I had a friend of a friend be forced to take (and pay for! Thanks America!) A pregnancy test when she had to go to the ER, despite her telling them she physically couldn't get pregnant because she is trans, I swear in some cases it's like they just don't listen to patients at all ðŸ˜
As an emergency physician I promise it's not something we do on purpose to harm anyone. It's because people lie to us all. the. time.
I've had patients who were lesbian, with their partner, swear up and down that they only had sex with women who were pregnant not once but twice. I diagnose surprise pregnancies quite frequently. It's not that I don't trust you, it's that I can't fully trust anyone.
Edit:
I appreciate the thougtful comments I'm receiving on this. To help clarify - in the emergency department if I'm ordering a urine hCG I'm probably seeing you in triage, I have 5 to 7 minutes to see you, ask questions, perform an exam, and place orders. No I don't have time to review your prior records, I have 60 patients in my waiting room and 10 people after you to screen, 14 more checking in the next hour.
Respecting your autonomy, your sense of self, and being an ally are very important to me. But I've also had patients believe they had a hysterectomy when they didn't because health literacy is hard. If I'm seeing 60 to 80 patients in triage in a shift my first priority is minimizing mistakes and misses.
As an aroace person who has been sexually inactive my entire life and never goes to bars/parties/etc. where I could potentially have been drugged or blacked out and not remember or something like that:
I understand that people lie and this is why I still have to hand over a pointless piss cup as if I'm potentially the next Virgin Mary, but I should be able to opt out by signing a waiver that says "I accept the potential legal/medical/financial/etc. consequences if I'm lying about it being literally impossible for me to be pregnant right now."
My favorite thing to say, back when I was younger and always under suspect of pregnancy, "I don't want to test for pregnancy. If I am pregnant, abort it while you're up there."
People are incredibly sue happy. In EMS we have people refuse, we tell them something bad could happen, we make them repeat the risk back, we make them sign a paper, the bad thing happens, and then they claim they are owed money because they couldn't have possibly known what those words meant. Or that they didn't think it would actually happen.
Also sometimes it is legitimate that it is difficult for them to understand all the potential consequences or scope we are talking about. I'm guessing you/most people think the only risk is harm to a hypothetical fetus. Which is true, but even that in turn can harm the mother if the unknown fetus is more than just a little cluster of cells and is stuck rotting inside. It can also be an even faster death if you have something called an ectopic pregnancy. Also fun fact, you can take hormonal birth control perfectly but it will not prevent ectopic pregnancy, but everyone taking birth control will adamantly say they are not pregnant. Not only is there always a tiny chance of pregnancy on birth control, they are only designed to stop pregnancy in the uterus. That is not the only place an egg can implant, and it is really bad, like bleeding out internally bad, when it is not caught before it causes something to rupture. I find the concept so terrifying and a lot of people have no idea that is even possible, and those who do often think they are protected by birth control.
Most systems would agree that you are not providing proper medical care if you do not rule out a time sensitive and extremely dangerous diagnosis that is very easy to quickly dispell, or allow a patient to become septic because of carelessness even if they claim they want that.
I actually DO know the risks are not just to a potential fetus, I know no method of birth control is 100% foolproof, etc. I'm just tired of having to deal with shit like this because so much of the rest of the US has zero sex education and ass-backwards values. It's not just about the inconvenience of peeing in a cup, it's about the principle of the thing. I know realistically it won't change, but I'm going to continue to roll my eyes and be annoyed every time.
Well I am sorry I did not mean to offend but it was a careless way to phrase it on my part. I find unknown pregnancy issues interesting (from the medical sense of awful things our bodies can do to us) and as you said most people lack education on health/sex that it's very hard to even find a stafting point for that conversation.
but I should be able to opt out by signing a waiver that says "I accept the potential legal/medical/financial/etc. consequences if I'm lying about it being literally impossible for me to be pregnant right now."
In court, they would argue that the medical professional didn't do their due diligence to make sure that you were properly educated about all the possibilities. Far easier to just get a pee cup.
Remember, a space goes between "trans" and "woman"
Not putting the space implies they're a different type of thing entirely rather than simply a different category of women. Honest mistake, I'm sure. But now you know.
I would be fully willing to take a one-time exam, like the multiple choice part of a driving test, to prove I'm educated enough about the possibilities to be allowed the option to sign such a waiver for all pregnancy tests I encounter in the future. I'm not saying this is a realistic option I think would ever actually be available to me, just illustrating how much it annoys me on principle lmao
As someone who is sexually active but takes not getting pregnant very seriously I'd also like to add an optional clause that says "in the event an unwanted pregnancy is discovered please yeetus the fetus"
Also ace. I'm almost 40 and have never even held hands, little less had sex.
