Post by themoneytree on Aug 14, 2019 1:27:16 GMT -5
Do women generally get sedation before the procedure? I guess some of this depends on how many weeks the pregnancy is? For those who don’t get sedation, does there appear to be a lot of pain?
Do women generally get sedation before the procedure? I guess some of this depends on how many weeks the pregnancy is? For those who don’t get sedation, does there appear to be a lot of pain?
I think anecdotally and what the research shows is that 50% of patients get sedation/anesthesia. Only 1 place out of the few I've trained/worked had a certified registered nurse anesthetist to give anesthesia to "put you out." I believe at that facility we used propofol (the same drug that is often used for colonoscopies and EGDs).
At all other places and what is typically the norm since there is no nurse anesthetist we use IV sedation that has a combo of an IV pain medication and an IV anti-anxiety med. It doesn't put the patient to sleep, but tries to relax them.
But overall the procedure seems to be tolerated very well without sedation. The first trimester procedure typically takes 3-5 minutes. We always give local anesthesia around the cervix. There is strong cramping for about 2 minutes and then it is typically over. The strong cramping lasts longer for 2nd trimester procedures since the procedure might last a few more minutes. There was 1 case I can remember, I think she was about 22w and it seemed like she was having pain. We always stop and talk with patients as we go if they seem uncomfortable. The pain typically subsides right when the procedure is over.
wanderingback, thank you for doing what you are doing and for the AMA. While I did not have any specific questions I learned a lot from this thread. And welcome back!
And thank you to everyone else for sharing your stories and experiences.
Welcome back! And thank you for answering questions so openly/informatively.
I had a D&C and took misoprostol to end two pregnancies and that really illustrated to me how little people know about the actual procedures. While mine weren't by choice per say (missed miscarriages), I fully support the right of every woman to have access to those procedures at any medically logical stage of their pregnancy/life.
Welcome back! I hope we can avoid doing anything that inspires you to leave again
Two things I've always wondered, based on my own personal experience having a surgical abortion. One, is it medically necessary to do an ultrasound if the decision to terminate has already been made, or is that one of those BS rules that is supposed to sway women to keep the pregnancy? Two, is there a medical reason why an abortion cannot be performed earlier than 6 weeks?
Doing an US is medical standard of care. Reason to do it is for a few reasons. To determine if a patient is pregnant, location of pregnancy and the gestational age of the fetus.
Just the other day the tech did the US, didn't find a pregnancy (which isn't uncommon), patient took a pregnancy test and it came back negative. So she avoided getting a procedure that she obviously didn't need.
It's good to know the location of the pregnancy in order to rule out ectopic. If we can't see the pregnancy on US and the pregnancy test is positive and they're not having any signs of an ectopic pregnancy, we'll still do the procedure/empty the uterus. If we still don't see anything that resembles the pregnancy after we look at the tissue, after the procedure we'll collect their blood to measure their hcg, then again 48 hours later. We have to ensure that the hcg is going down appropriately to ensure that it's not an ongoing pregnancy or an ectopic pregnancy.
Lastly, US is used for gestational age of the fetus. The procedure is slightly different and different equipment might be used for different gestational ages. Different equipment can be used up to 9-10 weeks depending on the provider and then different equipment can be used from 9/10-16 weeks. I'm only going to be doing abortions up to 15w6d because the procedure can be done differently after that. So I would need to know if someone was further along as I wouldn't feel comfortable doing the procedure much past that gestational age. Also, in order to comply with state law we need to accurately document the gestational age so that we are never performing any procedures after the state law allows.
Abortions are performed before 6 weeks, I guess clinic policy might vary slightly. Sometimes if the pregnancy is super early like 4-5 weeks then will counsel patients a little different. After every procedure we look at the tissue to make sure everything is removed that needs to be removed (there are different things we're looking for based on the gestational age). At 4-5 weeks obviously it's super early so sometimes it's hard to see what you need to see in the tissue to ensure the abortion isn't complete. So sometimes will do a repeat trans vaginal US afterwards to see if we can tell the pregnancy is no longer there or will again collect the hcg and follow for 48 hours to ensure it's going down appropriately. But to avoid all those possible extra steps some clinics might say that they don't want to do procedures before 6 weeks (none of this applies to the medication abortion, you can do it as early as they want). After 6 weeks 99.9% of the time we can see what we need to see and it's not difficult to ensure that the abortion is complete right after the procedure.
