18 OPINION
18 OPINION
1 SEPTEMBER 2023 ausdoc . com . au
Insight
Caught between the Pill and a hard place : a difficult journey
Dr Malcolm Fisher Retired anaesthetist and independent hospital and healthcare professional , Sydney , NSW .
My confusing time as a doctor in the early days of the contraceptive pill .
MY GP said it was okay to get jab number five at the chemist . While there , I asked the pharmacist how she felt about being an antibiotics and contraception provider . I couldn ’ t get away .
She was not enthusiastic about the antibiotics but had quite a diatribe about the contraceptive pill .
She was a feminist and ripped into the way Big Pharma abuses women . I didn ’ t dare ask about IUDs . In 1970 , I was trying — unsuccessfully — to be a GP . No training program in those days ; you were just sent into the world to have a go at it .
At that time in New Zealand , oral contraceptives had just arrived . But only for married women and those about to be ; it was deemed unethical to give them to single women . It made for a difficult journey . The early oral contraceptives were full of side effects : depression , thromboembolic disease and suppression of libido .
It was the ‘ good girls ’ who suffered — those about to be wed who were saving their good-girl status for the honeymoon .
After the wedding festivities , when it was supposed to be all bells and banjos , they were upset to feel very little — not even as good as the single trysts .
Until we understood it was the pill , there was thinking that there must be a psychological basis .
A visiting doctor had gone around the country in late 1969 claiming patients , especially women , went to GPs because of sexual problems but were often too embarrassed to ask . So we GPs should direct the question .
The oligarchs of general practice were unimpressed . They had never seen anyone with sexual problems .
But when Playboy and Penthouse arrived in New Zealand , things changed .
A consultation going nowhere , while courage was being built up , led to : “ Doctor , my husband has a magazine .”
Image courtesy of the National Archives of Australia .
Then it came out .
And the key to the solution was to say 85 % of New Zealand couples do that regularly . Problem solved .
As long as the new games did not hurt body or self-esteem , or involve children or animals , they were probably okay . Back to the pill .
Given the ‘ ethical ’ restrictions on accessing the pill , single women usually began with some other symptom . When they said , “ Doctor , I ’ ve got a boyfriend ,” you knew it was the opening gambit . Now , you were cornered . You could add that it was a new drug with side effects and that nobody really knew its long-term effects . You could perhaps talk about other options .
But if you acquiesced , you then hit the big problem .
The teaching back then was that women going on the pill should have a pelvic examination as the pill may mask the signs and symptoms of pelvic pathology . If they replied they did not wish to undergo a pelvic exam , you were in a cleft stick .
On one occasion , I saw a young patient in school uniform on a Wednesday . She was sexually active and practised last-minute withdrawal .
‘ God , men are stupid . It will be all around the school on Monday that the new doctor will only give you the pill if you are actually doing it !’
I knew that was hazardous . I gave her a script , with no pelvic exam .
On Friday afternoon , there were four girls in the same uniform — all wanting the pill .
When they left , the receptionist came in . “ Did they want the pill ?” “ Yes .” “ Did you give it to them ?” “ I gave it to the sexually active one but not the others .” “ God , men are stupid . It will be all around the school on Monday that the new doctor will only give you the pill if you are actually doing it !”
When I finished at the practice that Friday , we agreed at post-work libations that the female doctor at the practice would preferentially be referred girls in school uniform .
Despite the societal views , I do not think anyone got into trouble for giving the pill to single girls .
I thought about the pharmacist and their new prescribing powers ( at least in NSW ). Will they advise about the other options often on sale under the counter ? Is that a conflict of interest ?
Who does the follow-up ? Will they swap one type of pill for another if there are side effects ?
There seems to be a belief somewhere that pharmacists can do a lot of general practice stuff as it just means providing the right tablet . Even simple patient care is more than that .
I have overheard some very bad advice given in pharmacies and once pursued the customer and told them to go to their doctor and not take the stuff .
And like many doctors , I would like pharmacists to clear their shelves of expensive placebos .
But most of all , I would like people to think they would get better care from a doctor .
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