I still pee in the cup.
9 times out of 10, they are running multiple tests on that sample anyway. You're not getting out of doing it. They're going to run blood tests on you, too.
At a certain point, I think fighting over this becomes more about people's personal pride than any sort of practicality or even the cost, and to the hospital, your pride isn't worth the cost of litigation.
I mean yeah, I still pee in the cup too. I know all the reasons everyone is trying to explain to me. I already know, I already get it. I'm allowed to be annoyed anyway.
I think I've used too harsh of language. it's not that people choose to lie (well... Sometimes) it's usually that they don't have the understanding to know what's happening to their body. You do, but when we have a 7min conversation how can I tell that I can trust you do?
Imagine someone who is diagnosed with a surprise pregnancy who refuses testing for pregnancy, and something happens to the child. Even if I document their refusal they can still sue me later. I have a better chance of winning because of their refusal but Americans hate taking responsibility for their own health, and it wouldn't be hard to find an expert witness to say I violated standard of care by not ordering a preg test.
A pregnancy test isn't meant to be an attack on your person any more than checking your hemoglobin or kidney function. I don't expect them to be abnormal, but i if they are if drastically changes the way I think about your care.
Unfortunately it's just simpler to give the test, waivers often aren't worth the paper they're printed on and can even prove counterproductive. Say you sign one, have an adverse reaction and then try to sue saying you didn't understand it and they misled you, the fact there's a waiver available is now proof they knew it could be an issue
I don’t know why the upreg is the thing that gets fought so much more than even tox screens. Babe I just want to make sure this isn’t all being caused by the massive hormonal, metabolic, and anatomical changes of pregnancy I promise I’m not judging if you fuck or not.
(I did once have someone say it’s a privacy concern which would be fair except you’re in the ER, I have your full name, DOB, and blood with me and I’m about to have you strip naked into a gown. Privacy isn’t real here.)
To the person who said I’m calling them a dirty filthy lying whore then blocked me: no, I’m really not. I need to know if you’re pregnant or at least producing hcg. Lots of people don’t think they are when they are. Lots of people lie. Lots of people have other reasons they’re pumping hcg. Lots of people get drugged and raped and don’t remember. Lots of people block out memories. Lots of people lie to THEMSELVES. Lots of people have lots of unprotected sex. None of these people are worth my scorn or judgement. Everyone is doing the best they can with what they have.
It pissed me off because (pre Obama care days) I had to pay for a pregnancy test that I knew 100% I didn’t need to get treated for a yeast infection or whatever
I get it, but I was poor and didn’t have insurance.
Yeah healthcare is way way way too pricey but I’m very tired of hearing people yell about their upreg being expensive (true) but not their on arrival bloodwork (also true, and also probably not giving great info). I agree it’s extremely expensive to get it done and I’m very sympathetic to that because I’m not taking my life extending medication due to cost. It’s ONLY the upreg (out of all the normal tests we run) that gets people THIS lathered, though.
It's probably because they understand what the pregnancy test is for but not what the blood tests are for. The blood tests are vaguely medical to them so they can see those potentially being useful, but since they're certain they aren't pregnant (regardless of the actual chance of pregnancy), that seems like a charge that will be unnecessary. I don't agree with it, but I do get why they're thinking that way.
I guess it is mostly people without insurance taking issue? I've always had insurance and I've never seen the urine test itemized as a separate expense. Typically it's just one charge for the copay or for the labwork (blood and urine).
Yeah, and again, system issue, not an issue with the validity of upreg. I’m also uninsured and also not taking medication because I’m uninsured and likely shortening my lifespan by decades.
Like, sure, there are lots of good reasons (as you said) for a pregnancy test in triage. However, women are proveably systemically ignored in medical settings. Feeling like someone is ignoring you saying that you can't get pregnant when your bullshit meter for being ignored is in the crypt already is probably the cause.
Combine that with the fact that generally, women are the ones being asked about pregnancy tests, and there you go.
In Australia they don’t automatically pregnancy screen you if you’re female.
Why ? Because it’s an entirely legal issue, not a medical one. The only reason that pregnancy screens are carried out automatically in America is because they stop the legal liability from accidentally treating someone who’s pregnant.
In my whole life the only time I have been asked if I’m pregnant is when I’m about to have x-rays or imaging done. And if you say no, they just go ahead and do the x-rays, they certainly don’t do any pregnancy tests first.
