Public Health Law Map - Beta 5 - Medical and Public Health Law Site

injectable contraceptive that lasts about 3 months as used in the United States. As
with other high- maintenance implantables, medical care practitioners have a duty to
keep track of patients with implantable contraceptives. They should use the same
tracking system for patients with implantable contraceptives as for patients with
implanted devices such as pacemakers. The patient should be given written
information about the importance of follow- up care and the symptoms that should
prompt an immediate call to the medical care practitioner.
The patient should be contacted before the date when the contraceptive is scheduled
to lose effectiveness. If the patient cannot be contacted, the physician should send a
certified letter to the patient’s last known address and document that it was either
received or returned. Patients with Norplant should be seen at least once a year for
evaluation of potential side effects and must be seen at the end of five years to
remove or replace the implants. Patients with Depo-Provera will be seen quarterly to
renew the implant. When patients with either contraceptive are seen, they should be
carefully checked for sexually transmitted diseases, especially HIV. Although
implantable contraceptives do not facilitate pelvic infections as did IUDs, they do
facilitate the spread of sexually transmitted diseases by giving the false sense that
they provide protection during intercourse. Medical care practitioners should be
careful to educate patients that implantable contraceptives do nothing to protect
against HIV and that patients must also use condoms if they are to be avoid sexually
transmitted diseases. This should be fully documented in the consent form for
implantable contraceptives.
4. Natural Family Planning
The rhythm method has been expanded to include several methods of determining
the time of ovulation. Although most medical care practitioners do not recognize
rhythm as a medical matter, it is a form of contraception their patients may use or ask
about. There are risks to this method, and these risks should be explained to patients.
The most obvious risk is pregnancy. This is an effective method if used properly in
selected patients, but it requires training and good record keeping. In addition, the
woman must consider the social problems of abstinence. One study of the
effectiveness of rhythm was discontinued after several study subjects were beaten by
their husbands for refusing intercourse. Another risk is the use of rhythm as an
adjunct to barrier methods by a patient who is not trained. Many couples will not use
barriers if the woman is menstruating in the mistaken belief that conception is not
possible. This last risk should be discussed with patients who choose to use barrier
contraceptives because it may increase the incidence of pregnancy.
5. HIV Infection and AIDS
HIV is already one of the most common venereal diseases. Its low infectivity has
slowed its spread, but as an incurable disease with a long asymptomatic latency, its
predicted equilibrium level is high. There is nothing unique about the problems
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