Re: Prescribing contraception in residency

June 26, 2007

I can only tell you what I have done in practice - I will counsel patients about

all methods of family planning, and I will tell them that the only absolutely

sure method of pregnancy prevention is total abstinence and that is what I

advise for the unmarried. I talk about the psychological consequences of

unmarried sexual activity, especially for women. I do not usually bring in the

religious angle, simply the research about how bonding and breaking has

adversely affected our culture.

I also counsel about the known and suspected mechanism of action of all

contraceptives. I do point out that for those who believe that human life

begins at conception and should be protected from that point on, there are moral

concerns about hormonal contraception and about IUDs. I point out that the

effectiveness of pregnancy prevention is actually greater with NFP than with

barrier methods, as well as being esthetically more satisfying. I have a 2 page

handout on NFP that includes the names of a few NFP books (both secular and

religious) and will give that out. If a patient still wants a prescription, I

will ask a colleague to come in and counsel/prescribe. My colleagues think I am

nuts, but they have lately been referring women to me for baisc infertility

consults as a way of sharing the wealth.

alicia huntley cnm msn

rockford il

Prescribing contraception in residency

>

>I have talked to a few of you before, and thank you for your help!

>

>I am starting my ob/gyn internship monday, and I'd like to get 'my

>ducks in a row', too! I have been pondering what to do about

>prescribing contraception, and I would like any input from residents

>or people who have " been there " I am not sure how to get around not

>prescribing OCP's... I pondered counseling my patients about

>contraception and then asking another resident or attending to write

>the prescription, but the outcome is the same whether I write the

>prescription or someone else does it. I don't think I can force my

>religious/moral beliefs on anyone, and i feel that contraception is

>so widely accepted that it will be hard to get by not prescribing

>OCP's. I think that abortions are a different story, many people

>understand the refusal to participate in those, but I feel like OCPs

>are in a different league.

>

>Any advice would be greatly appreciated. My program director stated

>that he would fully support me in whatever decisions I made, but I

>was curious to see how others out there in the field went about this.

>

>Thanks for the help!

>

June 26, 2007

do it in such a way that you do not dump work on others if possible. in fact, it would work best if your beliefs resulted in you doing more unpleasant work than others. offer vto take an extra call.

Reply-To: nfpprofessionals To: nfpprofessionals Subject: Re: Prescribing contraception in residencyDate: Tue, 26 Jun 2007 22:54:30 -0500 (GMT-05:00)MIME-Version: 1.0X-Originating-IP: 209.86.89.64X-Sender: ahuntley@...Received: from n26b.bullet.sp1.yahoo.com ([209.131.38.241]) by bay0-mc3-f23.bay0.hotmail.com with Microsoft SMTPSVC(6.0.3790.2668); Tue, 26 Jun 2007 20:54:43 -0700Received: from [216.252.122.217] by n26.bullet.sp1.yahoo.com with NNFMP; 27 Jun 2007 03:54:42 -0000Received: from [66.218.69.5] by t2.bullet.sp1.yahoo.com with NNFMP; 27 Jun 2007 03:54:42 -0000Received: from [66.218.67.109] by t5.bullet.scd.yahoo.com with NNFMP; 27 Jun 2007 03:54:42 -0000Received: (qmail 58638 invoked from network); 27 Jun 2007 03:54:41 -0000Received: from unknown (66.218.67.34) by m45.grp.scd.yahoo.com with QMQP; 27 Jun 2007 03:54:41 -0000Received: from unknown (HELO elasmtp-curtail.atl.sa.earthlink.net) (209.86.89.64) by mta8.grp.scd.yahoo.com with SMTP; 27 Jun 2007 03:54:40 -0000Received: from [209.86.224.52] (helo=mswamui-valley.atl.sa.earthlink.net)by elasmtp-curtail.atl.sa.earthlink.net with asmtp (Exim 4.34)id 1I3Obu-0003sd-60for nfpprofessionals ; Tue, 26 Jun 2007 23:54:30 -0400Received: from 74.135.102.143 by webmail.atl.earthlink.net with HTTP; Tue, 26 Jun 2007 23:54:29 -0400

