Care Denied, Autonomy Ignored, IUD Left Intact

Note: This is the follow-up from the previous post regarding the scheduling of my IUD removal appointment at Planned Parenthood.

I had my appointment at the local Planned Parenthood for an annual gyne exam and for my IUD removal. Given my broad experience with women’s healthcare providers, both personally and professionally, I found the appointment was divergent from that of my past experience.

I entered the building past two rather polite protesters and encountered the security guard. Upstairs, the receptionist was sweet, caring and inclusive. She had a pleasant demeanor, was polite and helpful. Not only did she ask for my insurance info, but she also asked for my preferred pronoun (it’s “she”, if you are wondering).

I did bring up the issue I had when scheduling my appointment. She was appalled, and rightfully so. She let me know that what was said was off-message and inappropriate and that’s she’s let my clinician know. A+ for customer service!

I was called back for my exam. This started out as a pretty typical interaction with the nurse… until it wasn’t. She took my vitals, had me pee in a cup and began asking me about my medical history. All good. Then she asked about any symptoms or problems I may be having or have had recently. We proceeded accordingly until I mentioned a minor breast issue and that I still make milk even after having weaned four years ago.

This set off alarm bells for her. After an additional series of questions, she tells me that today’s appointment will be a breast exam and that my annual gyne and IUD removal will be pushed to a later date.

I inquired as to why both couldn’t be done today since I was there anyway and a manual palpitation of my breasts takes all of two to three minutes to complete, if that. She explained that it was about time and prioritization. Since cancer is a *bad* thing, they needed to do the breast exam today and would need to push the IUD removal till a later appointment. (Note: there is no mammography on site, that is to be scheduled for a later date as well.)

I asked again as to why both couldn’t be done since I had an appointment for the IUD removal. The receptionist had mentioned that there was no appointment immediately after me, so any extra time shouldn’t have been an issue.

I explained that since my intention was to get pregnant at 41, that I need to start trying with the next ovulation cycle. Hence, my need to get the IUD out today rather than later.

She insisted that due to time constraints, they couldn’t do both on the same day. I find this to be illogical and not in line with what I know of breast exams and how long they take. Eventually, I relented and grudgingly set a future appointment.

She then asked if I was using condoms in addition to my IUD. I said “no” and reminded her that I intended to get pregnant and she launched into a “condoms prevent STD’s” speech. This is yet another example of a lack of active listening skills. It felt like she was going through a rote script, rather than hearing what I was saying. It’s awfully tough to get pregnant if you are using condoms.

The physician then comes into the room. She and the nurse discuss my situation. I reiterate to the doctor my need to have the IUD removed and my relative lack of concern over still making breastmilk and the atypical breast swelling before my menstrual cycle. She repeats what the nurse said about time constraints and insists that I schedule a future appointment.

I’m then taken to another room where I’m given a paper half – gown for the breast exam. It is, as I suspected, a manual breast exam taking all of 2-3 minutes. She asked me to express breastmilk, which I did. We talked for a brief moment. I asked, yet again, about my IUD, explaining the inconvenience of having to return a second time and the timeline with regards to ovulation. I expressed my disappointment and my dissatisfaction. I was again told “no”.

We discussed the interaction during the scheduling of the appointment and the doctor apologized for the non-mission statement based conversation which had taken place.

I then was moved on to a blood draw for STD testing for which I had given consent. All told, this took 90 minutes, including multiple wait times and room transfers.

I am left feeling unheard and ignored.

My autonomy was not respected in these interactions with the nurse and the doctor.

Regardless of what issue may or may not be going on with my breast, I was there for a valid purpose – IUD removal, which they did not do.

The delay costs me additional time and money and possibly means that I miss my next ovulation cycle to boot. At 41, I can’t afford to miss a cycle to try to conceive.

I have many thoughts and speculate as to why I may have been denied my IUD removal. None of them make me particularly happy, though I do often wax in negative thought cycles.