I didn't get a chance to actually type a response yesterday, but thank you for all this information. It makes perfect sense.
The providers at my clinic were wonderful and I actually didn't question anything at the time, but thinking and reading things later had made me wonder how much of my experience was because of medical necessity and how much was because of rules and laws that had nothing to do with medicine. It sounds like at least in these cases, there were good reasons.
I'm so glad that you ended up in this specialty. It sounds like a really good fit for you, and your patients are so lucky to have you (though, this would have been true in ANY specialty you chose!). Thank you for doing what you do, on behalf of all women. My life would be so different, and not in the way I want it to be, if I hadn't had this option available to me when I needed it.
Welcome back! And thank you for answering questions so openly/informatively.
I had a D&C and took misoprostol to end two pregnancies and that really illustrated to me how little people know about the actual procedures. While mine weren't by choice per say (missed miscarriages), I fully support the right of every woman to have access to those procedures at any medically logical stage of their pregnancy/life.
TW loss:
Strongly agree. Infertility and recurrent loss have made me even more rabidly pro-choice than I have ever been... and I was already extraordinarily pro-choice.
The doctor who did my D&C after my last loss gave me probably the biggest gift I've ever received in my life: information about our daughter and why she died. It is more information than we have about any of our other pregnancies and the first conclusive test result we have ever had related to infertility/loss. Because the pregnancy was not very far along when growth stopped, it is very unlikely that we would have been able to get a sufficient, uncontaminated sample to genetically test if I had not had access to a D&C procedure.
The place I work the most hours is a "normal" health center, so I don't think most people know that abortion is done there,.
I asked my now retired gyn (an abortion proviser) once where I would get an abortion if I needed one, and his comment was that I was never going to have to worry about access (white though sometimes perceived brown, affluent, progressive area of the state). He said that the place I'd had a breast lump removed would do it (they advertised gyn surgery on their website) or I could have one done at one of the local major medical centers (where a friend had had one). I often wonder if it should be more known that you don't have to (at least here) go to an "abortion clinic" for abortion care, or if this would result in protests and attacks at the providers' facility.
This is something I've often wondered about. How do you find someone to perform an abortion outside of an abortion clinic? Do women just talk to their regular gyn?
I asked my now retired gyn (an abortion proviser) once where I would get an abortion if I needed one, and his comment was that I was never going to have to worry about access (white though sometimes perceived brown, affluent, progressive area of the state). He said that the place I'd had a breast lump removed would do it (they advertised gyn surgery on their website) or I could have one done at one of the local major medical centers (where a friend had had one). I often wonder if it should be more known that you don't have to (at least here) go to an "abortion clinic" for abortion care, or if this would result in protests and attacks at the providers' facility.
This is something I've often wondered about. How do you find someone to perform an abortion outside of an abortion clinic? Do women just talk to their regular gyn?
I’m not an obgyn, but yes patients talk to me and my colleagues about it. When it’s relevent during a regular office visit I’ll make it known that I’m pro choice and abortion services are provided at our health center or will help them find the services if they were to ever need it. A lot of patients in underserved areas don’t see an obgyn regularly. Also, those of us who find this work important know all the places to go for abortion services so refer out to each other as needed. Lastly, the internet is also helping these days in finding out where to go.
Post by wanderingback on Aug 14, 2019 9:30:21 GMT -5
seeyalater52 I’m so sorry. I’m glad your doctor was able to provide you with some answers that felt like a gift to you. Everyone deserves this type of care, but it’s especially true in cases like yours. That’s why it’s so important to keep access available, safe and legal for everyone. The antis make me so angry!
Do you find there are enough people going into abortion services? You work in a liberal area, but is the issue in conservative areas that it's too difficult for people to practice as an abortion provider due to cultural stigma, lack of people wanting to work in those areas, or state laws and restrictions?
