Poll: How many women won’t go to doctors because of pap test coercion?

Coercion1Some women who choose to decline pap tests are having a hard time accessing health care.  Pap tests are used to detect abnormal cells on the cervix which are thought to potentially lead to cervical cancer.  Some women do not wish to screen for cervical cancer.  However, even though all cancer screening is optional, the women who say “no” to cervical cancer screening often have their choices ignored.  Many women on this blog and on other forums have indicated they are being coerced and/or bullied into unwanted pap tests when they visit doctors.

Unfortunately, there is no research that has been done to determine the numbers of women who avoid doctors and/or who have healthcare withheld due to pap test coercion.  Online polls are not considered “formal” research, but they can provide an opportunity for women to share and learn from each others’ experiences:

Thank you for participating.

 

About forwomenseyesonly

Hi. My name is Sue and I am interested in promoting holistic and respectful health care.
Gallery | This entry was posted in cervical cancer, gynecology, pap test, unnecessary pap test and tagged , , , , , . Bookmark the permalink.

119 Responses to Poll: How many women won’t go to doctors because of pap test coercion?

  1. cindy knoke says:

    Excellent points you bring up!

  2. Alex says:

    This looks like it’ll make a good thread. I’m willing to bet a lot of women have run into at least one of these.

    What about adding one for them trying to integrate getting undressed as a rider to the situation? Like telling them “that’s how we do things” or trying to get her to do toe-touches in a gown (“scoliosis testing”) or something like that. It seems that they add stuff like that into immigration physicals as an “article of circumstance.”

    They love to put things on lists & get all offended when the exact parameters of their guidelines are not met. I’ve noticed that America is a very doctrine-bound society & the people here don’t really tend toward thinking about cause & effect as much as “the list says this.”

    • Thank you for the feedback Alex.

      • Alex says:

        You’re welcome. I hope I didn’t come off too “know-it-all-y,” I just get really pissed off with things like that. Trying to act like an aspect of a situation isn’t a part of it.

        It’s always some kind of angle: One minute they’re trying to start probing someone, then they’re trying to get them to get naked as its own thing, then they’re trying to fondle a teenager under her shirt, then they’re trying to con someone into getting organs removed arbitrarily, then they’re trying to force vaccines on someone that might just cause seizures/paralysis/death (or anything else). All this while acting innocent as the day is long!

  3. Moo says:

    I was threatened with withholding birth control pills unless I got the Pap test when I was younger. I assumed that birth control had something to do with Pap tests only and not so much cancer screening or the pill could cause cancer. I used walkin clinics that did not do paps even if they were asked for when I did not use birth control pills. Later I signed onto a family doctor’s roster. Then the pressure to pap was terrible and I was avoiding medical care. I found out from this site what was really going on: incentive bonus. The doctor told me I had to get a Pap test or I could no longer be his patient. I challenged that with “put it in writing.” I still avoid going to the doctor and going for something even minor causes me great distress. I feel I just do not trust this person.

    I have been told that because I do not participate in “screening” that I am going to cost the public system too much if I get diagnosed with something serious later. I am refusing vaccines, colon, breast and cervicla cancer screening, blood tests etc. I am not going to take antibiotics for infections either because I found herbals that work better. No more 2-3 times yearly antibiotics for upper respiratory infections. I have only one prescription med that I use for emergencies only, Probably avoiding healthcare as much as I do and not taking medications is better for me.

    • Heather says:

      I was bullied into having a Pap smear when I broke my hand. It is clear that cervical cancer has nothing to do with the treatment for a hand fracture, but the doctors were insisting that I must have a pap as a necessary part of comprehensive health care. I steadily declined pap, and as a result of the delays, my bones healed in a wrong position making me unable to write and do lots of other basic things necessary for everyday life. I had to travel at my own expense to what Australia considers a third world country to have it fixed. Now I can write, type, cook and work, though still have no sensitivity in 2 fingers.

      The point that the health system likes to make about me costing more to the taxpayers if I don’t screen is utter rubbish. I lead very healthy life and my broken hand was my first visit to the doctor in many years. But, bacuse I am Australian, I had to pay the following:

      – Every year, 2% of my income to Medicare, which funds the pap screening but couldn’t fix my hand.

      – Every year, nearly a thousand dollars to the private hospital health isurance, which all reasonably-earning Australians are forced to have, otherwise they have to pay more to the Medicare. The private hospital health insurance doesn’t cover lots of things, and when it does cover something, it still leaves many patients with a huge out of pocket bill if they use it. Also, private hospitals won’t take the patient back with an aftersurgery complication or a hospital-acquired infection, which means that despite being forced by the government to feed the private health industry, despite receiving a poor quality service in the private hospital and unnecessary suffering, the patient still ends up in an public hospital in a common ward with loonies and forced into Pap smears at every opportunity.

      – According to this year’s tax receipt, nearly $3000 of my regular taxes went to the health care system on top of the Medicare levy, and I presume something similar happens every year.

      – I had to pay for every visit to the doctors regarding my broken hand only to hear about Pap smears and get no help for my hand problems.

      – I had to pay for my trip and treatment abroad in order to be able to work and pay taxes again.

      In total, for the 2013-2014 financial year:
      – Australian Heath system gained nearly $7000 from me through Medicare levy, taxes and forced insurance.
      – I lost about $16500 to pay the medical tax portion, Medicare, insurance, doctor visits and trip and treatment abroad.
      – I got NOTHING back from the Australian Heath system, except for Pap smear bullying.

      So, who is costing whom???

      To add insult to an injury, Australian medical system keeps sayng that it is one of the best in the world.

      And, unfortunately, there are many women here who can tell a similar story about their countries too.

      • Heather says:

        P.S
        Needless to say that I was avoiding the doctors before I broke my hand, and I will totally avoid them in the future. They are uselesss! It is a pity that I cannot stop paying Medicare, health insurance and the medical portion of the tax on the grounds that I won’t go to a doctor in Australia for as long as I live. I could have saved all these money for the time I need medical help and get it in another country, where doctors know that broken hand is not attached to vagina.

      • Alex says:

        Holy shit! That’s like them twisting your fingers until you say it’s okay for them to probe you! You realize that that would be coercive iatrogenic assault & reproductive endangerment, right? It speaks very well of you to not go along with it, by-the-way.

        Certainly gets one to thinking about learning traditional bone setting, doesn’t it? Traditional Chinese Medicine is one idea. Actually, I had a huge argument with some guy on Happier Abroad where that almost exact same situation came up (the concept of someone breaking their leg was the specific difference). It was the “Why are flu shots free in America?” thread. The guy was training to be a doctor & was a complete asshole. He did all the typical medical personnel things (lying, bouncing blame back on the other person, dodging various subjects, playing victim, overall pretending that what happens isn’t what occurs- you know, the classics).

        People sometimes get on my case about seeing them as more or less the same, but they consistently do the same shit! Not to mention that they are selected, trained, and certified- perhaps there’s a running theme? If this is what they deem to be of sufficient quality, then it stands to reason that the polar opposite would NOT be approved of. Plus, if there’s camouflage & low accountability, that would most likely attract people that are aligned to attack people medically.

      • kholli says:

        Wow! I cannot believe Australia’s healthcare system is just as bad as that in the USA. I was under the impression you guys had a better deal, but I guess not– at least not if you are a female.

      • Elizabeth (Aust) says:

        Heather
        I assumed we faced less pressure than the Americans and Canadians, but it seems “many” Australian women also, face coercion or serious pressure to screen. Informed women have more protection, but it seems anything goes with everyone else!
        I think coercion is happening here more than we think, I naively thought things had changed (just a bit) but too many doctors (often speaking for the AMA) continue to link pap testing and the Pill, one male doctor seemed to be publicly endorsing coercion. (not one person challenged him)
        The Medical Board readily accepted a GPs statement that he respects a refusal, when he said something completely different on a health forum, boasting how he holds the Pill until women go in for a pap test. I think the Medical Board knows if they took action against him, they’d also, have to address the statements coming from the AMA and elsewhere.
        They all KNOW this is going on, they know consent is being violated, women are being assaulted, but they’re getting away with it, so it continues.
        Do you mind me asking? Did this happen in a casualty unit of a public hospital?
        It astounds me you’d arrive with a broken hand and they’re going on about pap testing.
        Honestly, it never ceases to amaze (and disgust) me.

      • Elizabeth (Aust) says:

        Heather
        The curious thing: if you look at cases before the Medical Board, they examine the doctor’s conduct and ask: was that exam a clinical requirement? If not, why was it done?
        How on earth could you justify a pap test when the woman presents with a broken ankle?
        I suppose the doctor would lie and say, he offered, you accepted…and of course, opportunistic pap testing is encouraged.
        I know there was one case where the male doctor tried to kiss a female patient who’d refused a pap test, the Medical Board skirted around the issue but said the pap test was obviously her choice.
        They must have to plot and plan or they’d end up in knots, dancing around trying to ignore the elephant in the room. I suppose this is why we only see real action when women go to the Police, then we see the Medical Board playing catch-up. When you permit (turn a blind eye) to doctors conducting pap testing with no consent, you’re hardly doing your job, unless that job is to protect doctors and a system that abuses women.

        If women take someone with them into casualty/the consult room, at least they’d have a witness so the doctor would struggle using the old, “I offered, she accepted” line. (coercion would probably be less likely to occur) Like all predators, they pick the best time to make their move, when they have the most power/opportunity and are more likely to get away with it.
        You’ll recall a young model posted here last year, she had an unnecessary breast exam (coercion was involved) and reported the doctor, he used that line, but fell short, routine breast exams are not recommended at any age, so he was either lying or incompetent.
        He received an official warning, but if a man grabbed a woman’s breasts in the street, I think he’d get more than an official warning. I don’t think doctors should be treated differently, they should get a harsher penalty because they’ve violated a position of trust.

      • kat rehman says:

        I was at a medication review for my debilitating migraine.
        I thought I would be asked how I was coping, did I think I needed to adjust my meds. And I was. But I was also asked about smear ( I’ve not screened in 15 years).
        To be fair I said I wasn’t going to screen and it was dropped immediately. But I was still pretty angry it was brought up at all. I’ve since opted out and have a new review next week. We’ll see what happens..

