You might not be aware of your right to refuse any part of any physical examination, especially in regards to pelvic examinations. The following excerpt is from the British Columbia College of Physicians and Surgeons’ Professional Standards and Guidelines regarding all physical examinations:
Physical Examinations
1. The scope of the examination and the reasons for examination should be explained to the patient.
2. If a patient refuses a part or the whole examination, it should not be done. The refusal should be noted in the chart. It may be possible to reschedule an essential examination to be done in the presence of a chaperone of the patient’s choice.
3. A physician must provide complete privacy for a patient to dress and undress.
4. A patient must be provided with an adequate gown or drape.
5. The physician should not assist with removing or replacing the patient’s clothing, unless the patient is having difficulty and consents to proffered help. Sensitive-Examinations.pdf (application/pdf Object).
In the case of the right to refuse pelvic examinations to screen for cervical cancer, I have had a family physician threaten to withdraw health care when I said “no thank you” to a pelvic exam. Withholding health care when a patient declines a pelvic examination is unethical, paternalistic and coercive. All cancer screening is optional and governed by the individuals’ choice. Cervical cancer is a rare cancer and a pelvic examination is extremely invasive. As well, the rate of false positives from a pap test is high, thus rendering the pap test a very unreliable screening method. Yet I feel I am on shaky ground when I decline this invasive examination, as my experience with having health care withheld illustrates.
I am concerned about the excessive pressure placed on women to screen for cervical cancer. Women are pressured to the point where they feel they no longer have the right to decline an invasive examination. In fact, cervical cancer is the only type of cancer women are pressured to screen for. Given other health concerns that are far more likely to cause death (heart and other cardiovascular diseases for example), as well as far more prevalent types of cancer (lung, colon, skin, prostate, thyroid, kidney, etc.), perhaps the time and energy expended by physicians to pressure and coerce women into pelvic exams would be much better spent on more significant health issues. And yes, women do have the right to say “no thank you” to a pelvic examination.
References:
ehealthmd.com/content/how-accurate-are-pap-smear-results
http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616/tbl/tbla-eng.htm
Sue, if only more women (and medical staff!) were aware of the facts, the figures, and regardless of what your risk profile is, it’s your RIGHT to decline any sort of screening, including the pap smear. It frustrates the hell out of me when doctors focus on our vaginas and breasts to the detriment of any other symptoms, screening or issues that myself and other women present for. If I am at the doctors because I am worried about my heart/ear infection/broken bone etc, I do not want my time wasted on my vagina. If I feel the need to get my vagina examined, guess what? I’m an adult, can make my own decisions, and will ask the doctor to check out my vagina. Otherwise, f**k off and deal with what I am here for. I don’t feel like risking a stroke/heart attack/other complications from a totally unrelated illness simply because some bean counter has decided I am simply a pair of breasts and vagina connected in some vague way to the rest of me.
I was looking for a good place to post this excellent article on breast screening.
So many great articles coming out by Dr Gilbert Welch and his team at Dartmouth Medical School and by women who’ve worked out they were over-screened or over-treated or both…these articles are rare here.
We’re now seeing some very worrying trends, including the fact more women opt for unnecessary mastectomy. No wonder, scared to death by the “over-awareness” driven by the pink ribbon juggernaut and screening programs…women basically removing their breasts because of “pre-cancer”…for things that are nothing more than a risk factor. This is a serious problem in the States with many women having breast screening annually and from mid 30s or 40. It would be like doing heart surgery on those with high cholesterol. (an example used in the article) Also, note how much the Susan G. Komen Foundation spend on research and how much is spent on education/awareness and screening. Shouldn’t we be spending a lot more on research? Speaking generally, what is the real motivation behind some of these awareness groups, power and commercial interest or women’s health?
I also, read an interesting article recently by Dr Malcolm Kendrick, who produced evidence to show high cholesterol is NOT linked to more deaths from heart disease. What?
Low cholesterol may be linked to more cancer…so why is every second person over a certain age taking a statin every day?
He’s written a book called, “The Great Cholesterol Con”…I just bought it. The graph he put together shows the lowest cholesterol levels in the world are found in aborigines, yet they have the highest number of deaths from heart disease. Also, the Swiss have the highest cholesterol levels in the world, but the lowest number of deaths from heart disease.
So it seems most of the preventative checks we have may be unnecessary and some expose us to risk. We’re not left with much, are we?
Blood pressure checks for those on the Pill and others over the age of say, 40.
Most GPs here order routine blood tests for people over about 40, checking all sorts of things, including cholesterol, iron, protein, glucose, Vitamin D etc. Assuming they’re all helpful/necessary, we probably don’t need to test every year if we’ve always produced normal-range results. Some say every 2, 3 or 5 years should be enough.
