Selecting a Medical Provider On
 One day you're going to reach the point where you'll need to see a
gynecologist. A gynecologist is a doctor who specializes in female
reproductive health services. Most are also obstetricians, or doctors
who specialize in pre-natal and pregnancy care, and you'll see them
referred to as OB-GYNs. The first visit to any doctor can be
fear-inducing, but for most women, that first trip to the gyno is more
frightening than just about anything else they can imagine.
It is an important and potentially lifesaving thing to do, however, and
it is critical that you select a doctor with whom you are comfortable;
one you feel you can share very intimate details of your personal life.
This article is intended to help you think through that process to
ensure you get the best care possible.
Necessity of Reproductive Health Care
When should you seek the care of a gynecologist (gyno)?
Guidelines established by the American College of
Obstetricians and Gynecologists (ACOG) recommend a brief, non-pelvic exam visit with a
gyno between the ages of 13 & 15 to discuss reproductive health, puberty
changes, menstrual periods, etc. Once you turn 18 or become sexually
active (whichever comes first), you should have an annual pelvic exam
and pap smear. These exams are important because they allow the doctor
to detect changes in your cervix and other structures that could portend
the development of cancers and a variety of other medical conditions.
With the increasing prevalence of HPV these days, these exams can be an
important mechanism to detect changes in your body that might be
indicative of problems down the road.
 Selecting a Gynecologist
Your gynecologist will be among the most important healthcare providers
you'll ever have This will be a person you'll discuss some of your most
intimate secrets with, and it will be vital that you establish a close
trust. Therefore, it is essential that you select someone who you can
feel comfortable with and shares the same values with respect to sex,
pregnancy and other aspects of your reproductive health.
Most girls will initially start out seeing the same doctor their mothers
have seen, and this is an excellent way to find one, assuming your
mother trusts him/her. If you are fortunate enough to have a mother you
can confide in and respects your right to have your own "space" when it
comes to reproductive health services, this is generally an excellent
option. In some cases, however, you may wish to have a different
doctor; perhaps one that you feel will maintain confidentiality and
won't reveal anything you say to your parents. If you're insured
(either through school, your parents, or your own policy), you'll need
to verify that any doctor you select is on the list of acceptable
doctors with your insurance company. Keep in mind that, if you use your
parent's insurance to pay for services without telling your parents in
advance, they may discover this when they receive a notice of benefits
paid in the mail down the road.
Once you arrive at your appointment, you’ll fill out some paperwork and
be taken back to have a cursory preliminary exam (blood pressure, pulse,
etc.). Shortly thereafter, the doctor will come in and introduce
himself or herself. At this point, you'll want to explain to the doctor
that you have a couple of questions before s/he begins the exam –
questions that you would like to ask to gauge whether or not s/he is the
right doctor for you. Any reasonable doctor will be happy to entertain
such questions. If s/he shows hesitation or refuses to answer your
questions, this should be a red flag to you and you should politely
thank him or her for his or her time and leave (checking out with the
receptionist).
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There are some critical questions you need
to ask any doctor you are considering:
- What are your polices on
confidentiality (see below) – will you keep what we discuss from my
parents? If the doctor feels the need to treat you like a child and
not keep your discussions private from your parents, you'll probably
want to find another doctor.
- What are your views on teenagers and
sex? You want someone who will be non-judgmental and is more
concerned with your health than imposing his/her morality on you.
If the doctor says s/he doesn't prescribe birth control for teens
(or even unmarried women like some do), then you should consider
finding a new doctor, regardless of whether you plan on getting on
BC or not. Again, you want to find someone who will be concerned
about your health, not your morality.
- Once I start hormonal birth control,
how long must I use a backup such as a condom? If your doctor says
something along the lines of “one month,” you should seek another
doctor. You can stop using a condom immediately if you begin birth
control on the first day of your period, and after one week if you
begin taking it on any other day.
Some doctors don't bother to keep up with the latest information
about how BC works, and providing this kind of erroneous information
is a good indicator that s/he isn't keeping up with the state of the
art when it comes to BC. You don't want someone treating you who
isn't keeping up with the latest information.
- What are your views on abortion
referrals? If you're one who considers abortion a viable option for
an unwanted or problem pregnancy, you'll want to be sure that your
doctor will treat this decision with respect and will honor your
requests for appropriate referrals. You don't want to find out too
late that your doctor doesn't believe in abortion after you've
become pregnant. Again, the focus should be on your health and not
his/her morality.
- What are your views on pre-natal
care and childbirth (assuming the doctor is also an obstetrician)?
This will give you some idea of how a pregnancy will be handled
if/when you become pregnant. Ask the doctor if he is going to allow
you to make the decision about whether to deliver vaginally or
through Caesarian, or if s/he is going to feel s/he has the right to
make those decisions for you. Some doctors try to coerce women into
delivering via C-section because of malpractice concerns rather than
any concern for your health.
- Will you provide me with a
precautionary prescription for Plan B? If you're going to be
sexually active and can't or don't want to be on a hormonal form of
birth control, then it is critical that you get a precautionary
prescription for Plan B just in case. This is true even if you
aren't sexually active. If you are raped, most states do not
require hospitals to even let you know Plan B exists, let alone
provide you with a dose. You never know when you're going to need
this, and some doctors wrongfully believe Plan B is an
abortifascient (even though it is only a high dose of regular birth
control) Again, you don't want an ignorant doctor or one who is
concerned with his/her morality over your personal health. You
should be the one who decides if you are going to get pregnant, not
your doctor.
