Purpose: The following exercise is designed to review pregnancy options counseling. Consider role-playing the following scenarios.
- One of your patients presents with an unexpected positive pregnancy test during clinic or in the ED. How would you approach this?
- When you ask a patient what questions they have, they want to know if an abortion will affect their ability to have children in the future. How would you respond?
- A patient is leaning toward adoption but is trying to decide, and wants to know more about the process and options. How would you respond?
- Consider the following responses to a common patient statement, in terms of what it allows or disallows in further conversation. Which response do you think is most helpful? What other questions/phrases might be helpful? (Adapted from Perrucci 2012, Exercise 3.3)
A patient says, “I feel sad.”
- Response 1: “Is that making you feel less sure about your decision?”
- Response 2: “Would you like me to give you a referral for a talk line?”
- Response 3: “What things have you done in the past to help cope with sadness?”
- Response 4: “Can you say more about that?”
- While you are explaining the protocol for a medication abortion to a patient, they mention that their boyfriend “absolutely cannot find out about this pregnancy”. What concerns does this raise and how can you explore the situation further?
Purpose: Discuss what you might do or what you might say to the patient in each of the following situations in the context of a uterine aspiration for abortion or early pregnancy loss.
- As you enter the exam room you hear the patient’s partner criticizing them for “acting stupid” and telling them angrily to “just shut up.” The partner is looking at the wall and ignores your efforts to introduce yourself.
- When you come into the room and ask the patient how she is feeling, she starts crying uncontrollably. She has her head turned away from you and does not make eye contact.
- Before you begin an exam or procedure, the patient asks, “Is this going to hurt?”
- The patient is a 14-year-old rape survivor who is 7 weeks pregnant. Every time you attempt to insert the speculum, they raise their hips off the table.
- You have just completed an aspiration for a patient at 8 weeks gestation. The patient asks, “Can I see what it looks like?” How would your response differ at 12 weeks gestation?