A 30-year-old woman comes to the gynecologist's office for an annual physical examination. The patient is in good health and does not report any symptoms. She shares that she has been reading about tubal ligation and would like to undergo the procedure because she is tired of using oral contraceptives and does not want to have children. She has had no adverse effects to oral contraceptives. The patient has been married for 10 years and describes the relationship as very stable. Which of the following is the most appropriate response to the patient's request for tubal ligation?

Question

A 30-year-old woman comes to the gynecologist's office for an annual physical examination.  The patient is in good health and does not report any symptoms.  She shares that she has been reading about tubal ligation and would like to undergo the procedure because she is tired of using oral contraceptives and does not want to have children.  She has had no adverse effects to oral contraceptives.  The patient has been married for 10 years and describes the relationship as very stable.  Which of the following is the most appropriate response to the patient's request for tubal ligation?

Quizplus · Accepted Answer

Every individual has autonomy over his/her own body, including reproductive health decisions (eg, sterilization, contraception). In this case, the patient is requesting a specific procedure, and it is the physician's duty to discuss the specific risks and benefits of a tubal ligation and alternative contraceptive methods. Although the physician should ensure that the patient understands the permanent nature of tubal ligation compared to other forms of birth control, expressing partiality bias at this stage should be avoided. The discussion should be patient centered and focus on the patient's own reproductive goals. (Choice A) This statement shifts the focus to the patient's partner. Although the physician can encourage the patient to share and discuss her decision to undergo the procedure with her partner, the physician should respect the patient's autonomy and focus on her understanding of the procedure and its risks and benefits. (Choices C and D) These statements ignore the patient's request for a tubal ligation and shift the focus to exploring her difficulty taking birth control pills, which may be perceived as judgmental and biased. A patient-centered approach should focus on risks and benefits of the procedure the patient is requesting as well as alternatives. (Choice E) Although this statement provides necessary information regarding the permanence of tubal ligation, it immediately introduces the physician's bias, which may be experienced as coercive (ie, pressuring the patient's decision). The risks and the benefits should be provided to help the patient come to a balanced decision. Educational objective: Physicians should support patient autonomy in making reproductive health decisions. Physicians should counsel patients regarding the risks, benefits, and alternatives to any procedure they are requesting. __________ References: The collaborative autonomy model of medical decision-making. (http://www.ncbi.nlm.nih.gov/pubmed/24233814) Elements for adequate informed consent in the surgical context. (http://www.ncbi.nlm.nih.gov/pubmed/24803343)

A 30-Year-Old Woman Comes to the Gynecologist's Office for an Annual