Emergency medicine after Dobbs vs Jackson Health

[Boatswain2PA]

I think he meant "tome"

Tome: a book, especially a large, heavy, scholarly one.

Aye, sometimes my phone spells things for me!

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[emergentmd]

SCOTUS ruling will not change EM one bit. I don't see this having any relevance other than fear mongering.

This is just my opinion, may be wrong but I doubt it matters one bit.

 

[WilcoWorld]

SCOTUS ruling will not change EM one bit. I don't see this having any relevance other than fear mongering.

This is just my opinion, may be wrong but I doubt it matters one bit.

It already is affecting EM.

Starting today there is a law in my state that "the Certification of Non-Viable Birth is to be completed by the health care provider who attended or diagnosed the nonviable birth".

 

[Dr Mantis Toboggan]

It already is effecting EM.

Starting today there is a law in my state that "the Certification of Non-Viable Birth is to be completed by the health care provider who attended or diagnosed the nonviable birth".

Yeah I see an absolute ton of miscarriages etc. My patients are frequently unwilling/unable to follow up with ob/gyn. I wish I had emergent’s sweet sweet FSED set up but I ain’t that lucky (just guessing those patients may not be a huge part of his business).

 

[Apollyon]

It already is effecting EM.

Starting today there is a law in my state that "the Certification of Non-Viable Birth is to be completed by the health care provider who attended or diagnosed the nonviable birth".

But, what about the threatened or inevitable ABs? It hasn't happened yet, and the pts aren't returning with the POC, "just to be sure".

 

[WilcoWorld]

But, what about the threatened or inevitable ABs? It hasn't happened yet, and the pts aren't returning with the POC, "just to be sure".

Threatened - I don't think I need to certify. Inevitable...I'm not sure!

 

[Apollyon]

Threatened - I don't think I need to certify. Inevitable...I'm not sure!

Because, what is it, 90% or somesuch of threatened AB result in viable births? Any bleeding during pregnancy gets the "threatened" moniker?

 

[emergentmd]

It already is affecting EM.

Starting today there is a law in my state that "the Certification of Non-Viable Birth is to be completed by the health care provider who attended or diagnosed the nonviable birth".

Extra hoops seems to be part of EM hospital work which sucks but from a clinical standpoint, how does this matter much. I did hospital EM 20 yrs and can't think of a case where it affected my clinical judgement.

Viable pregnancy = go see an OB doc
Wanting morning after pill before it was OTC = I don't do that, its not an emergency.
Ectopic needing surgery = Call OB
Ectopic that can go home on MTX = prescribe MTX as fetus not viable.

Maybe I am missing something, but I don't see any change in clinical eval/treatment

 

[thegenius]

It already is affecting EM.

Starting today there is a law in my state that "the Certification of Non-Viable Birth is to be completed by the health care provider who attended or diagnosed the nonviable birth".

What does this mean though...you are the one that has to certify that, for instance, there isn't a fetal heart rate on US?

We tell patients all the time they have a threatened / incomplete / complete / missed / blighted pregnancy.

 

[thegenius]

Because, what is it, 90% or somesuch of threatened AB result in viable births? Any bleeding during pregnancy gets the "threatened" moniker?

I often diagnose the 4-8 wk pregnancies with PVB with an otherwise normal workup with "threatened AB". Just means they are at increased risk of having a miscarriage.

 

[WilcoWorld]

Extra hoops seems to be part of EM hospital work which sucks but from a clinical standpoint, how does this matter much. I did hospital EM 20 yrs and can't think of a case where it affected my clinical judgement.

Viable pregnancy = go see an OB doc
Wanting morning after pill before it was OTC = I don't do that, its not an emergency.
Ectopic needing surgery = Call OB
Ectopic that can go home on MTX = prescribe MTX as fetus not viable.

Maybe I am missing something, but I don't see any change in clinical eval/treatment

What does this mean though...you are the one that has to certify that, for instance, there isn't a fetal heart rate on US?

