Earlier last week I was getting repeated calls from a patient and her mom who I had seen a few weeks back in clinic. She had been my patient for about a year, teenager, in school. She had started on the birth control pill even after a talk on long acting reversible contraception. She was having symptoms while at school and saw school clinic provider who said was related to stress and anxiety, occasional SOB and chest pain. When I saw her a few weeks ago, she said her mom wanted me to write her a note saying she was okay. "What?", my thought. She said she just needed a note saying that I thought she was okay and that nothing was wrong with her heart. Fine, anxious mother...not the first time.
Then the calls came, she needs another note. My nurse forwards me the calls saying she needs a note for school saying that her symptoms were related to anxiety. The fact was she had been seen in school by a clinician there who diagnosed her with stress related anxiety. Couldn't the school look at it's own records?
There is no problem to write a note, it's a part of it. But the story was changing, first it was for the mom, then it was for school. I've been through this before. The patient doesn't know exactly what they need and you end up writing letter after letter to finally get the needed result.
So I tell the patient to come in, let's get to the bottom of this. Mom shows up this time. "So you need a letter for school" I say, 'why can't the provider who saw you at school provide this information since they saw you when you had the symptoms'.
'We can't get in touch with him' the patient says.
'Why do you need this letter?', I really don't get it...
Patient looks blankly and points to her mom.
"Why do you need this letter" I repeat.
"Do you want me to tell you the truth or lie to you" mom says.
!!! really, the truth or a lie? I was exasperated. "I think I need the truth if you want to get what you need."
"Well don't judge her" mom says pointedly...the light turns on...
"She's going to have a procedure tomorrow."
Apparently when the patient filled out the paperwork for the abortion clinic, she listed chest pain. Now she needed medical clearance in order to have the procedure done. This is what the whole charade dating back one month ago had been about. The abortions services clinic told the mom to not tell me what the clearance was about because in her words "you might not write the letter".
How sad but true, see in Oklahoma, the legislators made it against the law to sue me if I lie to patients. I'm permitted to lie so that they won't get an abortion! I can certainly lie to the abortion service provider with whom I have no relationship!
It angers me. That abortion providers tell patients to hide. Patients, parents trying to help their children, live in fear of being judged or being lied to, to prevent them from exercising their constitutional rights. A whole month passes by which will make this procedure even more difficult. Imagine a savvy patient who might lie about medical problems in order to avoid the need for clearance. It's a dangerous situation.
I told the patient and her mom that I was going to do what I do for any patient who needs medical clearance for a minor procedure. No different. They seemed relieved. Just wanting to move forward, she's coming in 2 days later to get LARC.
I practice in one of the larger cities in Oklahoma. I was trained elsewhere, in a blue state where state facilities helped women who needed abortion services. Where it was a part of the discussion when a woman found out she was pregnant. Do you know all your options? What is your plan? Here are the resources.
Here in Oklahoma, the topic is taboo. Most of the time women know where to go to find these services and they don't ask me about it. When I see them they already know the direction their heading. We're in the Bible-belt, things like this aren't talked about in polite company. Abstinence only in the public schools, it's really gotten us far, landing us right at the fifth highest teen pregnancy rate in the US!
Race to the top, or bottom, such as it is. Even though some of the laws have been overridden, the effect is clear, a climate of fear and terror for women who want control over their lives.