Why do 85% of GPs not provide abortion services? - mod warning in OP (01/01/20)

SteM

Many doctors didn't offer free healthcare for under sixes either, they're businesses at the end of the day.

Beasty

FAMLEE - do not post in this thread again

One eyed Jack

bfa1509 wrote: »

I hate to open up this debate again, but I was baffled at how these abortion statistics were presented by RTE today:

https://www.rte.ie/news/2019/1231/1103681-unplanned-pregnancy-freephone/

The title says "Floodgates didn't open when abortion services introduced" according to the head of a maternity unit.

Buried in the article are the following statistics, which should be the real headline:

48% of maternity units do not offer abortion
85% of GPs do not offer abortion services

Why is this? These are shocking statistics!

Because litigation is a distinct possibility, and most GPs and hospitals will prefer to err on the side of caution to avoid expensive compensation claims and legal cases which would have adverse consequences for them personally and professionally. All medical professionals are averse to any liability for any consequences of their actions.

AndrewJRenko

It should be a requirement when the HSE are coming to renew contracts for medical cards - GPs should be required to provide the service if they want the contract for medical card patients.

AulWan

I am so grateful I live in a county where there are plenty of Well Woman Clinics who do not judge and whose primary focus is to take proper and compassionate care of their female patients, whatever their needs.

They are a little bit more expensive for private patients, but for any medical card holder, the Coolock WWC accepts medical card patients.

volchitsa

One eyed Jack wrote: »

Because litigation is a distinct possibility, and most GPs and hospitals will prefer to err on the side of caution to avoid expensive compensation claims and legal cases which would have adverse consequences for them personally and professionally. All medical professionals are averse to any liability for any consequences of their actions.

Litigation is a risk for any hard-to-diagnose, or hard to treat, condition but we wouldn't find it acceptable for doctors to opt out of providing care for complicated conditions and to only care for patients with simpler illnesses.

Why do you think abortion would be more likely to lead to litigation than, say, surgery or indeed problems arising from a difficult birth?

Loafing Oaf

Pauliedragon wrote: »

I would say a lot of doctors might be scared of a potential backlash from pro lifers. We've all read of cases over the years in other countries of places being vandalised and worse. I'm not saying it would go that far but it's still a devisive issue here. It might take a generation of people who never remember a country without abortion to have it more normalised and make more doctors comfortable providing it.

I think this is the main reason. Now in reality what protests there have been at GPs to date have been very low-key and sporadic AFAIK, but doctors would have a horror of any sort of controversy around their clinics. I don't think it'll take 'a generation' for this concern to die away though. Only a small number of GPs provided contraception when it was first legalised, but by the 1990s it was just a normal part of their service.

Eric Cartman

AndrewJRenko wrote: »

It should be a requirement when the HSE are coming to renew contracts for medical cards - GPs should be required to provide the service if they want the contract for medical card patients.

Why though, clearly demand is low and id even go as far as to say if there was 3-4 gp’s in each city in ireland offering it that it would meet most demand and accessibility requirements

Plumbthedepths

splinter65 wrote: »

Seems doctors in Ireland aren’t going to be told they have to be abortion facilitators either, just saying....

As long as they refer patients to a doctor who will provide the service no issue.

Wesser

15% is plenty. if the numbers were higher than that then each gp would be seeing so few patients for abortion every year that they would de-skill.

doctors need to be seeing a certain number of each condition every year to get good at treating it. thats what specialization is about.

AulWan

Plumbthedepths wrote: »

As long as they refer patients to a doctor who will provide the service no issue.

Thats fine, if they don't charge the patient for the appointment to write the referral.

If they don't want to provide abortion services themselves, they shouldn't want to gain financially by charging to write a referal to another doctor. And before anyone says its the same as writing a referal for a consultant, its not.

This is a service any GP is qualified to provide, under 9 weeks, its a waiting period, followed by a prescription.

One eyed Jack

volchitsa wrote: »

Litigation is a risk for any hard-to-diagnose, or hard to treat, condition but we wouldn't find it acceptable for doctors to opt out of providing care for complicated conditions and to only care for patients with simpler illnesses.

Why do you think abortion would be more likely to lead to litigation than, say, surgery or indeed problems arising from a difficult birth?

We wouldn’t find it acceptable? There isn’t anything anyone can do to compel medical professionals to provide treatments they don’t wish to provide, whether anyone finds that acceptable or not.