We tell patients all the time they have a threatened / incomplete / complete / missed / blighted pregnancy.

If a woman comes in with a miscarriage and there are products of conception and an open cervix on exam, I am now required by law to certify that she had a "non-viable birth."
I'm simply pointing out that it's not even a week after the decision was announced and there are already new laws in place that do affect me in the ED. As such, I don't think it's incorrect or "fear-mongering "to say this will affect EM.

 

[VA Hopeful Dr]

Extra hoops seems to be part of EM hospital work which sucks but from a clinical standpoint, how does this matter much. I did hospital EM 20 yrs and can't think of a case where it affected my clinical judgement.

Viable pregnancy = go see an OB doc
Wanting morning after pill before it was OTC = I don't do that, its not an emergency.
Ectopic needing surgery = Call OB
Ectopic that can go home on MTX = prescribe MTX as fetus not viable.

Maybe I am missing something, but I don't see any change in clinical eval/treatment

Isn't the morning after pill classified as "emergency contraception"?

 

[emergentmd]

Yeah I guess some

Isn't the morning after pill classified as "emergency contraception"?

To some may be defined as such but still not an medical emergency

 

[Dred Pirate]

Yeah I guess some

To some may be defined as such but still not an medical emergency

At the risk of starting a **** show. Do people always offer plan b for a sexual assault or do you direct them to their local pharmacy?

 

[emergentmd]

At the risk of starting a **** show. Do people always offer plan b for a sexual assault or do you direct them to their local pharmacy?

So I am pro life but will not judge other docs/people for having abortions. I disagree with it in the vast majority of cases regardless of gestation, but that is my beliefs.

So if someone comes in who has been assaulted, condom broke, or just wanted it to be safe then I ask the doctor working with me to take the case. I have been lucky for 99% of my career to be working in double coverage so never been an issue. I prob had about 3-4 people who requested this in 20 yrs so quite rare.

But if I were single coverage, I would tell them to come back when I am not working or go to the local UC.

 

[turkeyjerky]

At the risk of starting a **** show. Do people always offer plan b for a sexual assault or do you direct them to their local pharmacy?

I think, as a matter of decency, courtesy, and in understanding of the complicated logistics of accessing medical care in the setting of a recent sexual assault, we do a lot of things for these patients that we wouldn't do for those who've engaged in normal behavior.

Eg, if someone comes in after a sketchy hookup, I'm not offering them prophylaxis against STIs, etc.

That said, I'd be fine w/ giving out EC after intercourse. (Weirdly, I've never actually had a patient come in requesting it. Surprising, considering I used to practice at a spot where ambo rides followed by 12 hr waits for motrin prescriptions were common---plan B aint cheap!)

 

[turkeyjerky]

I keep seeing concerns about ectopics on FB/Reddit/Etc, ectopics. Personally, I think this is pretty far fetched (hopefully that doesn't age poorly...). However, has anyone heard anything about states planning to restrict the usage of uliprastal (ella)?

 

[Dred Pirate]

So I am pro life but will not judge other docs/people for having abortions. I disagree with it in the vast majority of cases regardless of gestation, but that is my beliefs.

So if someone comes in who has been assaulted, condom broke, or just wanted it to be safe then I ask the doctor working with me to take the case. I have been lucky for 99% of my career to be working in double coverage so never been an issue. I prob had about 3-4 people who requested this in 20 yrs so quite rare.

But if I were single coverage, I would tell them to come back when I am not working or go to the local UC.

I personally see a big difference in this situation between a sexual assault vs condom breaking, other unprotected sex. The later should simply never come to the ED assuming other access to EC at a local pharmacy. I would have an issue denying EC to a sexual assault pt. We had a big kerfuffel when one doc wouldn’t give it out to pt he signed up for (we had three docs at the time) and another doc got pissed and went ahead and ordered it for the pt.