      • adawells says:

        Hi Kat,
        I’ve been checking the websites of a number of GP surgeries and some of them are adopting the following practise: they make it clear that, of course you can opt out of the screening call and recall programme, and they even provide a template letter on their websites in some cases. Then what they do is send you a “reminder of your opt-out status” from your GP practice, every 3 or 5 years, just in case you are having doubts about your decision. It gets them around the legal requirements that they have to offer a choice to opt out of the national call and recall system, but in reality they have simply replaced the national system with a another letter every few years from your local GP practice.

        I opted out permanently in 2003, and it was permanent – I’ve never been asked since, but I think they’ve brought in this new idea as too many women have been opting out! This is one example, but I did find another which sent “reminder of your opt-out status” letters every 3 years. Just replacing one system with another. If they keep pestering you write another letter, saying you don’t want the matter raised anymore, under any circumstances.
        http://www.callowlandsurgery.co.uk/cervical_smears_t1783.html?a=0

  4. ADM (Canada) says:

    In my younger years I had to have the full well-woman exam to get BC. That is coercion although I did not know it at the time. Now I refuse all cancer screening and I’ve had a bit of pressure but I resist it. If it got too much I would complain to the clinic manager and the medical college. I don’t really avoid health care because of the pressure but I will put off making an appointment. I’m just tired of hearing about paps all the time. It’s as if there is no other medical test or health issue a woman can have. I know it’s incentive payments that cause the focus and if there were removed the focus would shift. The clinic is currently offering a new service of emails and they will send reminders for tests and the examples listed are for colonoscopy, mammograms, and pap smears. I’m sure it’s just coincidence that the three examples are the tests that Dr’s receive incentive payments for.

    • kat rehman says:

      Thanks adawells. I will certainly do that if I’m asked again. It beggars belief these supposed educated people don’t understand no!
      And migraine is in your head and behind your eyes. Way away from the vagina!!

  5. ADM (Canada) says:

    http://www.theglobeandmail.com/news/national/bonuses-paid-to-mds-had-little-effect-on-cancer-screening-rates/article19604108/

    And yet funding for mental health programs get cut and people who seriously need help and are a danger to themselves and/or others are not hospitalized because there are no beds. Depression is a leading cause of disability and it can kill. But let’s spend billions on incentive payments for a rare cancer. It makes me angry.

    • ADM (Canada) says:

      Correction, I meant millions not billions.

    • Moo says:

      Wow thanks for putting up this article. I knew about the incentives but not the $millions spent total. I will be sending a copy of it to my member of provincial parliament the next time my doctor threatens to drop me as a patient for not screening.

      • ADM (Canada) says:

        I’m in shock at the amount of money that was/is being spent for Dr’s to do their job. I wonder if other provinces are similar. I’m not sure if it’s in the comments to that article or another one I looked at but a couple of people posted that they had been dropped as patients for refusing cancer screenings. The Dr likely drops them to open space for a patient who will have the screenings so they can get the incentive payments. So the incentive payments are not only in themselves unethical but they are encouraging other unethical behaviors.
        On top of the millions factor in the cost of the cancer screenings and possible follow-ups for any suspicious findings and treatments for false positives. How much are the cancer screenings costing the tax payers.

    • adawells says:

      ADM this is a very interesting article and correlates very much with the bonuses paid to GP’s in the UK. They get paid about £750 to reach a 50% screening rate and an extra £2000 for hitting the 80% target. I was sorry to read that those poor doctors are earning so much money that it doesn’t really incentivise them very much. I’ve also read that the UK cervical screening programme costs us UK taxpayers £175,000,000, about half of that going in GP bonuses. Sickening.

      • Kate (UK) says:

        Ada,
        It may not have had an impact in Canada, but it obviously did here. The participation rate in 1988 was 42%. By 1994 it was 85%. I’m pretty sure that it those targets and incentives were removed, the pressure on us would ease. But hey, it’s not about protecting women, it’s about protecting the program, right? Victory at all costs.
        I’m not sure how the QOF system works, but it’s obvious that this obsession our politicians have with targets is very unhealthy. Literally.
        Anyway, you seemed to be curious as so what the invitation letters for cervical screening were like these days, so I thought I’d let you *read* mine.
        This is from the Thames Valley PCA, dated January this year, ‘on behalf of’ my local surgery.

        Dear Miss X,
        I am writing to invite you to come for a cervical screening test. Cervical screening is a free and confidential service offered by the NHS to all women aged 25 to 64.
        Screening takes place every three years for women aged 25 to 49, and every five years for women aged 50 – 64. Some women are invited more often if they have had an inadequate or abnormal result, or if they need to follow up after treatment for abnormal cells.
        To make your appointment please call your GP surgery to arrange a date and time. If you are still having periods then the best time to have your test is 13-18 days after the start of your period.
        If you have already made an appointment for a test, please ignore this reminder and go to your appointment as planned.
        Information about cervical screening and the recall process are included in the enclosed leaflet ‘NHS cervical screening’ which you are advised to read before coming for the test. The leaflet also explains about another test that will be carried out on your screening sample if your screening result is mildly abnormal.
        Cervical screening, like other medical tests, is not perfect. It may not find every abnormality of the cervix. If you have any unusual symptoms like discharge or irregular bleeding, don’t wait for your next test, but see your GP or the person who did your last test.
        Please make sure that you inform your GP practice of any change of name or address at the time of booking your appointment, as this will enable them to keep your records up to date.
        Yours sincerely, Screening Nazis.

        There endeth the lesson. Make of that what you will.

      • adawells says:

        Hi Kate,
        Thank you very much for letting us read an actual “invitation for screening”. I wondered if it ended with Heil Hitler by any chance, or had any swastikas on the note paper?
        You are right about the incentive targets being a game changer for the British programme. I have read a number of times in academic journals that the programme would not exist without them. At the same time I have heard from screening advocates like Jane Wardle, that women love their screening programmes. If that were truly the case, they wouldn’t need to spend £80 million in bribes to GP’s to pester women into coming would they?

      • Elizabeth (Aust) says:

        Interesting your invitation mentions the possibility of a false negative, but not one word about false positives, the latter is far more likely. The only reason, IMO, they mention false negatives is to scare women into regular screening.

        A GP “Steve” posted a while ago on Dr McCartney’s site. He makes some good points, but then blows away his credibility by saying sexually active women “should” have cervical screening. It amazes me that is always the end position, no matter how bad the evidence. (as he outlined) He later justifies his statement saying that was his personal opinion, just as he’d advise wearing seat belts and not smoking.
        I couldn’t disagree more with this last bit, I agree wearing seat belts and not smoking are sound decisions, but you could not put pap testing with those two things. Talk about pick the odd one out!
        The pap test helps very few women and harms huge numbers, it therefore means it exposes us to a lot of risk with the remote possibility of benefit, so it’s entirely appropriate (I’d say essential) for women to weigh up the pros and cons and make up their own minds. (not to mention the law and proper ethical standards agrees with me)
        I don’t smoke and I use a seat belt, but I have never had a pap test and never will.

        Here is the post:
        “The incidence of cervical cancer peaked in the UK in 1950 with 11 deaths per 100,000. By 1964 it had already declined to 9 per 100,000. In 1964 rudimentary screening was introduced. But it was not until 1987 that a national programme of call-and-recall screening was introduced. By then mortality had already fallen to 6 per 100,000. Since then it has fallen to just above 3 per 100,000. The degree of decline between 1950 and 1964 (before any screening was introduced) was effectively the same as the degree of decline after the introduction of rudimentary screening which, in turn, was the same as the degree of decline after 1987 when the national screening programme commenced.
        The rate of death from cervical cancer has fallen by nearly 80% since 1950 and screening is often cited as the cause of this decline. But the reality is more subtle. The decline began long before widespread screening was introduced – it had already fallen by 50% by 1987 – and other factors such as improved hygiene, reduced levels of STDs, increased use of condoms, less smoking, etc. have undoubtedly had a significant role. The incidence of diagnosis and death from stomach cancer has declined even more dramatically over the same time period yet we have never screened for that.
        Cervical screening DOES save lives BUT at best the national screening programme has reduced your risk of death from cervical cancer from a tiny 0.006% to an even tinier 0.003% – a relative reduction of 50% but an actual reduction of less than 0.003% – yet we continue to hassle women about smears. This doesn’t seem right to me.
        I think sexually active women SHOULD go fo a smear test on a regular basis but far better to do that from a position of knowledge and understanding than from a position of ignorance and, in some cases, preceived coercion.”

      • adawells says:

        Great post, Elizabeth. Doctors may realise that the screening programme is pointless, but then they’ve got their bonuses to think about haven’t they, and being just off that 80% threshold and missing out on that £2,600 bonus must come hard when you’re on their kind of salary….
        I noticed that the “invitation” referred to an enclosed leaflet, which may have contained further information about false positives. One thing is sure, is that I doubt the leaflet mentioned that women have a choice. The letter itself didn’t say “Should you wish to take up your invitation…” It just said “when you make your appointment” and assumed you’d be going.

      • adawells says:

        This graph shows how cervical cancer has declined from 1971-2012. The UK cervical screening programme claims credit for the reductions after it was introduced in the UK in 1988, but you will see there is no obvious drop in deaths after its introduction. The only drop after this date is from women aged over 65, who could not have taken part in the UK programme, as the UK only screens women up to 65 years of age. There is a graph from our Office of National Statistics which shows the reduction in cc from 1950-1999, and putting these two graphs together, it is clear that screening hardly makes any difference in preventing deaths.

      • Kate (UK) says:

        Oh, the ‘information’ leaflet is just the usual sales brochure. The latest one has a white cover with flowers on it, and it no longer has ‘the facts’ on the front. But it’s still garbage. We could go through it paragraph by paragraph and tear it to shreds.
        ‘This leaflet tells you about cervical screening. It aims to help you choose whether or not to take part in the NHS Cervical Screening Program.’
        Yet there is no mention of what to do if you don’t wish to undergo testing – the tone throughout the leaflet pretty much assumes, just as the invitation letter does, that you WILL comply.
        At the end, there’s a summary which tells you the benefits and difficulties (not risks, oh no!) of cervical screening. The benefits listed is the usual rhetoric – screening reduces your risk, the disease has declined because of our wonderful program, blah blah blah –
        The difficulties, aside from a vague nod to false negatives, is the need to retest due to inadequate sampling, and the fact that the test picks up minor abnormalities which would have cleared up on their own, but apparently the only downside to a false positive is that it might cause us to worry. Oh, and some women find having the test an ‘unpleasant’ experience. No shit, Sherlock! If the majority of us found the test acceptable in the first place there would be no need for those incentive payments, would there?

