When a medic’s personal beliefs overtake duty of care

Quinter* was wheeled into the emergency department unconscious. Her husband frantically implored the emergency unit staff to save his wife. She lay there quiet, an oxygen mask drawn over her nose and mouth while the precious red liquid of life flowed out of her.

The response team sprang into action and in minutes, Quinter had a multitude of tubes going in and out of her and all manner of monitors were beeping incessantly. She was holding on despite the ongoing the bleeding. It was now possible to properly examine her.

Lond story short, Quinter delivered her first baby a year ago. She had an uneventful delivery to an adorable baby boy who was now learning to walk and say his first words. Six weeks after delivery, Quinter attended the post-natal clinic as recommended and after her medical checkup and cervical cancer screening, she was offered contraceptives.

Though Quinter was offered counselling regarding the various methods, the nurse put the fear of God in her regarding use of hormonal contraceptives. She emphasised how hormonal contraceptives may result in increased blood pressure, making Quinter opt out without further consideration. Quinter was then offered the only non-hormonal long-acting method available, which was the copper-based intrauterine device.

She was sent away with a caution that the coil may make menses heavier than usual but that was a common side effect and she should not worry. Quinter went away feeling grateful she had avoided undue complications. However, she did notice that her menstrual periods, even through they were regular, were remarkably heavier and lasted longer.

Ove the next Several months, the menses got heavier, leaving Quinter weak and tired. She struggled to get through the day, especially as the baby got bigger and more demanding. She slowed down on her housework and hardly ever wanted to engage socially with people due to fatigue. On this fateful day, she was on the second day of her menses. She had given up on using regular sanitary towels and instead opted for adult diapers. She passed out in the kitchen while making breakfast.

During examination, the offending intrauterine device was found partially dislodged in the cervix and was easily removed. She was treated for severe anaemia by transfusing her blood and other supportive treatments and she was able to go home within three days. She had cheated death.

Contraceptives, like all other medications and medical technologies, have their pros and cons. Each one comes with a set of advantages and disadvantages and even the unexpected side effects. There is no such thing as “one size fits all”. This is the reason there continues to be research and innovation to develop more contraceptive options for both men and women, to ensure everyone finds a suitable option.

In line with the recommended guidelines for contraceptive provision, a patient must be fully educated about each method, its mode of action, effectiveness rate, advantages, adverse effects and expected outcomes. Thereafter, the patient is screened for suitability of a method, with some methods not being advised for those with certain conditions.

In Quinter’s case, though she was told of the different methods, she was inadvertently nudged towards the intrauterine device by the nurse. The nurse was a victim of high blood pressure induced by the progesterone implant. In the past, she had the implant inserted in her arm, which resulted in marked weight gain and this triggered high blood pressure. She remained hypertensive even after removal of the implant.

For the nurse, her opinion regarding hormonal contraception forever remains skewed. Her personal experience has totally scarred her perception of the usefulness of hormonal contraceptives. Unwittingly, she passes on her personal biases towards these methods onto her patients, yet she is supposed to remain objective. In Quinter’s case, it made her even forget the need to properly counsel Quinter on the adverse effects and plan for their eventuality.

Had Quinter been objectively informed, she would have known when to call it in and come back to the clinic for advice regarding the heavy bleeding in good time. She would never have gotten to this life-threatening point. Quinter was grateful to be alive.

Quinter’s case is a classic example of how health care provider bias gets in the way of service provision. In most cases of medical care with multiple treatment options, it is human for a provider to have a bias towards a specific option. There is nothing wrong with that. However, practitioners have a duty of care to objectively discuss these options, backed by evidence, to enable the patient to make an informed decision on what they would prefer.

It is morally wrong for the patient to be denied the option to make an informed decision, even if it is a decision that you, as the care provider, dislikes!

Dr Bosire is an obstetrician/gynaecologist