I don’t think abortion would be any more likely than any other procedure to give rise to litigation, but no indemnity from prosecution means medical professionals aren’t going to take risks they aren’t comfortable with when they can’t be compelled to do so.

Loafing Oaf

AulWan wrote: »

This is a service any GP is qualified to provide, under 9 weeks, its a waiting period, followed by a prescription.

AFAIK GPs dispense the pills directly themselves

Wesser

What percentage of GP s insert coils?

a very relevant but not so topical question!

Shefwedfan

Wesser wrote: »

What percentage of GP s insert coils?

a very relevant but not so topical question!

Are you really trying to compare a life to a piece of plastic?

Not at all relevant

Loafing Oaf

Shefwedfan wrote: »

Are you really trying to compare a life to a piece of plastic?

Not at all relevant

I think he/she is suggesting if the number of GPs providing the service comfortably meets the demand, then the percentage doing it isn't of much significance.

volchitsa

One eyed Jack wrote: »

We wouldn’t find it acceptable? There isn’t anything anyone can do to compel medical professionals to provide treatments they don’t wish to provide, whether anyone finds that acceptable or not.

Actually there is. It comes under professional ethics, for starters. If some medical treatment which is adapted to the patient's needs is refused due to the doctor's personal wishes or beliefs, that's a potential FTP charge. Even if there is little harm done to the patient.

The reason there have traditionally been exceptions for sexual health care such as contraception and abortion is because of religious influence. But those are the exceptions, not the rule, and thankfully IMO they are being eroded.

I don’t think abortion would be any more likely than any other procedure to give rise to litigation, but no indemnity from prosecution means medical professionals aren’t going to take risks they aren’t comfortable with when they can’t be compelled to do so.

You're just making stuff up again, Jack. The fact of delivering a baby means the doctor or midwife incurs a risk, but as healthcare professionals they have a requirement for providing care which means they are expected to take that risk and simply to take reasonable precautions so as to minimise the risk. Oh, and insurance.

That's why there is a duty to provide care in medicine, not to guarantee outcomes. Because the outcome can never be guaranteed (we all die in the end), the professional is expected to provide the care that is best adapted to that patient. No more, but also no less.

Wesser

of course its relevant.
Do we monitor what percentages of gp s do various tasks.
why do we only monitor what percentage provide abortions?
of course if more gp s put in mirena coils... we wouldnt need so many abortions..... or is it so? do a high enough percentage of gp s put in coils that the market is saturated and demand is met? or maybe if we had more gp s putting in coils the price would come down and the service would become more accessible? if coils were freely available... would the demand for abortion decrease? i dont know. they are hyppthetical questions.

Albhabeth

I had an abortion recently. I found out that I was pregnant very early at 5 weeks. I immediately made an appointment with a women's centre - avoided my normal GP because he has no interest or patience for gyno issues.

By the time an appointment was available, my pregnancy was medically confirmed (e.g. bloods sent away and results back), plus the 72 hour waiting period, and one counselling session, it had taken more than 3 weeks after I first presented.

I finally was allowed to take the tablets at more than 8 weeks pregnant. My mind wasn't fluctuating and I wasn't hyper emotional or anything. The only parts I can describe as upsetting or stressful was the delay and the abortion itself was quite painful and a bit more so because of being further along.

It's actually - or at least could be in the future - a huge problem that so few services are active and available because of the time sensitivity of the issue. I'm sure if I was closer to the cut off date I could have been prioritised however.

brightspark

AndrewJRenko wrote: »

It should be a requirement when the HSE are coming to renew contracts for medical cards - GPs should be required to provide the service if they want the contract for medical card patients.

There are areas in the country where medical card holders have trouble finding a GP who can take them as it is.

As the referendum was 66.4 per cent to 33.6 per cent, you would expect that there might be in the region of 66% of doctors providing the service, but perhaps doctors have a better insight than the general population.

But even assuming that doctors actually voted in similar ratios to the general public, it would still mean that if doctors were forced to withdraw from the medical card scheme if they refused to provide the service, then you can expect about one in three doctors to no longer be available to medical card holders, imagine what that will do to the waiting lists!

As someone without a medical card it should improve things for me but I wouldn't want to be a medical card holder waiting to see a GP.

Wesser

Albhabeth wrote: »

I had an abortion recently. I found out that I was pregnant very early at 5 weeks. I immediately made an appointment with a women's centre - avoided my normal GP because he has no interest or patience for gyno issues.

