Last week Healthed published the article “Many women on oral retinoids without contraception” in which Dr Antonia Shand and Professor Natasha Nassar discussed their recent research suggesting a high proportion of Australian women of reproductive age are taking oral retinoids without also using effective contraception.

I would like to relate a personal experience as a cautionary tale, to provide supportive and reinforcing comment.

As a GP, I learnt to always double check my patients were using effective contraceptive cover whenever they were prescribed potentially teratogenic medications, despite letters from specialists assuring me that “the patient has been advised about the importance of adequate contraception”. I was often surprised that this did not seem to be the case, and was perplexed that patients and doctors could finish a consultation with such different understandings, even to the extent of some patients stating that they did not need “additional” contraception.

Then I attended an appointment with a family member. The specialist prescribed the medication, and delivered their clearly well-rehearsed and repeated education /information spiel. 

This included the following (quoted verbatim): “You cannot fall pregnant on this medication”.

I interjected: “No, what you mean is, you must not fall pregnant on this medication.”

The specialist visibly paled, and it was obvious that they were mentally reviewing all the patients to whom they had delivered this confusing advice.

My family member is well-informed and health literate.  She was well aware that the contraceptive pill is used to treat some dermatological conditions, and reasonably assumed she was being prescribed a version of the COCP, so could cease the one she was taking.

As doctors, we often subtly (and not so subtly) blame patients for non-compliance. Because what we said made sense to us, we assume it will also be clear to the recipient of our communication. 

In my work as a Medical / Clinical Educator, I have frequently used this experience as an illustration of the importance of clear communication, from the perspective of the recipient, not just in the delivery. It is usually met with the same shocked, haunted pallor on the faces of the doctors and other health care providers, regardless of discipline. 

We are all at risk of poor communication, but our patients are at the greatest risk of all, despite our best intentions.

Dr Kathryn Robertson is an educator at Medical Protection Society and The Cognitive Institute.  She was previously a Senior Lecturer at the University of Melbourne, and has more than 35 years of experience as a GP.

If you have a cautionary story you think would help other GPs, send it to editor@healthed.com.au for consideration.