I ran across this news article the other day which made some excellent points. It is about a very commonly taken drug that has recently been found to drastically increase the risk of depression in women, especially among adolescent girls. The article discussed why this new research hadn't created more of a stir. It's a good read and if you haven't guessed, the drug is birth control. And the reason it hasn't created a big stir, because it is not politically correct to say anything bad about the magical pill that has freed women.
While the side effects of birth control pills apparently aren't considered very news worthy (or at least least not considered politically correct news), I don't think they are a big surprise to most of the women in the world. Female hormones are a messy soup we've all been dealing with since our teens and I don't think I've ever met anyone who has taken oral contraceptives who doesn't complain about some of the oh-so-fun side effects: depression, weight gain, change in sex drive, mood changes. I have met so many women who express hatred towards being on the pill. There's also the deadly side-effects we try not to think about: the increased risk of certain cancers and the greatly increased risks of blood clots and strokes.
Personally, while I was on the pill I experienced morning-sickness-like nausea a few days each month as well as the weight gain, decreased libido, and mood changes. And after years of mostly being on the pill, when I stopped it to try to get pregnant I found my menstrual cycle was a mess. It no longer cycled on it's own. After waiting for many months for it to resume, I finally resorted to a massive hormone shot to get it jumpstarted again. That did do the trick and eventually I was able to get pregnant, but the whole experience made me much more aware of the fact that you can't mess with bodily functions without their being consequences--often ones you aren't too happy about. (Here's a pretty good list of some potential side effects of hormonal contraceptives.)
And it made me wonder whether there is any correlation between the increased infertility we see in the world and the oh so prevalent use of oral contraceptives. The invention of the birth control pill has definitely greatly changed the timing of childbearing for women across the world. In the US, the number of women having their first child when they are 35-39 or even 40-44 has been increasing ever since. Since fertility has been proven to decrease with age, using the pill to push back childbearing would definitely cause more people to encounter infertility problems when they finally try, even if messing with the hormone cycle itself doesn't do so. And increased maternal age also equals increased risk of Down's Syndrome, other chromosome problems, and spontaneous abortion. What is the price being paid for that extra "sexual freedom" in their 20s? When women finally decide it's time to have children and then have to go through IVF to get them, do they have regrets?
The newer birth control pills allow a woman to choose to only have a period a few times a year. Some even are set up to never have a period at all while on the pill. I have to admit that I am not a big fan of my period. It is messy and gross. I get moody. I get nasty cramps. I get migraines. But at the same time, I find the idea of chemically altering that very natural cycle of my body alarming. This article discusses some of the pros and cons people see with the new style pills. The manufacturer's point out that even on the regular monthly period style pills, you weren't really having a period. It was just a fake period to make people feel better. That doesn't really make me feel better, but it probably does mean that the consequences of any style of birth control pill is probably about the same. Manufacturers also argue that in modern society, we have more periods than our ancestors did. I can believe that--fewer children equals fewer breaks in the cycle for pregnancy and nursing. Still, the idea of using artificial hormone manipulation year after year after year worries me. Many people will be on birth control pills for most of the time between 16 and 50, and while we're told that is safe, I don't feel a lot of trust in that. I ran across one article that admitted that it is hard to study the effects of long-term continuous contraceptive use. "It's important to note that there are no long-term studies looking at the health risks, if any, of taking birth control pills for more than one year. Segal says that's unrealistic because "it would require women to promise not to have babies for three, five, even 10 years."