      • adawells says:

        I have read in many reports that the only downside to smear testing is the “brief discomfort” and “only a few weeks of worry awaiting results”. What all of these reports fail to address is the medicalisation of all adult healthy women’s lives, and turning them all into patients, who need constant medical surveillance, throughout their lives. In other words it is saying that being female is an illness, which requires regular invasive, medical intervention. Reports have also demonstrated that screening well women, leaves them feeling less confident in their health, and more dependent on further medical health interventions. They begin to doubt their own bodies, and from early adulthood are taught that their very existence is down to these screening programmes. It’s not just a short term worry at the time of the test.

      • kleigh us says:

        Very interesting. My aunt was just saying that she told her doctor that she did not want any more pap smears. And he told her well its OK because you don’t have periods any more and your post medapas. That doesn’t make since so he’s saying younger woman who mensturate are in danger but older woman no longer need them? He also told her she should consider having one if she has a infection. That I’d a load of bull. Her doctor and most American doctors have to be stupid spitting out this bs. I wonder if its what there taught by farma run schools.

  6. Victoria says:

    I said yes to question 1 even though I’ve always refused. I’d still use the word “pressure” every time to describe their approach. Even when they first bring it up, not knowing I’m about to refuse, their tone is that it’s a box you have to check. There’s no sense of it being just an offer.

    I answered no to question 3 about being put off going to the doctors, however every time I go I’m tense about the questioning I’m going to get. I’ve formally opted out in the UK but they ask if I’m up-to-date without checking my files (on the screen right next to them). Then, when I say I’ve opted out they still say “Can I ask why?” and we’re back to the same questions I got before I signed that form! I do ask for a specific nurse ever since I had an appointment with her at random and I found her to have a better attitude than the others. She still asks but I find her tone much better than the others. This means I have to plan well ahead and can be a bit more restricted with appointment slots.

    • adawells says:

      It is great news that you have managed to opt out, as so many women find this very difficult to do. After refusing for many years, I was suddenly telephoned at home one day in 2003, and asked why I was not attending for cervical screening. I was disgusted by being telephoned at home like this, but I stayed calm and explained my reasons. Two days later the opt out letter appeared in the post. What a joy that was to fill in!

      But you are never off their lists, and they see it as their mission to constantly ask you to consider rejoining the programme again. Stand your ground and don’t ever give in. They know that the more women get along with their lives without these tests all the time, the more other women are going to do the same.

      • Victoria says:

        I experienced exactly the same sequence of events. The phone call happened when I was in need of some food, just about to eat lunch later than usual, so I wasn’t at my best mentally. I managed to get them off the phone and to send out the form, though. I remember my husband was in the room and thinking, “What if I had other people visiting?” I’d have had to go to another room and speak quietly or outside if I’d wanted to have the call in private. When I got off the phone I could tell my husband had been a bit worried from listening to my half of the conversation. All he could work out was that I was having a serious conversation about medical tests, completely out of the blue.

        I’m fully expecting my “opt out” to expire. I think it’s either 3 or 5 years. This time I will only sign a form if I agree with the wording. I won’t sign something to say I “accept the risks” or anything to that effect. I suppose I’d have to write my own letter to the registry, but I still don’t agree with having to do that. I’ll try to keep it to one sentence! They don’t need anything more.

      • adawells says:

        Hi Victoria,
        I was in a similar position to yourself, when I got the call. I had no idea that they did this kind of thing. Just like the Stasi in the former German communist state. The lady was polite, but when she asked me why I thought I was unlikely to get cc I found myself having to explain my sexual history to a complete stranger on the phone. Of course the next question was that my husband may have had multiple partners before he met me, so this raked him into the conversation. He was furious when I told him that I had to explain to this complete stranger on the phone that he hadn’t had multiple partners before we met. Any person would be. But I told him this is what happens every time I visit our GP, that because I refuse a smear, the topic gets onto my sexual history. My husband has the same GP and I asked him if he ever got asked the same. Of course not. Can you imagine GP’s asking men about who they’ve slept with, if they went to an appointment about earache? So many of them would get a punch in the mouth and end up on the floor.
        I had no idea that such an opt out form existed way back in 2003, so it was a lovely surprise when it turned up out of the blue two days later. I had obviously given thorough answers. It was a form to permanently opt out, and I have to say that I’ve never been bothered since by them, but then I keep doctor’s visits to the absolute minimum.
        I think they must have changed the rules since then, as the opt out forms are not permanent anymore and only seem to grant you exemptions until the next screening round.

        I only had 10 glorious years of freedom though, as I had to have a total hysterectomy earlier this year for womb cancer. I have my first follow up appointment later this month, which I’m absolutely dreading…I don’t know how I’m going to get through it. They told me that as they are reasonably certain that the cancer hadn’t spread outside the womb, that I should only need the one visit to get a full discharge. Now, where have heard that story somewhere before….?

      • Victoria says:

        Adawells – all the best for your upcoming appointment (for a good outcome not just a sane approach to smear testing).

        Now you mention your husband’s reaction, you’re right, I think part of their concern is to do with how intrusive the health system can be, seeing as they’ve never experienced it themselves. My husband’s like me, in that he doesn’t respond how you’re expected to to peer pressure.

        “The last reminder” in big red letters. You’d think the next step is people banging on the door like bailiffs. :O It also reminds me of how people speak to children: “This is the last time I’m saying this…” before the punishment. Next time I’ll dispute the wording on the opt-out form and maybe they’ll still let it go through, but if not I’m curious to see how far they’d take it. They can’t strike me off the GP’s list and I can hang up on any phonecalls and shred any letters.

      • adawells says:

        I would love to be able to see what these “invitation letters” are like, but can’t find any online versions. I have seen so many posts about them being so dictatorial and patronising, even from women who do go to screening. It is disgusting women are being threatened like this in the UK.
        This link brings up a load of cervical screening procedures, but I couldn’t find any examples of the letters amongst them. They are from 2004 and I am sure they have updated them in the meantime, but very interesting all the same:
        http://www.cancerscreening.nhs.uk/cervical/publications/programme-management.html.

        I noticed that in one brochure about ceasing women from the programme that over 42,000 middle aged women had requested to be ceased. That figure must be a lot higher now as more women find out more and more about the limitations of the test.

  7. Victoria says:

    To clarify, even the nicer nurse still pressurises a little, so I still experience pressure every time I go. Her approach is different and I don’t get that look of disgust from her, which I did from other nurses. Lesser of two evils.

  8. kholli says:

    I only go to the doctor when I feel like something there is a problem I cannot solve on my own. I used to go to the gyno yearly, by force, to get birth control pills. Luckily, my partner got fixed so I no longer need birth control, however I am still harassed about PAP tests when I do go to the doctor. The last time I went to the doctor it was in regard to heart palpitations. The guy (I do not have a regular doctor and this guy was the only one available) first told me that there is no such thing as stress, suggested I take antidepressants, then asked how long it had been since I had had a pelvic exam. This all occurred within minutes of meeting him, with me having said hardly a word. I asked him what that had to do with anything and he copped an attitude, saying that he would not be a responsible doctor if he did not suggest it to me. I argued against that, he got angry, left the room, and came back with another doctor. He gave the other doctor instructions to finish up my visit and fled the room never to be seen again.

    Another time I went to a supposed leg specialist for an unexplained swelling in my foot. The VERY FIRST thing she said to me was, “When was your last PAP smear?” I asked her how that mattered and she said, “Well, there are vessels in the pelvis that can get constricted and cause swelling in the lower extremities.” I don’t know about you all, but I have never had my pelvic vessels evaluated during a crotch exam before and because I am not an idiot, I know that sticking a plastic brush into my sterile cervix has nothing to do with my veins.

    I want to SCREAM! And every time I must go to the doctor, I prepare myself for the question, same as I prepare myself to be told that I am “obese” because I do not fit into the arbitrary “healthy weight” category of the BMI chart and therefore will not be taken seriously at all.

    Now, I find myself middle-aged and in peri-menopause, with severe menstrual symptoms that destroy me for a week every month, but I will not go to the doctor because I know the drill– spread your legs, insert unsterile instruments, prescribe birth control pills, become a gynecologic slave.

    • vickibee says:

      I am so sorry that they pressure you this way. And kudos to you for sticking to your guns! You are absolutely right to question judgement especially if you are seeking assistance for something unrelated. Your choice to screen is yours and yours alone, and as an adult I have found it easier to just say “I do not participate” in a firm and assertive voice. That typically quiets them and no requires no follow up. If there was, I would tell them that I have such and such reason, (in my case, I think the test is crap to put it lightly). I have found that while a lot of us are scared to go to any health care practitioner, I come in ready to argue. Although that may not be a necessarily good approach because we may become trigger happy, it allows you to get into a mindset that is empowering to yourself.

      I would definitely recommend trying that approach, and should it fail, tell them that they are being unethical and coercive.

      With regards to your leg, the specialist probably was alarmed because swelling of a singular leg can at times be related to onset of cervical cancer. CC is accompanied by a slew of other symptoms, and therefore if not symptomatic in any other way, you can consider yourself clear. She was most likely trying to rule out a possibility right from the get go, however she has no business asserting a demeaning tone.

      Any choice you make is yours, and you are entitled to treatment if you want it. If you are experiencing a lot of menstrual problems, you could consider searching for a reputed gynecologist and book an appointment strictly to have a chance to talk. I am unsure of your symptoms but if it is endometriosis, or PCOS, there are ways to treat and evaluate it without pelvic exams. While diagnostic exams are much different than preventive ones, they are not the only resources available. You shouldn’t have to live in pain or discomfort or be bullied. If you ever find a practitioner unethical, coercive or down right rude, you can remind them of your rights as a patient to be treated with care and respect. And you have EVERY right to file a complaint.

      Best of luck!