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Planned Parenthood & Other Clinics
The Planned Parenthood Federation of America, (Planned Parenthood, or
PPFA) is the pre-eminent reproductive health services provider for young
people. It has clinics in every just about state in the country, and
offers the entire range of reproductive health services at the vast
majority of them. PPFA is a name you can trust, and you can feel
comfortable seeking health services at any of their clinics anywhere in
the country. If you can't find a reliable doctor near you, or just want
quick access for exams, birth control or related services, PP is easily
an excellent choice. You can find the nearest Planned Parenthood
HERE
If you're fortunate enough to be in a high school that offers basic
reproductive health services, they can often help you find a doctor that
specializes in adolescent health care that would be an excellent fit for
you (and frequently offer basic services on site). And, if you've waited
until you've gotten to college, most colleges have on-campus health
clinics that offer a wide range of reproductive health services (or can
provide referrals to off-campus doctors who do). Many states also have
public health clinics that provide basic reproductive health services as
well, including birth control at reduced rates. Check your state health
department's web site for locations and additional information.
Honesty
Once you've found a doctor you are comfortable with, it is essential
that you are honest and forthright with him/her. Doctors are there to
ensure your health, and if you aren't telling the doctor what you're
doing with respect to your sexual health, there's no way s/he can do the
job properly. If you're sexually active, let him/her know, and be
prepared to explain to what extent you've had sex, and any relevant
background that s/he might ask about. It might be a bit embarrassing at
first, but it will get easier as you develop a trusting relationship
with the doctor. In the long run, it is critical that you level with
him/her to ensure that you get the best, most appropriate care.
"Crisis Pregnancy" Centers
Becoming pregnant as a teen, especially if it was unplanned can be a
terrifying experience. You may be tempted to seek out help at the first
place you find. Perhaps you’ll look in the yellow pages, or on an
Internet directory, or you may just happen to be passing by some place
that advertises "pregnancy help" - a "crisis pregnancy" center that
promises to offer you "help" with your pregnancy. This seems like just
the place to turn if you suddenly find yourself pregnant, and don't have
a doctor you can rely on to examine your options.
The problem comes when you go in to discuss your options with these
folks. Many "crisis pregnancy" centers are simply fronts for religious
or "pro-life" organizations whose sole purpose is to dissuade you from
having an abortion, or, in many cases, even considering abortion. If you
bring up the subject of abortion, they'll show you images of mutilated
fetuses (many of them PhotoShopped to enhance their effect on you).
These places will often locate near high schools and colleges, and it is
not uncommon for them to take over locations that used to be occupied by
a Planned Parenthood or other reproductive health clinics knowing that
women will come in believing that they are in a Planned Parenthood
facility (and therefore expecting honest information).
These places are typically staffed by volunteers associated with a
church or religious group, and they are not required to be licensed as
medical providers (that alone should be a red flag). The vast majority
of the employees in these places have no formal medical training
whatsoever, and have only rote information that they drone out to try to
persuade a woman from contemplating all of her alternatives. They
promise to "be with you all the way" and they will - until your child is
born. Sure, they may provide you some free diapers and formula, but once
your child is born, their mission will be over and it becomes your
responsibility.
The point is, if you want completely legitimate, honest and unbiased
information, you want to avoid these places. Regardless of the decision
you make (even if you are anti-abortion yourself), you are entitled to
receive full, unbiased, medically accurate information upon which to
make your decision, and you can't rely on these kinds of facilities to
provide it.
Confidentiality
One thing you will want to discuss with any doctor you are considering
is how they interpret confidentiality laws relating to minors and
reproductive services. If you are 18 or older, this is a non-issue,
since the federal Health Insurance Portability and Accountability Act (HIPAA)
guarantees your confidentiality with respect to medical treatment, even
with respect to your parents. With minors, however, there is a mix of
state and federal regulations that affect what doctors can and cannot
share with your parents. Most states have laws that guarantee a minor's
access to confidential reproductive health services (for those 12 and
older). This is largely the result of federal Title X legislation that
provides family planning service funds to states. HIPAA also provides
some protections against disclosure for medical treatment.
It would be beyond the scope of this article to explain how these laws
interrelate and how they work in all 50 states, so the best course of
action is for you to specifically discuss how your doctor interprets
these laws and explain to him/her that you expect full confidentiality
in all of your reproductive health issues unless you specifically
authorize him/her to release information to your parents. S/he expects
honesty from you, and it is perfectly legitimate for you to let him/her
know that honesty is expected in return.
Summary
Your reproductive health is one of the most critical aspects of being a
female. The choices you make about how to manage your sexuality and the
health issues that are involved with it can have a significant impact on
your life, and you'll want to select a medical provider who you can
trust to help you make those decisions without being judged or having to
worry about the doctor substituting his/her morality for what's best for
your personal health. Do your research, find a doctor and ask questions
that you consider important about your reproductive health. Make sure
the doctor you choose is one you can trust and are comfortable with.
Your very life could depend on it.
Related Articles:
Your First Trip to the Gynecologist
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