Should pregnant doctors work in termination of pregnancy clinics?BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c867 (Published 17 February 2010) Cite this as: BMJ 2010;340:c867
- Megan Millward, F2 doctor, Bristol
I found clinic days as a foundation year 2 (F2) doctor strangely satisfying. After three months of on-calls in obstetrics and gynaecology, running between emergency department and labour ward, I was ready for some clinic time. I was also seven months pregnant and getting round, heavy, and tired. Imagine my confusion when I was assigned to repeated sessions of the weekly termination of pregnancy (TOP) clinic. On questioning the rota coordinator on the appropriateness of this decision (imagining that someone may have overlooked my rapidly swelling gravid uterus), I was told that as most of the other doctors had conscientiously objected I was the only junior doctor available for those weeks.
Discussions with doctors in other fields and with non-medical friends and family only heightened my unease about being a pregnant doctor consulting on and certifying terminations. In my experience most junior doctors don’t want to get involved with terminations, even when they are pro-choice. Most of those I spoke to were objecting to the work not because of strong religious or personal beliefs but because the system allowed them to object, without question, thereby avoiding an emotionally awkward clinic. My family did not realise that doctors could refuse to perform certain clinics or tasks. My lay friends were under the impression that if a medical procedure is safe and legal, and if you are qualified to provide the service, it would be unprofessional to refuse.
Reactions of patients in the TOP clinic to my pregnant appearance varied. When I started in the clinic most patients did not notice or comment—perhaps because of their own internal conflict or because they didn’t want to start a tricky conversation. More commonly, partners or parents of patients would politely ask me questions about my pregnancy after the patient had left the consulting area to get undressed for the examination. However, as I progressed through my third trimester, whenever I moved from sitting doing paperwork to standing in my full gravid glory I was often asked by patients, with a confused, guilty look, “Are you pregnant?”
I had run the TOP clinic three months earlier in my pregnancy, and I was surprised that, other than the incredibly competent nurses and specialist counsellor, you were pretty much left to your own devices. In a general gynaecology or antenatal clinic you have to run even the most obvious decisions by the consultant. I was amazed that I seemed to be making serious, life changing decisions, virtually unsupervised. The TOP clinic was “sensitively” hidden in some clinic rooms behind theatre, but it seemed to be hidden from most of the middle grade and consultant staff as well. The clinic was cancelled if a junior doctor was not available. They had only an out of date information folder as back-up. I began to wonder whether the clinic was unashamedly ignored rather than being just discreet.
Don’t get me wrong: I found the clinics a good learning tool, especially as I plan to become an obstetrician one day. I realise that as more women become doctors the traditional role of the male obstetrician and gynaecologist will become a thing of the past. This will be even more likely if termination clinics become nurse led, as has been proposed.
After a bit of research, I found that GMC guidance states that personal and religious beliefs must be set aside if they compromise the care of patients (www.gmc-uk.org/guidance/personal_beliefs_and_medical_practice.asp). I believe that some of the patients I saw for a termination of pregnancy appointment experienced care that was less than ideal as a result of an emotional dilemma spurred by my pregnant appearance. I think that doctors who conscientiously object to such clinics need to consider who is left to perform in their place. Is it appropriate for patients to see a pregnant doctor for their termination of pregnancy appointment? Is it suitable to have an obvious reminder of the alternative consequence when patients are already facing a difficult decision? Pregnancy is a familiar sight in society, and some may argue it is inevitable that some patients will be seen by a pregnant doctor. Why then is it common for efforts to be made to arrange ultrasonography sessions for women wanting an abortion separate from routine antenatal scanning?
Next time you object, think about your patients and who they may see instead. The clinic may be awkward for you, but you might just learn something.
Cite this as: BMJ 2010;340:c867