My biggest concern with oral contraceptives is that they are handed out like candy that won't hurt anything, without serious thought and consideration of possible consequences. Especially now that you can get shots that last for months or implants that last even longer, it is important to know what you are getting into. Whether it is a teenager wanting to be sexually irresponsible (even though those pills aren't going to save her from STDs or the emotional fallout of too much intimacy too soon) or a woman who is having any sort of female complaint. The immediate answer is always "oral contraceptives." Seriously, I have never gone into a gynecologist with a complaint about my health that wasn't answered with that. They don't want to figure out what's up or why you're experiencing discomfort, they just want to throw some hormones at it and hope it goes away. If one doesn't work, they will just try trial-and-error until they find one that bothers you less. When you look for information on birth control you mostly find glowing reviews of the freedom of choice they've brought and little or no info on possible consequences. Stories like this one, that acknowledge all is not golden, are rare. I am glad I had the knowledge and tools to make choices about when I'd have children and how many, but I also think these decisions need to be made with full acknowledgement of the risks and consequences involved and I don't believe that usually happens. For example, as someone who has loved ones who suffer from depression (so I know firsthand how dangerous and destructive it can be), I think it is VERY important that the link between depression and hormonal contraceptives be well publicized.
And this has just covered some of the medical questions of the pill. Being a medical blog, I won't go too deeply into the effect birth control has had on the structure of the traditional family and society in general. Yes, it has made it possible for women to be as irresponsible and consequence-free in their sex lives as males were able to be. That may sound "fair" but is it good for society? It seems like we'd all be much better off if we'd developed a way for men to be made more accountable instead. This quote pretty much sums up my feelings: "Many young people across our nation, who in the natural course of life should grow up, marry, and rear children, are instead trapped in a world where sexual intimacy is casual, responsibility and long-term commitments are denigrated, and children are viewed as a burden, a distraction from the pursuit of happiness and personal fulfillment. They have lost connection with the divine purpose of mortal life, arriving instead at the sterile apex of the me generation."("Defending the Family in a Trouble World" by Bruce D. Porter)
If you'd like to read a lot of different viewpoints on the effect birth control has had on our society, check out this article from CNN commemorating the 50th anniversary of the pill.
Friday, May 26, 2017
How to Protect Your Modesty in a Medical Setting
So if you are like I am and care about maintaining your modesty, how do you do so while still getting the medical care that you need? Here are some practical ideas to try.
Communication
First off: communicate your desires clearly, firmly and in advance. Whenever a medical test or procedure is suggested or planned, ask your medical practitioner to clearly explain exactly what will be done, who will do it and what you will be wearing. That may sound over-the-top, but medical professionals seem to err on the side of take-it-all-off for even some of the simplest tests and procedures. Always ask for details. Even for "simple" procedures. Don't settle for the generalities they usually give you or you will most likely be unpleasantly surprised. If you aren't happy with the answers, ask them to explain why certain aspects of the procedure are medically necessary and then discuss ways to provide the medical necessities while still maintaining your dignity and comfort.
For example, often patients are told that they must remove all their underwear before a test or procedure. When asked why, we had a nurse explain it was because certain synthetic fibers can cause problems. The follow-up to that explanation would be: "So what material can I wear that would not cause any problems?" I'd much rather go buy some new underwear than to be stripped bear. Another example, sometimes people are told they can't wear anything but a skimpy hospital gown into an MRI. In truth, they just need to make sure you don't have anything metal-- no rivets, zippers, etc.--and it is faster and easier for them to make you take it all off than to sort out what would be problematic. A t-shirt and yoga paints (and underwear, too) go through an MRI just fine. I know. I've done it.
Talk to your doctor in advance about what is actually needed versus what is standard practice. These type of discussions are much more likely to yield results when you aren't already on the clock in the very expensive surgery center, MRI, etc.
Have your doctor include your wishes in their orders:
Nurses, technicians and surgery preps are very concerned with doing what the doctor wants--much, much more than they are worried about doing what you want. So as you have these discussions with your doctor, insist they write the modesty plans you make into the official medical orders. You will probably still have to point them out to the health care workers you encounter (they often don't seem to read all that paperwork) but once you point it out to them, they are unlikely to fight both you AND the doctor.