I can only tell you what I have done in practice - I will counsel patients about all methods of family planning, and I will tell them that the only absolutely sure method of pregnancy prevention is total abstinence and that is what I advise for the unmarried. I talk about the psychological consequences of unmarried sexual activity, especially for women. I do not usually bring in the religious angle, simply the research about how bonding and breaking has adversely affected our culture. I also counsel about the known and suspected mechanism of action of all contraceptives. I do point out that for those who believe that human life begins at conception and should be protected from that point on, there are moral concerns about hormonal contraception and about IUDs. I point out that the effectiveness of pregnancy prevention is actually greater with NFP than with barrier methods, as well as being esthetically more satisfying. I have a 2 page handout on NFP that includes the names of a few NFP books (both secular and religious) and will give that out. If a patient still wants a prescription, I will ask a colleague to come in and counsel/prescribe. My colleagues think I am nuts, but they have lately been referring women to me for baisc infertility consults as a way of sharing the wealth.alicia huntley cnm msnrockford il Prescribing contraception in residency>>I have talked to a few of you before, and thank you for your help!>>I am starting my ob/gyn internship monday, and I'd like to get 'my >ducks in a row', too! I have been pondering what to do about >prescribing contraception, and I would like any input from residents >or people who have "been there" I am not sure how to get around not >prescribing OCP's... I pondered counseling my patients about >contraception and then asking another resident or attending to write >the prescription, but the outcome is the same whether I write the >prescription or someone else does it. I don't think I can force my >religious/moral beliefs on anyone, and i feel that contraception is >so widely accepted that it will be hard to get by not prescribing >OCP's. I think that abortions are a different story, many people >understand the refusal to participate in those, but I feel like OCPs >are in a different league. >>Any advice would be greatly appreciated. My program director stated >that he would fully support me in whatever decisions I made, but I >was curious to see how others out there in the field went about this.>>Thanks for the help!>>>> >

June 26, 2007

I found it possible to counsel on the risks and benefits of OCP's and then involve my colleagues in signing the actual prescription. This strategy is highly contingent on the good will of fellow residents. The commodity in trade for this is work - it shouldn't have to be so but if you work harder than everyone else and make their lives easier, it was my experience that the other residents were supportive. This was 20 years ago but the issues were largely the same. Good luck.TMG I have talked to a few of you before, and thank you for your help!I am starting my ob/gyn internship monday, and I'd like to get 'my ducks in a row', too! I have been pondering what to do about prescribing contraception, and I would like any input from residents or people who have "been there" I am not sure how to get around not prescribing OCP's... I pondered counseling my patients about contraception and then asking another resident or attending to write the prescription, but the outcome is the same whether I write the prescription or someone else does it. I don't think I can force my religious/moral beliefs on anyone, and i feel that contraception is so widely accepted that it will be hard to get by not prescribing OCP's. I think that abortions are a different story, many people understand the refusal to participate in those, but I feel like OCPs are in a different league. Any advice would be greatly appreciated. My program director stated that he would fully support me in whatever decisions I made, but I was curious to see how others out there in the field went about this.Thanks for the help! T. Goodwin MDProfessor and Chief, Maternal-Fetal MedicineUniversity of Southern California

June 27, 2007

check

nfpoutreach@... wrote:

>

> * *

>

> * " I have been pondering what to do about prescribing contraception, and

> I would like any input from residents or people who have ‘been there.’ " *

>

> The main question facing a young doctor beginning an ob /gyn internship

> is this: How do I help shape the culture of the medical profession with

> the authentic values of the Gospel? How do I bring my convictions, and

> values, to bear upon my chosen profession? Everyone must answer this

> question, according to his or her profession and circumstances.

>

> Specifically, how should a new doctor address the abortion,

> sterilization, and contraceptive culture in modern medicine?

>

> Contraception and sterilization are serious matters. It is a false

> distinction to say that abortion is serious, but contraception and

> sterilization are only relatively serious. All of these are deadly to

> the soul, and are bad medicine. Abortion kills a perfectly healthy

> unborn baby. Sterilization destroys a perfectly healthy fertility

> system. Contraception turns against fertility, and temporarily

> sterilizes, a sexual act which nature designed for procreation. The root

> cause of abortion is the abuse of sex; which is promiscuity and

> contraception. Contraception always leads to more abortion, not less. A

> principled doctor cannot play with any of these matters. They cannot

> present themselves as an accomplice to these deeds.