      • kholli says:

        Thanks. Well, whether a swollen leg has anything to do with cervical cancer or not, I find it ridiculous for that to be the very first question, without examination or other discussion first. In the end it must not have been that great of concern to the doctor because her conclusion was this: “It is just lymphatic backup. Very common. It will go away on its own.”

    • Alex says:

      The guy said there was no such thing as stress?! I’ll bet he’d sing a different tune if someone had a knife to his throat! “No such thing as stress,” huh? Probably wouldn’t try to angle you into any kind of probing, either- the thinking at that point would be “What might get me cut?” and would probably precipitate a bit of an audit of his activities. “Hmm, maybe trying to spring something like this on someone & getting angry when they refuse might not be the best path to self-preservation.”

      Sorry if that was a bit severe & out of nowhere, but I really think they need to be in a state of danger- think anybody would be cavalier about trying to aggressively “play doctor” on someone if they stood a high chance of being shot up or cut up for it? Same applies to when they get iatrogenically detrimental.

      I sincerely believe if there was a risk that they’d get shot for trying to be dictatorial & controlling, they’d back off when people made their own decisions (including someone making a self-determined decision about what does & does not go into them).

    • Moo says:

      Well sweetie, perimenopause is somewhat of a mystery to most women because what we need to know about it is suppressed. Some women end up with some very painful tests and unneeded surgeries due to the hormonal flux at that time. All of this is because a doctor will feel there is 1% chance there is cancer.

      Best to see a Chinese traditional medicine doctor or naturopath is you can afford it. I cannot so I get some herbs and take them (vitex and dong quai). There are other herbs that are helpful but it is difficult to find any information at one source on the internet. You also have to try to diagnose yourself somewhat to figure out what the imbalance is.

      Weight prejudice is there. Fat does store and produce estrogens. I think that insulin resistance does play a huge role in almost preventing people from losing weight. Hunger is a very strong urge. Unless some person can almost eat 70% vegetables which is just very difficult.

      • kholli says:

        I am not huge, just a lot heavier than I used to be and on the wrong end of the BMI scale. I have no signs of insulin resistance and I do not eat as healthfully as I want to or should, but my diet is far better than 99% of Americans (I study this, so I know– as a vegan I eat more than 70% vegetables and do not even come close to meeting my caloric requirement according to the USDA’s accounting system). My weight issue is most assuredly the result of my very stressful lifestyle, my complete lack of time to myself, inability to exercise or do anything else healthy (such as recreate!), and the fact that I have not slept for 5 years. If I ate like most Americans, I’d weigh 300 pounds at least.

        The point is, that I have yet to deal with a doctor who knows anything about anything. I am now in the health field and I realize this more and more. What people don’t realize is that doctors, in their standard training, are not taught to think critically– they are taught a trade, just like a plumber, wherein decisions are made based on standard protocol, prefabricated scripts, and established correlations (not causations). Doctors who go beyond this are rare– those who are smart, motivated, or have undergone more extensive training.

        This is exactly why they are obsessed with vulvas and vaginas– their forefathers, in their Puritanical perversion got their jollies and asserted their patriarchal power by finding “legitimate” ways to poke around in pussy since they weren’t allowed to openly do so in “civilized” society.

      • Alex says:

        kholli: Very intelligent points. I think there’s a lot of presumption that there’s something there when people are certified. I knew a guy with a high school diploma that COULDN’T READ! There’s a pervasive disbelief in lying, too. No, of course someone isn’t lying- they don’t look like they are. No devious expressions or outright admitting it without a flat tone like it’s a dry joke, so it must not be that way.

        Complexity sometimes comes off as more potent overall & if it’s information that someone doesn’t know for themselves, it can have a somewhat mystifying effect. Fluency in a language that someone else doesn’t speak. It’s also like when someone knows all kinds of gun terms or understands references where someone else would be lost, it comes off mildly magical.

        It’s also sometimes hard for someone to argue without knowing the situation really well. Sometimes you have argue from a place of ignorance, just like you might have to fight in the dark at some point. They come off so sure & say things in such a fluent way that people believe them, plus they don’t want to “be an idiot” and argue without expertise. They want credibility & can’t usually get that without certification or agreement from someone that has certification.

        When someone wants someone else to be a certain way & they don’t have an actual “lay-out,” it seems that they elevate them to the level that they want. I guess it also doesn’t occur to someone that they might very well have a problem at some point & that there wouldn’t be any help. Sure, you’d have use of it- but that doesn’t mean it’s there!

      • Moo says:

        They follow algorithms for diagnosing and treatments. The problem is that they do not work for all patients. Sometimes there is more than one symptoms that a patients does not mention. I do believe that they do not want to think critically not that they are not capable of it, Most only spend a few minutes with each patient to consult, 8 minutes on average.

        The medical field is too much about money. You have to wonder when the medical students with the highest grades move towards dermatology and plastic surgery.

    • Kleigh US says:

      sounds like oppertunistic screening. I think doctors are traned to push paps at any visit. they are obssed with gyn exams and pap.

  9. vickibee says:

    A few years ago I had a GP at my university threaten to not prescribe birth control if I failed to have a full physical. Since then, I do not take birth control because I am finding a hormone free lifestyle a lot more appropriate. However on one particular visit, she was doing a pelvic exam and decided to press really hard on my right side and it hurt. She exclaimed that I must have had an ovarian cyst, (which I am confident I did not, she was just rough) and forced me to go through a transvaginal ultrasound. To put into perspective, I was 18 just wanting to clear up my skin with birth control. Since then, I have not had any pelvic checks and I refuse to unless there were symptoms indicating a serious problem.

    About 10 months ago, I developed a urinary tract infection, and since I had had many of them in past, I was very confident of what it was. I ended up going to a hospital because it was a weekend and clinics were closed and there was no urgent care centre near me. The usual drill is pee in a cup and get antibiotics. This time I ended up having to wait quite some time to see a doctor so I was drinking a lot of water to ease a bit of the pain and discomfort. When the time came to pee in a cup, my urine no longer had a lot of tissue or blood (sorry for TMI) and the attending physician looked at it and said I did not have a UTI and must have an STI and would need to submit for a pelvic exam. First of all, excuse me for assuming my sexual behaviour, I am confident that I did not have an STI. Secondly, I will not because it is not medically necessary to diagnose a UTI because the only thing you are going to see is perhaps an angry urethra, which is a symptom in most bacterial infections. This physician refused to send my urine for cultures without consenting to the exam, and refused to send my blood for cultures as well until I did, and then took my bed away stating that I must not be sick and that I could stand. I was so floored I broke down and cried and then they forced me to sign a discharge form. I am sad to say that I did not file a complaint, and if I ever remember this physicians name I will ruin his life.

    This seriously traumatized me and I no longer sought out care until recently. In this time I also did a lot of research and found this board and am now a huge advocate for informed choice.

    Earlier this week I went to a clinic to get a proper prescription for a persistent yeast infection. I had been on antibiotics and tried to use an OTC medication (Canesten) and while my symptoms improved, they endured for quite a few weeks and was fed up of dealing with them. I was scared as hell, I made my fiancé come with me, I came with Bill 201 of Patient Rights in Ontario, and was ready for battle. I am no longer going to let myself get walked over and talked down to by doctors. I walked into the room and the doctor came in and she asked me normal questions, what had brought me in etc. and I obliged with the required responses. She then came back and said when my last pap was, and I said years ago, and that I no longer participated. She looked confused and then asked if I participated in any well woman exam, to which I said no, I do not participate in those programs. I said so in a very stern voice and she backed right off. She then asked questions about my symptoms, and I ended up getting the prescription I needed. While this physician was not rude, simply trying to do her job, I am finding that if we are assertive and confident nothing will ever be a problem.

    I am done being afraid, but I have most definitely felt the pressure, and that isn’t right. Women have rights to the care they want to receive, and if they put on the pressure, I am ready to put it back on and file complaints. Ensure that when you are standing up for yourself, do not resort to insults no matter how angry they may make you, try your best to leave your emotion out of it. Act as logically as possible, and as recommended, if they are refusing treatment for an unrelated case without a pap or pelvic, make them sign a form highlighting the issue. And then report the hell out of them. The only reason doctors feel they can walk over us is because we let them. Do not let them, and it will stop. While they are practically oppressive, we have allowed them be this way. I know for myself that my two not so nice previous situations could have been mitigated if I knew how to stand up for myself and my rights.

    Stay strong ladies, if I can do it, you can too.

    • adawells says:

      Yes, you are quite right. Sometimes you can find that you have made more of an impression than you think you have. The doctor may modify their behaviour next time around, so the next lady gets the benefit. I think that we are now swimming with the tide, even though we still have a way to go. The pro-screening lobby is definitely worried.

  10. Moo says:

    Dear adWells it is absolutely disgusting that you were called by a complete stranger and asked questions about why you wanted to stop cervical screening and question as about your sex life.

    Ontario stop screening letters form to download
    https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=269708
    Yes, I had to sign about taking responsibility ……. . I do not want the phone calls or letters but nothing apparently will stop the doctor from asking. At least I did not have to go through what you did just to get the form.

    • adawells says:

      Hi Moo, I was absolutely furious about it for two days until the opt out form arrived in the post, but my husband was furious too, that his sexual history was also implicated in the whole business as well. I don’t think men realise what women have to put up with every time they need health care. It certainly brought it home to him how intrusive this screening programme is. Until Victoria’s post above, I’ve never met anyone else who has ever got one of these forms, and if I ever mention it, I get the usual response of “I never knew you could opt out”.

      Our call and recall system really annoys so many women here, and I’ve read so many posts on other websites saying how annoying the letters are, even from women who attend regularly. The patronising tone and constant reminders assume that women don’t have a brain and are completely incapable of making their own decisions about attending. In order to clear up the GP’s address lists of women who may have left the area (and therefore reach the 80% target more easily) many GP’s have been sending out letters to women saying that unless they respond to this letter, they will be struck off the GP’s list. I have seen posts from pro-screeners complain about this practise that this is disproportionately affecting women’s access to healthcare, while men, of course, have no worries about being struck off a GP’s list, because the doc isn’t trying to reach an 80% target with them. I was glad to hear that the recall letters piss off even those who are OK about attending.

