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The question

When my 21-year-old daughter saw our family doctor for her annual physical, she asked for a renewal of her birth control pills. The initial prescription was from another health clinic, as she was not at first comfortable to ask our family doctor in a small town. His reply was that he doesn't believe in birth control pills and to go back to where she received her first prescription. We both felt total disbelief and wondered: Did he act within his professional guidelines?

The answer

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This doctor might be a very good clinician, especially if you are having a baby, but he does not sound like a good fit for a single, young woman with a sex life. Though the doctor's reaction would leave many patients gobsmacked, he is not obligated to provide a service that goes against his beliefs, except in certain emergencies.

However, he must ensure an appropriate referral is made. In this case, he did just that: he told your daughter to go back to where she received her prescription. If he didn't, she could have lodged a complaint against him with the college of physicians and surgeons in your province; she can still contact the regulatory body as it may be able to offer names of doctors taking new patients.

Teresa Killam, a family physician in Calgary, said all physicians have personal opinions, values and ethical standards and it's important to be mindful of them in the patient-physician relationship.

The vast majority of doctors, she said, would not withhold that type of prescription from a patient, though she acknowledged "it certainly can happen." There are two major concerns with this case: one is if you are a patient in a rural area, there may not be an alternative for finding birth control; the second is that while he may have followed his obligations, the encounter may have compromised the doctor-patient relationship. By that, I am suggesting your daughter likely feels totally turned off by this doctor.

"In an era of patient-centred care, we are hopeful most physicians are engaging in really good relationship building and communication skills," said Dr. Killam, who is also a lecturer at University of Calgary's family medicine department. "If they don't connect, it is reasonable to find another doctor."

There are a few approaches your daughter can take. She can ask for another doctor in the same clinic or she could see another doctor out of town and ask for a year's prescription. If she's in a more populated area, she could go to a community health centre; if she's a student, special health services may be available.

Since your daughter is young and healthy, her main reasons for a doctor's visit are going to be for birth control pills and Pap smears; many doctors would want her as a patient. If she decides to find a new doctor, she should ask for the physician's perspective on contraceptive practices; she does not want an instant replay of this event.

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Readers may recall a question some months ago from a patient who had problems accessing emergency contraception. Both illustrate how doctors can refuse to provide a service to patients based on moral or religious objections. However, they must refer them to other providers or locations where it can be obtained.



The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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