2015 is a watershed period in the medical profession. Facing unprecedented scrutiny from payers, patients, and other stakeholders, frontline clinicians are more accountable than ever for hewing to evidence-based, cost-effective practice. As a result, professional norms are shifting and increasingly supplanting traditional views on what is best for patients. Last fall, the American Academy of Pediatrics (AAP) provided one of the boldest examples of this shift by recommending long-acting contraceptive devices as the first-line form of birth control for teenage girls.1
When I was a medical student, my colleagues and I dealt with the deluge of information getting hurled at us by forming associations whenever possible – even when these associations were overly simplistic in real life, they could still reliably help us pass tests. Here is what I remember learning about long-acting contraceptive devices, such as intrauterine devices (IUDs): they can make sexually transmitted infections worse (never mind the nuanced evidence showing that those with preexisting infections can be successfully treated with standard antibiotics after insertion) and they are primarily used by older, multiparous women who already had many children (never mind the fact that there is no particular reason for this to be true). Based on this information, sexually active teenagers would have been the last group of patients I would have recommended IUDs to in my practice.