When women visit a doctor they often are not going for the purpose of a pap smear, but find themselves having one anyway. Frequently this is not because women have asked for one but because their doctor has told them they should have one or that they need one. Doctors are aware that many women dislike pap tests. As a result, some doctors have developed and utilize the following coercive tactics to harness compliance:
- Doctors make the pap test their first priority, and regardless of the reason for a woman’s visit the doctor will attempt to broach the topic at the beginning of the consult.
- The question “when was your last pap test?” is often asked ahead of any questions that address the woman’s own health concerns. Women often feel they must submit to a pap test before the doctor will address the original reason for their visit.
- After establishing in an authoritarian manner that the woman “needs” to have a pap test because she is “overdue” for one, the doctor will instruct the woman to get undressed and to lay down on the exam bed.
- The doctor will then quickly leave the room. The doctor’s quick exit has left the woman without the opportunity to discuss or decline the exam, and she also has been left alone with the full weight of the doctor’s expectations and instructions. Many women in this situation will get undressed and into position rather than risk annoying the doctor.
One definition of coercion is to compel or restrain by force or authority without regard to individual wishes or desires. The way in which doctors present pap tests leaves women with limited opportunity to have input into whether or not they feel they want or need one. In fact, some women are led into a pap test without any awareness of the purpose of the exam.
Pap test coercion has gone largely unnoticed for years. Many women have not questioned the methods used by doctors and have complied as a matter of routine. However, research that highlights the harms of over screening, increased access to information, recommendations to increase the age to begin pap smears, recommendations to lengthen the interval between pap smears, and the discovery of alternative and better methods to screen for cervical cancer have recently encouraged more women to ask questions. More women are beginning to opt out of pap tests, and because some women are beginning to say “no” they are becoming more aware of the coercive tactics used by some doctors that can make refusing a pap test so difficult.
More women are also realizing that they have a right to informed consent. It is interesting that a number of women who have had a pap test do not know what the test is for or that they have the right to say “no”. Doctors have failed to inform women of even the most basic details prior to gaining access to their most intimate areas. Men are treated differently by doctors when it comes to prostate screening. Men are offered information, are involved in the discussion, and are offered a choice of whether or not to screen. This same respectful treatment has not been extended to women even though women and men have an equal right to informed consent. Coercion has been the norm for far too long in women’s health care – and more women are becoming aware of this.
Female doctor who does not have pap tests: http://margaretmccartney.com/2012/03/20/why-i-dont-have-smears/
Informed consent missing: http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html
What some male doctors do when women say “no”: http://forwomenseyesonly.com/2012/10/17/what-some-male-doctors-do-when-women-say-no/