Also, do you know if OB-GYNs are required to learn abortion? I've had 2 different reproductive endocrinologists lead me through abortion for miscarriages - my first miscarriage used two rounds of misoprostol to complete, and my third was a D&E in a hospital with my RE performing it. So I assume it's something that comes up fairly often and I doubt they just refer their patients to planned parenthood, right? How do things like that affect abortion access? I imagine even in places like Alabama there are OB-GYNS and REs performing D&Cs and D&Es for miscarriage, which is the same procedure as an elective abortion. Would that be a "private" option for women if elective aboriton becomes more restrictive? Would that have further regulations if elective abortion becomes more restrictive?
Post by PinkSquirrel on Aug 14, 2019 10:00:08 GMT -5
What do you think we should be doing to address Dr. Parker and his sexual harassment issues? How do you think his being the only provider in MS impacts how we address things?
Do you find there are enough people going into abortion services? You work in a liberal area, but is the issue in conservative areas that it's too difficult for people to practice as an abortion provider due to cultural stigma, lack of people wanting to work in those areas, or state laws and restrictions?
Also, do you know if OB-GYNs are required to learn abortion? I've had 2 different reproductive endocrinologists lead me through abortion for miscarriages - my first miscarriage used two rounds of misoprostol to complete, and my third was a D&E in a hospital with my RE performing it. So I assume it's something that comes up fairly often and I doubt they just refer their patients to planned parenthood, right? How do things like that affect abortion access? I imagine even in places like Alabama there are OB-GYNS and REs performing D&Cs and D&Es for miscarriage, which is the same procedure as an elective abortion. Would that be a "private" option for women if elective aboriton becomes more restrictive? Would that have further regulations if elective abortion becomes more restrictive?
I’ll respond more later when I’m on a computer. However just a few weeks ago a colleague was referred a patient from an obgyn for abortion care for a spontaneous abortion (miscarriage). She was actually venting about it because how ridiculous, right? It happens fairly regularly and like I said before I’m in a progressive area. So to answer that one question, yes obgyns refer their patients out all the time to abortion clinics for procedures. Will respond to the rest later.
What do you think we should be doing to address Dr. Parker and his sexual harassment issues? How do you think his being the only provider in MS impacts how we address things?
I’m not sure about this. He did resign from board positions, which I guess was a good step not to taint the organizations. I’m 100% a victims advocate and I like to believe women. However in my personal life right now I know a man being accused by a woman for sexual assault and it’s false and he’s going through litigation to prove it because he has the receipts and the false accusations have essentially ruined his career. So not every case is black and white.
When everything first came out in my circles we discussed it online after reading both sides/accounts and it was a pretty mixed bag of reactions and no one has talked about it since. I don’t know him personally but I know many of my colleagues do. Sorry I wish I had a better/more concrete answer.
And to clarify I believe there is only 1 abortion clinic left in MS, but other doctors do work at that one clinic besides him. At least last I checked that’s how it was.
I’ll respond more later when I’m on a computer. However just a few weeks ago a colleague was referred a patient from an obgyn for abortion care for a spontaneous abortion (miscarriage). She was actually venting about it because how ridiculous, right? It happens fairly regularly and like I said before I’m in a progressive area. So to answer that one question, yes obgyns refer their patients out all the time to abortion clinics for procedures. Will respond to the rest later.
This makes me infuriated and so sad for that patient. She was in a terrible time in her life and had to chase down medical care outside of the guidance of her obgyn. It makes me incredibly grateful that my obgyn encouraged me to get the D&C and spent a lot of time answering my questions and walking me through the process. Every woman deserves that type of personalized care.
I asked my now retired gyn (an abortion proviser) once where I would get an abortion if I needed one, and his comment was that I was never going to have to worry about access (white though sometimes perceived brown, affluent, progressive area of the state). He said that the place I'd had a breast lump removed would do it (they advertised gyn surgery on their website) or I could have one done at one of the local major medical centers (where a friend had had one). I often wonder if it should be more known that you don't have to (at least here) go to an "abortion clinic" for abortion care, or if this would result in protests and attacks at the providers' facility.
This is something I've often wondered about. How do you find someone to perform an abortion outside of an abortion clinic? Do women just talk to their regular gyn?
My OB made the referral when we chose to terminate for medical reasons. It took place in a hospital. Otherwise I would have had no idea where to turn except for PP. And I wasn't even sure if PP could handle what I needed since I was 21 weeks along and my OB said most doctors won't perform abortions that far along for a variety of reasons (not moral reasons, just reasons involving training, requirements, not wanting to deal with protesters or death threats any more than they may already do).
