Thursday, August 13, 2009


Been thinking a lot recently about patients' appointment-making habits. They come in all different shapes and sizes here:

1. The patient who calls bright and early with a freshly-sharpened pencil in her hand and an extra behind her ear, with her Day Runner open to the page that represents the day she'd never take lightly. Inside the lines are neatly printed numbers and bullet points, names and contact information, addresses, directions, and price ranges to encompass any possible abortion procedure.

2. The patient who can't quite remember the name of the receptionist she talked to, but it was something like Stacey (Tracey?). She can't remember the clinic name off the top of her head, but has the number circled in the phone book and could access it in a few seconds ("Janie, pass me the yellow pages!"). She may have to reschedule the first appointment she made, but will, rest assured, make the one next Wednesday.

3. The patient might have called three weeks ago. Might have been wrote down pricing information on a Taco Bell napkin while riding shotgun and balancing the cell phone on her shoulder. Said napkin was then used to blot garish lipstick, or so blow a baby's nose, or inadvertently tossed into the bag full of discarded burrito wrappers and cinnamon twist crumbles. An appointment is never actually set.

Having spoken to hundreds of women over the course of my abortion career, I can safely guess by having a quick conversation with them which ones will be OK and which will need some help. I try to be extra careful with those ones. I also try to pinpoint the determinants of patient organization: what is it, demographically, psychosocially, that makes a patient more likely to put all the necessary information in a safe place and stick to a plan to make the appointment happen? Does this have to do with the patient's actually willingness to go through with the abortion? Her sense of self-efficacy for actually achieving an abortion? Or is it a general lack of organizational talent and communication skills? Anything else, or a combination of the above?



  1. I think sometimes it's about chaos/stress. Some people have more of it in their lives, others don't. I think the more our lives our disorderly in general, the more difficult it is to be organized about all appointments - everything - even an abortion. I don't. I recently spoke to someone who asked me to look up when she was last seen at the clinic. It was in April. She asked how far along she was then. She was 12wks or something. She had changed her mind that day + wanted to now know how far along she was. I told her 27-28wks. She asked what that meant, how far that was. I told her she was near the end of her seventh month. "Ohh," was the response. I asked then if she had received pre-natal care. The answer was "no." She had moved out of state, just moved back....her voice trailed off. It was enough to know there had been just lots going on in her life. Enough going on she didn't even know she'd be having a baby in a couple months. (She did have an appt to have pre-natal care the following week.)

    So...I think it's about chaos.

  2. Now, I'm usually willing to give a person the benefit of the doubt, but I think the above situation reflects more proactive negligence than lack of opportunity due to chaos(and I mean negligence in the generic sense). I feel like this is more a case of "I want to forget", or even a case of "I have no idea how serious this actually is". And so I think at the end of the day some women have issues communicating. Could she have asked a friend/relative who has kids what it means to be pregnant? Could she have asked the clinic staff the first time what it meant not to have the abortion? Could she have Googled "pregnancy" and learned what goes on in one's body and life while pregnant? Certainly. I think the reason why women don't do those things has to do with an inability (inadvertent or not) to analyze situations objectively and to seek out information that would allow them to solve problems. I think it's the same reason why people have unprotected sex; it's not always the case that there is a true physical or psychosocial barrier, but often there is a cognitive breakdown that prevents people from seeing the reality of their situations and weighing options.

  3. Oh, this is sort of tricky. I don't know about the word "negligence", but I'd agree with both of you that the "category" of #3 is probably split between these two cases, of external chaos on the one hand and various forms cof internal overwhelm on the other (and of course they overlap).

    Then there's another thing you mention, anti-anti, which is that for some women the delays do strongly seem to reflect either genuine ambivalence or a reluctance to assume authorship of whatever is to happen next -- perhaps to avoid "culpability" for something that might stigmatize her in others' eyes. In either case, you end up waiting for something external (a push or an obstacle) to make the decision for you. I *always* worry about clients from whom I get this vibe, and try to have a very clear conversation with them, asking them to identify what they Want and Need and then resolve to pursue it. (Note this also goes for women who ARE on track to have an abortion but suggest to me that they are not on board with a decision to have it but "they have no choice" or that it is someone else's idea -- because women who don't feel ownership of their abortion decision are more likely to feel regret later.)

    OK this was a long comment! Thanks for writing this post...


This is not a debate forum -- there are hundreds of other sites for that. This is a safe space for abortion care providers and one that respects the full spectrum of reproductive choices; comments that are not in that spirit will either wind up in the spam filter or languish in the moderation queue.