>

> * *

>

> * " My program director stated that he would fully support me in whatever

> decisions I made. " * This means that the intern can state his position:

> " I cannot perform abortions, sterilizations, or dispense contraception

> because they are bad medicine and because my conscience tells me that

> they are serious moral evils. There are thousands of other medical

> procedures I can perform, but I will not be an accomplice in these three. "

>

> He is a physician and therefore he should be healing people instead of

> putting harmful chemicals in healthy bodies. Prescribing contraceptives

> opens up the possibility of cooperating in giving abortifacients. This

> is both material and formal cooperation.

>

> Most patients look to their doctors for good medical advice. Doctors

> should take advantage of this and offer their reasons for encouraging

> people to stay away from the contraceptive culture. They could point to

> the multi-billion dollar industry the pharmaceuticals have created, and

> now promote through slick advertisements in the mass media.

>

> Doctors could explain the connection between contraception and their

> social consequences: greater promiscuity and infidelity in marriage, a

> 50% divorce rate, a lack of male responsibility, 35% of children now

> born outside of marriage, more single parent (and poor) families,

> dysfunctional families, an epidemic of STDs, lack of good male role

> models … Bad medicine has wide social and moral consequences.

>

> A Catholic doctor who sacrifices his principles, and violates his

> conscience, by making referrals to other doctors who will prescribe

> contraceptives and do sterilizations is giving bad example to other

> residents and patients. Their resistance to serious evils should be more

> than a token one. They should refuse to either prescribe contraceptives

> or make referrals.

>

> Pope VI, in his encyclical /Humanae Vitae, /encourages doctors thus:

>

> " Let us express our highest admiration for doctors and for those health

> professionals who, in their mission desire to safeguard what is

> compatible with their Christian vocation rather than what corresponds to

> some human advantage. Therefore let them constantly pursue only those

> solutions that are in accord with faith and right reason. And let them

> strive to gain the agreement and the compliance of their colleagues in

> this matter. Moreover, let them consider it their special mission to

> acquire all necessary learning in this difficult area (NFP). Thereby

> they may be able to give good advice to spouses seeking their counsel

> and to direct them along the right path. Spouses rightly seek such

> direction from them " (HV 27).

>

> If the pressure on a new doctor to conform to the contraceptive culture

> is too great, then he or she should go elsewhere and seek employment

> where he will not have to violate his conscience. More Catholic and

> pro-life doctors should consider starting up totally pro-life medical

> clinics. There are many successful examples of these around the country,

> and these doctors are very willing to share their experiences. These

> clinics give a powerful witness to Gospel values and good medicine. Many

> families seek them out.

>

> There are some evils in our society that will only change when enough

> conscientious people refuse to participate in them. Abortion and

> contraception are two of these.

>

> The life issues belong to doctors and nurses in a special way. The

> Church looks to them to take real leadership in bringing the values of

> the Gospel, and the light of Christ, to the medical profession. This

> will create some career problems and temporary tensions, but this is the

> price that witnesses to the Faith have always been asked to give

> throughout the centuries

>

> Cordially yours,

>

> Fr. McCaffrey

>

> --

> Natural Family Planning Outreach

> (New address)

> 2828 NW 57th Street, Suite 211

> Oklahoma City, OK 73112-7070

>

> Director: Rev. McCaffrey, S.T.D.

> Assistant Directors:

> Rev. Hogan, PhD

> Rev. Habiger, OSB, PhD

>

> nfpoutreach@...

> www.nfpoutreach.org <http://www.nfpoutreach.org/>

>

> -------------- Original message from " medschoolrunner "

> : --------------

>

> I have talked to a few of you before, and thank you for your help!

>

> I am starting my ob/gyn internship monday, and I'd like to get 'my

> ducks in a row', too! I have been pondering what to do about

> prescribing contraception, and I would like any input from residents

> or people who have " been there " I am not sure how to get around not

> prescribing OCP's... I pondered counseling my patients about

> contraception and then asking another resident or attending to write

> the prescription, but the outcome is the same whether I write the

> prescription or someone else does it. I don't think I can force my

> religious/moral beliefs on anyone, and i feel that contraception is

> so widely accepted that it will be hard to get by not prescribing

> OCP's. I think that abortions are a different story, many people

> understand the refusal to participate in those, but I feel like OCPs

> are in a different league.