I respect peoples religious views, everyone can life their life they want, but I don’t think you can push your views onto a patient who happens to have different views (assuming no laws are being broken)

PS - awhile back there was a big fit in my state where some rph's were refusing to fill oral contraceptives - I did not support them - as long as there is not another issue with the rx - (pt safety, interactions, etc) they should not deny it.

 

[thegenius]

Oh boy...it might start to get touchy on this thread...

 

[emergentmd]

I respect peoples religious views, everyone can life their life they want, but I don’t think you can push your views onto a patient who happens to have different views (assuming no laws are being broken)

So I think this goes both ways. If you are outside looking in, you have the doctor and patient. So you have two people who's views should be respected.

By not prescribing EC, I am not pushing my views on the pt. If I picked up the chart, saw the pt, lectured the pt on Pro life, and then refused EC then I have crossed the line to pushing my views on the pt.

If I were the only provider, I would see the pt, tell them I respect their right to EC, but I am not prescribing it. They can go to another ER, UC, or see their PCP to get EC. If they went to another place, their medical care is not compromised.

But I have never had to deal with this b/c I will not pick up a chart requesting EC and just have my partner see the pt. In about 3-4 of these encounters, I have never had an issue.

I think there is some similarity to the Colorado cake maker refusing to make a gay couple's cake. He is not pushing his views. He just do not want to compromise his personal morals. The couple could have easily respected his views, went to another cake maker, and moved on but they decided to make a national statement.

 

[HemeOncHopeful19]

If I were the only provider, I would see the pt, tell them I respect their right to EC, but I am not prescribing it. They can go to another ER, UC, or see their PCP to get EC. If they went to another place, their medical care is not compromised.

I think the problem is that unlike in the cake analogy you don’t get sent a bill if they don’t make the cake. Now if you no-charged them or whatever I would say that’s fine.

I do agree with your actual policy of just letting a different doc handle it though.

 

[emergentmd]

I think the problem is that unlike in the cake analogy you don’t get sent a bill if they don’t make the cake. Now if you no-charged them or whatever I would say that’s fine.

I do agree with your actual policy of just letting a different doc handle it though.

People go to the ER and pay for medical advice/treatment if needed. They don't go to get what they want or else should not have to pay. There are countless times I declined ordering an MRI and they still had to pay. Its not like when someone comes in for a cough, wants Abx, goes home empty handed that they don't get a bill.

I do not see how getting a bill has any relevance to care

 

[HemeOncHopeful19]

People go to the ER and pay for medical advice/treatment if needed. They don't go to get what they want or else should not have to pay. There are countless times I declined ordering an MRI and they still had to pay. Its not like when someone comes in for a cough, wants Abx, goes home empty handed that they don't get a bill.

I do not see how getting a bill has any relevance to care

Fair enough, I suppose I hadn’t thought about it being available OTC at a pharmacy.

 

[WilcoWorld]

Oh boy...it might start to get touchy on this thread...

It really didn't take long for this thread to get to denying emergency contraception to rape victims.

 

[Groove]

I've never found myself in a situation where I felt the need to administer EC in the ED. It's simply not an emergency and it's not my job to provide it. I have zero problems explaining that to a patient and directing them elsewhere.

 

[WilcoWorld]

I've never found myself in a situation where I felt the need to administer EC in the ED. It's simply not an emergency and it's not my job to provide it. I have zero problems explaining that to a patient and directing them elsewhere.

It could be argued that the criminalization of abortion has made this an emergency - a sexual assault victim has a very legitimate reason to seek emergency contraception in that context.

 

[turkeyjerky]

Are you guys really saying that you don't/wouldn't offer EC to a rape victim?

I get not offering it to some hood rat after a hookup under the premise of 'not an emergency', but that's something else entirely. Now I'm wondering what other standards of care you guys casually toss to the side.

 

[thegenius]

Are you guys really saying that you don't/wouldn't offer EC to a rape victim?

