Beyond the impacts to the patient's mental well-being which are much better handled by the other comments with that experience, I want to approach this from a different angle.
because a cheap dipstick and a few drops of pee can tell us if we have a five alarm fire happening.
That is also part of the problem too.
I just checked the charge master for the hospital near me. A urine pregnancy test will be billed at almost $300 and the cash uninsured cost is $98.
So, this is not a cheap test for many people (especially since the rest of the visit is likely going to be extremely expensive already).
Yes. It’s very rare. No. We don’t want to miss it.
While on its own this sounds good, there is a reason they don't recommend a lot of tests proactively. There are risks associated with the test including turning off patients from seeking care at all. There is no recommendation for monthly MRIs looking for cancers, no one is suggesting every visit should include a prostate exam, and while colon cancer is a leading cause of death, the current recommendations for colonoscopies is every 10 years after age 45.
Maybe the risk that someone without a uterus may have an abdominal pregnancy with zero symptoms isn't worth the additional stress on the patient to push for testing unprompted.
Elaborating slightly: the pregnancy test requirements absolutely destroy all trust between the patient and the care team. All of it, gone and not coming back.
I came in with an acute issue, you immediately completely ignored that, refused to hear out my symptoms and insisted pivoted to an impossible issue, asked me a bunch of intrusive questions about the issue you made up in your head, and then told me I was probably lying about both the imaginary issue and the real one and you wouldn’t even pretend to care about the real issue until I tested negative for the imaginary one.
The fuck am I supposed to trust someone who is explicitly operating on the assumption that I am lying every single time I open my mouth? The fuck is the point in saying anything? The fuck is the point in not just signing myself out to go suffer at home, since there’s obviously no way for me to convince the doctors that I have symptoms at all?
(Yes. Impossible. I’m a fucking virgin, and I’m not Catholic. Ramble on about whatever infinitesimal odds of an ectopic pregnancy you like, there still needs to have been a dick involved somewhere.)
God damn. I've only been to the emergency room once in my adult life, so I hardly have much experience, but I was treated as a person who's opinions and answers to their questions mattered, and who got at least a perfunctory say in what was going on.
Being a cis man is apparently a golden ticket in the healthcare industry, and everyone else gets to ride in steerage where they amuse themselves by slapping you in the face and calling it medicine.
Specifically a white and reasonably well-groomed cis man.
And it’s not universal, but the likelihood of being treated like shit is going to be at best 30-40%, rising to between 80 and 90% the more urgent you feel about your issue. And knowing that is going to massively impact how you interact with all healthcare, even the areas that are generally good to you. You’re going to do shit like decide not to get swabbed for strep because your throat hurts and you don’t want to spent ten minutes answering the same three useless questions at the local urgent care. That’s why the usual pro-call-all-women-liars argument pisses me off. Treating patients like liars massively increases the likelihood that they will simply stop seeking care altogether. Leave the hospital and not come back no matter what their symptoms are.
But they leave that out of the statistics when they try to justify it. It doesn’t sound like you’re providing me evidence-based healthcare, it sounds like you’re ignoring the vital evidence of my words. It’s nothing but a very, very good way to teach a person that their words don’t mean shit to healthcare workers, so why waste them and your money?
The medical field has had a lot of blatantly moronic ideas that persisted a lot longer than the 3.5 seconds you’d expect it to take to call bullshit. Someday, calling all women liars and demanding pregnancy tests on hysterectomy patients who aren’t even in for abdominal symptoms is going to be looked on as badly as insisting that Black women can’t feel pain.
When people come in with symptoms, especially A+E, the first job is to rule out common serious pathology. This is why there are general questions about bowels, periods, pregnancy, urination, diet ect. It makes certain diagnosis less likely especially the ones which needs immediate attention such as appendicitis or an ectopic pregnancy.
Which then brings us to why pregnancy tests are important. It's not a matter of trust in you as an individual, it's a matter of statistics and likelihoods of a cohort. The truth is, pregnancy possibility is one of the things patients routinely are inaccurate on reporting in A+E when they're stressed or in pain, there are many many cases where patients swear to god they can't be pregnant and it then turns out they are.