>

> Any advice would be greatly appre! ciated. My program director stated

> that he would fully support me in whatever decisions I made, but I

> was curious to see how others out there in the field went about this.

>

> Thanks for the help!

>

June 27, 2007

"I have been pondering what to do about prescribing contraception, and I would like any input from residents or people who have ‘been there.’"

The main question facing a young doctor beginning an ob /gyn internship is this: How do I help shape the culture of the medical profession with the authentic values of the Gospel? How do I bring my convictions, and values, to bear upon my chosen profession? Everyone must answer this question, according to his or her profession and circumstances.

Specifically, how should a new doctor address the abortion, sterilization, and contraceptive culture in modern medicine?

Contraception and sterilization are serious matters. It is a false distinction to say that abortion is serious, but contraception and sterilization are only relatively serious. All of these are deadly to the soul, and are bad medicine. Abortion kills a perfectly healthy unborn baby. Sterilization destroys a perfectly healthy fertility system. Contraception turns against fertility, and temporarily sterilizes, a sexual act which nature designed for procreation. The root cause of abortion is the abuse of sex; which is promiscuity and contraception. Contraception always leads to more abortion, not less. A principled doctor cannot play with any of these matters. They cannot present themselves as an accomplice to these deeds.

"My program director stated that he would fully support me in whatever decisions I made." This means that the intern can state his position: "I cannot perform abortions, sterilizations, or dispense contraception because they are bad medicine and because my conscience tells me that they are serious moral evils. There are thousands of other medical procedures I can perform, but I will not be an accomplice in these three."

He is a physician and therefore he should be healing people instead of putting harmful chemicals in healthy bodies. Prescribing contraceptives opens up the possibility of cooperating in giving abortifacients. This is both material and formal cooperation.

Most patients look to their doctors for good medical advice. Doctors should take advantage of this and offer their reasons for encouraging people to stay away from the contraceptive culture. They could point to the multi-billion dollar industry the pharmaceuticals have created, and now promote through slick advertisements in the mass media.

Doctors could explain the connection between contraception and their social consequences: greater promiscuity and infidelity in marriage, a 50% divorce rate, a lack of male responsibility, 35% of children now born outside of marriage, more single parent (and poor) families, dysfunctional families, an epidemic of STDs, lack of good male role models … Bad medicine has wide social and moral consequences.

A Catholic doctor who sacrifices his principles, and violates his conscience, by making referrals to other doctors who will prescribe contraceptives and do sterilizations is giving bad example to other residents and patients. Their resistance to serious evils should be more than a token one. They should refuse to either prescribe contraceptives or make referrals.

Pope VI, in his encyclical Humanae Vitae, encourages doctors thus:

"Let us express our highest admiration for doctors and for those health professionals who, in their mission desire to safeguard what is compatible with their Christian vocation rather than what corresponds to some human advantage. Therefore let them constantly pursue only those solutions that are in accord with faith and right reason. And let them strive to gain the agreement and the compliance of their colleagues in this matter. Moreover, let them consider it their special mission to acquire all necessary learning in this difficult area (NFP). Thereby they may be able to give good advice to spouses seeking their counsel and to direct them along the right path. Spouses rightly seek such direction from them" (HV 27).

If the pressure on a new doctor to conform to the contraceptive culture is too great, then he or she should go elsewhere and seek employment where he will not have to violate his conscience. More Catholic and pro-life doctors should consider starting up totally pro-life medical clinics. There are many successful examples of these around the country, and these doctors are very willing to share their experiences. These clinics give a powerful witness to Gospel values and good medicine. Many families seek them out.

There are some evils in our society that will only change when enough conscientious people refuse to participate in them. Abortion and contraception are two of these.

