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Re: IUD and PIDFrom: Karen J. Bacon, RNC, WHNP (karennp@iei.net)Fri May 28 20:53:18 1999
> At 7:57 PM 5/28/99, Steven Crawford wrote: > >In all due respect, IUD placement, in my opinion only, should occur in > >collaboration > >with a physician. I realize this may cause some painful rebuttal, but I am > >seriously only stating this fact for the patient's best overall interest. > > > >Patients are the focus of our existence. We are here for them to be > >treated in a > >professional, non biased manner. > > CNMs and APRNs and FNPs all are educated in evaluation of the patient and > the suitability/non-suitability for an IUD. During this thread, there has > been disagreement as to use of IUD in a woman with prior PID.....it has not > been along professional lines. MDs and CNMs have said they would not use an > IUD with prior history of PID. MDs and CNMs have said they would insert an > IUD. Both sets of professionals are able to assess the suitability for IUD > insertion, and there has been honest disagreement. I agree. I have deliberately tried to avoid the NP/CNM vs. MD flame wars that have previously occurred in this forum, and I will again this time, but I will state for the record that I disagree with Steven Crawfords viewpoint. I posed the questions not because I wasn't already aware that IUD's do not cause PID, but because his original post seemed to insinuate blame that the CNM who placed the IUD was at fault because the patient had a recurrence of PID. Now, she may indeed have been if she did not screen the patient appropriately, but being able to screen patients appropriately is not ONLY within the clinical scope of an MD, like it or not. As has been demonstrated, many MD's on this panel would place an IUD in a patient with a previous hx. of PID, so the controversy lies there, not in who is placing the IUD. In my current practice, there are physicians who put them in without doing pregnancy tests or GC/Chlamydia cultures first. As an MD on this forum, they may meet with opposition to that practice, but an advanced practice nurse would be cyber-tarred and feathered (although I know of no APN's who do this). We can respectfully agree to disagree on the topic, but I have great confidence that my use of IUD's in no way jeopardizes a patients "best interest or future fertility" anymore than any MD's (and none of the nine physicians in my current practice or the six in my previous practice have ever had a problem with my discretion using them). Ofcourse, Dr. Crawford can limit his NP's/CNM's practice in any way he chooses, and I respect that also. Sorry if I rambled.
-- Karen J. Bacon, RNC, WHNP (Inserter of many IUD's - none of which have been removed for PID) Indianapolis, IN karennp@iei.net
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