Play the religion card:
If you get push back on your requests for more modesty, choose your wording carefully. If you just say "it makes me uncomfortable" people are likely to treat you as a scared child who they need to convince there is no reason to be afraid. They will try to convince you that your desires are unnecessary and/or irrational rather than looking for alternatives that will work for you. However, they have been trained (or should be anyway) to be respectful and accommodating of people's religious beliefs. For example, if someone came in saying they needed kosher food, the health care worker would be in big trouble with all kinds of people if they tried to convince them that such belief was stupid and unnecessary. So make sure to clearly frame your desires for modesty as a religious belief. Example: "My religious belief is that it is wrong to let any man besides my husband see my naked body. How will your medical facility work to respect that belief?"
Hold your ground:
Don't let people bully and push you into doing something that makes you uncomfortable or that you will greatly regret later. There is nearly always additional options, even if they would rather not admit it. If you aren't happy with the situation, make it stop until a resolution is found that makes you happy. They have a schedule to keep. That tends to make health care workers try to railroad you through whatever is quickest and easiest for them. But, if you hold your ground and absolutely refuse to move forward, it becomes quicker and easier for them to find a way to meet your modesty needs.
Blame Aunt Flow:
Ladies have one more option. If you really want to keep your underwear but aren't very good at being firm or making a scene, go ahead and lie and say you are having your period. They'll have no choice but to at least give you some lovely disposable underwear to wear.
Why it matters:
For background info on why patient modesty is important, read our other patient modest post.
Communication
First off: communicate your desires clearly, firmly and in advance. Whenever a medical test or procedure is suggested or planned, ask your medical practitioner to clearly explain exactly what will be done, who will do it and what you will be wearing. That may sound over-the-top, but medical professionals seem to err on the side of take-it-all-off for even some of the simplest tests and procedures. Always ask for details. Even for "simple" procedures. Don't settle for the generalities they usually give you or you will most likely be unpleasantly surprised. If you aren't happy with the answers, ask them to explain why certain aspects of the procedure are medically necessary and then discuss ways to provide the medical necessities while still maintaining your dignity and comfort.
For example, often patients are told that they must remove all their underwear before a test or procedure. When asked why, we had a nurse explain it was because certain synthetic fibers can cause problems. The follow-up to that explanation would be: "So what material can I wear that would not cause any problems?" I'd much rather go buy some new underwear than to be stripped bear. Another example, sometimes people are told they can't wear anything but a skimpy hospital gown into an MRI. In truth, they just need to make sure you don't have anything metal-- no rivets, zippers, etc.--and it is faster and easier for them to make you take it all off than to sort out what would be problematic. A t-shirt and yoga paints (and underwear, too) go through an MRI just fine. I know. I've done it.
Talk to your doctor in advance about what is actually needed versus what is standard practice. These type of discussions are much more likely to yield results when you aren't already on the clock in the very expensive surgery center, MRI, etc.
Have your doctor include your wishes in their orders:
Nurses, technicians and surgery preps are very concerned with doing what the doctor wants--much, much more than they are worried about doing what you want. So as you have these discussions with your doctor, insist they write the modesty plans you make into the official medical orders. You will probably still have to point them out to the health care workers you encounter (they often don't seem to read all that paperwork) but once you point it out to them, they are unlikely to fight both you AND the doctor.
Play the religion card:
If you get push back on your requests for more modesty, choose your wording carefully. If you just say "it makes me uncomfortable" people are likely to treat you as a scared child who they need to convince there is no reason to be afraid. They will try to convince you that your desires are unnecessary and/or irrational rather than looking for alternatives that will work for you. However, they have been trained (or should be anyway) to be respectful and accommodating of people's religious beliefs. For example, if someone came in saying they needed kosher food, the health care worker would be in big trouble with all kinds of people if they tried to convince them that such belief was stupid and unnecessary. So make sure to clearly frame your desires for modesty as a religious belief. Example: "My religious belief is that it is wrong to let any man besides my husband see my naked body. How will your medical facility work to respect that belief?"
Hold your ground:
Don't let people bully and push you into doing something that makes you uncomfortable or that you will greatly regret later. There is nearly always additional options, even if they would rather not admit it. If you aren't happy with the situation, make it stop until a resolution is found that makes you happy. They have a schedule to keep. That tends to make health care workers try to railroad you through whatever is quickest and easiest for them. But, if you hold your ground and absolutely refuse to move forward, it becomes quicker and easier for them to find a way to meet your modesty needs.
