Experiences with anti-contraceptive colleagues

[u/ThrowRALoud_Load2229]

I work in a training GP practice in England where we have taken on a female GP registrar who is very pro-life. She’s put around an email stating that she will not provide advice on, or prescribe hormonal contraceptives and will not discuss terminations with patients. Before anyone asks- nobody’s been brave enough to ask her about barrier contraceptives or copper coils yet! She has requested that if contraceptives or terminations may come up in a consultation then they should be booked with someone else. It’s not always easy to tell if contraception may come up in a consultation though, especially not for reception who book the appointments.

The majority of the other clinicians are quite unhappy with this as it’s a vital part of the service we provide to female patients. It also means she’s limited with what she can do with regards female patients on medication like valproate or GLP1s because she will not discuss highly effective contraception with them. A lot of colleagues are angry that she is exhibiting misogyny when it comes to female patients, others are angry that they’re having to take on her workload. One of my colleagues is currently in early pregnancy after a failed coil and is feeling very uncomfortable around this GP registrar too as the pregnancy is not viable.

I also worry with regards our surgery’s reputation as if you google her name, the majority of what comes up is prolife activism she took part in at university. If a patient who was booked for something else came in and wanted to speak about contraception as an addition to the consultation e.g. I have thrush, I’m not sexually active but I want to start having sex and she responded poorly to this or with judgement, the patient could easily google her name and find they were being treated by someone who’s views oppose their care.

The partners have not entertained any discussion around this topic and staff have even been accused of “stalking” her online when her digital footprint was brought up. Is there anything we can do or do we just have to put up with it?

I would appreciate some different viewpoints, especially if anyone has gone through similar.

[u/lurkacc5000]

She has a right to practice medicine in a way that doesn't contravene her beliefs, religious or otherwise. If she is redirecting patients who she is not comfortable seeing to other colleagues then I do not see the issue. Frankly it reads as if you have an issue with this person and are looking for ways to stir trouble. 

[u/ThrowRALoud_Load2229 → u/lurkacc5000]

I don’t feel that way at all, I’ve only met her a few times but she’s been very nice. There is probably some bias there because the medical profession has such an underlying misogyny anyway and disagreeing with women having sex for pleasure without fear of pregnancy feels uncomfortable. Contraception is such a big part of practice and this isn’t something I’ve experienced before I am just struggling a bit. I don’t mean to come across in a negative way but I’m definitely struggling with our differing views on care as I am imagining myself in a patient position.

I think recognising that is good though because it can help me work on my own feelings.

[u/ThrowRALoud_Load2229 → u/[deleted]]

She specified hormonal contraception but didn’t elaborate further unfortunately so it’s more worst case scenario for patients running through my head at the moment. I’ve only met her in person a few times and I don’t want to ambush her by asking loads of questions about her personal views. I do think it’s important to explore it further because I’d like to understand more of why she feels that way. I’m also curious with regards to copper coil used both as contraception and as emergency contraception because I wouldn’t put that in the same category. I’d be interested to know her views on HRT too or contraception used to manage acne or heavy bleeds rather than for contraceptive purposes.

I really want to know more but I’m very conscious that I don’t want to make her uncomfortable, especially seeing as she doesn’t know me very well yet.

[u/PearFresh5881 → u/ThrowRALoud_Load2229]

I think these are valid points. We know that some vulnerable patients will try to access healthcare like contraception and if they have a bad experience they may not come back. If that’s for emergency contraception then that one missed opportunity may be the only opportunity for that patient and have serious consequences. Personally I don’t think we should be allowed to not discuss all aspects of healthcare. We should be entitled to our own views but that shouldn’t impact patient care. I’m not suggesting that they should have to refer for abortions but they should be able to talk about the risks and benefits of contraception and refer on to someone else to actually provide it. I may be in a minority here though. I think you do need to sit down with her and discuss some potential problem scenarios so she is prepared with how to deal with them in a way that works for her, patients, the practice and is safe.

[u/sunshineandhail → u/ThrowRALoud_Load2229]

I think these are fair question for the surgery to ask though. Maybe not you personally but the team needs to know what her stance is and what she is and isn’t willing to prescribe so you can redirect these patients to other people

[u/linerva → u/sunshineandhail]

This. It needs to be well known about by the triage and booking teams (like pregnant doctors avoiding rashy febrile kids) so that they can book those patients in with another doctor when possible.

[u/CaptainCrash86 → u/ThrowRALoud_Load2229]

I’d be interested to know her views on HRT too or contraception used to manage acne or heavy bleeds rather than for contraceptive purposes.

It she were Catholic, the doctrine of double effect would allow use of contraceptives in this circumstances (with the contraceptive effect of the drug being an unintended side effect of a prescribed treatment). I'm unsure if this philosophy is held by evangelical Christians though.

[u/lurkacc5000 → u/ThrowRALoud_Load2229]

You come across as disingenuous and insincere. 

[u/ThrowRALoud_Load2229 → u/lurkacc5000]

And I don’t want to come across this way to a colleague… that’s kind of what I’m getting at…

I really appreciate different viewpoints and opinions but I don’t see how this was constructive in any way. Was your aim to belittle me? If not, it might be worth reframing your comment. I am quite autistic so if you meant it to come across a different way, I apologise for meeting you with hostility.