The life issues belong to doctors and nurses in a special way. The Church looks to them to take real leadership in bringing the values of the Gospel, and the light of Christ, to the medical profession. This will create some career problems and temporary tensions, but this is the price that witnesses to the Faith have always been asked to give throughout the centuries

Cordially yours,

Fr. McCaffrey

--Natural Family Planning Outreach (New address) 2828 NW 57th Street, Suite 211 Oklahoma City, OK 73112-7070 Director: Rev. McCaffrey, S.T.D.Assistant Directors: Rev. Hogan, PhD Rev. Habiger, OSB, PhD nfpoutreach@... nfpoutreach@... www.nfpoutreach.org

-------------- Original message from "medschoolrunner" : --------------

I have talked to a few of you before, and thank you for your help!I am starting my ob/gyn internship monday, and I'd like to get 'my ducks in a row', too! I have been pondering what to do about prescribing contraception, and I would like any input from residents or people who have "been there" I am not sure how to get around not prescribing OCP's... I pondered counseling my patients about contraception and then asking another resident or attending to write the prescription, but the outcome is the same whether I write the prescription or someone else does it. I don't think I can force my religious/moral beliefs on anyone, and i feel that contraception is so widely accepted that it will be hard to get by not prescribing OCP's. I think that abortions are a different story, many people understand the refusal to participate in those, but I feel like OCPs are in a different league. Any advice would be greatly appreciated.

My program director stated that he would fully support me in whatever decisions I made, but I was curious to see how others out there in the field went about this.Thanks for the help!

June 27, 2007

Thanks Fr. McCaffrey.Kathy Re: Prescribing contraception in residency

"I have been pondering what to do about prescribing contraception, and I would like any input from residents or people who have Â‘been there.Â’"

The main question facing a young doctor beginning an ob /gyn internship is this: How do I help shape the culture of the medical profession with the authentic values of the Gospel? How do I bring my convictions, and values, to bear upon my chosen profession? Everyone must answer this question, according to his or her profession and circumstances.

Specifically, how should a new doctor address the abortion, sterilization, and contraceptive culture in modern medicine?

Contraception and sterilization are serious matters. It is a false distinction to say that abortion is serious, but contraception and sterilization are only relatively serious. All of these are deadly to the soul, and are bad medicine. Abortion kills a perfectly healthy unborn baby. Sterilization destroys a perfectly healthy fertility system. Contraception turns against fertility, and temporarily sterilizes, a sexual act which nature designed for procreation. The root cause of abortion is the abuse of sex; which is promiscuity and contraception. Contraception always leads to more abortion, not less. A principled doctor cannot play with any of these matters. They cannot present themselves as an accomplice to these deeds.

"My program director stated that he would fully support me in whatever decisions I made." This means that the intern can state his position: "I cannot perform abortions, sterilizations, or dispense contraception because they are bad medicine and because my conscience tells me that they are serious moral evils. There are thousands of other medical procedures I can perform, but I will not be an accomplice in these three."

He is a physician and therefore he should be healing people instead of putting harmful chemicals in healthy bodies. Prescribing contraceptives opens up the possibility of cooperating in giving abortifacients. This is both material and formal cooperation.

Most patients look to their doctors for good medical advice. Doctors should take advantage of this and offer their reasons for encouraging people to stay away from the contraceptive culture. They could point to the multi-billion dollar industry the pharmaceuticals have created, and now promote through slick advertisements in the mass media.

Doctors could explain the connection between contraception and their social consequences: greater promiscuity and infidelity in marriage, a 50% divorce rate, a lack of male responsibility, 35% of children now born outside of marriage, more single parent (and poor) families, dysfunctional families, an epidemic of STDs, lack of good male role models Â… Bad medicine has wide social and moral consequences.

A Catholic doctor who sacrifices his principles, and violates his conscience, by making referrals to other doctors who will prescribe contraceptives and do sterilizations is giving bad example to other residents and patients. Their resistance to serious evils should be more than a token one. They should refuse to either prescribe contraceptives or make referrals.

Pope VI, in his encyclical Humanae Vitae, encourages doctors thus:

"Let us express our highest admiration for doctors and for those health professionals who, in their mission desire to safeguard what is compatible with their Christian vocation rather than what corresponds to some human advantage. Therefore let them constantly pursue only those solutions that are in accord with faith and right reason. And let them strive to gain the agreement and the compliance of their colleagues in this matter. Moreover, let them consider it their special mission to acquire all necessary learning in this difficult area (NFP). Thereby they may be able to give good advice to spouses seeking their counsel and to direct them along the right path. Spouses rightly seek such direction from them" (HV 27).