It’s great to see you on here again! And it’s also great to hear such open talk about abortion. I would love to see this become a trend to counteract the overwhelming amount of noise from pro lifers.
I remember way back on TN when you were like hey I might go to med school, and now here you are as an important advocate and caregiver at such a crucial time. You are literally changing women’s lives for the better.
Post by klingklang77 on Aug 14, 2019 12:22:07 GMT -5
For the record I am totally pro-choice, at any trimester. It’s a woman’s right, IMO. Just because I had a bad experience doesn’t mean I get the right to say not a good idea based on what happened to me.
That being said, how do you deal with coerced termination?
I had a surgical termination, but it wasn’t what I wanted. My exH (hence the reason he is now my ex) was totally unsupportive. He basically said that we wouldn’t be able to see my family (I lived in Australia at the time), and he didn’t want to waste money on a child. I was totally stuck, so I just decided to terminate. I didn’t want that, though. He was in the room and did all the talking for me.
My question is do you allow partners in the room? Can you see through this type of manipulation? Maybe it’s an odd question, but I’m really curious as to what providers think about this situation.
Doing an US is medical standard of care. Reason to do it is for a few reasons. To determine if a patient is pregnant, location of pregnancy and the gestational age of the fetus.
Just the other day the tech did the US, didn't find a pregnancy (which isn't uncommon), patient took a pregnancy test and it came back negative. So she avoided getting a procedure that she obviously didn't need.
It's good to know the location of the pregnancy in order to rule out ectopic. If we can't see the pregnancy on US and the pregnancy test is positive and they're not having any signs of an ectopic pregnancy, we'll still do the procedure/empty the uterus. If we still don't see anything that resembles the pregnancy after we look at the tissue, after the procedure we'll collect their blood to measure their hcg, then again 48 hours later. We have to ensure that the hcg is going down appropriately to ensure that it's not an ongoing pregnancy or an ectopic pregnancy.
Lastly, US is used for gestational age of the fetus. The procedure is slightly different and different equipment might be used for different gestational ages. Different equipment can be used up to 9-10 weeks depending on the provider and then different equipment can be used from 9/10-16 weeks. I'm only going to be doing abortions up to 15w6d because the procedure can be done differently after that. So I would need to know if someone was further along as I wouldn't feel comfortable doing the procedure much past that gestational age. Also, in order to comply with state law we need to accurately document the gestational age so that we are never performing any procedures after the state law allows.
Abortions are performed before 6 weeks, I guess clinic policy might vary slightly. Sometimes if the pregnancy is super early like 4-5 weeks then will counsel patients a little different. After every procedure we look at the tissue to make sure everything is removed that needs to be removed (there are different things we're looking for based on the gestational age). At 4-5 weeks obviously it's super early so sometimes it's hard to see what you need to see in the tissue to ensure the abortion isn't complete. So sometimes will do a repeat trans vaginal US afterwards to see if we can tell the pregnancy is no longer there or will again collect the hcg and follow for 48 hours to ensure it's going down appropriately. But to avoid all those possible extra steps some clinics might say that they don't want to do procedures before 6 weeks (none of this applies to the medication abortion, you can do it as early as they want). After 6 weeks 99.9% of the time we can see what we need to see and it's not difficult to ensure that the abortion is complete right after the procedure.
I didn't get a chance to actually type a response yesterday, but thank you for all this information. It makes perfect sense.
The providers at my clinic were wonderful and I actually didn't question anything at the time, but thinking and reading things later had made me wonder how much of my experience was because of medical necessity and how much was because of rules and laws that had nothing to do with medicine. It sounds like at least in these cases, there were good reasons.
I'm so glad that you ended up in this specialty. It sounds like a really good fit for you, and your patients are so lucky to have you (though, this would have been true in ANY specialty you chose!). Thank you for doing what you do, on behalf of all women. My life would be so different, and not in the way I want it to be, if I hadn't had this option available to me when I needed it.
Also as a disclaimer my answer is obviously true in the U.S. with all it's resources. Providing care in a resource poor setting is different if there is no access to US or follow up blood work. There is definitely advocacy around teaching doctors and nurse practitioners/midwives in resource poor countries how to perform MVA (the aspiration procedure that doesn't need electricity), so my answers above might not apply in such a setting.