      By the way, Moo, I can’t thank you enough for telling me to ask to see the biopsy form after I had had my hysteroscopy procedure. Surgeon did show it to me on the computer, so I am very glad you told me about this. I have no medical background so knowing about these things was very useful to me. Thanks for that bit of advice.

  11. Moo says:

    I get suspicious about biopsy/pathology reports. I had a huge tumor (lipoma which is usually benign) removed from my back a few years ago. There was no pre-operation biopsy, only an ultrasound but I got a copy of the report. From what I could research these types of tumors are rarely cancer. They do check them after the surgery for cancer anyway. I only got the surgery paid public because it was so large and there is a small risk of cancer. I had to wait for YEARS for the lipoma to be large enough and painful enough to get public to pay for the removal. The surgeon told me before “the risk of cancer is 0.5%, so 1 in every 200 is cancer”. I was not worried because I thought my research showed I likely did not have cancer so I said “I’ll be one of the 199”.

    What my point is that cervical cancer risk is lower than the risk of cancer from my lipoma BUT at every medical visit I am harassed about getting a Pap test. Then it is 0% if I am HPV negative but I have to pay $90 for an HPV test that has to be done with a pap. So back up there. It got me thinking.

    It is a huge deal for a women to get a hysterectomy but you needed it because you had cancer. I hope you are feeling better now. I hate when women are pushed toward hysterectomy when there are alternatives that would be better.

  12. jane doe says:

    I was denied access to HRT when I went into premature menopause in my mid-30s and refused a pap test.

    I became old before my time, and as a young person with an elderly body my sense of identity disintegrated and I no longer knew who I was. I felt (and still feel) that I had to dress like my grandmother and let my hair turn white.

    I lost my job due to the depression, anxiety and degenerative physical issues (and my employer’s misogyny). I was already at high risk of osteoporosis due to thyroid issues and lactose intolerance, and have had several fractures since.

    Although I accept that even with HRT I would not have been able to conceive, I also missed out on the possibility of finding a partner and was condemned to struggle with a wrecked life and body on my own.

  13. Mint says:

    A nurse once rang me to talk about cervical screening. She asked me to make an appointment for a smear test. I said “no thanks” and so she said “may I ask why”? I said “no, you may not”. End of conversation.

    • Alex says:

      Nice! It’s interesting- if someone were to badger you in a sales call, it’d definitely get seen as them doing something wrong & no one would have any problem with refusing/hanging up/getting nasty back.

    • Jola says:

      What a horrible method of the NHS! Call a person and ask her about the pap crap?! What does it mean? And they dare ask you why you don’t want to undergo the rubbish? You told her right – brilliantly, but next time answer that she may have the crap done instead of you and instead of so many poor, unaware women, gullible women who don’t know how much harm they are put to later on by the ”caring medical staff”.

      It is just intrusion into human life!

      • Alex says:

        That’s a good one- her getting this test instead. Then, when she answers that it wouldn’t do anything to diagnose if Mint (or whoever else that’s using this) has a problem, she could say: “Well, neither would me getting it.” Then hang up.

        Jola: I don’t mean to sound like these things are okay & you should just dodge them by moving to another country if you don’t like it (instead of their behavior being altered), but why do you still live in the UK? You seemed to think pretty highly of the Czech Republic, although I don’t know how functionally dictatorial they are with this sort of subject (I definitely remember hearing that they get coercive with birth control).

        How are things with you? I’m starting to work more on my languages & get my damned citizenship (it can be hard to track down all the right papers, but it seems that I’ve got an option through Italy).

  14. Jola says:

    When I lived in Poland, I was never coerced into having a pap crap whenever I went to a GP and I would have never thought of being pressured to have the pap. When (still in Poland) I received 2 invitations for a pap crap, I ignored the first one, and when the second came a few years later, I wrote an e-mail to the people who sent it to me telling to them to stop sending me such invitations forever. They replied politely, with respect and I never heard from them. When I came to the UK, I got such letters, with reminders in red! I will never forget the words reading: ”The last reminder” – in red and bold. Before the reminder I had got 2 more letters with the same bullshit. Three years later I got another letter and I declined the crap by signing the declaration, which, among others, reads that (more or less – I don’t remember the words exactly): ”…and I am aware of the death caused by not undergoing the pap smear examination” – as I said, it said more or less what I have written. Well, upon signing the rubbish, I couldn’t resist adding: ”I am signing the declaration, but I do not agree with the statement – and I rewrote the sentence”. I felt in a ridiculous situation when I was signing the declaration and writing this sentence – so strange, so stupid and so hopeless and helpless at the same time – as if something wrong had happened to my mentality. I asked myself what I was doing at the time and for what?!

    My first child was born in Poland and after the childbirth, I didn’t receive a letter telling me that I should have a post natal check up. My second child was born in the UK and here I got a letter inviting me for the post natal check up, but I declined it – of course, it is obvious why. Here, in the UK, I am afraid of going to a GP because of being asked about the pap crap. Once I went as I had terrible problems with my nose, and I wasn’t asked the stupid question, which was great for me, but, to be honest, I avoid going to the doctors here just not to be asked the question. I am polite, but when it comes to some situations, I can be impolite – I really answer loudly and clearly that I don’t like this or that, so I just don’t want to argue with them – for what? Saying it politely: ”I don’t want to talk to people who are pain in the bottom”.

    • Victoria says:

      ”…and I am aware of the death caused by not undergoing the pap smear examination” – that rings a bell. I don’t remember the form too clearly and I just signed it to get them off my back. I do remember finding the wording quite severe, like I was signing a disclaimer before joining the army/going into space.

      Next time, if I ever have to sign one again, I’ll dispute any wording I disagree with.

      • Jola says:

        It is nothing but scare tactic. In such circumstances (when the words are severe), we should be severe as well. We must defend ourselves. Otherwise, the medical staff will do what they want. They are allowed for definitely too much. And think how many people are dying of diseases which are not tackled properly by the governments. So many people die of, for example, Chronic Obstructive Pulmonary Disease (mainly smokers, 90% of them). Why is almost nothing done about it? Shame on the so called ”developed countries’ governments”. By the way, in these countries women have ”so many rights” – really? What about their basic right of saying NO to the rummaging of their vaginas?! Where is the so called ”democracy and equality”?

    • Jola says:

      Hi Alex – believe me, if only i had a possibility to go there with my family, I wouldn’t hesitate for a while to go there, or back to Poland. But it is not so easy when you have a family and are settled in one place to leave the place for somewhere else. Job, first of all job. If it was the same as we have here, we would go. School for children is the next thing – there are actually many things that would have to be done from the start, again. Again and again – but, maybe some day, no, it’s stronger than ”maybe”.

      You know, actually, both in Poland and in Czech Republic people, against the appearances, have rights of saying just NO. There can be no coercion if you say NO. You say the doctors what they are allowed to do or not. A lot is changing in that part of Europe. BTW, do you know that in the Czech Republic people can smoke stuff legally – yes, this is the Czech Republic. Hahahahah – you will not believe, but that’s true. I personally don’t smoke anything, neither do I drink and I haven’t written it because I like it. It’s just a fact.

      Look, for you as a native speaker of English living to that part of Europe won’t be a problem, in terms of work I mean because you can always teach people there as a native speaker. In any country they will always want native speakers of a given language. I am not a native speaker of English. I have an MA in English, but it’s different.

      Good luck with your learning – what languages are you learning?

      Cheers!

      • Jola says:

        Sorry, Alex, I have been teaching people all day and now I don’t know what I am writing – tiredness and lack of thinking now. Of course: You say to the doctors, and l leaving (not living) to that part of Europe. Cheers!

      • Alex says:

        Well, I’m trying for Spanish & Russian first. The problem of it is that it can be hard to find things that give you an explaination of how things work. A major thing is that things aren’t spelled as they are pronounced in English, so even if a guide is given, it doesn’t always make sense. It’s very hit or miss.

        Didn’t know that about “recreational substances” in the Czech Republic. That’s a definite plus for me (I’d partake here & there, but I really like how it’s that much less to have aimed at you legally- suspicion, possession, accessory charges, frame-ups, etc…). All this applies to kids as well, so it’s a big plus in the “upbringing environment” category. It’s bizarre & counter-productive that they do the kinds of things that would START a drug habit over the suspicion of drugs.

        I remember hearing things like Portugal had decriminalized all drugs & so did Russia (I think it’s 10 days personal use is something you’d only get a fine for). Also, I had heard Spain & Italy had done the same. Another thing is that a lot of countries (most of the world, it seems) is against all the genetically modified stuff.

  15. Elizabeth (Aust) says:

    To avoid disclosing private information you can fall back on the evidence, “I’m not satisfied with the evidence”…”I can’t do something that makes no sense”…”I’m not prepared to accept much risk at all for a remote risk” “Over-diagnosis is a serious concern” “It seems the risks exceed any benefit” etc.
    Initially I didn’t like the numbers with cervical screening (apart from finding the test totally unacceptable) doctors don’t expect us to know them, so often challenge “our information”. (THEY often don’t know them) They like it even less if we come back with, “Oh, the Lancet, the BMJ, NEJM” etc.
    Now it’s easy, I’m HPV- and confidently monogamous…end of story.
    If they dared to suggest my husband was sleeping around, I’d calmly state if I felt that was likely and I was concerned, (and I’m not) I could simply test myself for HPV in 5 or so years time…IF I FELT that was necessary.

    I think doctors (and others) like to draw us out so they can shoot us down. I’m always polite, almost painfully polite…and rely on the evidence. Let’s face it, it’s powerful, and that’s why they’re scared to death we’ll find it.
    I don’t discuss private matters over the phone or with strangers would be a good response if you received a call at home.
    Also, you can always fall back on informed consent…our legal right.
    “I could contact the Medical Board tomorrow, but I’m sure all cancer screening requires my informed consent and I don’t need an excuse to refuse, it’s my choice”…might be enough.
    I think all of it is a try-on, they’ll do whatever works to get as many women in for testing. If you push back, complain…the problem is very likely to fade away.
    I think the illegal and unethical practices and disrespectful attitudes that have become the norm in women’s cancer screening, has encouraged many to speak down to women, bully them, dismiss us etc. I think it’s important to challenge and/or report rudeness, coercion, pressure, misleading statements etc. Every complaint will make someone stop and think. For too long they’ve gotten away with outrageous conduct. A threat to dismiss you as a patient is a serious matter that should be reported to the Medical Board.
    I can’t be sure about American doctors though…and your insurance companies sitting their nose into your medical care. An American woman online was told by her insurer she must have a pap test and mammogram or her insurance cover was in jeopardy. I can’t see how they could get away with that…when all screening carries risk and informed consent is a legal and ethical requirement. Once again, if it was challenged, I suspect the requirement would fade away.

