Signature Block Professional Medical Consent Made Easy

Signature block professional medical consent

hey guys welcome back mama dr. Jones OBGYN and mom 2 4 we're talking about tubal ligation or getting your tubes tied and having to have your husband's consent for that this tweet is from Hollie resist and it says my OBGYN just said if I want my tubes tied electively than my husband's signature is also required on the release form I asked her if that was a long she said it's not but it's their policy my face has been stuck like this for 15 minutes I'm pissed as you should be Hollie resist that is insanity let's talk about it a lot of you guys were tagging me in this asking me is this true do you do this is it required what does the law say my initial reaction was this is insane I've never heard of this this must be just some terrible physician the more I started reading the more I was horrified by everybody's experiences with discussing tubal ligation with their physician so I wanted to look more into what are the laws surrounding requiring a spousal consent for permanent sterilization and then to talk a little bit more just about tubal ligation or getting your tubes tied in general so I found an older article this is 1974 Journal of American Medical Association which is JAMA a very popular peer-reviewed research journal I can't see the whole thing but I can see the abstract and even then it seems like there was some contention among physicians whether this should be required or not newsflash 1970s it should not I'm calling you from 2020 and we're apparently still having problems with this and I don't know why and it's blowing my mind it seems like this was extremely common in the 1970s that was legally challenged in a handful of legal cases deemed inappropriate to require spousal consent for permanent sterilization however it never went to the Supreme Court so it was never actually made illegal it just was kind of looked down upon that means nobody's stopping any individual physician or hospital system from having this as requirement which is crazy it is worth saying that there's a lot of really insane regulations from both the federal government and insurance companies and hospital systems about permanent sterilization for instance if a hospital system is Catholic owned you can't do permanent sterilization procedures in that hospital at all patient comes in they're pregnant they're having a baby by c-section they want their tubes tied doesn't matter you can't do it that Hospital has deemed you can't tie tubes in its facility in the town I live in there are two hospitals one of them they can't do any kind of permanent sterilization procedures they also won't place IUDs unless it's for something other than contraceptive birth control I don't work anywhere like that I would have a very hard time with that it was never made illegal and now what people can just do it if they want I guess so I live in trained in and work in the south and have never been around this personally there are plenty of people on the internet who are saying that they experienced this and I asked a group of my OBGYN friends there were a handful of them who said yeah I've worked with someone who does that you guys why less common but still written about is spousal consent being required for vasectomy I found a handful of places where people were saying this but by and large the men that I saw talking about this were like no I just walked in and got my vasectomy based on completely anecdotal evidence because I don't have any way to get any evidence other than that it seems like it happens much less frequently with vasectomy it needs to be made illegal because that is not okay you own a uterus but you're a person with autonomy to make decisions for yourself first and if you are in a situation where you want your tube side and your spouse doesn't want you to do that the first thing you should do is work it out with your spouse but I'm saying that from the privilege of being in a relationship that's not manipulative and not one-sided every person has autonomy over their body and their decisions I didn't feel like I had a ton to say about that other than one it's abhorrent to it should go away and three how do we get it to the Supreme Court to make it a federal law that you can't require spousal consent for someone to get their tube side I need a breather when I talk I don't know the answer to that I don't know how to make that happen it would be nice if maybe someone watching this knew that another and I noticed it seems like people are very frustrated in the process of trying to get their tubes tied particularly if they are young or don't have children even people who didn't have a spouse were being denied tubal ligation based on a single factor or a couple of factors there's a whole reddit thread of people saying I couldn't get my tubes tied because of my age because I hadn't had any kids and so I wanted to talk a little bit about the reasons I think maybe this happens and how I think it can be avoided and why I think it's important to discuss this issue this is a good segue into tubal ligation in general what is tubal ligation tubal ligation is taking a segment of the fallopian tubes out or learning a segmented fallopian tubes together it essentially blocks the sperm from being able to get through the tube to where it would meet the egg they stay separated no fertilization can occur no pregnancy can occur tying the tubes is a misnomer we don't tie the actual tube that's not anatomically possible we need to have a discussion about what is permanent tubal ligations are permanent and intended to be permanent I made a tech talk about this one time the comments were kind of overtaken with people saying it's not permanent my friend got pregnant after getting their tubes tied my friend had their tubal reversed permanent does not equal fail-proof there is a failure rate for any type of contraceptive that you use including tubal ligation it's very low weigh less than 1% but it can't happen can you reverse a tubal I would consider this to be the same as a tattoo nobody says they're not permanent my friend had theirs removed tattoos are intended to be permanent that doesn't mean that you can't sometimes cover them up or get them removed but they're intended to be there forever and there are consequences that come along with trying to reverse that so the same goes for tubal ligation it can be very difficult to have it reversed sometimes it doesn't work it's very expensive it's intended to be there forever why does this happen why are you guys telling me that you've been denied tubal ligation because of your age or how many kids you have I think this probably happens for a variety of reasons one of them being training system of obstetrics and gynecology has some very sick we can't roots in paternalism we are working really hard to get