Monday, February 27, 2012

Abortions "To Go": Modernizing Abortion Services

We had a client yesterday who asked if she could get in and out of the clinic within an hour or so. I told her it wasn’t possible since the sedation alone would require her stay about thirty minutes after her abortion just to make sure she was feeling okay…let alone all the paperwork and labwork we’d need to do prior. She still wanted to get in and out within a maximum of two hours. She was busy and had a lot to do.

I think some clinics have entire abortion appointments that last about two hours. At our clinic, it usually takes four. I mean, of course, the abortion only takes a couple minutes, but women are usually waiting around FOREVER. I often think there’s something wrong with how either we schedule people or how we organize the appointment flow since sometimes people are at our clinic for even more than five hours. Patients complain a lot about this and I can’t blame them. It’s not like our waiting room is super comfortable or welcoming (sadly, I find this is true in a lot of clinics).

On one hand, as abortioneers, we want to spread the message that abortion is a simple and common procedure (it is!), but we make women wait ages in either over- or under- heated waiting rooms between labwork, counseling, and their abortion. They fill out millions of pieces of paper that ask for a lot of the same information repeatedly. We definitely are sending mixed messages: if abortion is simple and common, why would you be in the clinic for over three hours?

The abortion-to-go girl is right, in my opinion. If a patient is totally sure of her decision (most are by the time they come in, or else they just don’t show up for their appointment…usually), then we should be able to accommodate them and get them through their appointments quickly. That might mean clinics need to think outside the box a little and be more creative in scheduling and in how they process appointments, but they should do that then. Let women fill out their paperwork online, for example. (Or clinics should move to electronic medical records!) What if patients could make payments online before their appointment? I think clinics are so far behind technology now…imagine if a client could even book her appointment with her iPhone because the clinic has an app for that. I think it could happen.

Anyway, I really think we can all do better at actually providing abortion services in a more quick and efficient manner while holding onto warm and kind staff (who of course will be more kind and warm if patients are happy and not complaining!). What do you guys think?


  1. A worthy ideal, indeed. However, my understanding from working at different clinics in different states and under different affiliates is that much of the time women spend waiting for an abortion is dictated by the amount of willy-nilly restrictions imposed by the gov. Certainly, abortioneers can try their best, but several steps (including ultrasound, consent, and lab work) are required both legally and medically to have an abortion.

  2. I think it's totally doable--agreed with the previous commenter that [misogynist] govt restrictions add a lot of time, but even beyond that there is so much dead time! At my PCP's office, I book my appt online, fill out questionnaires in advance online, and have all my followup communication online--these are only options, and i could do it all in person, but i always choose to do it in advance. And i think that the fact that i do it in advance means that the clinic staff have a greater ability to efficiently do those procedures with everyone else. I am usually in and out within 20 minutes beyond the length of my appointment, often less.
    Contrasting that with when i go to PP for gyn care--last time I got there, i waited 20 minutes, was given a bunch of paperwork to fill out even though i was just there for an IUD check, filled it out, waited, gave it back to the triage person, talked to them, answered the same questions verbally to them, was called back for my appointment, talked to the provider who said i probably didn't need to have filled out most of the paperwork, and then had my appointment. Total time? 2.5 hours. For a 5 minute, no-anesthesia procedure, that has no government regulations.
    We can definitely do better.

  3. Yup, I agree totally with this post. The last clinic I visited had an entire-business-day wait. I'm talking women who'd show up before the doors were open (with 9am appointments) and not walk out until after 5.

    What this means is that in addition to the actual cost of an abortion and gas to get there, women and their rides, both, lose at least 2 days of work (abortion + follow up visits).

  4. daughter of wands - thank you for your comment. It's true that some states add all sorts of restrictions that add time, but the state I work in doesn't have any of those (luckily!) and I know we're one of the few. Still, the average appointment is at least four hours and sometimes they last as long as what notmygnome described. Most of that time is down-time, just waiting. Patients always, always, always complain about it and I just think we need to do better, when and where possible.

    I wonder if even helping to make waiting rooms more wait-friendly if there truly is nothing to be done about the time spent in the clinic. If that's the case, surely efforts to make the space relaxing, non-medicinal, etc. could be made.

  5. eliz - thanks for your comment. Yeah, I just don't get why it takes so long. Lots of time, the paperwork seems totally repetitive, too, asking the same questions or information over and over. I love that your PCP allows you to book your appointment online and get follow-up information online, too. Recently, my PCP emailed me my lab results, highlighted any concerns, and wrote a little note on there. I was also given a web address where I could access all medical records. LOVED it. Made it very simple so I didn't have to rebook follow-up appointments.

    notmygnome - I feel bad and embarrassed that it took so long at the clinic you last went to. Imagine if people had to travel long distances to get to that clinic, too. Or if there was bad weather and it made them end up having to get a hotel because it was too late or not safe enough to drive home. Then add on, like you said, the cost of the aboriton, the travel cost, the lost time and income at work, and that's ignoring that most patients have kids at home waiting for them... it's all so complicated. Abortion is already hard enough to access for most; clinics can do better to making them easier on the day of.

  6. My clinic has a TV with cable, but Saturday morning programming is not the greatest. Still, you might catch a semi-decent chick flick while you wait.

  7. Wait... Three to four hours for the whole procedure? Yea, that doesn't strike me as abnormally long for any type of doctor's office. I've waited four hours to see a specialist for five minutes, and over two hours to see my GP. I do agree that wait times should be shortened, but it doesn't strike me as exclusively in abortion clinics.

  8. About a Girl,
    Not an abortioneer myself, but wouldn't having patients filling out forms and records on line pose either a security or privacy risk? Given the extremes the anti-choicers go to find personal data on docs and patients, putting a big store of patient data online somewhere seems like an invitation to trouble.

  9. Hm, Chris, fair enough -- it would have to be based on a secure/https site with good encryption, but even more than that it'd need to be maintained by a clinic that is very security-savvy. Probably easier to do what my old clinic did: offer just the blank forms online, so patients could print them out and bring the completed forms to their appointment. Not quite as breezy, since the staff still have to type in the info for EMR, but it does shave about 45 minutes of detailed paperwork off their time at the clinic).


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