Blame Aunt Flow:
Ladies have one more option. If you really want to keep your underwear but aren't very good at being firm or making a scene, go ahead and lie and say you are having your period. They'll have no choice but to at least give you some lovely disposable underwear to wear.
Why it matters:
For background info on why patient modesty is important, read our other patient modest post.
Wednesday, February 8, 2017
Medical Records
It has always bothered me that at most doctor's offices, medical records are treated like secrets. It would bother me that when the nurse left the examination room, she would take the records with her and plop them in the door. Heaven forbid I should sneak a peak at records describing me!
According to the government, "The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule." But actually getting providers to hand over those records can be expensive and sometimes frustrating.
I have had a few doctors offices that are great. When we asked our cardiologist how we could get a copy of the echocardiogram he was running on our son, he happily popped in a CD and burned us a copy on the spot. When I went by later to get a copy of his EKG, the receptionist printed it out from her computer. Part of the trick is knowing who to ask. When we arrived for the echo, we asked the receptionist if we'd be able to get a copy ad she acted like it wouldn't be possible--in reality she just had no idea. Persistence paid off and the doctor gave us no trouble over it all.
Many offices and especially offices out-source their records to third-party companies. That means if you want a copy, you usually have to fill out a form and commit to an indefinite amount of money for copying said records. How much they can charge you varies from state to state. You can look for your state here.
After fun experiences with knee surgery and a decision to never go back to the Carilion hospital near us, I wanted to gather all the records from their system. After talking to the records department on the phone, I filled out the necessary form and submitted it. The records office warned me that asking for all my records could result in thousands of pages and thousands of dollars so I might want to be more selective. I wanted it all so I continued on. I was very surprised when I received a very thin envelope from HeathPort, the 3rd party information company that Carilion uses to store and retrieve its medical records. There were so few pages that it fell into the free category. The documents contained spotty information on a few procedures I'd had done and none on others. We called HealthPort. Their customer service was unfriendly and unhelpful. They insisted that they'd sent my complete records and demanded to know how we could know something was missing. Hmmm, because they were missing entire procedures! We finally got them to grudgingly agree to try again. A few weeks later we got a larger package. This time it included an invoice for around $20. This time it at least had mention of all the procedures and had a more complete record of the surgery I'd had done. The copies were terrible quality but at least they were there. Still no images, though, even though we'd expressly checked that box on the records request form. No images from EKG, EEGs, MRIs, surgery, etc. We called HealthPort again and were told they don't do any images and that we'd have to contact the hospital.
Back I went to the hospital record office. I sat there for over an hour while they tried to find and print out my images. They kept asking, "Are you really sure you had it done here? We can't find you?" That is definitely confidence-building. Finally they managed to find and print one EKG. I was told that they didn't have my EEGs. I'd have to try to contact the neurologist who ordered them. And they didn't have any images from the surgery. I'd have to ask the orthopedic surgeon about that. They also told me that I'd have to go to Imaging to get copies of the MRIs. That would have been nice to know before I'd already waited an hour because when I went to Imaging, sure enough, they could burn a disk for me, but it would be an hour or two wait. And no one ever, in the process of getting the MRIs, had let me in on the fact I could get copy of the images or how to do so. They only tell you if you ask.
It was a long and frustrating day. I still haven't gotten up the energy to go through all that again with the orthopedic surgeon's office, but one of these days, I will.
So why bother getting them at all? Because unless you stay in the same town with the same doctor your whole life, this information will disappear. And someday you might want it. After all this, I realized I should try to get some records from a previous doctor in a previous state. I called... but it was too late. They'd been destroyed. How long medical facilities must keep records varies from state to state. You can check out yours here.
Even if you stay with the same practice, if your doctor changes it seems to make your records vanish. I requested my records from the family physician's office I've been using. It came from another third party and was decently complete, except that it contained nothing from the first doctor I'd seen at that practice years ago. She was my doctor for several years and then left the practice and I was transferred to another doctor. The records contained none of the tests or visits I'd had with her, and there were a few things I wish I had.