Do you find there are enough people going into abortion services? You work in a liberal area, but is the issue in conservative areas that it's too difficult for people to practice as an abortion provider due to cultural stigma, lack of people wanting to work in those areas, or state laws and restrictions?
Also, do you know if OB-GYNs are required to learn abortion? I've had 2 different reproductive endocrinologists lead me through abortion for miscarriages - my first miscarriage used two rounds of misoprostol to complete, and my third was a D&E in a hospital with my RE performing it. So I assume it's something that comes up fairly often and I doubt they just refer their patients to planned parenthood, right? How do things like that affect abortion access? I imagine even in places like Alabama there are OB-GYNS and REs performing D&Cs and D&Es for miscarriage, which is the same procedure as an elective abortion. Would that be a "private" option for women if elective aboriton becomes more restrictive? Would that have further regulations if elective abortion becomes more restrictive?
Yes it is difficult to find enough providers in more rural areas and in less-liberal areas. In those areas doctors are flown in to provide services if needed. I know several people that do this. I don't want to move to a rural area, but I do think eventually I will offer my services to fly to certain states.
There are so many reasons why it is difficult for people to want to and to practically be able to provide in those areas. Of course much of it has to do with stigma and not wanting to tell their families, friends, etc. But on the other hand it can just really be difficult due to policies. Some employers will specifically ban employees from being an abortion provider. So if you work at X hospital during the week and want to work per diem during the weekend at Planned Parenthood, it might specifically be forbidden in your contract. Then, yes there are other state policies such as you have to have admitting privileges at a local hospital (which is very hard to come by often. Often you have to admit a certain number of patients per year to that hospital and since abortion is so safe this rarely happens). So people don't want to jump through all those hoops to provide care.
In regards to required to learning abortion - as far as I'm aware it is typically an "opt-out" type of policy at many programs. So you can learn if you want to, but you don't have to. Some residency programs are at Catholic hospitals so my assumption is that they don't learn about them there. In addition, their general learning about contraceptive options is limited at Catholic hospitals from my understanding. Like not learning how to put in an IUD or implant. I remember reading a qualitative study about this where obgyns from Catholic hospitals felt less prepared for certain aspects of reproductive care (obviously). The ACGME accredites all programs and has standards, so I'm not exactly sure how places get around this.
I previously answered the question about obgyns referring patients to Planned Parenthood. Yes that happens all the time.
I honestly can't speculate how things will be as regulation tightens up. In more conservative areas I know doctors face difficulties with jumping through hoops at certain hospitals who are "pro-life" and then getting the appropriate team to care for patients who need access for even just miscarriage care, fetal demise, termination for medical reasons, etc. So it's already not an easy process for everyone and people are trying to make it more difficult. That's why it's so important to keep access legal so that anyone who needs an abortion for any reason is able to access it.
For the record I am totally pro-choice, at any trimester. It’s a woman’s right, IMO. Just because I had a bad experience doesn’t mean I get the right to say not a good idea based on what happened to me.
That being said, how do you deal with coerced termination?
I had a surgical termination, but it wasn’t what I wanted. My exH (hence the reason he is now my ex) was totally unsupportive. He basically said that we wouldn’t be able to see my family (I lived in Australia at the time), and he didn’t want to waste money on a child. I was totally stuck, so I just decided to terminate. I didn’t want that, though. He was in the room and did all the talking for me.
My question is do you allow partners in the room? Can you see through this type of manipulation? Maybe it’s an odd question, but I’m really curious as to what providers think about this situation.
Wow - not sure where or when this happened, but I am so sorry and your exH is horrible. From my experience from about 5 years ago, there were multiple questions by the counselors and nurse about if I was feeling threatened or coerced into the decision. I'm not sure it would have been easy to say "yes" if I was and there was someone else there, but they specifically made sure I was alone with just those two in the room when they asked.
First, a deep and sincere thank you for what you do. I have a ton of questions, sorry.
1) Sounds like you provide other care; how much of your time is spent on that vs terminations?
2) How many of your patients have insurance? Does that change the care at all? Obviously that varies tremendously based on setting.