I get not offering it to some hood rat after a hookup under the premise of 'not an emergency', but that's something else entirely. Now I'm wondering what other standards of care you guys casually toss to the side.

When I have sexual assault cases in the ED, I do virtually nothing. I ask the patient are there any “non-sexual” injuries I need to be aware of…eg were they hit in the head, cut, etc. if they say no then I let the SART nurse do whatever they do. Then they come out and usually advise abx and sometimes plan B. I do whatever they ask for.

Strangely…I don’t recall the last time I’ve been asked for plan B or EC. Probably happened once or twice and I can’t remember the last time.

 

[Groove]

Are you guys really saying that you don't/wouldn't offer EC to a rape victim?

I get not offering it to some hood rat after a hookup under the premise of 'not an emergency', but that's something else entirely. Now I'm wondering what other standards of care you guys casually toss to the side.

I am not required by state law to provide information to the pt about EC nor am I required to dispense it upon request.

These links might help if anyone is interested in their particular state laws.

Policy Research

NCSL’s experts are here to answer your questions and give you unbiased, comprehensive information as soon as you need it on issues facing state legislatures. We answer more than 20,000 requests for information a year.

www.ncsl.org

Emergency Room Requirements to Offer Emergency Contraception Services to Sexual Assault Survivors | KFF

www.kff.org

 

[Groove]

When I have sexual assault cases in the ED, I do virtually nothing. I ask the patient are there any “non-sexual” injuries I need to be aware of…eg were they hit in the head, cut, etc. if they say no then I let the SART nurse do whatever they do. Then they come out and usually advise abx and sometimes plan B. I do whatever they ask for.

Strangely…I don’t recall the last time I’ve been asked for plan B or EC. Probably happened once or twice and I can’t remember the last time.

In my last state, our SANE(SART) nurses never asked me to provide EC (actually we had a different process). In my current state/region, the SANE examination is actually done at another facility and once I medically clear the pt, I never see them again which is fine by me. (Drastically speeds up the LOS for these patients.) If EC is offered to them, I think it's done through a different provider after the SANE examination and forensics are done. I can imagine that in a more liberal policy state, the process and state requirements would be much different. I'm in the South though, so I practice in fairly conservative areas with a pro-life agenda.

In my last state, I would be required to obtain forensics with this SANE kit and it took forever. You had to get everyone in the room so the pt wouldn't have to tell the story twice and there was so much pressure to get good samples, seal the kit properly, etc.. I hated picking up those patients. It's so much easier where I work now.

 

[emergentmd]

Are you guys really saying that you don't/wouldn't offer EC to a rape victim?

I get not offering it to some hood rat after a hookup under the premise of 'not an emergency', but that's something else entirely. Now I'm wondering what other standards of care you guys casually toss to the side.

I am not sure why abortion discussions always lead to being judged for not prescribing EC. But to your answer, and this is just what I would do which is not substandard medical care nor does it compromise the pts health. You may disagree, but I would NOT prescribe EC. You want rocephin/azithro/HIV meds, norco, xanax, I would give it without a thought. But if there is a solution that would meet standard of care and also not infringe on my beliefs, then what is wrong with this?

Telling a pt that I am not comfortable with prescribing EC and having her go to see another doc in an hour, does not increase her pregnancy chances.

I guess I miss the big issue here unless some just want to push pro lifers into a corner for a gotcha moment. Doesn't matter anyhow b/c EC are OTC, so why is this even a discussion to be had?

 

[southerndoc]

Oh boy...it might start to get touchy on this thread...

I agree. However, as long as laws and practice patterns are being discussed and not politics, then it's ok. E.g., you can say my state doesn't allow it, I personally don't want to prescribe it, etc. However, throwing in stuff about administrations, how laws should be, etc. is getting political and will be dealt with.

Yes, it's a fine line and some may disagree with what is political and what isn't, but @BoardingDoc and I monitor the boards pretty closely.