If I make a return visit, then they get additional money from both my health insurance company and me with my copay. I’d rather not assume the case is financially motivated, even with the understanding that the government is threatening to cut their funding.

So, let’s assume it’s because they wish to make sure I truly wish my IUD to be removed. They did ask questions about domestic abuse, including whether or not I’d had or a have a partner who coerced me into getting pregnant. My response was “no”.

Rolling this around in my head, I do wonder if this is an imposed waiting period to be sure that I’m not being coerced into a pregnancy.

There is some merit to this method, however, it assumes I am not telling the truth and that I need to be protected. I understand that abused women often protect their abusive partner and deny abuse until they are fully ready to leave the relationship. I also understand that PP works with a population with a high domestic abuse rate and with rape victims.

That said, the nurse and physician with whom I interacted, intentionally chose not to actively listen to my words. When I explained my age and my knowledge of my ovulation cycles, etc. and repeatedly politely asked for my IUD to be removed, they should have been able to ascertain the truth in my words. Or, at least to have better explained the rationale behind not removing my IUD.

The other thing I roll around regarding their decision to delay the IUD removal is my personal life. The staff did inquire as to my relationship status over the course of the visit. I informed them about my separation from my husband and my dating new partners in the last year.

Did this influence their decision not to remove my IUD? I hope not. My personal life is, well, personal and it is not up to the care provider to determine if my personal life is settled and appropriate for having a baby.

Alternatively, maybe, it’s a fluke, a one-time issue with this provider and this office. Maybe, they usually pull out an IUD upon request and something about me or our interaction triggered this response. However, my conversation with the receptionist on the phone at the time of scheduling the appointment indicates otherwise. What if the receptionist at the initial phone call was trying to give me a heads up as to how these IUD removal appointments usually go down?

What if I had only told them I want my IUD out due to excessively heavy periods with anemia, headaches and dizziness accompanying my cycle? Would they have removed it due to that reason alone? I believe in telling the full truth to my care providers. I don’t love my IUD, but I do kind of want to see if I can get pregnant. I don’t believe I should withhold information just to get what I want. There is potential physical harm in that and there is real harm to the provider – patient relationship.

Lastly, what if they told me the truth, with no negligence or malice behind it? What if they really only budget a very short time for visits and even a few minutes over time is a real hardship with regards to other patients? What if the insurance companies only pay for visits of a limited length and PP would be out that money if the visit went too long? This does the patient a great disservice, as sometimes, it is necessary to provide more time to adequately address issues. My body, my choice, except for when it’s inconvenient for others.

I bite back at their prioritization of my breasts over my IUD removal. I am well aware of the risks of breast cancer and I appreciate their concern. However, every gyne visit I’ve had since I was 15, we addressed both breast and uterine issues. The visit at PP was atypical in their focus on only one aspect of my health.

Point in fact – there was NO medical reason to leave the IUD intact. The logistical reason of inadequate time for the appointment, doesn’t hold water given that I was in the office for an hour and a half, at least an hour of that was interacting with the doctor and/or nurse.

I’m still mulling over the rationale regarding the postponement of my IUD removal and as of yet, I have not uncovered a satisfactory reason why my IUD not have been removed at this visit. I will always assume negligence or ignorance over malice. However, the assumption that someone else knows best about my health and my life is erroneous and authoritarian. It is infantilizing to assume that I do not speak the truth or know my mind. Infantilizing to tell me that you, as my provider, know best about my life and my lifestyle.

I live in this body. My values and beliefs govern this body. I do not, nor shall, I cede control to another. My body neither belongs to my care provider, nor my partner. I own my decisions and the consequences thereof.

Planned Parenthood, I will always support you. I will continue to donate to you and I will continue to march for you. I will vote accordingly to support you. Access to safe abortion and birth control is an imperative for women’s health. However, it is unlikely I will be a patient at this office again.

Tell me, readers, of your experiences with care providers who denied you the care you requested. Tell me your stories of needs denied in the comments below.

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