The comprehensive American annual for everyone is not evidence based and not recommended in most countries.
BUT, “routine” visual checks of the genitals, rectal, recto-vaginal, bi-manual pelvic and breast exams are not evidence based, they’re unnecessary/unhelpful. Mammograms are optional (I’ve said NO) and pap tests IMO, should only by offered to the roughly 5% who are HPV+ and aged 30 or older. (If HPV primary testing is unavailable and women wish to test, adopting the Finnish program greatly reduces the risk of false positives/over-treatment/excess biopsy, that’s 7 pap tests in total, 5 yearly from 30 to 60)
There is no screening test for ovarian or uterine cancer, so routine TVU and the CA-125 blood test should be out as well. I even read an American woman was offered a routine endometrial biopsy to check for uterine cancer…what? That’s terrifying…honestly, some American doctors scare the life out of me…I see the grim reaper.
Most of these checks are not only unnecessary, they waste scarce public health resources or cost us or our insurance companies money (the latter driving up the cost of insurance) AND, they carry risk to our health and well-being. All of this invasive stuff IMO, also negatively affects our quality of life.
http://www.nytimes.com/2013/04/28/magazine/our-feel-good-war-on-breast-cancer.html?pagewanted=all&_r=1&
Elizabeth thank you for linking this article. The author states: “The chances of a 20-year-old woman getting breast cancer in the next 10 years is about .06 percent, roughly the same as for a man in his 70s. And no one is telling him to “check your boobies.” I worry there will be more and more pressure placed on very young women, it is so sad the way young women are targeted while at the same time they are least likely to have cancer but are the ones who stand to lose the most. I remember your comment after coming back from the conference in Oxford: “The highlight for me was Peter Gotzsche from Nordic Cochrane Institute, he is the speaker I’ve been waiting decades to hear, someone with the guts to say it with absolute conviction, “breast screening is harmful and should be stopped”. His presentation and graphs were impressive. Naturally, we had the questions from the audience desperately looking for middle ground, “should it be reserved for high risk women?”
The response was clear, “NO, it’s harmful, why would you do something harmful to anyone?”…and another question, “So what is the alternative?”
Response: “Do you know that song, “Don’t worry, be happy”…no one gets near my prostate, so why shouldn’t women have the same right”. Thank you Dr Gotzsche, why is that statement so difficult for most doctors?
Fiona Godlee, Editor of the BMJ, said she has refused her first mammogram and another doctor in the audience has also, refused screening. At the break I spoke to several other doctors who’ve all refused breast screening.” I wanted to re-post this comment as it is very revealing regarding the harm that comes from unnecessary breast screening.
I like your comment about American doctors scaring the life out of you, and seeing the grim reaper – I feel the same way. Maybe women need to start a black ribbon campaign that reminds them to be wary of unnecessary screening and the risks involved. I worry that soon every woman over the age of 60 will be walking around without breasts and a uterus.
Elizabeth, thank you for the link to the article! It’s just brilliant:
“The thing is, there was no evidence that the size of a tumor necessarily predicted whether it had spread. According to Robert Aronowitz, a professor of history and sociology of science at the University of Pennsylvania and the author of “Unnatural History: Breast Cancer and American Society,” physicians endorsed the idea anyway, partly out of wishful thinking, desperate to “do something” to stop a scourge against which they felt helpless. So in 1913, a group of them banded together, forming an organization (which eventually became the American Cancer Society) and alerting women, in a precursor of today’s mammography campaigns, that surviving cancer was within their power. By the late 1930s, they had mobilized a successful “Women’s Field Army” of more than 100,000 volunteers, dressed in khaki, who went door to door raising money for “the cause” and educating neighbors to seek immediate medical attention for “suspicious symptoms,” like lumps or irregular bleeding.
The campaign worked — sort of. More people did subsequently go to their doctors. More cancers were detected, more operations were performed and more patients survived their initial treatments. But the rates of women dying of breast cancer hardly budged. All those increased diagnoses were not translating into “saved lives.” That should have been a sign that some aspect of the early-detection theory was amiss. Instead, surgeons believed they just needed to find the disease even sooner.”
Some more great quotes from the article:
“…Huge jump in D.C.I.S. diagnoses potentially transforms some 50,000 healthy people a year into “cancer survivors ” and contributes to the larger sense that breast cancer is “everywhere,” happening to “everyone.” That, in turn, stokes women’s anxiety about their personal vulnerability, increasing demand for screening — which, inevitably, results in even more diagnoses of D.C.I.S. Meanwhile, D.C.I.S. patients themselves are subject to the pain, mutilation, side effects and psychological trauma of anyone with cancer and may never think of themselves as fully healthy again.
