lives.  

It’s not always just about omission. Sometimes people genuinely incorrectly think that they ‘can’t be pregnant’.  Like perhaps they don’t relise that you can get bleeding even if you are pregnant. Perhaps they only ‘mostly’ took their pill this month, or perhaps they ‘only’ had sex once; people have very different levels of understading of basic medical knowledge or sex education. And therefore it is unfair and dangerous to assume how much they may or may not know. Most of us working in healthcare have seen patients who insisted they couldn’t be pregnant but actually were.

Accepting patients as complex, living people means understanding that not everyone is truthful all of the time. Therefore whilst we try our best to believe patients, we have to also never take a risk that relies on assumptions. We owe it to our patients to keep them safe by never assuming things.

It is much safer for patients and for clinicians to have a blanket policy that means you just test everyone for pregnancy than it is to risk some people not knowing they are pregnant, or lying about their sexual activity, and then causing them harm which could have been avoided if only you’d checked just in case. Would I personally demand a pregnancy test on a woman who told me she was a lesbian? No, but my hospital policy would probably still mean that I’d request if we could run the test anyway. Because if I didn’t, then I’d be in trouble for not following local policy and potentially risking someone’s life.  

My hospital (and pretty much every hospital I’ve worked at) has a policy that states any uterus-having person of childbearing age should have a pregnancy test before they have a CT or xray. Patients can refuse, if they wish, as long as we explain the risks. But we have to ask for it. Because if they happen to be pregnant, we’d be exposing their foetus to unnecessary radiation, and potentially to cause harm. When we know someone is pregnant, we often choose slightly different tests in order to spare them of radiation, so it can change how we investigate them. Bear in mind that I work in the NHS, so doing the test costs my patients nothing apart from a bit of pee.

Looking at it another way, it’s also arguable that such policies are also there to prevent healthcare providers and hospitals from legal action. If someone wasn’t offered a pregnancy test (perhaps they didn’t think they could be pregnant, perhaps they weren’t asked at all), and did end up having their baby exposed to unnecessary radiation and harm, they would be within their rights to take legal action against the clinician. It would probably be argued that the doctor should have done a pregnancy test to make sure that their patient wasn’t pregnant. We deal with thousands and thousands of patients. If you take it at face value when all your patients say they don’t think they are pregnant, you (and they) will eventually be wrong. And if you base your diagnoses, nvestigations or treatment on an assumption, sooner or later you will cause someone harm. Which is something we try to avoid as much as possible.

It is not personal and it is not meant to be offensive. It’s a rule that is there to protect people in general.

A clinician has no particular reason to believe that you, personally, are lying. Nor do they set out to cause any one person inconvenience, or to make them feel like a liar. But they are obligated to protect all their patients from harm, and this in reality means not assuming that everyone is telling the truth all the time. Testing for pregnancy is cheap, non-invasive and confirms that ruling out a life-threatening condition, or carrying on with particular investigations or treatments is safe. It’s simply a lot less unreliable or dangerous than assuming everyone is telling the truth all the time.

livvmd:

A couple of years ago, there was a post going around medblr of various medical students showcasing their grades with the message that even those who get below A’s are able to get into medical school. For the life of me, I cannot find it. (if anyone has a link, please send it my way!)

I wanted to put my own grades out there to show that it’s not the end of the world if you don’t have a 4.0 (no matter what SDN tells you). I just checked my verified AMCAS application for the first time since applying and my undergraduate GPA was 3.36 (undergrad BCMP GPA 3.19). I found out last week that I got into medical school.

One bachelor’s degree, one master’s degree, three (!!!) MCATs, one gap year, and two application cycles later, and I’m starting on my path to becoming a doctor this coming August. 

7-weeks:

the LGBT “ally” makes an AIDs joke in class and
the first thing i think about is pandemics.

actually the first thing i think about is squeezing my hand around his neckbeardy throat
but for the sake of the poem
the first thing i think about is pandemics

and how it wasn’t until 1985 that ronald reagan acknowledged the aids crisis
by then five thousand men had died and hundreds of thousands were infected
by then half a generation of queer americans would be wiped out by 2000
their bodies emaciated and tired of pretending like someone would give a shit

you see, the HIV virus operates by turning its RNA into DNA by using the host cell
and staying there until something draws the virus out
you see, hate operates by turning innocent comments into hateful institutions
and staying there until something draws the hate out

in the classroom
in the city
in congress

in Chechnya. Did they kill the inmates by hanging them by their own DNA
in Orlando. did he imagine the bullets infecting their bodies like Ronald Reagan’s agenda would
in New York City. did they think the protests would end soon because they were all infected

do they think i won’t get mad when they make an AIDs joke because hate hasn’t infected me?
hate is a retrovirus
hate doesn’t go away after the bodies start piling
hate comes back no matter what drugs we’re taking

and the classroom laughs like homophobia ended two years ago.
you see, HIV doesn’t kill the body but leaves it open for something else to
you see, hate doesn’t kill the body but leaves it open for someone else to

the classroom
the city
congress

Now, the only difference between hate and AIDs is that AIDs requires someone to fuck me
but hate has fucked us over since before there was an infection
and the warning signs of a curable disease are everywhere
in this body we call America

Our bathrooms are the center stage of our rights to exist in public
our public offices see gay people as a constitutional crisis
our public health crises are seen as God’s will against the gays

Like when they thought the hurricane in Houston was God’s response to their lesbian mayor
or when a Colorado pastor said the wildfires in California was God’s revenge against the gays
now, I’m wondering if anyone else can see America’s ribcages jutting out of her chest.

We think we’ve been inoculated so the jokes we make are innocuous
until the disease starts showing up again
while I’ve been warning everyone that the fight is never over.
After gay marriage became constitutional, I think
the majority of Americans stopped swallowing the blue pill of history,

And then somebody drops an AIDs joke like a gay man’s body in the 1980s,
emaciated and tired, but still goddamned alive.

––– Sean Glatch