If the pressure on a new doctor to conform to the contraceptive culture is too great, then he or she should go elsewhere and seek employment where he will not have to violate his conscience. More Catholic and pro-life doctors should consider starting up totally pro-life medical clinics. There are many successful examples of these around the country, and these doctors are very willing to share their experiences. These clinics give a powerful witness to Gospel values and good medicine. Many families seek them out.

There are some evils in our society that will only change when enough conscientious people refuse to participate in them. Abortion and contraception are two of these.

The life issues belong to doctors and nurses in a special way. The Church looks to them to take real leadership in bringing the values of the Gospel, and the light of Christ, to the medical profession. This will create some career problems and temporary tensions, but this is the price that witnesses to the Faith have always been asked to give throughout the centuries

Cordially yours,

Fr. McCaffrey

--Natural Family Planning Outreach (New address) 2828 NW 57th Street, Suite 211 Oklahoma City, OK 73112-7070 Director: Rev. McCaffrey, S.T.D.Assistant Directors: Rev. Hogan, PhD Rev. Habiger, OSB, PhD nfpoutreachatt (DOT) net nfpoutreachnfpoutreach (DOT) org www.nfpoutreach.org

-------------- Original message from "medschoolrunner" <kwins002umaryland (DOT) edu>: --------------

I have talked to a few of you before, and thank you for your help!I am starting my ob/gyn internship monday, and I'd like to get 'my ducks in a row', too! I have been pondering what to do about prescribing contraception, and I would like any input from residents or people who have "been there" I am not sure how to get around not prescribing OCP's... I pondered counseling my patients about contraception and then asking another resident or attending to write the prescription, but the outcome is the same whether I write the prescription or someone else does it. I don't think I can force my religious/moral beliefs on anyone, and i feel that contraception is so widely accepted that it will be hard to get by not prescribing OCP's. I think that abortions are a different story, many people understand the refusal to participate in those, but I feel like OCPs are in a different league. Any advice would be greatly appreciated.

My program director stated that he would fully support me in whatever decisions I made, but I was curious to see how others out there in the field went about this.Thanks for the help!

Kathy Schmugge

Family Life Coordinator

Diocese of ton

June 28, 2007

I congratulate you on your convictions. Hold on to them ! I just graduated from a residency in OB/GYN from town and did not prescribe contraception or do sterilizations. It can be done ! It sounds like your program director will support you. That is huge. People in my program disagreed with me, but respected my position. I firmly believe that good ethics is good medicine. Too often "NFP-only" physicians define themselves on what they do not do, not on what they do. BCP and IVF I believe are suboptimal medicine. As suppressive therapy or circumventive therapy they do not find the problem and fix it as we are taught to do in every other field of medicine. What I am trying to say is, do not feel like you are offering suboptimal care. It may not be the norm or "standard" ... but you should be proud

of the type of doctor that you are and what you have to offer to patients. So be encouraged. yeungpjr@... Feel free to contact me if you would like to chat more.

Looking for a deal? Find great prices on flights and hotels with Yahoo! FareChase.

June 28, 2007

I agree with the other comments that have been made. It is important

to discuss the issue up front with attendings, supervising residents,

and peer residents.

I would like to add one comment about whether the " outcome is the

same whether I write the prescription or someone else does it. "

If you give patients objective information about risks and benefits

of OCPs, you make it clear that you are not morally judging the

patient if they choose to request OPCs, you make sure they know that

there are other options (NFP, abstinence) that you recommend, and

that you have a personal moral boundary that you cannot cross to

write a prescription yourself, then I believe there is no moral

culpability for you to have one of your colleagues write an rx for

your patient. The patient has received a lot more guidance on the

issue than if she had gone directly to one of your colleagues, and

she knows your own personal stand very clearly. Much more clearly

than if you were to say, I don't recommend it, but I will write it

for you anyway. And much more clearly than if you were simply to

never have seen the patient.