Doctors and nurses should be cautious when faced with a seemingly innocuous request to change the method or type of contraception.
An immediate agreement that this can be done defuses the aggression and determination not to be talked into continuing with what seems to be the cause of difficulties. Then the situation can be further explored to find out what is behind the anxiety.
Mrs J. had her hair combed into an immaculate French pleat at the back and was wearing a smart business suit. She put her briefcase between herself and the doctor. She wanted to be sterilized and come off the Pill. ‘That man doctor said I was far too young and would change my mind?’ She harrangued the doctor about ‘men’ and ‘patronizing doctors’ until this woman doctor felt uncomfortable not agreeing with her. The doctor shuffled the notes around and managed to interject, ‘Some doctors are like that but Dr M. is usually quite sensitive and understanding.’ Mrs J. stopped her complaints and glared at the doctor accusingly. ‘Anyway,’ the doctor continued, ‘tell me about why you would like to be sterilized.’ Mrs J. explained that she was 26 had a responsible executive career and did not want any children. She did not want to go on taking contraceptive pills, she always felt nauseous when she restarted each pack and was sure they could not be doing her body chemistry any good. Other methods? They were quite disgusting or barbaric or just unreliable, so she had decided on sterilization. ‘What about your partner?’ the doctor queried. ‘My husband,’ she emphasized, ‘understands that my career must come first.’ There was an expression of contempt on her face. The doctor, attempting to understand the contempt, tried out: ‘It sounds to me as if you wish he would disagree.’ Mrs J. was less strident, ‘Oh, he never stands up for himself – he likes a quiet life.’ There was a long pause. ‘He can’t even get an erection half the time now,’ she said, looking more vulnerable. ‘He offered to have a vasectomy, but I thought it might make the erection problem worse.’ With the loss of her defensive hostility, the doctor was able to talk with Mrs J. about her relationship. Her need always to be seen to be in charge at work and how difficult it was to switch off when she was at home. How she wanted him to be assertive (and erect). She did not ask about sterilization again, had a routine check and renewal of the Pill and left, promising to return if things were not improving.
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