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The Complexities of Birth Control Pills
As one who has spent much of his life trying to take complicated things and make them simple, I am often struck by the gift that some people seem to have for taking simple things and making them complicated. Take birth control pills, for example.
You would think this would not be a complicated matter. “Ok, Suzi, take one pill per day. Um…that’s about it.” But you would be amazed at how many different ways I’ve seen people goof this up. I have often heard the same line, “Hey doc, those pills you gave me didn’t work. I’m pregnant.” I’ve learned that after I hear that sentence, I’m likely to hear one doozy of a story afterward. For example:
Staci: “Hey doc, those pills you gave me didn’t work. I’m pregnant.”
Dr. Bastiat: “Um, ok, did you take one pill every day?
Staci: “Of course I did! Do you think I’m stupid? I took one every single day that I had sex.”
Dr. Bastiat: “Ah.”
Staci: “My boyfriend drives a truck, and is gone for a week or two at a time. But as soon as he got home, I’d start taking a pill every day. I never missed one.”
Dr. Bastiat: “Did you ever wonder why there were 28 pills in a four-week pack?”
Staci: “Huh?”
I thought to myself, “I could practice medicine for the rest of my life, and I’ll never hear anything more stupid than that.” Over the years, I’ve learned not to say things like that. As it turns out, stupidity is a competitive sport:
Kaci: “Hey doc, those pills you gave me didn’t work. I’m pregnant.”
Dr. Bastiat: “Um, ok, did you take one pill every day?”
Kaci: “Well, no, they made me sick. So I gave them to my boyfriend.”
Dr. Bastiat: “Ah.”
By this point, it was taking me longer and longer for me to instruct women on how to take birth control pills. Most of them looked at me like I was stupid as I said, “You – you personally – take exactly one pill. Every day. Regardless of your plans for that day. Or that evening. Every single day. One pill.” But my instructions got longer and longer as my patients displayed their creativity (if not their intelligence) by finding new and fascinating ways to screw this up:
Maci: “Hey doc, those pills you gave me didn’t work. I’m pregnant.”
Dr. Bastiat: “Um, ok, did you take one pill every day?”
Maci: “Of course I did! Do you think I’m stupid?”
Dr. Bastiat: “One pill.”
Maci: “Right.”
Dr. Bastiat: “Every day.”
Maci: “Of course.”
Dr. Bastiat: “With a glass of water.”
Maci: “Huh?”
Dr. Bastiat: “You swallow the pill with a glass of water.”
Maci: [looks horrified and offended] “I don’t do it like THAT!”
So after I engaged in extensive and awkward questioning of Maci’s intelligence and my career choices, I finally realized that Maci had been inserting the pills where she had sex, and she was extremely offended that I was suggesting that she engaged in oral sex. She’s not that kind of girl.
You might think that practicing medicine is pretty boring. And on a good day, you’re mostly right. But my patients keep it interesting. Every once in a while, one of them will take my boring, simple day and turn it into something much more complicated than I thought it was. I’ve had patients who can’t read who I’ve trained to use insulin pumps, and after some work, they’ve become really good at it. And then, I have some who can’t figure out birth control pills.
I’ve learned to go with the flow. Rather than respond with, “You did what?!” now I just sit back in my chair, look up at the ceiling, and think to myself, “Hmm… I don’t think I’ve heard that one before…”
And as the years go by, my instructions for patients get longer and longer, and more and more involved. They call this practicing medicine.
After years of experience, now I can even sense when my day is about to become more complicated. For example, I start paying attention when I hear those dreaded words, “Hey doc, those pills you gave me didn’t work. I’m pregnant.”
Published in General
Yeah, it’s tough. And it’s not just medicine.
Any more, as soon as I hear “Hey, Mark. That Hayek guy, he was an idiot,” I lean back in my chair and mutter to myself, “This is going to be another long day.”
Never, ever, challenge the stoopid.
“Foolproof” user interfaces are a bad investment. There will always be a greater fool coming down the pike.
I’m speechless.
Reminds me of a story Doc Daneeka once told…
I think nowadays I get most of my exercise shaking my head at the stupidity.
There was a patient in California that sued her doctor and pharmacy because she got pregnant using contraceptive jelly.
Of course she would eat some before she had sex. But she got pregnant anyway.
I had a friend who was a medical products engineer. He said it was impossible to “doctor proof” equipment.
One example he gave was having designed a connector for a piece of ICU equipment that could only be connected 1 way.
One of the physicians had “fixed” this by taking a scalpel to it and carving it into a shape that would fit together… wrong.
Doc, I know exactly what you’re talking about. I started with a short paragraph of instructions on the syllabus I handed out to my classes. But then someone would find a way around one of my instructions. So I would expand that section. Then another. Then another expansion. After ten or so years, my instructions were the size of a novel. Finally I gave up and went back to my simple paragraph.