 

[WilcoWorld]

I am not sure why abortion discussions always lead to being judged for not prescribing EC.

I think it's because a healthcare system explicitly stopped providing EC due to the abortion ban:

A health system has stopped providing plan B (which is NOT an abortion pill, please educate your colleagues about this, so many medical professionals get this wrong). So yes believe people who are saying that miscarriage and ectopic management is getting harder and harder to obtain. Our ED colleagues are important in this fight so I def think if you have the capacity to get involved with your administration that would be much much appreciated.

https://www.kansascity.com/news/politics-government/article262988028.html

 

[Franzd'Epinay]

So I think this goes both ways. If you are outside looking in, you have the doctor and patient. So you have two people who's views should be respected.

By not prescribing EC, I am not pushing my views on the pt. If I picked up the chart, saw the pt, lectured the pt on Pro life, and then refused EC then I have crossed the line to pushing my views on the pt.

If I were the only provider, I would see the pt, tell them I respect their right to EC, but I am not prescribing it. They can go to another ER, UC, or see their PCP to get EC. If they went to another place, their medical care is not compromised.

But I have never had to deal with this b/c I will not pick up a chart requesting EC and just have my partner see the pt. In about 3-4 of these encounters, I have never had an issue.

I think there is some similarity to the Colorado cake maker refusing to make a gay couple's cake. He is not pushing his views. He just do not want to compromise his personal morals. The couple could have easily respected his views, went to another cake maker, and moved on but they decided to make a national statement.

This seems counterintuitive to me.

If you're staunchly anti-abortion, shouldn't you be running to prescribe EC so the rape victim could take it as fast as possible and prevent fertilization, thus avoiding an abortion down the line?

 

[Dr Mantis Toboggan]

This seems counterintuitive to me.

If you're staunchly anti-abortion, shouldn't you be running to prescribe EC so the rape victim could take it as fast as possible and prevent fertilization, thus avoiding an abortion down the line?

As Plan B might prevent implantation of a fertilized egg, some are not comfortable ordering/prescribing it.

 

[Franzd'Epinay]

As Plan B might prevent implantation of a fertilized egg, some are not comfortable ordering/prescribing it.

So wouldn't you want to prescribe it as fast as possible so that it prevents ovulation/fertilization instead of preventing implantation?

Surely something like this would fall under the doctrine of double effect, no? You're prescribing it to prevent fertilization, not to prevent implantation.

Actually, now that I think about it, you don't even need to go into double effect territory. Wouldn't this be like a regular adverse effect? There aren't many treatments in medicine that are risk-free, after all.

 

[Rendar5]

I believe it takes at least 24 hours to form a zygote after insemination (seveeal steps take place even after a sperm reaches an egg prior to zygote formation) so plan B is a pure contraceptic medication if given within the first 24 hours After 24 hours I can see someone having a concern if they’re prolife (to the same extent that someone is not a believer in IUDs).

So if you want to keep someone from a potential abortion (if you consider prevention of implantation an abortion), you may want to get someone to give it to them within 24 hours of a rape.

That said, I rarely give someone plan B as it’s usually the SANE nurse who handles that. Maybe 2-3 times in the last 10 years.

 

[turkeyjerky]

So wouldn't you want to prescribe it as fast as possible so that it prevents ovulation/fertilization instead of preventing implantation?

Surely something like this would fall under the doctrine of double effect, no? You're prescribing it to prevent fertilization, not to prevent implantation.

Actually, now that I think about it, you don't even need to go into double effect territory. Wouldn't this be like a regular adverse effect? There aren't many treatments in medicine that are risk-free, after all.

I think it's this kind of crazy thinking that leads asshat governors making comments about insisting on replantation of an ectopic.

 

[southerndoc]

I think it's this kind of crazy thinking that leads asshat governors making comments about insisting on replantation of an ectopic.

This is now turning political. Any further political comments will be dealt with accordingly.