3) What fraction are TFMRs? I'd guess this also varies by setting.
4) Do a lot of physicians burn out on this type of care?
5) Is there a surplus or deficit of MDs? I'm wondering if this varies by state and what happens to providers when clinics shut down - do they move or transition to another area of practice?
6) What kind of statistics are gathered by your clinic? Are these mandated by regulation or possibly gathered for advocacy purposes? Can a patient get an abortion without it going in their medical record? Is there any other reporting that is not anonymized? (These questions come from a privacy perspective)
For the record I am totally pro-choice, at any trimester. It’s a woman’s right, IMO. Just because I had a bad experience doesn’t mean I get the right to say not a good idea based on what happened to me.
That being said, how do you deal with coerced termination?
I had a surgical termination, but it wasn’t what I wanted. My exH (hence the reason he is now my ex) was totally unsupportive. He basically said that we wouldn’t be able to see my family (I lived in Australia at the time), and he didn’t want to waste money on a child. I was totally stuck, so I just decided to terminate. I didn’t want that, though. He was in the room and did all the talking for me.
My question is do you allow partners in the room? Can you see through this type of manipulation? Maybe it’s an odd question, but I’m really curious as to what providers think about this situation.
At my health center since where I do most of my hours since it's just a general clinic we often get to know our patients well. So that's why it's nice to be able to provide there. We generally know if they're in a relationship, if they've been trying to get pregnant, if they have enough food to eat, if they're in a domestic violence situation, if they have a job, etc. But we still have a counseling session with them before the procedure to do our best to make sure it is their decision only and to give them any resources that they might need.
In other places where I've trained and work that are pretty much women's health/abortion clinics only, they all do counseling sessions in which the patient is the only one allowed in the room. Their support person is not allowed in the counseling room with them. This is either down with a trained counselor specifically for this or a licensed social worker everywhere I've worked. In one place we had patients write down answers to certain questions for those that could read and write in either english or spanish and then the counselor would have a more private conversation with them in another room with no one else present. So everywhere I've been the partner would not be able to do any or all of the talking as they wouldn't be in the room. Having the partner doing all the talking would definitely be a big red flag. I'm sorry you had to go through that.
Even in regular care if a partner is doing a lot of the talking, I make sure to talk to the patient themselves alone by asking the partner to leave the room for a few min.
One thing we typically tell patients is they don't need to make a decision today, so if they are unsure or have questions they can go home and think about it and we give them resources that they can use to help with their decision. I've had a patient on the exam table ready to start the procedure and she seemed to be getting more and more anxious, so we told her that she could come back when she was feeling more confident in her decision and she decided to do just that.
Lastly, another thing I've learned is how to counsel patients if they want an abortion, but their partner doesn't and they're afraid to tell them if they've already told them they're pregnant. So we will counsel them on talking about it being a miscarriage and things they can do to help so their partner won't find out if that's what they want.
So unfortunately I doubt we'll be able to pick up on every single cause of coercion if the patient doesn't verbally or through body language indicate that that is happening, but through multiple steps in the process we do try to make sure there are no red flags that could indicate they're not confident in their decision or they're being coerced.
What do you think we should be doing to address Dr. Parker and his sexual harassment issues? How do you think his being the only provider in MS impacts how we address things?
I’m not sure about this. He did resign from board positions, which I guess was a good step not to taint the organizations. I’m 100% a victims advocate and I like to believe women. However in my personal life right now I know a man being accused by a woman for sexual assault and it’s false and he’s going through litigation to prove it because he has the receipts and the false accusations have essentially ruined his career. So not every case is black and white.
When everything first came out in my circles we discussed it online after reading both sides/accounts and it was a pretty mixed bag of reactions and no one has talked about it since. I don’t know him personally but I know many of my colleagues do. Sorry I wish I had a better/more concrete answer.
And to clarify I believe there is only 1 abortion clinic left in MS, but other doctors do work at that one clinic besides him. At least last I checked that’s how it was.
Yes, sorry he isn't the only one in MS, that's absolutely correct, that should have said one of the only.