that undercurrent completely wiped out but there are still some of those things there and I don't know that there are always things that are recognized overly I don't think that means that every physician who has said no to someone is paternalistic I think there are multifactorial things that go into this this conversation especially in somebody who is young is really really important to be had in a way that is extensive and two-way like me talking to you and you talking back to me you own a uterus but you are a person with the ability to make decisions regarding your body first and I cannot ignore that and still be a good doctor time with our patients is a huge factor in why this conversation isn't given the right amount of attention and the correct discussion there also are probably physicians out there who just kind of suck at talking about things like this I can't fix that but I can have the conversation here with you guys in there how I would in my clinic ACOG has a whole committee opinion on permanent sterilization some of the things they really stress in that committee opinion are respecting autonomy for the patient discussing the risks of the procedure discussing alternatives to the procedure discussing benefits of the procedure this is kind of the process we go through with any risk benefit discussion or at least I do and I think anyone should inform consent includes risks benefits and alternatives and it's a two-way discussion I don't just give you a paper and have you sign it it requires both of us to be open minded and listening what are the risks the risk that we always hear talked about is the risk of regret in my clinic I always start this conversation with I'm going to talk to you about the risk that you will regret this procedure and I say the first thing you think is I'm not going to regret it nobody brings up getting their tube side if they think they're going to regret it every single person who ended up in the regret group thought they would not end up in the regret group you can't approach this like I will never be the person who regrets it you have to approach it as sharing the data and understanding it so that if you ever you get to a point where you regret it you go yeah I knew this was a possibility I didn't think it would happen to me but here we are this is understandably hard to fully study and assess because you can't really quantify regret like how much it interferes with someone's lifetime I could regret it but then it's like well yeah I wish I hadn't done it but oh well and then someone could regret it so much that it completely destroys their life moving forward and that's hard to quantify a very common misconception that I see is that you're more likely to regret a tubal ligation if you don't have any kids that is a myth and it continues to be propagated by the medical community over and over and over if someone is child free by choice or has had a lot of miscarriages and decides they don't want to go through that again they actually fall into a low-risk regret category so stop telling people they can't get their tubes tied because they don't have kids most of the data that I'm gonna go through comes from a crest study I'm going to link it I recognize that this data is relatively old I am unaware of any data that is newer or any data which goes against what I'm about to say so if someone knows of better data which is more recently published or data which is decent and disagrees with this please let me know the risk for regret if you're less than 24 is around 40% that's not insignificant that's a lot of people between 24 and 30 is about 20% wide a few people but a lot lower than 40 for ages 31 to 35 is about 8% and risk for over 35 is about 2% what do we do with these numbers it's important to think about them in a sense of most people if you look at those numbers most people in all age groups don't regret their decision so in a patient who is well counseled on the risk and still wants a procedure done I feel like they shouldn't be told no surely based on age no discussion about permanent sterilization is complete without talking about the alternatives that includes long-acting reversible contraceptives like IUDs and Nexplanon which is the implant that goes in the arm they have failure rates equal to tubal ligation and they are reversible as well as vasectomy which is a permanent option for a person who's in a relationship with a single male partner that's obviously the only time that would be something that worked it is both cheaper lower risk and as effective as tubal ligation I think it's worth noting than in someone who's in that really high risk of regret group there are things that maybe they can consider for a year or two and see if they still feel the same maybe they get an IUD for a few years and then decide to get there to decide it's just an option it should be discussed in practicality it's really hard I think for some people to have this discussion without seeming like they're ignoring the patient's autonomy and so you'll notice in the discussion as I have it I continue to reiterate I want to give you the information so that you're fully aware but at the end of the day if you go through it and you still want your tube side you get to make that decision you have the autonomy to do that you know which categories you fall into you know if you're more likely to have regret or not based on your age and then there are other factors that come into it too but that's the biggest one and you also know what your life situation is and what your motivations for seeking this procedure are now what are the benefits I think this is something that's largely ignored the benefits also include avoiding the risk of undesired and unintended pregnancy which includes things like seeking abortion having a baby you don't want all these things should be included in the risk I have taken care of patients who have had their tube side and regretted it and it's really really terrible at the same time that should not be done at the expense of denying someone their autonomy to choose to do what they would like with their body although I understand and have been in the position of wanting to avoid potentially contributing to sterilization regret we also have to avoid paternalism - holly resists and everybody else who has been through something like this and shared your story thank you you sharing your story helps me to see that this is happening and to speak up and try to be a voice of reason and also kind of bring some clarity to the situation for anyone who needs to bring this up with their physician do you feel like you're not being listened to find anyone I know that's not always easy but that's the one if you're not subscribe hit that subscribe button I will see you next Monday be kind to yourself to each other to me in the comments be kind and I will see you next time [Music]