Doctors Know Best...
Or Do They?
Molly McLaughlin
Issue date: 11/2/09 Section: True Story
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This is not an unusual message for me to receive, and not just because I work at Planned Parenthood. I've always been pretty confident in my knowledge of reproductive health and for years friends have called me about their female health issues. Growing up, I was allowed plenty of access to information on the subject from my older sister who worked in the field. At age 10 I spent Take Our Daughters to Work Day with her, packing gift bags with condoms. I've had the same gynecologist for seven years and felt I'd been given adequate and accurate information about my sexual health. Sure, there were times I felt a bit rushed out of the office, but overall I believed I had received good care. However, after seven years on combined oral contraceptives (those containing both progesterone and estrogen), I learned I never should have taken them in the first place, forcing me to question the information I've trusted all these years.
I learned of the error in my doctor's ways during a Planned Parenthood appointment. An obvious benefit of working there is access to birth control, so I had set myself up with an appointment, filled out all the paperwork, and met with our nurse practitioner, just like any other patient. One look at my medical history, however, and she exclaimed, "I cannot believe anyone ever had you on birth control with estrogen in it!" As standard practice, any patient stating they suffer from migraines fills out a headache history form. Of all the completed forms I've seen since, mine is the most severe. I answered yes to every single symptom including those we regard as most concerning: visual disturbances like zigzag lines or blind spots, referred to as an "aura" and numbness or weakness on one side of the body. Lo and behold, birth control methods containing estrogen raise the risk of stroke in those who experience migraines with visual disturbance. With a minimal amount of research, I confirmed that birth control with estrogen made me up to eight times as likely to have a stroke. This risk increases by seven times for smokers.
Our nurse has personally seen two patients with migraines, one age 26, the other 28, who had strokes while on birth control containing estrogen. This news was shocking and terrifying, but it also made me angry. How had I never heard about this? How had no doctor, including a migraine specialist, a neurologist and my gynecologist, ever connected these factors? Here I am, a 26 year old woman with a severe migraine history, spending almost a decade on birth control that could have caused me to have a stroke, all because no doctor ever took the time to make a connection.
Prior to this experience I had always thought of Planned Parenthood as a place people went when they couldn't go to a "real" doctor. Surely a trained gynecologist would know a lot more than the reproductive health assistants and nurses at Planned Parenthood. Certainly a migraine specialist would think to ask what birth control I used. After learning that such crucial information had slipped through the cracks in my own healthcare, I realized how wrong my assumption had been.
Time and time again, patients tell us their doctors didn't take the time to answer their questions or even gave them erroneous information. I've heard patients' stories about doctors making judgmental and disparaging remarks when they asked for STD testing. I've heard about doctors dropping the oh-yeah-it's-probably-herpes bomb, then walking out of the room before the patient had time to ask any questions. Sadly, it seems that all too often, doctors do not bother educating their patients on important sexual health issues. We've been lead to believe that doctors hold some superior knowledge over how our bodies function, while they don't invest the time to ensure we have the information ourselves. It's as if we as patients do not deserve the information because we aren't doctors. That's their job. I trusted my doctor not to prescribe me something potentially harmful. I assumed that his word was the final word on my health.
" Perhaps we need to reconsider the thought that doctors always know best, that getting a second opinion is being "high-maintenance," or that more expensive healthcare means better healthcare."
In a society where all types of medications are continually injected into our consciousness through unrelenting advertising, it's easy to assume that a doctor would understand and thoroughly review any risk factors in your medical history. After all, we are certainly a country with an ever-increasing list of ailments. My husband jokes about first world allergies--do we ever hear about people in Africa with peanut and gluten allergies?
For every new illness, a medication appears, and behind every new medication is a doctor willing to dole out a prescription. This is not to say that birth control is an unnecessary medication. It has spared countless women from dealing with the conundrum of unwanted pregnancy. I spend my days encouraging women and girls to get on a method of birth control, but I feel confident that the organization I work for does so responsibly. As the number of medications on the market multiplies, doctors should be increasingly vigilant about ensuring they are suitable and safe for their patients. Instead, it seems people are rushed through their appointments faster, without proper information, while doctors receive incentives for prescribing certain medications.
By no means do I intend to cause alarm or discourage anyone from birth control. Rather, I hope to pass on crucial information I never received and to question why most doctors don't take the time to educate their patients. Perhaps we need to reconsider the thought that doctors always know best, that getting a second opinion is being "high-maintenance," or that more expensive healthcare means better healthcare.
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