So the moral of the story is: demand what belongs to you. You paid for these tests and treatments. You should have a record of what was done and how it was done. Don't wait for some one to offer the records to you (they won't). Don't wait until you need them or they may already be gone.
According to the government, "The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule." But actually getting providers to hand over those records can be expensive and sometimes frustrating.
I have had a few doctors offices that are great. When we asked our cardiologist how we could get a copy of the echocardiogram he was running on our son, he happily popped in a CD and burned us a copy on the spot. When I went by later to get a copy of his EKG, the receptionist printed it out from her computer. Part of the trick is knowing who to ask. When we arrived for the echo, we asked the receptionist if we'd be able to get a copy ad she acted like it wouldn't be possible--in reality she just had no idea. Persistence paid off and the doctor gave us no trouble over it all.
Many offices and especially offices out-source their records to third-party companies. That means if you want a copy, you usually have to fill out a form and commit to an indefinite amount of money for copying said records. How much they can charge you varies from state to state. You can look for your state here.
After fun experiences with knee surgery and a decision to never go back to the Carilion hospital near us, I wanted to gather all the records from their system. After talking to the records department on the phone, I filled out the necessary form and submitted it. The records office warned me that asking for all my records could result in thousands of pages and thousands of dollars so I might want to be more selective. I wanted it all so I continued on. I was very surprised when I received a very thin envelope from HeathPort, the 3rd party information company that Carilion uses to store and retrieve its medical records. There were so few pages that it fell into the free category. The documents contained spotty information on a few procedures I'd had done and none on others. We called HealthPort. Their customer service was unfriendly and unhelpful. They insisted that they'd sent my complete records and demanded to know how we could know something was missing. Hmmm, because they were missing entire procedures! We finally got them to grudgingly agree to try again. A few weeks later we got a larger package. This time it included an invoice for around $20. This time it at least had mention of all the procedures and had a more complete record of the surgery I'd had done. The copies were terrible quality but at least they were there. Still no images, though, even though we'd expressly checked that box on the records request form. No images from EKG, EEGs, MRIs, surgery, etc. We called HealthPort again and were told they don't do any images and that we'd have to contact the hospital.
Back I went to the hospital record office. I sat there for over an hour while they tried to find and print out my images. They kept asking, "Are you really sure you had it done here? We can't find you?" That is definitely confidence-building. Finally they managed to find and print one EKG. I was told that they didn't have my EEGs. I'd have to try to contact the neurologist who ordered them. And they didn't have any images from the surgery. I'd have to ask the orthopedic surgeon about that. They also told me that I'd have to go to Imaging to get copies of the MRIs. That would have been nice to know before I'd already waited an hour because when I went to Imaging, sure enough, they could burn a disk for me, but it would be an hour or two wait. And no one ever, in the process of getting the MRIs, had let me in on the fact I could get copy of the images or how to do so. They only tell you if you ask.
It was a long and frustrating day. I still haven't gotten up the energy to go through all that again with the orthopedic surgeon's office, but one of these days, I will.
So why bother getting them at all? Because unless you stay in the same town with the same doctor your whole life, this information will disappear. And someday you might want it. After all this, I realized I should try to get some records from a previous doctor in a previous state. I called... but it was too late. They'd been destroyed. How long medical facilities must keep records varies from state to state. You can check out yours here.
Even if you stay with the same practice, if your doctor changes it seems to make your records vanish. I requested my records from the family physician's office I've been using. It came from another third party and was decently complete, except that it contained nothing from the first doctor I'd seen at that practice years ago. She was my doctor for several years and then left the practice and I was transferred to another doctor. The records contained none of the tests or visits I'd had with her, and there were a few things I wish I had.
So the moral of the story is: demand what belongs to you. You paid for these tests and treatments. You should have a record of what was done and how it was done. Don't wait for some one to offer the records to you (they won't). Don't wait until you need them or they may already be gone.
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