I miss NHS for many reasons.One of them is the freedom to choose whether you as a clinician wish to be a part of Medical termination of pregnancy or not.I have an ethical issue with termination of pregnancy and NHS gave me the freedom to say a no and all throughout my working in UK ,I was not a part of even single TOP accept if it was for a congenitally malformed baby or any such medical indication.
In Indian Practice one can choose not to do a MTP/TOP(Termination of pregnancy) ,but then that can affect your practice,as these couples come to you for a termination first and may be an year later come back for an Antenatal check up of pregnancy.So,I do perform 1st trimester terminations in India and feel guilty every time I do so.
I feel less guilty when it is a medical ( with pills) as I just prescribe the medicines.I know,still the involvement is there and am responsible for it.Medical TOP has good 30 % chance of being a faliure.There is a very clear RCOG guideline on of these 30% who would need surgical intervention ( Suction and evacuation).Those who have an endometrial thickness grater than 15 mm or the retained product of conception is approx 15 mm. There is no recommendation to prescribe a second dose of misoprost.I am very cautious in explaining the risk of failure to my patients and the aftermath but have realized that after a failure they insist on a second dose of misoprost as the 'radiologist' suggested so.That is 'quackery'.Practice of medicine without evidence is quackery and shouldn't be practiced.
So,please listen to your doctor properly during the consult,if you don't understand ,ask,ask,ask and ask before you decide any particular process.But once taken a decision don't try to influence a doctors treatment.Agreed you have a right to make a choice but the doctor has the right to say No to treat you.
In Indian Practice one can choose not to do a MTP/TOP(Termination of pregnancy) ,but then that can affect your practice,as these couples come to you for a termination first and may be an year later come back for an Antenatal check up of pregnancy.So,I do perform 1st trimester terminations in India and feel guilty every time I do so.
I feel less guilty when it is a medical ( with pills) as I just prescribe the medicines.I know,still the involvement is there and am responsible for it.Medical TOP has good 30 % chance of being a faliure.There is a very clear RCOG guideline on of these 30% who would need surgical intervention ( Suction and evacuation).Those who have an endometrial thickness grater than 15 mm or the retained product of conception is approx 15 mm. There is no recommendation to prescribe a second dose of misoprost.I am very cautious in explaining the risk of failure to my patients and the aftermath but have realized that after a failure they insist on a second dose of misoprost as the 'radiologist' suggested so.That is 'quackery'.Practice of medicine without evidence is quackery and shouldn't be practiced.
So,please listen to your doctor properly during the consult,if you don't understand ,ask,ask,ask and ask before you decide any particular process.But once taken a decision don't try to influence a doctors treatment.Agreed you have a right to make a choice but the doctor has the right to say No to treat you.