It’s really interesting to hear American doctors rattling it off as part of an initial triage work-up. Its just not done here.
I don’t know why the upreg is the thing that gets fought so much more than even tox screens.
I think it may be because tox screens are still about you (the patient).
Meanwhile when a healthcare professional insists on testing you for pregnancy after you already told them you can't be pregnant (wether you are correct or not in your belief that it is not possible), it feels like being told "I don't respect you enough to take your words into account and an imaginary fetus is more important to me than providing you with the care you need right now".
I was once tested for pregnancy without my knowledge (I was in the ER and barely conscious, if that, so I only found out when someone told me I was not pregnant, yay), and even though there were legitimate reasons for doing this (namely, I wouldn't have been able to even be asked, I would have needed to be prescribed meds harmful to a potential pregnancy), it still felt a little violating and intrusive. And that's without living in a late stage capitalism christofascist hellscape that would have charged me a month's worth grocery shopping for it, or considered a three weeks clump of cells fundamental rights ranked higher than mine.
You tell me you’re not pregnant. I take your word for it. I order a CT abdomen/pelvis. I irradiate your fetus. You sue me and I lose my license and the ability to do the only thing I’ve ever been good at.
I'm a CIS woman in the US and any time I've had radiation they took my documented answer as evidence and never forced.a test. The most they have done is asked for me to give a reason I was sure I wasn't pregnant and " birth control" was sufficient every time. The only times I can think of when I had one done at a hospital was right before surgery, which is more serious than a dose of radiation. And unfortunately between the regular kidney stones and the abnormal one that needed surgery to remove, I had a lot of abdominal X-rays and 3 CTs during my thirties
And I agree with you, but that sounds like it's time for you to pay for that, then. Literally, your argument is that you're doing it entirely to protect yourself. Charging someone that literally cannot get pregnant (like a trans-woman) in order to cover YOUR OWN liability, just seems fucked up, IMO.
In many circumstances if you aren't litigious you're just being complacent with things like wage theft or OSHA violations. However in the case of someone denying a pregnancy test and then finding out they're pregnant and suing because they wanted to keep the baby they weren't even willing to test for the existence of, I think that ones on the patient, not the doctor.
All of these doctors have malpractice insurance and yet that isn't on the bill. If they feel the need to do unnecessary tests against the will of the patients in order to protect themselves from risk, then they shouldn't be charging patients for that test. I don't think that's even remotely absurd, but here come the defense of medical billing bullshit...WTF?
I agree that they need to do these tests to protect themselves (first thing I said). They then need to pay for that in house, because that's how protection works. They don't charge for the gloves, they don't charge for the sterilization. They shouldn't be charging for litigation protective testing.
You are getting charged for the gloves and the sterilization, the food, the sanitation workers…. Nothing is free in America. People also sue each other all the time. Doctors have no control over what you get charged at most hospitals in America. The real way to fix this problem is universal healthcare.
I agree with everything you just said, and yet it doesn't change anything I said above. So, I'm curious, why are you and everyone else blindly defending the medical billing bullshit? "Don't charge people for unnecessary tests against their will," should be one of the least controversial statements on the planet, and for some reason you decided that was so egregious that you needed to argue against it. Why? I'm not asking you for your argument like above, but just why do you think the current medical billing situation needs you to defend it?
Great, do your job, and then pay for your own protection. You don't bill people for malpractice insurance, you don't bill people for PPE, and you shouldn't be billing people for this. Forcing services on people against their will is called theft and fraud in any other situation. It's not personal, it's business, and doing your job doesn't justify theft.
Also, it's weird that you think it's personal for me. I'm a guy, I'll NEVER be hit by this. It's still fucked up and wrong. It's not personal, it's just bad business to bill someone for a test that is against their will. At least from the customer perspective.
And if you don't think you should pay for your own protection, then can I start coming to your house and billing you for services that have nothing to do with you that you don't consent to?
Edit: Also, has anyone ever called a stranger "my <insert friend term here>" and not come off a bit creepy?
Great! Again, if you're doing something to protect yourself, then that should be on you, not the patient to pay for it. If you're in a system where the patient doesn't pay, then it sounds like there was no reason to argue with me in the first place.
And I didn't say anything about you being from the US, so good job on your weird focus on the US. But you did decide to argue with me in favor of charging patients, so I did assume that you were speaking from a place where that was was relevant. If you're not, then why are you jumping up to speak about my comment which was entirely about charging or not charging patients for services rendered against their will?