    • Alice (Australia) says:

      Very good approach, Elizabeth!
      “I’m not satisfied with the evidence”, full stop.

      I would never let a medical stranger to fish out the details of my private life, especially over the phone. It is called private life for a reason. And it’s none of their business, no matter what their intentions are.

      I also find that whenever a nurse or a doctor say “May I ask why you decline this or that?”, it’s not because they actually want to know why we said ‘no’ and to respect your choice, it’s to continue the unwanted discussion and select a new tactics for the pressure.

      They steer the talk into the way so that we have to prove, explain and defend our choice. That’s not the way it should be: they are the all-knowing quacks, so they must explain and prove that their system is working to our benefit. And we will decide whether we like the offer.

      They turned our heath care system into a lucrative business. Fine! But with the business-like model comes the famous “the customer is always right”.

      Regarding the theme of the topic, I am another person who now avoids Australian doctors completely, because the very few times I went to see them for help, I got nothing but a pap-lecture. As Heather said here earlier, pity I cannot stop them from stealing huge amounts of the tax money from me and rather save it for the time when I really need some quality heath care to go to another country to get it. There is no hope that Australian “bikini” medicine with third-world hospital infection rates can help anyone.

      • Elizabeth (Aust) says:

        Alice
        You’re dead right, “may I ask why?” is all about drawing you out to shoot you down.
        Papscreen even list the excuses women might use when they refuse screening.
        I’m too busy, it hurt last time, it’s embarrassing etc.
        I think some women don’t want to screen, but feel they must come up with a reason so too busy is an easy option.
        Papscreen refer to these excuses as “barriers”…that says a lot. I also, saw a guide with the excuses and a suggestion opposite, ways to, hopefully, “overcome” the barrier. It says to me Papscreen have no real respect for our right to choose, just to draw us out to challenge the so-called barrier. The only acceptable answer as far as they’re concerned is Yes to screening. If informed consent is ever mentioned, it’s an afterthought, their words and actions make clear they have NO respect for our right to choose.
        If they did, they wouldn’t have targets or use words like avoid, barriers etc.

        I realize my situation is uncommon, to have a doctor (and her practice) I can see with no fear of pap test pressure or lectures about early detection or mammograms save lives. Whether it’s because they view me as a crank, a threat or an informed woman, the end result works for me.
        We have some powerful influences at work in this country, they don’t want women to be given a real choice about screening and certainly don’t want evidence based screening, too much money is being made testing and harming the masses.
        Switzerland may be the first country to scrap breast screening, we’ll be close to last. We’re now crowing we’ll be the first to move to HPV primary testing, but no mention we’ve been seriously over-screening and over-treating for decades or that the new program will condemn many to unnecessary biopsies etc. We’ll test for HPV too early, too often and for too long…doing it properly would be too costly an exercise (for them) Control of women is paramount so no self-testing unless you refuse the invasive test for 6 years and it will only be available through a GP.

        IMO, a lot of money is wasted in this country on non-evidence based screening, millions.
        The evidence for breast screening is concerning, and cervical screening should only be offered to about 5% of women. We dance around and manipulate the evidence making out it’s all so difficult, I see this as a juggling of vested interests, to keep them all happy. Screening works with this conflict of interests…women come last.

      • adawells says:

        Speaking of the doctor’s list you had of “excuses” used by women to “avoid” screening, I have been trying to get hold of a copy of “Hit that target” D. Gallen, Doctor 1994 Oct 12:72, which was cited in an article by Foster and Anderson on the ethics of tactics used in cervical screening targets. Has anyone managed to get hold of this article? Have not had any luck in finding it even in my university library.
        D. Gallen is now a professor of general practice in Wales.

      • Victoria says:

        On the “may I ask why?” question: I’ve noticed this as well and as much as I agree with the responses we could give, I don’t think we should have to explain ourselves at all. Even mentioning how unreliable the test is and how it’s never had randomised controlled trials etc etc… is just entering into a debate with them. I don’t want to waste my time doing that or spend any longer than I have to looking at someone with a face that thinks I’m a silly girl (I’m 29 and look younger – one nurse even said, “And you’re under 25 so there’s no need to ask about smears…”).

      • Karen says:

        Adawells- This one sounds good too: Mead MG. How to achieve cervical cytology targets. Update
        1989 Dec 1:1040-6.
        I am also searching, but no luck so far.

      • adawells says:

        We must be reading the same article, and I’d love to know what was in those two articles, but I’m unable to find them at the moment. I think Doctor may have changed its name to GP Online now but I’m not sure, and I cannot find Update magazine. I’m still investigating.

        The article Cervical screening in general practice: a new scenario by Jane and Julian Chomet, BMJ, 9 June 1990 is quite sickening. It’s also cited in the article by Foster.
        “An invitation that has met with some success is one that coincides with a woman’s birthday and is sent as a congratulations card offering a well woman check as a birthday present from the practice. Each invitation contains a definite appointment date and requires the patient to confirm that she is coming or to contact the practice to change the date”…

        I wondered what she herself received as a birthday present from her family and found that she wanted a colposcope as a wedding anniversary present rather than a ring.

        http://www.independent.co.uk/news/people/obituary-dr-jane-chomet-1396591.html.

        Although she seems to have found a great number of abnormalities it is not clear how much cervical cancer she actually found.

      • Karen says:

        “She once said: ‘If I don’t see patients I’m miserable.’ Jane Chomet was always far too busy to be miserable.” They so creep the hell out of me.

  16. Mint says:

    I opted out of screening many years ago. This fact doesn’t stop the GP or nurse asking me to reconsider my position EVERY time I visit my local surgery. I’m sure that they think that one day I will cave in and agree to their demands. It’s like a game to me now. I sit on the chair, watching the nurse scroll through my medical record on her screen. A red flashing cursor highlights the questions she “needs” to ask me and the examinations the surgery “require”. I can read the screen from my position.

    “Do you smoke?”
    “How many units of alcohol do you consume each week?”
    “How many times a week do you exercise?”

    Weight
    BP

    Cervical screening – overdue
    Breast screening – refused – discuss with patient

    The nurse dutifully goes through the list. I refuse to answer her questions, jump on the scales or allow her to take my blood pressure. She tries to discuss the screening and in my very English over-polite way (I channel Elizabeth!), I let her know that I would just like my script refilled for my asthma as that is the reason for my visit.

    I know we will have the same conversation again in 12 weeks time.

    Sigh.

    • Alex says:

      FOR ASTHMA?! It really shouldn’t shock me, since I’ve heard of it for things like sleep medication & all kinds of other nonsensical horseshit, but it always does.

      I don’t know how everything is lined up for you, but sometimes getting a good level of “huff & puff” type of exercise actually works for that. My Uncle Louie basically outran his asthma (they said he’d die if he ran around the schoolfield twice & he eventually ran a marathon). I was watching Fearless & training in martial arts worked for the actual person Jet Li’s character was based on. Not trying to be preachy, it’s just that people get an impression of permanent ailments when sometimes they DO go away. At the minimum, they go away in effect.

    • Elizabeth (Aust) says:

      Oh, Mint, I certainly hope we don’t start getting this sort of consult when we move to a call and recall system. I can see my doctor or someone else at the practice and just deal with the reason for my visit. There are no on-screen “prompts” directing the consult.
      I know my file has been marked, “no pap tests or mammograms”.
      I’ve never been weighed, sometimes I ask for a blood pressure reading.
      I’ll be speaking to the practice manager if “prompts” start to interfere with my consult time, most consults are only allotted 10 or 15 minutes anyway.
      I know call and recall will make it harder to “avoid” cervical screening, so more women will be pushed into screening. You won’t be able to say, “I was tested at another Clinic”…or use some other fob off.
      The system is used to control women and force them to screen to achieve the target. It means, as I understand it, every woman is registered with a particular Clinic and it’s their responsibility to get you screened. So you might get harassed by the receptionist, get a call, have your file flagged etc.
      It may mean more women avoid the doctor. If you do your reading though, they can flag and chase till the cows come home, being informed means all of their efforts will amount to nothing. If you’ve decided not to screen, there’s not a damn thing they can do about it and a direct complaint should deal with the matter once and for all.
      Sadly, though, too many women will feel cornered, some still don’t realize they can reasonably decline the test, no need to make an excuse, feel immature, silly or anything else.

      • P R C says:

        Why is the exam not called a vaginal exam instead of pelvic exam because that is all it is !!!

    • Elizabeth (Aust) says:

      Mint
      Would it help to send a letter setting out your frustration or speak to the nurse, your valuable consult time is taken up going over old ground? Can they please ensure your informed decision about screening is respected? It is far better for your health to concentrate on the reason for your visit. Being quizzed every 12 weeks would annoy me. In that case, I’d probably become quite direct…not rude, but clearly feeling exasperated at doctors wasting my consult time to ask the same questions over and over like mindless robots. I’d probably stop her and say, “Excuse me, but I find being asked the same questions at every visit annoying and unproductive, can we leave the computer prompts and deal with the reason for my visit?”
      Although it sounds like you’re in control and quite enjoying the game of cat and mouse…nice being the cat, isn’t it?
      It reminds me that asking people questions about food, exercise etc. often prompts the “right” answer. We have a segment in a weekend paper, you list the things you ate and drank that day and a nutritionist goes through it, she usually finds something to criticize. Of course, I suspect most people bend the truth and the Mars bar becomes a handful of activated almonds.
      I loved the responses from a comedian, whether it was true or not, leftover pizza and coke for breakfast, pie floater and beer for lunch, pizza and beer for dinner, a large one so he has breakfast sorted for the next day. I could feel the dietitian snorting with dismay, but didn’t bother to read her response, surely something like, why not replace the pie floater and beer with a salmon salad and mineral water?