Please refrain from putting politics into this discussion.

 

[WilcoWorld]

This is now turning political. Any further political comments will be dealt with accordingly.

Please refrain from putting politics into this discussion.

Unless we confine the discussion solely to doses and mechanism, this topic is inherently political. Any discussion of whether or not someone will or will not provide reproductive health care has political implications.

 

[Groove]

I believe it takes at least 24 hours to form a zygote after insemination (seveeal steps take place even after a sperm reaches an egg prior to zygote formation) so plan B is a pure contraceptic medication if given within the first 24 hours After 24 hours I can see someone having a concern if they’re prolife (to the same extent that someone is not a believer in IUDs).

So if you want to keep someone from a potential abortion (if you consider prevention of implantation an abortion), you may want to get someone to give it to them within 24 hours of a rape.

That said, I rarely give someone plan B as it’s usually the SANE nurse who handles that. Maybe 2-3 times in the last 10 years.

The problem is this is all hypothetical. Did they have sex with their partner 16-24 hours before the alleged rape? (i.e. Are you preventing implantation of an embryo from their partner, unknown to them, or are you preventing fertilization/embryo formation from the rapist?) Did a rape in fact occur or was it a sexual encounter with a previous paramour that ended badly and now she wants EC and is reporting it as a rape? Especially so with younger patients as I've had several teenagers that were brought in by their parents for "rape" when the story sounds like they were caught having unprotected sex in bed with someone from school. These are all things I simply can't answer in the ED and that's up to the authorities and police to decide.

Ultimately, Plan B has the ability to prevent fertilization and implantation and it's impossible to know whether fertilization has occurred or not. For those of us that have ethical/moral/religious beliefs that prevent us from termination of a potentially viable pregnancy, the use of Plan B is viewed as an abortifacient irrespective of the technical definition because of the difficulty in proving that any of the above conditions did not exist. That's usually the cause in hesitancy/refusal in administering or prescribing plan B from pro-life physicians. As I've said earlier...as an EM doc, it's even easier for me to justify avoidance of being dragged into any situations where I'm pressured to prescribe or administer any of these drugs as it's never really a true medical emergency and I'm not preventing anyone from receiving the drug in a timely manner by refusing it in the ED. They can always walk next door and obtain it from someone else. I choose to practice in a state where I'm luckily not forced to discuss or prescribe these medications.

I'm not a family doctor, not an OB/GYN, not a priest or preacher... I'm simply an emergency doc and these cases rarely if ever constitute a medical emergency where I'm obligated in any way to ensure failure/prevention of pregnancy. I think there are some truly tragic cases where consideration of these drugs is certainly understandable on the woman's part but it's simply not my job to administer or prescribe them.

 

[WilcoWorld]

The problem is this is all hypothetical. Did they have sex with their partner 16-24 hours before the alleged rape? Did a rape in fact occur or was it a sexual encounter with a previous paramour that ended badly and now she wants EC and is reporting it as a rape?

 

[southerndoc]

Unless we confine the discussion solely to doses and mechanism, this topic is inherently political. Any discussion of whether or not someone will or will not provide reproductive health care has political implications.

Are you suggested we close the thread?

 

[WilcoWorld]

Are you suggested we close the thread?

No, but I'm not opposed to political discussions.

My point is that if one's position is the status quo, then refusing to discuss it is a political action endorsing that position.

For instance, if I was a residency PD and 29 of my last 30 graduates were all white dudes, and someone said "Hey Wilco, I'd like to talk to you about whether we should be recruiting minority applicants" and I said "I don't want to talk politics" - I would be taking a political action under the guise of not talking politics.

I just don't think we can discuss the ramifications of a SCOTUS ruling apolitically.

 

[Groove]

No, but I'm not opposed to political discussions.

My point is that if one's position is the status quo, then refusing to discuss it is a political action endorsing that position.

