BC without seeing Dr.?

[qwerty]

I know some of you work in medical fields. I am hoping that you can offer me another perspective on this situation.

I had my 2nd child in march of 2010. A pap smear was part of the 6 week check up in April 2010. I opted to wait on using BC because of breastfeeding. I put off going in for BC until February of 2011. The Dr. gave me a script for 15 months of BC without an exam because insurance would not pay for another one until a full year had passed. Dr. said at my age missing one annual is no biggie.

My pharmacy will not fill scripts for longer than 12 months without the patient getting a new script from the Dr. When the 12th month arrived, I received an e-mail from pharmacy stating that they have contacted my Dr. to renew the script and he agreed. He wrote a script for another 15 months.

I have had other concerns about this Dr. before. I am concerned that they are just giving out BC without an exam for almost 3 years. I thought that BP needed to be monitored and that pap smears were important. Should I report this Dr.? Should I demand an exam? I am extremely careful about any medications that I take and it makes me nervous to keep taking BC without a check up.

[MaggieTheCat]

I am assuming you live in the U.S. where it is common practice for women to have to get a pap every year, no matter what their history is.

Other areas of the world, such as the U.K., do not require a pap every year. Women who have had no abnormal paps, have no history of cancers/strokes/etc in their family, and who are a certain age (over 30 maybe, don't know for sure) only need one every 2-3 years.

If you are concerned, your best option is to talk to your dr. about it before deciding anything. Ask him why he is willing to give you the RX without an exam and if it's normal for someone in your situation (similar medical history, age, etc.) Ask him how often you should be getting paps and if there's anything you should be aware of (certain symptoms or anything) to watch for in the meantime. Make your decision from there.

You can certainly ask for an exam if you want one (or at least, I assume he'd give you one.) He probably knows how most women feel about pelvic exams and pap smears and if your medical history is good, may let some women slide for a year or two.

If you're concerned about BP, a lot of pharmacies have free BP machines where you can monitor your own BP.

[Little Retail Rabbit]

I was gonna basically say what Maggie said- as I'm from the UK, I have actually been on BC for nearly 9 years now, and not once had a cervical smear/PAP smear. I will be due for my first this year, and it will be another 5 years before I have another (unless one is required).

If it were me, it wouldn't bother me at all, but as you're more used to actually having them done, I would just ask your doctor if you could have one done. I only ever have my blood pressure checked, and as Maggie pointed out, you can get that done at a pharmacy. While I'm not going to give you medical advice (not in a position to), I am quite confident in saying that things probably are all well, and this is ok. But of course, if it sets your mind at ease, speak to your doc.

[qwerty]

I didn't know that annual exams were not the norm everywhere. I guess I have just taken the push to see GP/gyne every year as necessary. I am glad to know that this is not so uncommon.

[Sapphire Silk]

I usually tell people to trust their instincts. If you are concerned, consider finding a new doctor, or insisting on an annual exam and pap.

[Pagan]

My pharmacy will not fill scripts for longer than 12 months without the patient getting a new script from the Dr. When the 12th month arrived, I received an e-mail from pharmacy stating that they have contacted my Dr. to renew the script and he agreed. He wrote a script for another 15 months.

That's not just your pharmacy, that's federal law. No Rx can be filled for more than a year. I don't know what the doc is trying to do because he should know that, too. At the pharmacy I worked at, we suspected that some docs do that thinking that because they wrote it that way, we had to fill it that way. Guess again, Sparky!


Like Panacea said, if it's bugging, ask him or find another doc. BUT

I have had other concerns about this Dr. before. I am concerned that they are just giving out BC without an exam for almost 3 years. I thought that BP needed to be monitored and that pap smears were important. Should I report this Dr.? Should I demand an exam? I am extremely careful about any medications that I take and it makes me nervous to keep taking BC without a check up.

That's changed. Guideline now is biannually within 3 years of first intercourse (but no later than 21) and over 30, every 3 years if you've had 3 consecutive clear Paps. The group I go to does this, but they do do a pelvic exam every year.