I like the one in which the girl put a pill up her hoo -haw. Seems reasonable to me.
How many of these people are allowed to vote Doc? If the answer is most of them, then we need sex robots to limit dumb people breeding and we need genetic engineering as a safety net.
I will use this article to justify my beliefs from now on.
Boss Mongo has a similar story about Afghanni sex education. Pretty sure it violates the Coc.
It may be a corollary to Goedel’s Principle (which shows that no matter how many axioms you add to a formal system (at or above a certain complexity level), there will *always* be some theorems that you can’t prove or disprove.
By analogy, no matter how carefully you explain something, there will be a way for someone to misunderstand it.
Doc… a lot of Democrat women in your practice?? Just a wild guess of course..
As my brother says, “When they tell you the average IQ is 100, they mean it”.
This is also the reason I never bother to produce more than rudimentary documentation for any software I produce at work. Nobody bothers to read it, and when they do, they misunderstand it anyway.
I guess that’s why they invented Depo-provera.
Thanks, Mr. Kojak. We are going to have to give that point to the non-Doctor team.
Dr. Bastiat, you have 3 minutes to reply for the Doctors. You have the floor.
I’m supposed to put the pill where?
Too funny.
You need to specify once every 24 hours rather than every day. I can hear someone saying ‘I didn’t think I could take it at night.’
Thanks, Doc. Some days a little levity is worth a lot. And this was one of those days for me.
That reminds me of my high school AP English class. It was ostensibly supposed to be composed of the people in our school who were best and brightest at English composition and comprehension but, because the honors teacher was (justifiably) universally reviled, 3x the pupils that should have been enrolled were in it. We spent two whole 84 minute periods on how not to write a 5 paragraph essay (the test doesn’t like them) and the amount of incomprehension was stunning; I spent the period counting how many times each student said “like” and sticking my tongue out at the teacher when no one else was looking (he was fine with it, we got along through mutual bickering and a massive degree of affection).
The one class experience that topped that was Spanish 1 my senior year. To avoid shop, I enrolled in that, having already done every French course our school offered. The guidance counselor failed to inform me that the class was composed almost entirely of non-honors freshman and, more so, people on their 2nd or 3rd try at it. And it took effort to fail a level 1 language class. It took three weeks to explain the concept of verb conjugation, one kid threw a hissy fit every time the teacher spoke French to me or asked a cognate question (“we’re only supposed to be learning Spanish!”), and definite and indefinite articles were a lost cause. I spent most of my time contemplating elaborate escape attempts, or trying to see whether I could commit lingchi with the endless worksheets. The teacher finally took pity on me (once I left for a senior assembly and, after he stopped reprimanding me, I explained that I really wasn’t a freshman) and gave me level 2 and 3 sheets to keep me from snapping and throwing the kid who made a presentation of his “el trap house” through the window. My French teacher used to smile and wave at me cruelly through the window, while I mimed pleas for rescue. None ever came.
“I can explain it to You, I can’t comprehend it for You.”
Does it involve camels?
Kindred spirits, though we are generations apart.
!. So they never learned this concept in English grammar?
2. Good thing they were spared declensions in Latin, German, etc.
Not quite the same thing, but it made me think of this:
I took two semesters of Arabic last year (night class at a well regarded uni for non-Western languages), and some of the guys in the Thai class definitely didn’t look like they were learning because they wanted to read Veeraporn Nitiprapha in the original Thai. Of course, my very nice Arabic teacher was going on about learning dialect works in order to blend in at the souk (in a mostly heritage learners class), and then just kind of looked at me and sighed, because she knew no amount of dialect words were going to do that.
Not going to lie, if they were on their third attempt at Spanish 1, their English grammar probably wasn’t too hot (though they were all native speakers). As I recall, the lower level English classes also eschewed most grammar, and reading more than one or two books.
I’m a Russian double major, if the declensions (and their five million #$%^&*! exceptions) don’t kill me, the verbs of motion will.
If a urine sample was needed, I started out giving the patients a small plastic tub to carry the sample cup, so they wouldn’t be carrying around a pee-coated cup. I stopped doing that after a patient handed me a small plastic tub full of urine.
So I started giving out zip-lock sample bags with the cups, until I got a bag full of pee.
So I started giving out very specific instructions:
Even so, about once a month, a patient will come out of the toilet with a sample cup wrapped in a paper towel and try to hand it to me.
Or this:
More likely goats. Very few camels in Afghanistan.
Put me in mind of this, a long running joke with my Taiwanese friend.
I couldn’t resist (warning for strong language and inappropriate humor):
I overheard my late Aunt Jemima (really) once explain to my sister that birth control pills are 100% effective if you hold it between your knees.
Sounds like they worked just fine: the boyfriend didn’t get pregnant.