I hope you understand we as patients cannot trust you either. I've had medical professionals outright ignore my concerns and they basically tortured my mom to death during COVID by intubating her repeatedly against her wishes. Never again. I have seen the laziness, massive egos, and downright hostility given to patients, and the lack of genuine give a shit that doctors and nurses seem to have these days.
A lot of medical professionals got traumatized during COVID and if they're still in the field they're so desensitized and shut down. The desensitization from the field was bad before but I think a lot of people really hit their limit during the pandemic and that's partly why it seems like so many more medical professionals are terrible compared to how it used to be. Not excusing though and I'm very sorry that your mom went through that. Just saying you're right, doctors and nurses ARE worse these days. For the US specifically our health system needs to change badly. The only people attracted to the profession do it for money or they just dont have empathy so it doesn't bother them to do what they do.
You don't get what they're saying. A patient saying they've had a hysterectomy doesn't mean they've had a hysterectomy. Think about the absolute stupidest people and remember that they can also go to the hospital.
well, no. but if they had medical documentation in their chart about having had one, they had one.
but more importantly, that other part: people who've never had a uterus to begin with. I DO get what they're saying, but they probably picked the single most goofy place to comment it under (responding to a story of a trans woman being asked to take a pregnancy test)
Huh, just reading this thread, genuinely curious, is this normal American procedure? Where I live we just have it all centrally documented. Any healthcare professional can, with permission, just see it, which just seems to make sense to me. No idea why you'd do it decentrally, but if that's the norm in the states, if it's all just what a patient tells you, then that does excuse the doctors
Yes, even if they've never been to that hospital. Hospitals use a shared network that gets access through your health insurance/medicaid. Its basically on a secured provider-only internet.
No we use something like Alleva which is a protected HIPAA compliant server system that tracks patients care documents. All hospitals participate in it.
Your mind sounds made up on this, but while there are some assholes most of us genuinely care and try to do our best with the limited time and resources we have.
That's all well and good, but any test that you want to run that assumes I'm lying should be free and only charged if I'm actually lying.
I mean, gee, what you're saying sounds reasonable, but also what percentage of the time were you wrong to not trust your patient in the last year? And how much money did your hospital make off of those people who were wrongfully mistrusted?
It sure seems like hospitals have a financial incentive not to trust people no matter what the numbers are. How many women have you treated in the same you've been practicing that you saw those two lesbians who were lying? I'm guessing lots, and that this test catches an absurdly small number of people lying.
I mean, geez, whatever number of women are lying - .001% - so you normally demand medical tests with that small a chance of being necessary?
It might be because I'm with Kaiser, but why the fuck is it so hard to pull a medical record? Don't all doctors have access to it?
Even if you aren't in a centralized network like Kaiser, don't you send your medical records ahead of time to any appointment? They should be able to take a fraction of a second and look over those records yeah? A hysterectomy would be listed there.
Probably for the same reason you didn't read the second half of my comment. If I'm doing a chart review on every patient I triage then no one is getting triaged.
If an item is of great concern to you in regard to whether it's true, the chart would be the source of that truth.
That being said, it sounds more like you're being slammed. There's no time to give substantial individual attention if you only have 5-7 minutes per patient. That's nuts.
Look, I get that, but I seriously think y'all are just making more work for yourself. If a patient is going to lie, they're going to lie. Asking again in multiple different ways isn't likely to change that. And saying shit like "are you sure?" Just makes you look like a dick. Take note of what the patient says and let them lie in the bed they made. It makes zero sense to harass every single patient because some lie.
Not in the medical field but my grandmother worked in the red Cross for fifty years and had a close friend who was a doctor for about the same amount of time.
She once told me about a time when her friend had trusted their patients word on an issue because that patient had never previously lied to them. Except that time they did, don't remember exactly what it was she said they lied about, but whatever it was, because it was missed that patient suffered massively because they were given the wrong form of treatment from what they needed, and the doctor almost lost his medical license because they chose to trust a patient who'd never before lied to them
Exactly! It damn near inevitable, even from good patients. The standard should be "lie or omit at your own risk" Not "the doctor is responsible for managing human stupidity." I mean, obviously there's a point to confirming certain information, but the extent that it's gone these days is just ridiculous.
4.4k
u/mysocksareinsideout MakeshiftEmery Jul 31 '26
I had a friend of a friend be forced to take (and pay for! Thanks America!) A pregnancy test when she had to go to the ER, despite her telling them she physically couldn't get pregnant because she is trans, I swear in some cases it's like they just don't listen to patients at all ðŸ˜