Yamani Hernandez (ED NNAF) came out about sexual harassment Dr Parker directed towards her last week, the conversation hasn't stopped. It's not just Candice and based on what I've heard in my circles (I've been doing abortion work for 15 years - not as a provider), people have been aware of multiple instances and people he's sexually harassed for a number of years, he's just been too big and important for anyone to do anything. Saying you believe survivors then going into talking about a guy being falsely accused and how people seemed mixed on what they thought does not feel at all like you believe the women who have come forward.
We say believe survivors every time and yet, when it's someone "on our side" accused they get the same protections every other poorly behaved man gets. We just stop talking about it and hope it will go away. We need to do better, we need to be better.
First, a deep and sincere thank you for what you do. I have a ton of questions, sorry.
1) Sounds like you provide other care; how much of your time is spent on that vs terminations?
2) How many of your patients have insurance? Does that change the care at all? Obviously that varies tremendously based on setting. But I'm curious. FWIW, I had a TFMR covered by insurance and the docs implied that I was lucky and they could use the sedatives/anaesthetic (not at all sure what I had) and that many people go without.
3) What fraction are TFMRs? I'd guess this also varies by setting.
4) Do a lot of physicians burn out on this type of care?
5) Is there a surplus or deficit of MDs? I'm wondering if this varies by state and what happens to providers when clinics shut down - do they move or transition to another area of practice?
6) What kind of statistics are gathered by your clinic? Are these mandated by regulation or possibly gathered for advocacy purposes? Can a patient get an abortion without it going in their medical record? Is there any other reporting that is not anonymized? (These questions come from a privacy perspective)
1) I don't want to give away too many details. But right now 3-4 times per month I work essentially at an abortion clinic. The rest of my time is at a "general clinic" where we do general medical care, which includes procedures and those procedures do include abortion.
2) So at my medical clinic we take care of mostly poor people, so they are either on state insurance or have no insurance. Depending on the state, some state insurance will cover abortion. Some private insurances will also cover abortion. At abortion clinics I'm not sure about the breakdown in regards to insurance vs no insurance. Obviously if you have insurance that covers it then you don't have to worry about. Some people also don't want to use their insurance because they don't want it to show up on their bill or think it might cause problems for them in the future, so they choose to pay out of pocket. Everywhere that I've worked and trained I believe that a first trimester procedure and the abortion pill are both generally the same price for those that have to/choose to pay out of pocket. From what I've seen the price does increase slightly as you get in to the 2nd trimester at certain weeks because then that is a 2 day procedure, so more time and equipment is involved. So I guess the answer is that insurance coverage doesn't change care from my end at all, but the patients usually talk to the financial people about all of that and they try to help them get coverage/funds that they need before I see them.
3) I'm not sure on the data about TFMR. I'm only trained up to 16w, so before people will have their anatomy scan, so these are patients that I'll less likely see. Most of the cases I do are less then 12w. I often don't know why a patient is having an abortion unless they open up about it and that is completely fine with me as the reason is irrelevant as long as the decision was made on their own.
4) I'm not sure the burn out rate. I would think it would be less than in some other fields of work, but I'm honestly not sure. All of the older colleagues that I work with seem to be very happy with what they're doing and in general seem to have less complaints than other doctors I know. The good thing is that a lot of people seem to be per diem and can work 3-5 days per work at their own schedule, so I'm sure that helps with burn out. Again I'm in a progressive area, so I haven't experienced some of the hoops that doctors have to jump through in more conservative areas, so they might be feeling more burned out than I'm used to seeing where I've trained and worked.
5) I assume you mean are there a surplus or deficit of doctors doing this work specifically. It all depends on the area. In my area there is definitely a surplus. In other areas there is a deficit and doctors get flown in to provide care.
6) I know at 1 clinic demographic information is collected for patients that choose to answer to help with data collection for funding. This is all anonymous. Each state is different in what they require for their data collection for statistical purposes. I just moved to this state about 6 months ago and I'm honestly not sure exactly what this state requires for reporting. I won't falsify a medical record. I will coach patients through things like if they need to lie to a partner for example, but won't falsify a medical record. Also in our system for teenagers, we have the option of billing not going through the insurance so it doesn't show up (this is true for any care in regards to mental health, drugs/alcohol or reproductive care) on their parents insurance if they're on it. But again that's just so the procedure doesn't show up on their insurance, it's not me falsifying the medical record.