By the time an appointment was available, my pregnancy was medically confirmed (e.g. bloods sent away and results back), plus the 72 hour waiting period, and one counselling session, it had taken more than 3 weeks after I first presented.

I finally was allowed to take the tablets at more than 8 weeks pregnant. My mind wasn't fluctuating and I wasn't hyper emotional or anything. The only parts I can describe as upsetting or stressful was the delay and the abortion itself was quite painful and a bit more so because of being further along.

It's actually - or at least could be in the future - a huge problem that so few services are active and available because of the time sensitivity of the issue. I'm sure if I was closer to the cut off date I could have been prioritised however.

thank you for your contribution. the true metric of performance will be mean wait time for the service... not the percentage who provide the service. we will only find that out next year.

however can i also point out that lots of irish people are on waiting listsfor years for services that are not so topical or controversial or linked with feminism.....eg a hip replacement, arthritis, endometriosis, and suffer with their symptoms and and this affects their emotionsl state and quality of life. however because abortion is so topical.... it gets all the lights.

Albhabeth

Wesser wrote: »

thank you for your contribution. the true metric of performance will be mean wait time for the service... not the percentage who provide the service. we will only find that out next year.

however can i also point out that lots of irish people are on waiting listsfor years for services that are not so topical or controversial or linked with feminism.....eg a hip replacement, arthritis, endometriosis, and suffer with their symptoms and and this affects their emotionsl state and quality of life. however because abortion is so topical.... it gets all the lights.

I think the main issue with waiting times for this service is that they're important specifically because of the legal cut off times. Like it was rare that I found out so early about my pregnancy, most women don't until around 6-8 weeks. And the procedure is relatively simple too in early pregnancy. Just take some prescribed pills in your own home - no extended doctor contact time or overnight stay required. It could easily be much quicker and simple if services were available.

Logistically, not just because of feminism, it's not quite comparable to the long term illnesses you mentioned but obviously the health service as a whole does require improvement in most areas.

Albhabeth

Albhabeth wrote: »

I think the main issue with waiting times for this service is that they're important specifically because of the legal cut off times. Like it was rare that I found out so early about my pregnancy, most women don't until around 6-8 weeks. And the procedure is relatively simple too in early pregnancy. Just take some prescribed pills in your own home - no extended doctor contact time or overnight stay required. It could easily be much quicker and simple if services were available.

Logistically, not just because of feminism, it's not quite comparable to the long term illnesses you mentioned but obviously the health service as a whole does require improvement in most areas.

Not to be flippant, but medical abortion wait times are a simple fix. In most cases all that's actually needed is pee on a stick, take a tablet, take one day off work. This is easily done if doctors offered the service and doesn't take away from other healthcare needs. As an endo sufferer myself, I know well about waiting times and diagnostic swings and roundabouts

Dav010

Medics are permitted to opt out of providing this service if they consciously object to it, the GP cannot be forced to carry out an abortion. But there are obligations and responsibilities which the GP must adhere to, for instance to provide aftercare and advice, and to refer to a colleague/Clinic where the service is available.

The provision of this service will never be a condition of a HSE contract, the Government would not be stupid enough to continence including it as a condition, the Medical Council would not agree to it, the IMO would never accept it.

In all likelihood, this is a generational issue. Many current GPs are above the age of 50 and have hardened opinions on this matter, Doctors training to be GPs will receive more training in this and will be more likely to provide the service.

Beasty

I've just deleted a number of posts

Do not turn this into a rehash of the referendum discussion. This thread is about GPs not providing abortion services. Stick to that

Any questions PM me - do not respond to this post in-thread

One eyed Jack

volchitsa wrote: »

Actually there is. It comes under professional ethics, for starters. If some medical treatment which is adapted to the patient's needs is refused due to the doctor's personal wishes or beliefs, that's a potential FTP charge. Even if there is little harm done to the patient.

The reason there have traditionally been exceptions for sexual health care such as contraception and abortion is because of religious influence. But those are the exceptions, not the rule, and thankfully IMO they are being eroded.

It doesn’t come under professional ethics that a medical professional can be compelled to provide services they do not wish to provide. That would simply be unethical in and of itself. Specifically in cases where abortion services are concerned, a conscientious objection is provided for by both the Irish Medical Council and Irish Law -


Guide to Professional Conduct and Ethics for Registered Medical Practitioners (Amended), 8th Edition 2019

Health (Regulation of Termination of Pregnancy) Act 2018

volchitsa wrote: »

You're just making stuff up again, Jack. The fact of delivering a baby means the doctor or midwife incurs a risk, but as healthcare professionals they have a requirement for providing care which means they are expected to take that risk and simply to take reasonable precautions so as to minimise the risk. Oh, and insurance.

