it is hot. the room is filled with people all eager to listen, and the ceiling fans are not doing a great job of moving the hot air around. the resident goes through the PowerPoint, then it's question time. the professor (of reproductive medicine) is there again. he asks very specific pimping questions, with theory and mechanisms thrown in. the resident keeps redirecting questions to me, referring to me as Miss ALex. Miss Alex? who the fuck is miss alex? what is this the miss muffett's story hour? you can at least settle on dr. alex! i am, of course, sweating: it is uncannily hot, too hot to think, and all i can think of is slowing down my metabolism and breathing in futile hopes of sweating less.
the first problem is clinical practice: what is used in the US as emergency contraception is different. so while plan b (progestin-based contraception) is available in Vietnam, it is apparently way more expensive than Mifepristone (also known as 'the abortion pill', which in the US can only be dispensed by specially licensed physicians, whereas here you can buy it in the pharmacy). so while i can speak of efficacy and dosing, practically speaking all these questions of use, or even more important theoretical discussions of prostaglandin paracrine effects (yes, we got into that too) is useless because that's not our practice.
then i am asked why women in the US continue to use emergency contraception, adn i am faced with the dilemma of explaining to my culturally and socially conservative audience about prevalence of one-night stands, drunken mistakes, or american dude's dumb inability to put on a condom. the truth is, i dont know. the truth is it is not always drunken hook ups, it is sometimes very responsible contraceptive failure, like forgetting to take a singular pill, or the condom actually breaking. sometimes, it is on again, off again boyfriends; it abusive and coercive partnerships, it is difficulty in getting to one's doctor on time. there is no singular answer. so why, then, despite the ability to buy plan b without the prescription (yes, at someone high price) and even more effective Ella (yes, at even higher price), the unintended pregnancy rate in teh US remains so high? why dont patients take plan b if/when needed but turn to pregnancy termination, the rates of which, also, remain so high? are we as physicians not doing a great job telling women about this emergency contraception thing? or, better yet, are we doing a shitty job contracepting women in the first place? and while as a family planner i fully believe that long-acting reversible contraception is the best-est ever, i cannot place a device in the uterine cavity without my patient's consent. nor can i show up at her house every morning to remind her to take a pill, or stalk her at a bar and remind her to put on a condom. i guess what we can do is continue to remind our patients that emergency contraception does exist, in cases of those unanticipated trysts, OKCupid dates taht have gone too great, or in cases of abuse and domestic violence.
alright, i will get off my soap box. the horse is dead, its beaten body is now rotting in the sweltering heat.
No comments:
Post a Comment