  17. Moo says:

    I might refer to the “Health Belief Model” that is used for pushing screening tests. http://en.m.wikipedia.org/wiki/Health_belief_model

    It promotes “fear” of disease yet it only highlights benefits of screening and not the fully informed deficients or harms from screening. The “barriers” to screening are noted and how to overcome them is promoted. The option of not screening or informed consent is not discussed in these studies.

    I get the annoying “health screening” questions almost everytime. The most annoying was (I found out later after coming acress the screening questionnaire online later) was a prenatal questions. “Have you have any alcoholic drink in the past three me the?” As well are questions about being homeless and my partner relationship. Odd to ask those questions to an infertile 50 year old woman plus my husband sees him for often than me. So his screening questions were harmful because they were aimed at women who were in the third trimester. He only did the questionnaire to make money.

    The “Do you eat five vegetables and fruit per day?” question was the most stupid one. He deliberately misquotes it. It is five “servings” of fruit OR vegetable per day. No one but a millionaire celebrity with a personal chef is likely to eat five fruit and five vegetables per day. Is a vegetable defined as a whole head of cabbage or a whole brocholi? I should catch him on that one. I know for sure his diet is terrible. He eats maybe one meal per day and drinks coffee.

    Yes, even the harrassment for asthma medication. I refuse the daily inhaler as they are steroids. I just use an emergency inhaler. I need it maybe twice per year but I would rather have it around instead of gasping for air and scaring the crap out of everyone around and having to find a hospital. Yes, there is that huge hassle to screen for something even just asking for a simple refill on the emergency inhaler. Yet he will only give me one and no repeats so I have to come in.

    • Alice (Australia) says:

      Great link to the “Health belief article”. This is precisely how in works:

      And we all heard the corresponding manipulating lies:
      Modifying variables: in most countries being a female is enough — your body is a public property, shut up and hand it in for the life-long medical surveillance.
      Perceived seriousness: “Cervical cancer is the main cause of death in women”.
      Perceived susceptibility: “If you had sex at least once in your life, you are at risk of CC”. Some quacks insist that even virgins need pap screening.
      Perceived benefits vs Perceived barriers: “Screening saves lives”, manipulation with screening statistics, presenting over-screened harmed women as saved cancer survivors. Any “no” to screening for any reason is an excuse and a barrier that needs to be broken by the doctor.
      Perceived threat: everyone is at risk, cervical cancer or breast cancer are rampant.
      Self-efficacy: convince the women it is irresponsible and immature not to want to be raped with tools at regular intervals.
      Cues to action: idiotic campaigns, fear-invoking posters, insulting ads, misleading brochures… We’ve seen it all.

      A perfect model… for misleading, manipulating and making big money!
      I just can’t get it why the word “health” is mentioned.

      • Elizabeth (Aust) says:

        Alice, that sums it up perfectly, yes, that’s women’s cancer screening.
        The lies have just become part of the screening story, like the nonsense that cc was once the leading killer of women, rubbish. There has always been an attitude that you can lie to women if it helps with coverage, so these lies are never challenged or corrected. The whole screening story should start with, “Once upon a time there was a big bad cancer called…” Princess Papscreen can save the day wielding her golden speculum.
        It amazes me the lies that just keep going around and around…one of my personal favourites, “cervical cancer rates are lower here than in Africa because we have a fabulous cervical screening program”…inference being: prior to screening our rates were similar to Africa, WRONG, and if we didn’t screen they’d return to (or be) that level, WRONG or that your risk of cc is high if you don’t screen, WRONG AGAIN.
        Even a high risk woman has a low risk of being diagnosed with invasive cc, it’s rare!

        The African rate is obviously higher, but they have unique risk factors.
        You CANNOT compare Africa with Australia, the States, UK or Canada, but this is the garbage they produce to mislead women and protect the screening program.
        We’re talking about some very low people who have near contempt for women, their health and rights. Zero respect for women, they’re happy to feed us a steady diet of absolute garbage. It’s an insult to our intelligence.

      • vickibee says:

        Awesome post, Alice. Couldn’t have said it better myself.

  18. Elizabeth (Aust) says:

    Victoria,
    I agree, we shouldn’t have to explain ourselves, that’s why I think it’s easier to find a decent GP and get your file marked, “No screening, this patient does not want to waste consult time talking about mammograms/pap tests, she has made an informed decision to decline”…your request could be made in writing or to your doctor directly. I’d shop around until I found someone prepared to add that note to my file. (I know that’s difficult for some women)
    The matter is handled then once and for all.
    It’s up to individual women to decide whether they wish to discuss the matter with their GP, I did (briefly) and mostly relied on the evidence. I felt that would shut down the topic and I’m pleased to say that’s been the case. (in the main) My GP also, knows I’m well read when it comes to women’s cancer screening. We’ve discussed breast screening in some detail over the last 5 years and she was keen to take down some of my references. I definitely feel in control in the consult room. I think the power dynamic is important, find someone you can work with, who’ll listen and respect your decisions. Someone who speaks over you, is rude, dismissive or patronizing should be avoided like the plague. Some doctors get “prickly” if you decline testing, they rarely accept a NO…avoid!
    If the call and recall system is introduced here, I’ll immediately remove myself from the register and if they tell me I can’t be removed permanently, I’ll take the matter further, something tells me they’ll find a way then.

    • Moo says:

      I suspect that my doctor has already illegally removed me from his roster so he can get his quotas. I am going to call the government hotline to check. For a patient to remove themselves from a roster, it is fairly simple just register online for a doctor connect for a new doctor. If they have some personal information really anyone can remove a particular individual from a roster and they will never know about it. Officially a doctor can remove a patient from a roster but has to have a good reason and must inform them by registered mail.

      As for this Dr Chomet. I am sure she did plenty of damage to women’s cervix and the surrounding area with her laser. That is just overkill. They didn’t know that most of these HPV infections would clear up on their own. It is really pathetic to be so zealous in your lifelong work and find out later that you were totally wrong.

    • Alice (Australia) says:

      I’m afraid that’s what the eHealth (PCEHR, or MyHR as it was renamed once again) will be about here, in Australia.

      First, the government will force everyone into the eHealth, then they will make the opt-out process difficult and won’t delete the data that they already put there. And then they will be collecting, sharing and using our personal and medical information in any way they see profitable. The database will be centralised and nation-wide. So the women who move interstate won’t be able to ditch one state screening register and avoid being put into a new one.

      We all know how much Australian health authorities “respect” the security and privacy of our personal information, especially when it comes to their vested interests. The old mantra “screening saves lives” puts them above the law (remember them dogging in AEC rolls!), let alone above our choice.

      • Moo says:

        Any claim for a women that had “regular” testing and still got cancer. That sum is likely a capped amount. I would be interested if there were actually any court cases against the registry ever.

        It is rather ridiculous because people move around and die from other causes. So there are other reasons why they feel they need to track every women. It is an excuse to find out the numbers of women of reproductive age and their “fertile status”. How many pregnancies, who is pregnant, who is likely to be pregnant. They also record income, addresses, postal districts, number of partners, if someone is sexually active, menopause. You cannot tell me that they are not using that data or sharing it with other departments. It is supposed to be used for “planning” purposes maybe to know how many docotrs they need to train or hospital clinic is to open. I think it is going to be used for population control in the future. I already heard of low income women being given LEEP for minor HPV infection which will lower their likelihood of getting pregnant again.

        Ontario actually passed legislation that no one can have their records removed from the registry. I can stop the letters that is all. However they will still send out notices to my family doctor (if I have one that lists me as registered) and any healthcare worker that I give blanket “permission” to access my health records can also find out what has been going with all my cancer screenings.

    • Finnuala says:

      I have opted off the register in NZ but they tell me I can’t remove my name and background details.

      • Elizabeth (Aust) says:

        Finnuala ,
        A quick word to your local solicitor will sort that out, I imagine they’ll then find a way very quickly of permanently removing you from the register. It might be worth sending them a letter initially, setting out if it can’t be resolved you intend to seek legal advice. I imagine your name and background detail means after 4 or 5 years they’ll start hassling you again, that’s what happens in the UK with their call and recall system.
        If it’s introduced here, I’ll be challenging any suggestion they “can’t” permanently remove me from a register, especially one I didn’t ask to join in the first place.
        Most of these difficulties fall away when they’re challenged, really challenged, no pill without a pap would be resolved very quickly with a quick call to the Medical Board, harassment, a complaint to the surgery etc.
        The problem is most women don’t complain and accept the “we can’t” excuses, largely because many believe pap testing is not something we can reasonably decline, that’s what we’ve been led to believe so many women simply feel embarrassed, guilty or silly when they refuse to test. Pap testing can never be compulsory for anything, it’s nothing more than an option for us to consider. Any doctor suggesting otherwise is misleading you or is incompetent and needs a refresher.

      • adawells says:

        I read that NZ has the same call and recall system as in the UK. I managed to opt out in 2003 and it was permanent, and I ‘ve not been asked on rare visits since, but I think they have now changed this, as too many women were getting out permanently. I think they’ve changed it now so that you can only opt out of a round, and you will be recalled as normal in the next round, which isn’t really an opt out at all.
        IMO I think the reason they keep your details is all financial. Should a woman develop actual cervical cancer and she has been having regular smear tests I think she can claim a substantial sum (£250,000?) from the programme, so they keep records of those who have declined to save themselves having to pay out in the event a cancer occurs. I also think this is the reason that they keep asking. Even if a woman was taken critically ill to hospital for other reasons, they would check the smear test records to clear themselves of having to make this pay out in the event of a cancer being found.
        I’ve also read that so many women were opting out that it affected the poor GPs pay, and some GP’s were removing women from their lists and only keeping the compliant ones in order the ensure the 80% screening target. To deal with this they built in rules which allowed the GP to be paid for those women who had opted out, so they get money for nothing.
        The third reason is that they have to hold the door open for you, in case you exercise your right to rejoin the programme, which the UK rules state they must do.
        This is my understanding of why they keep a list of names of women who have opted out.