Yet who among them would dare do things differently? Which of them would have skipped that fateful mammogram? As Robert Aronowitz, the medical historian, told me: “When you’ve oversold both the fear of cancer and the effectiveness of our prevention and treatment, even people harmed by the system will uphold it, saying, ‘It’s the only ritual we have, the only thing we can do to prevent ourselves from getting cancer.’ ”
“The fear of cancer is legitimate: how we manage that fear, I realized — our responses to it, our emotions around it — can be manipulated, packaged, marketed and sold, sometimes by the very forces that claim to support us. That can color everything from our perceptions of screening to our understanding of personal risk to our choices in treatment. I’ve called it breast-cancer overawareness. It’s everywhere. There are pink garbage trucks. Women are petrified.”
Wow! Thanks Elizabeth for another informative comment, and for sharing this. You deserve a medal for your continuing work in advancing knowledge on this topic and for countering the myths and propaganda designed to scare and coerce women. When I search the internet on this topic, I keep finding news items and blog posts that have “Elizabeth (Australia)” as a commenter. You keep showing up with intelligent rebuttals to the stupid propaganda that is out there. Others who are following this topic likely know this already, but I was amazed by your obvious dedication and commitment. Just wanted you to know that your efforts are noticed and very much appreciated!
Elizabeth is a wonderful example of how one person can literally change the world. I can only imagine how many women she saved from fear, harm, pain, agony and depression by opening their eyes on overdiagnosis, overtreatment, medical misinformation and vested interests! Her diligence and determination have no limits for admiration!
Thanks for your kind words, FL and Al. It makes a nice change.
I was silenced for decades, so now I can’t stop posting and talking. For a very long time my posts were unwelcome, deleted, edited and I often got a warning from a moderator, that my post might put women off testing and cost lives. Giving women real information was viewed as a huge threat and an irresponsible thing to do.
I was banned from a few sites. Women/doctors could post any old nonsense, yet if I posted the evidence, complete with medical journal references, I was challenged.
I find it grossly unfair, unethical and IMO, possibly illegal for the medical profession to mislead, pressure and coerce women into “elective” testing. Informed consent is a legal and ethical requirement, or is that just for men?
My anger and frustration became a calm resolve after my younger sister was seriously over-treated, she did not provide informed consent for the testing or the “treatment”. She was told all women must have pap tests and given no real information. Pap testing is rarely presented as a choice. Yet these same doctors have no concern about the huge number over-treated, sadly, few women take legal action after being over-treated. It’s therefore IMO, viewed as “safe” to accept the high risk of over-treatment on behalf of your patient. Catching or preventing that rare cancer is the ONLY concern. (and/or collecting your target payment)
A cone biopsy was the result of this “simple life-saving test” that all women “should” have…my sister’s false positive pap test and colposcopy were probably caused by a new brand of tampons. (inflammation)
Many things can produce an “abnormal” pap test – infections, (most transient and harmless) inflammation, (tampons, condoms) hormonal changes, (during and post menopause, pregnancy) trauma (childbirth) and even completely normal changes in the maturing cervix of women under 30 and normal changes in older women.
So while the law and proper ethical standards are ignored, while non-evidence based testing persists…I’ll continue to post. I care about that huge group of women, they matter as well. It’s wonderful that so many women are now speaking out…it makes my day to find an article and see that someone has beaten me to it.
Elizabeth, you are right. You are always right. I’ve said thins in the BlogCritics, but it would fit here too:
While there are plenty of faux comments around the Internet about certain doctors, medications or with unrealistic stories, there are still many women who truly believe that they had a life-threatening disease and that their lives were really saved by the screening and subsequent treatments. And they do believe that they are doing the good and right thing by urging the others to “take care of themselves” and “go get checked”. Those mislead women are also sure that the people like us here, who do their own research, question medical recommendations and voice the revealing facts, are malicious and trying to detract the others from the “vital” medical surveillance and intervention. It’s too difficult for them to accept that they allowed to be deceived, voluntarily handed their body to the system, which used them for profits and statistics and harmed them for no benefit.
They behave in the same way the majority behaved centuries ago, when some strange man started saying that the Earth is round. The majority were sure it was flat, and truly believed that the strange man was either mad, or malicious for trying to detract them from their “vital” faith. Hence the excommunications and burnings at stake.
Fortunately, the aggressive pro-screeners can’t burn us at stake and the medical system can’t “excommunicate” us, but the comments they direct at us are pretty nasty. They are missing the main point: the medical system does benefit from deception, over-screening and over-treatment, while people like us don’t make any money on saving someone from unnecessary harm. Who is more likely to tell the truth then? If anything, we spend our free time on writing about true facts, reading through researches and presenting the evidence. We are not doing it for profits, we are saying it because it’s the truth, just like the man who was insisting that the Earth is round wasn’t profiting from that.