This leads to the problem. It's not that they don't specifically believe you as a person, it's just that statistics and past experience show that a patients word isn't infallible. Hence the pregnancy test, because a missed ectopic can kill you, and it's a straightforward low invasiveness test. If it's negative, the diagnostic process can move on with one serious potential cause ruled out.
To contrast this, let's say as part of the history they ask you how often are you opening your bowels, and you say 7 times a day. No doctor in their reasonable mind is going to say "nope don't trust you, best monitor and count the times you go to the bathroom to make sure". People don't lie about things like that (outside of very very niche cases), hence doctors can take everyone at face value.
I hope this helps explain why pregnancy tests aren't people not trusting you.
to my face. You talked over me and called me a liar and refused to touch anything until I had proven you wrong, but you still continue under the assumption that I was lying, it just happened, coincidentally, to be true.
I have heard this line of reasoning before. It has only gotten more idiotic and misogynistic with every tiresome repeat. It’s just wrong.
You are not giving the best care possible, because you are making it more likely that I, and every other woman who doesn’t like being called a liar, will simply give up and seek no care and go experience severe complications at home. That is not the best care. That should be the worst case scenario that you shit your pants over. The patient in front of you is your only patient, and treating that patient as secondary to your imaginary friend is not good care and never will be.
They didn't believed in your ability to correctly assess that, not that they specifically think you're lying nor that specifically YOU are lying.
People lie all the time, people lie to their medical providers, people mistakenly think they cannot get that and so on and so on. It's in their job not to take everything on a word.
Surprise pregnancy is a thing. If doctor would just believe someone because they said something on that, and they would die in result, would it be better than not believing? I doubt so.
Doctors, in the end, are more about not letting you die than about building trust through believing you fully no matter the risks of doing so.
Are doctors assured in patient's awareness enough to believe that they didn't mistaken medical procedures (Hysterectomy by itself doesn't include ovary removal and thus doesn't necessarily prevent pregnancy), or there was no medical error, or anything alongside the lines? Or are they also expected to fully research everything and then double check for every patient, using much more invasive procedures?
Why would doctor want to risk be sued just so the patient would "have more trust that doctor believes fully" or to risk patient's life for the same reason?
So how are they supposed to know that you, specifically, are not a liar, when the statistics show that a good percentage of patients (of either gender are) are? You're taking this unnecessarily personally. Do you also refuse to show your drivers licence when pulled over by the cops, because the police should take you at your word that you have a valid one? Do you think you can get a job without providing references because the employer should just trust you about your previous experience?
Also, every test has a false negative and false positive rate and doing thousands of unnecessary tests increases the likelihood of false results, which in this case potentially skews diagnoses away from what is really going on. I’m not aware of exact specificity and sensitivity of pregnancy tests (probably varies by brand) but no tests are 100% on both.
I agree healthcare is way too expensive. We still should do upregs. We do a bunch of proactive testing—the whole bloodwork battery we usually do for most ED visits is proactive, after all. We run MRIs for symptoms that don’t line up neatly with anything. We sometimes nasal swab for a host of viruses even when the pt doesn’t look very viral. These are all good data points to have to build a clinical picture.
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u/Flat_Hat8861 Aug 01 '26
Beyond the impacts to the patient's mental well-being which are much better handled by the other comments with that experience, I want to approach this from a different angle.
That is also part of the problem too.
I just checked the charge master for the hospital near me. A urine pregnancy test will be billed at almost $300 and the cash uninsured cost is $98.
So, this is not a cheap test for many people (especially since the rest of the visit is likely going to be extremely expensive already).
While on its own this sounds good, there is a reason they don't recommend a lot of tests proactively. There are risks associated with the test including turning off patients from seeking care at all. There is no recommendation for monthly MRIs looking for cancers, no one is suggesting every visit should include a prostate exam, and while colon cancer is a leading cause of death, the current recommendations for colonoscopies is every 10 years after age 45.
Maybe the risk that someone without a uterus may have an abdominal pregnancy with zero symptoms isn't worth the additional stress on the patient to push for testing unprompted.