For instance, if I was a residency PD and 29 of my last 30 graduates were all white dudes, and someone said "Hey Wilco, I'd like to talk to you about whether we should be recruiting minority applicants" and I said "I don't want to talk politics" - I would be taking a political action under the guise of not talking politics.

I just don't think we can discuss the ramifications of a SCOTUS ruling apolitically.

I'm not opposed to political discussions either but I was under the impression it's against SDN TOS hence why the moderators police it so much. That being said, any political discussion on abortion or any other hot topic is almost certain to spark a maelstrom of heated opinions which probably wouldn't serve much good other than to entertain the regulars.

All that being said, I'm glad we have a thread on the topic that's open "for the moment" because the topic is certainly relevant to most practicing physicians, regardless of specialty. It's not like any of us were that surprised to see this thread started after the SCOTUS ruling...

 

[BoardingDoc]

No, but I'm not opposed to political discussions.

My point is that if one's position is the status quo, then refusing to discuss it is a political action endorsing that position.

For instance, if I was a residency PD and 29 of my last 30 graduates were all white dudes, and someone said "Hey Wilco, I'd like to talk to you about whether we should be recruiting minority applicants" and I said "I don't want to talk politics" - I would be taking a political action under the guise of not talking politics.

I just don't think we can discuss the ramifications of a SCOTUS ruling apolitically.

I have written and rewritten numerous responses to this comment. I can not fully articulate why I feel that what you wrote is wrong except to say that moderation of political statements does not equal their endorsement, nor does it equal their antagonism. It is simply moderation. This rule exists because this is a forum about the practice of emergency medicine, and not about US politics. There are numerous venues out there which focus on the latter, and many which combine both. I would ask anyone on either side of the fence, who feels that they can not refrain from expressing what is understandably a profound personal belief, to make that expression elsewhere.

 

[WilcoWorld]

I have written and rewritten numerous responses to this comment. I can not fully articulate why I feel that what you wrote is wrong except to say that moderation of political statements does not equal their endorsement, nor does it equal their antagonism. It is simply moderation. This rule exists because this is a forum about the practice of emergency medicine, and not about US politics. There are numerous venues out there which focus on the latter, and many which combine both. I would ask anyone on either side of the fence, who feels that they can not refrain from expressing what is understandably a profound personal belief, to make that expression elsewhere.

I'm not trying to tell you to close the thread or how to moderate. That's your job and you get to decide how to do it.

I agree that moderating a discussion is not the same thing as endorsing it. Debate moderators are a good example of this. I'm talking about something different that happens when one engages in a discussion (rather than moderating it) in that case refusing to question the status quo is a form of endorsing it. That said, I think I've made my point as clearly as I can, so I'll stop harping on it for now.

 

[thegenius]

I'm not a family doctor, not an OB/GYN, not a priest or preacher... I'm simply an emergency doc and these cases rarely if ever constitute a medical emergency where I'm obligated in any way to ensure failure/prevention of pregnancy. I think there are some truly tragic cases where consideration of these drugs is certainly understandable on the woman's part but it's simply not my job to administer or prescribe them.

It's really sad, I believe. A woman can be raped or sexually assaulted, and by all accounts a legitimate, believable story...and you might administer ceftriaxone and azithromycin but not Plan B? For some reason semen-infused gonorrhea or chlamydia is worth treating or prophylaxing, but not pregnancy? The woman was raped!

She was held down and forcefully inseminated against her will.

 

[southerndoc]

Semen-infused gonorrhea? LOL

 

[wholeheartedly]

I‘m having a really hard time with this. If a woman is raped and in an ED being examined, I can pretty much guarantee all she wants to do is get it over with and go home where she can curl up into a ball and cry. But now, despite the trauma she’s experienced, she’s got to figure out where else she can go to get meds to prevent her becoming pregnant from this horror? and tell more ppl what happened, and pay more money she might not even have? it is not small thing to pay to go somewhere else. no small thing at all and really out of touch with a lot people’s financial reality.