That's why there is a duty to provide care in medicine, not to guarantee outcomes. Because the outcome can never be guaranteed (we all die in the end), the professional is expected to provide the care that is best adapted to that patient. No more, but also no less.

Your language is fairly vague, and I don’t know what you mean when you say I’m making stuff up (again?) when these are the facts -


Only ten out of the 19 maternity units in the country offer full termination services while the others offer care, supervision and manage complications arising from abortions.

Health Service Executive data shows that as of 13 December, 348 GPs had signed the contract to provide abortion services, which represents only 15% of GPs nationwide.


It seems entirely reasonable to conclude that medical professionals cannot be compelled to provide services they do not wish to provide, and they cannot be compelled to provide, and they are unwilling to provide those services due to the risk of litigation given they are not indemnified from prosecution. Oh, and insurance - insurance is already expensive as it is, and litigious claims don’t make the cost of insurance any cheaper, nor does insurance indemnify any medical professional from any civil or criminal liability. It’s entirely reasonable to conclude that given those numerous factors, medical professionals are more comfortable with some risks than they are with others, and it would be unethical to compel medical professionals to take risks which they have a conscientious objection to, which is why they aren’t obligated to provide services they do not wish to provide.

I don’t see how attempting to force medical professionals to provide services they do not wish to provide is in any way acting in a patients best interests tbh, far more likely that their needs would be better served by the small number of medical professionals who are willing to provide those services in spite of the risks to them both professionally and personally.

One eyed Jack

Wesser wrote: »

thank you for your contribution. the true metric of performance will be mean wait time for the service... not the percentage who provide the service. we will only find that out next year.

however can i also point out that lots of irish people are on waiting lists for years for services that are not so topical or controversial or linked with feminism.....eg a hip replacement, arthritis, endometriosis, and suffer with their symptoms and and this affects their emotionsl state and quality of life. however because abortion is so topical.... it gets all the lights.

That’s not the reason at all why issues around abortion are such a time sensitive issue, it’s simply because of the fact that a termination of a pregnancy can only be considered within the time frame of a woman being pregnant, and the sooner a termination of pregnancy is provided, the better the outcome for the woman.

Other conditions simply aren’t as time sensitive as pregnancy and that’s why the idea of ‘waiting lists’ for a termination of pregnancy will tell you precisely nothing, and cannot be compared to waiting lists for other conditions, nothing to do with being controversial or “being linked with feminism”, it’s simply a fact that there are far more practical concerns involved in pregnancy.

AndrewJRenko

Wesser wrote: »

15% is plenty. if the numbers were higher than that then each gp would be seeing so few patients for abortion every year that they would de-skill.

doctors need to be seeing a certain number of each condition every year to get good at treating it. thats what specialization is about.

I know this principle apply to surgery and very specialised tasks, but does it really apply to a GP led service like this?

Eric Cartman wrote: »

Why though, clearly demand is low and id even go as far as to say if there was 3-4 gp’s in each city in ireland offering it that it would meet most demand and accessibility requirements

People should be able to use their own GP for all services, where it is technically feasible that the GP can provide the service. People shouldn't have to travel to other parts of town and starting from scratch on their medical history unnecessarily.



If you want the fairly lucrative contract to provide medical services, you should be providing a full range of GP services.

Dav010

Eric Cartman wrote: »

I dont k ow if i buy the last bit though, there are a serious contingent of younger people who are also pro-life , many from non eu countries entering the medical field also. I dont think youll see as much of a shift as you think

You could be right. Because it is such an emotive issue, many current GPs may either object or just simply decide not to offer a procedure which they have not provided previously in their professional careers. But new grads will be trained for this, and Doctors going through GP training will see this procedure more often. But I agree, it will be the decision of the GP, either on moral, religious or practically grounds.

thomasdylan

AndrewJRenko wrote: »

If you want the fairly lucrative contract to provide medical services, you should be providing a full range of GP services.

Medical card contract rates aren't lucrative at all though. There's lots of complaints from GPs about it and there's also a massive shortage of GPS.

The decision to provide abortion is a moral one and morality is subjective. Forcing someone to go against their own ethical beliefs on abortion is wrong.