Back to Selections from Issue #2 / HA! Home Page / The Lilith Collective / Selections from Issue #1 / Issue #3: The Work Issue / Essential Links
by Ami Goldstein, SNM with Susan Saenger

    How autonomous are you in your health care decisions and choices? Take this quiz to find out.

    1. How did you decide which birth control method to use?

        a. My doctor told me that depo provera (the shot) was the best!

        b. I read Our Bodies, Our Selves and discussed with my practitioner several different kinds of birth control methods including pills, diaphragm, cervical cap, condoms, natural family planning, etc.

        c. I'm a lesbian and it's not an issue - at least not about getting pregnant.

        d. I flipped a coin.

    2. When was your last period?

        a. If I look back at my birth control pills and a calendar I could probably figure it out.

        b. Hell, I know when I ovulated and boy, was it fun!

        c. Umm...

        d. Let me ask my boyfriend/girlfriend.

    3. You've skipped your period for 2 months. What do you do?

        a. I go to the doctor who prescribes progestin and I take it.

        b. Take a pregnancy test. If it's negative I call my care provider and ask,"Should I be concerned?"

        c. I sure as hell ain't pregnant. Maybe I'll drink some Blue Cohosh tea; I heard that was good for bringing on your period.

        d. Do nothing. Maybe it will come next month (maybe I will too).

    4. You're feeling under the weather. What do you do?

        a. I go to the doctor.

        b. I drink lots of fluids, stay home and rest.

        c. I go to the doctor and demand antibiotics and cough syrup with codeine.

        d. I go to work, sneeze on people, cough on my friends, and complain about how miserable I feel.

    5. What do you do when you disagree with what your health care practitioner wants you to do?

        a. I do it anyway - they know what's best.

        b. I ask for more information and other options.

        c. I go to another provider, explain the situation and tell him/her what I want.

        d. I do nothing.

    Actually, quizzes aren't our forte, so to avoid the hassle of scoring, we made 'b' the best answer. So, if you answered mostly or all 'b', you're doing alright as far as we're concerned (unless you're lying in order to look good). Basically, these answers exemplify taking responsibility for your own health care and collaborating with your health care providers. Some 'b' responses are also examples of care providers respecting your autonomy in health care decisions.

    We all consider ourselves mostly autonomous human beings who make our own decisions about our own health care. To some degree though, we lose autonomy when we become patients. While the loss of some autonomy may be necessary in order to receive care, Body Politic thinks we should be as involved as possible in all health care decisions. In order to do this, we "patients" must take responsibility for becoming educated and finding a practitioner who can be a resource, support person, advisor, and respectful collaborator and advocate.

    Think about going in for your annual PAP. There is an inherent loss of power and autonomy when you're lying naked, flat on your back with your legs up in the air with a light shining on your vagina, which has a huge, cold, metal speculum hanging out of it. That's just for the Pap smear. Then you get to have the exam in which the practitioner puts two KY-jellied fingers into your vagina and presses down on your abdomen to find out where your uterus and ovaries are (aren't they in there?). Meanwhile, you can't see what's going on behind that little white paper sheet. In this situation, you're the recipient of health care. You are not in control and it seems that there is no room for your autonomy.

    The first and hardest step toward autonomy is recognizing your rights to knowledge and participation in your own health care. The scenario above in many ways can't change. Women need PAP smears and other kinds of physical examinations. But you can change the way you approach the examination table. Prior to an exam you can contact the practitioner to provide information and ask her to describe what she is doing while she is doing it. You can get rid of that white sheet so that you can see what is going on. You can reserve the right to say NO.

    Many health care providers feel threatened when you ask questions. Your questions can be interpreted as an expression of doubt about the practitioner's competence, rather than an attempt to obtain information. Yet you are paying for these services, and as a client you have a right to question and understand the care that you are receiving. Qualified practitioners do have more knowledge regarding health care than the general public, but it is the practitioner's responsibility to explain conditions, procedures, and choices to all of their clients.

    But what about your responsibilities? Responsibility means that you participate in your care. Suppose you have a urinary tract infection and choose to treat it with herbal remedies rather than antibiotics. You might consider describing your plan to your practitioner so that he or she can be informed and can plan for follow-up or alternative care if needed. The idea is partnership. You also have a responsibility to listen to the practitioner's reasons for suggesting a particular treatment. Body Politic was told when learning Chinese divination (the I Ching) that if you ask the "little old man in the yellow coat" a question, you should be prepared to accept the answer. If you ask someone for advice and then proceed not to follow it, why should that person bother to give you any advice again? You have a relationship with your health care provider and, in order to get optimal care, consider caring for the relationship.

    To be autonomous means to make your own informed decisions based on information you have received from a health care provider and other sources.

    To participate in your own care, to be in relationship with a provider who respects you as an autonomous woman, means that your care provider neither hands you a prescription instead of care and information, nor always gives you what you want, but rather provides you with counseling on multiple options.