The truth is hard to see and accept at times, especially if the deception is based on fear and supported by the profession that is supposed to be trusted, be knowledgeable and act in our best interests.
And a bit more:
Screening “…finds many cancers that never need treating and that are, by definition, survivable. Meanwhile, some women with lethal disease may seem to live longer because their cancer was found earlier, but in truth, it’s only their awareness of themselves as ill that has been extended. “Imagine a group of 100 women who received diagnoses of breast cancer because they felt a breast lump at age 67, all of whom die at age 70,” Woloshin said. “Five-year survival for this group is 0 percent. Now imagine the same women were screened, given their diagnosis three years earlier, at age 64, but treatment doesn’t work and they still die at age 70. Five-year survival is now 100 percent, even though no one lived a second longer.””
“It has been four decades since the former first lady Betty Ford went public with her breast-cancer diagnosis, shattering the stigma of the disease. It has been three decades since the founding of Komen. Two decades since the introduction of the pink ribbon. Yet all that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating “cancer survivors” who may have never required treating. And ultimately, it has come at the expense of those whose lives are most at risk.”
Elizabeth I heard about the link (or lack of) between cholesterol and heart disease a while ago. Dr Mercola, a medical Dr who became a natural medicine expert, has been talking about that for some time. From what I understand the original connection between cholesterol, namely LDL aka the lousy cholesterol, and heart disease was made in the 1960′s and was bad science from the beginning and follow-up studies could not reproduce that connection. Unfortunately medical science ran with the original results and has not kept up with the newer research or has dismissed it. As they do with many things. Dr Mercola has discussed a few times that our bodies need LDL because it is involved with vit D metabolism which has been shown in several studies to be a key factor in the prevention of several diseases. I refuse to have my cholesterol tested and when my Dr put it on my requisition I didn’t fast. Medical science has so to speak demonized so many things that are normal and healthy such as LDL cholesterol, red meat and saturated fat which your brain needs, the sun which has been shown to not be the source of skin cancer but a prevention because of vit D. In fact some research has shown the wearing of sunscreen is bad because it blocks the skin from the rays needed for vit D and all those moles people are having removed and being told are “precancerous” are not and are simply normal. Then of course there is the perception of the healthy female body of a disease waiting to happen.
ADM I have heard the same about moles being removed unnecessarily as most will never progress to cancer. Many people are terrified of the sun, and of every mole they see. It is paralyzing the amount of conflicting information. I cut my losses a long time ago and stopped going to doctors. And in my opinion my skin, breasts, uterus, cervix, ovaries and peace of mind are all intact and healthy as a result.
I don’t get my skin checked by doctors, I do it myself and I’ve successfully removed two BCC’s over the last few years without any visible scaring. Black Salve or Cancema is not registered by the TGA though you can use it on your animals. Unfortunately no clinical trails done on it yet, though not for lack of trying to have it included. I work in alternative medicine and many practitioners use Black Salve on themselves, just not on their patients for liability reasons. Though I do know there is a handful of GP’s who quietly ‘suggest’ it to their patients.
The problem is it works, and without any adverse reactions from what I can gather, it’s a drawing agent that works on specific cell structures such as cancer. The ingredients are easy to obtain and make at home, so there’s no real profit for Big Pharma.
I made the mistake of telling people what I was doing the first time I used Black Salve on my face, some people were curious, though they wouldn’t do it themselves and some people were angry at me for putting my health at risk, I was lectured about the dangers of untested products. And it’s not surprising that there is misleading information about Black Salve on the Internet, Quackwatch for example, warned against a corrosive ingredient that’s not even used in the recipe. People really don’t like going against mainstream health authorities, even when accepted treatments can be completely unnecessary and disfiguring.
I asked my dermatologist about routine skin checks and she said not to bother, I only have a few moles on my body. She’s a practical woman…she said to see her if something changes or something new appears. (that’s bothering me)
As we age we get more bumps, sunspots etc, my mother has had a few things removed over the last ten years.
Anyway, my doctor got major brownie points there, many/most doctors would just push the routine check.
I think some people have been surprised at the thoroughness of these exams. Some doctors ask you to undress down to your underwear, others ask you to remove your bra as well, and some doctors (I suspect mainly American) check everything and I mean, everything.
We had a dermatologist checking everything, inside and out (internal exams for some young women, I don’t think many of the men or older women got such “thorough” checks) and taking photos, and he’s now sitting in prison. So this seems to be another area of potential abuse, take care.