And they don't necessarily monitor your BP. I think it's if you fall in to certain groups. I know at my place, the take my BP along with other vitals, but they've never said anything to me. Even after one year, genius that I am, went in the day after getting a flu shot (I always feel a little crappy the next day) and driving in our lovely afternoon traffic while it was still pretty warm out (late fall, still in the 80s). The office was moving right along and I didn't get a chance to sit down and relax before they called me back. My BP was up, naturally. But, they took it at the end, and it was back down in my normal dead-person range.

[emt_cookies]

They changed the guidelines like other have said.

Also, just because he wrote the 2nd script for 15 months does not mean he plans on not seeing you. If you want an annual pap, you can still schedule one.

[Moogles]

Was gonna say, I have had one in 2 years, since the last failed attempt to get me on BC (stupid allergies). My Dr, who has been seeing me since I was in my mom's belly, normally pushes for testing if she thinks it's necessary. Due to scarring from when I had my daughter 3.5 years ago, it's not possible for me to have a pap without being in excruciating pain, and I don't want to have reconstruction done:S

[raudf]

Went to my OB for the first of two ultrasounds and on the wall I saw, "Medicare will only cover one pap smear every two years!" I guess that they are pushing towards a guidelines change? Didn't think to ask the nurse about it.

Private insurance has it for every year, but when I did talk to my Gyn/OB, he said that unless I have a family history of uterine/cervical cancer or irregular paps, then there is no real reason to do them that often. He said some people still do it in spite of the lack of risk factors just for peace of mind.

I'd say if you're worried, discuss it with the Gyn. If he/she doesn't address your concerns, then it might be time to find a new one. Health is one thing you should NEVER leave to... doctors who don't seem to take you or your concerns seriously.

[qwerty]

Update: I called to question the recommendations on how often I should come in. The receptionist was confused and said that my prescription should not have even been renewed. I went in for an appointment and decided to switch doctors. I cannot get any answers out of this practice. I do not feel comfortable with making medical decisions when my doctor cannot be bothered to answer a few questions.

While at the appointment my doctor brought up the subject of permanent birth control. I tried multiple times to get information on the pros/cons of hormonal BC vs the procedure that he is suggesting. He ignored every question that I asked. He only would give me a pamphlet that was nothing but a sales pitch. I have had other issues with this practice wanting me to consent to medicines/procedures but refusing to provide adequate information on which to make a decision. He also had obviously not even looked at my chart and was wrong several times on my medical history including not knowing that I gave birth twice. He thought that my first daughter was my only. The kicker...he delivered my second daughter.

The final straw was when he pushed me to decide on the procedure because, he implied, that I cannot afford more children. He does not know my economic situation. I find it highly inappropriate to push a young woman (27) to consider permanent BC when she is not sure if she wants more children.

* The procedure he is pushing is Essure. I've never heard of it.
** I have been thinking about getting my tubes tied but hubby and I had wanted more children. The decision is still up in the air.
*** I NEVER disclosed to the doctor that I was considering a tubal.

[Solumina]

Yeah he doesn't sound like the best doctor, hopefully you will be able to quickly find someone much better.

[PandaHatBear]

** I have been thinking about getting my tubes tied but hubby and I had wanted more children. The decision is still up in the air.
*** I NEVER disclosed to the doctor that I was considering a tubal.

In the UK, most Obs/Gyn will suggest the Mirena (http://en.wikipedia.org/wiki/Mirena) rather than sterilisation for women. It's apparently just as effective, and can be reversed far more easily! (Did you know that some women have still gotten pregnant despite having a sterilisation! That must be awkward!) I think it lasts about 5 years before needing replaced. But whatever you decide to do, find a doctor who is happy to go through all the choices with you so you can make an informed choice. There is a huge amount of contraception available and I'm sure you'll find something that will fulfil your needs.

Disclaimer: I am merely a medical student. Find yourself an excellent doctor.

[MaggieTheCat]

(Did you know that some women have still gotten pregnant despite having a sterilisation! That must be awkward!)

Sorry for the slight off-topic, but I just wanted to throw out there that vasectomies are not 100% failproof/permanent, either. I have a good friend whose father had a vasectomy and 10 years later, his wife got pregnant (and yes, the baby was his.) So yeah...I know it is extremely rare, but I will be forever paranoid now and even if my husband had a vasectomy, we would probably still use some other form of BC.