      • Elizabeth (Aust) says:

        You’ve made some great points Ada, interesting the concern all falls one way, probably because they know they’re unlikely to be sued for over-treating women. Over three quarters of the women who take part in our program end up having a colposcopy and usually at least a biopsy, you’d think that would be a concern from a liability point of view when the lifetime risk of the cancer is only 0.65%. It doesn’t take much research to find over-screening and early screening is the reason we have such high false positive and referral rates.
        I couldn’t find any information on excess cone biopsies, there is virtually no research on this important issue, I suppose you don’t fund research that might threaten the program or expose you to legal action. I found one study here that gave me the 77% figure. (lifetime risk of referral) I tried to find out about excess cone biopsies, no luck, but my sister’s doctor told her they do about 50 for every one that turns out to be necessary, that’s a lot of excess cone biopsies. My sister had a false positive and excess cone biopsy, probably caused by inflammation from a new brand of tampons.

  19. Elizabeth (Aust) says:

    Have you done some research, Alice, are opt-out forms in the system at the moment or is this still years away? I want to be ready…
    I was speaking to someone the other day who approached a civil liberty group about pap test pressure, they didn’t see a problem really, because it was about preventative health.
    It’s amazing how that label allows the profession and others to get away with outrageous violations of our legal rights and proper ethical standards. If what we see around us is not a violation of civil liberty/rights, I don’t know what is, the individual has been reduced to a herd and informed consent and even consent itself is violated. We get misleading information, there are hidden target payments made to GPs etc.
    It’s the old white coat bullet-proof protection. Trust me, I’m a doctor…ahhh, no thanks.

    • Alice says:

      That’s exactly how it works: attach a “preventative health” label — and they can get away with absolutely anything, no matter how unethical, misleading or even illegal it is.

      Regarding the Australian eHealth, at the moment it is operating on the opt-in basis. But because only 5% of Australians opted in, the health authorities approved the plan to opt everyone in with a vague option to somehow opt out later. Huge money have been spent, so we need the numbers! (Sounds familiar?)

      Also, while the authorities don’t like the low uptake rate, the doctors didn’t like that in [then] PCEHR (Personally Controlled Electronic Health Record) the patients had “too much” control over what the doctors could access in their medical records. So, as a part of the “improvement” plan, it is expected that not only we are all going to get an eHealth record, we will also have way less control over what goes there and how that information is used.

      I think, by now, we all learned that we cannot trust Australian government to run any medical initiative for our benefit. Whatever they do, it’s to make it easier for them to control us. I will be the first person to opt out and make sure (if possible) that opting out doesn’t just mean that my health record is hidden from me and is still secretly filled with new information and accessible by the government. If that turns out to be the case, I will have no choice other than never giving any doctor my real name, address, DOB or Medicare card number.

  20. Elizabeth (Aust) says:

    Australia really is a highly regulated country, very big brother. I’m sick to death of being told what to do and when. I could never work out why our programs were so bad, I assume vested interests are in the ear of politicians, they influence and protect the program. Who knows? But I know our programs are unethical and I’d say, operate illegally. The law says informed consent is a necessary requirement, yet I see no evidence of it in these programs.
    How does that concept sit with hidden incentive payments to GPs? With screening targets?
    Misleading awareness programs? Disrespectful orders? Giving women BAD medical advice like urging them to seriously over-screen with the pap test, which does nothing more than fill up day procedure. It takes little time to find the evidence for that fact….so I can only assume they don’t want to know. It suits them to look the other way and keep spouting the screening story. We need more and more evidence, we can’t rely on overseas research and the other self-serving nonsense that keeps our harmful programs in place.
    I’ve heard we have very powerful vested interests protecting breast screening in this country, I assume that’s why we only started hearing about risk a year or so ago, when over-diagnosis and uncertainty of benefit has been the subject of discussion for about a decade in many countries.
    It’s concerning…and what do we do? We’re going to EXTEND the program to include those aged 70 to 74. I assume someone benefits from that move, but it’s certainly not women aged 70 to 74.

    • Alice says:

      So true, Elizabeth. Sad but true.
      That’s why I no longer trust Australian medical authorities. No matter what their promises are, whatever they do — it is done to benefit and protect themselves first of all.

  21. vickibee says:

    If any GP tries to tell you it is a leading cause of death or is a common occurrence, refer them here.

    While cervical cancer is prevalent in low income, poverty and disease ridden countries, WHO has posted the leading causes of death for women worldwide, and based on income taking geographical location into account. Cervical cancer does not even hit the chart in any one of them, including African countries where HIV positive women are at a very increased risk to develop the disease.

    In developed countries with high income, the leading causes of death for women are:

    1. Ischaemic heart disease
    2. Stroke
    3. Alzheimer’s and other dementias
    4. Trachea, bronchus and lung cancers
    5. Lower respiratory infections
    6. Breast cancer
    7. Chronic obstructive pulmonary disease
    8. Colon cancer and cancers of the rectum
    9. Hypertensive heart disease
    10. Diabetes mellitus

    With cervical cancer no where to be found since it is so rare.

    Clearly if we want to prevent death, reduce harms of over screening, and actually tackle problems, we can do a lot more to focus on the prevalent causes of death and forget about our vaginas. A bad screening test does not equal health. It equals a lot of harm done. WHO even declares that for cervical screening to be of any benefit it must be done to a large population (following the study done that explained that to save 1 woman, 1000 women would need to be screened for 35 years), otherwise it is useless.

    At least WHO gets on board that an HPV test is a good starting at age 30, and is more effective when colposcopy is only considered for women who have tested positive through a subsequent VIA. Their entire 58 page paper demonstrated that there was no benefit for routine cytology. (cough.. sound familiar… Dutch and Finnish program anyone?)

    So ladies next time your doctors are giving you a hard time, just remind them that its rare and that unless they decide to offer an evidence based program that you want (and that’s the key word) to get on board with, forget about it.

    http://www.who.int/mediacentre/factsheets/fs334/en/

    • Alex says:

      I would caution against referring them here, simply because they ARE the types to cause shit. I was arguing for a while with a guy that was just training to be a doctor on HappierAbroad & he just kept going with his various & typical bullshit (lying, trying to bounce blame back at people, dodging subjects & questions, generally acting like they’re the victim, ignoring the structure of the situation). It was the “Why are flu shots free in America?” thread, if you’re interested. Keep in mind, some of the guys on there are pretty much nuts & more than a few of them are very bitter toward women- again, I’d advise against directing them here.

      I get your intentions, but a lot of things are not a misunderstanding. They get taught bullshit, sure- but that doens’t account for a lot of the things they pull. Someone can’t size up a situation, deduce what they’d like to be different about it, and then try to impose that situation by accident- never mind trying to cover it up afterwards.

      Their sneaky & conniving ways indicate malice over ignorance. Lies to scare people or like when they try to guilt-trip someone (that crying child poster in England is a perfect example) are things that point to them thinking things through. I figure if it were in print, it would read as: “Hmmm, how to counter this person’s decisions?”

      • vickibee says:

        Hi Alex,

        I realize that my comment above was not clear. I would not have referred them here simply because this is a board for like minded women, and it is no place for the pap-nonsense crew to join. The comment above was top refer them to WHO to review the paper I was citing. I cited a few WHO papers with the data above and provided the link to one.

        I completely feel that if a woman feels that her physician is missing information or is simply arrogant and relentless, they should refer them to that paper.

        Gosh I saw that ad, totally disgusting. Might as well put that same poster up for every woman who drives a car; motor vehicle accidents are more likely to happen.

  22. Elizabeth (Aust) says:

    Great post Vicki, cervical cancer is more common in Africa, but there are so many other threats, cc is still way down the list. I know some charitable foundations are offering pap testing, seems absurd when many don’t have enough to eat, clean drinking water or proper sanitation.(midwifery services, basic medical care, condoms etc.)
    We had a GP stop over at BlogCritics or was it Dr Sherman’s site, anyway, she tried to tell us cc is rare now thanks to screening. She’d also, had “precancerous” cells removed (hasn’t everyone?) and was concerned that women may read our comments and stop screening. Again, amazing that providing women with real information and suggesting they have a say in their healthcare is so often viewed as highly irresponsible.
    It’s concerning when some of our doctors accept the screening story…or perhaps, it’s an attempt to derail the discussion, to protect screening. Everyone seems to be so concerned about these rare cancers, but not a jot of concern for all the women being over-treated, especially when most of it is avoidable. The fuss about cc has never made sense from a healthcare point of view while major risks to our health are placed on the back burner.
    We seem to have limitless funding for the pin-up cancers, cervical and breast.

    • vickibee says:

      Elizabeth thank you so much for your reply. That story about the GP almost made me laugh out loud. Most GPs really don’t have a clue, I find. I truly believe that while some doctors must have ulterior motives and are focused on the quotas to get their “reward” for screening the needed percentage of patients, I am convinced that most are totally unaware. These unaware physicians actually make me feel sorry for them, because I truly think that they have been spoon fed garbage since the day they went to medical school and now that there is evidence popping out left, right and centre, they no longer know how to approach this.

      Even basic statistic centres such as Health Canada show that it is not a common occurrence, and that the cancer is very rare. This cancer was never booming to begin with. This isn’t an epidemic that requires screening to prevent widespread disease. The approach that the physician in question tried to use is consistent with vaccination to prevent widespread pandemics. While not vaccinating one child in a population still results in the same outcomes (No disease, because it cannot be spread), it is effective because everyone is asymptomatic and cannot contract the disease (herd effect). This is not even a similar analogy to be used for cancer screening. Screening comes with its own risks, including false positives and negatives, as well as what procedures are undertaken subsequently.

      This GP failed to acknowledge that the incidence of cervical cancer has nothing to do with screening. The reduction of the occurrence has to do with the fact that a particular subset was screened within a given population, and that subset then received treatment that they needed. There is no denying that there are fewer incidences of CC than there were 50 years ago, however the only reason for this was that an entire population had to undergo vicious screening in order for our small subset to derive any benefit from it. Treatment fixes cancer, screening doesn’t. And I am pretty sure everyone on this board totally agrees that while cancer is a problem, it is most certainly not the widespread pandemic that physicians make it out to be.

      I think that while certain women may decide they don’t want to screen because they see this board, it most certainly will not increase their chance of having cancer. However the scenario does exist where a woman who may be high risk in every category opts not to screen just simply because she sees this blog and does not do her research taking herself into account. In that particular case our GP may be right, that woman is at an increased risk and may actually benefit from screening. I’d like to think we are all smarter than that scenario.

      The point to take from this, (and the GP totally missed it), is that while cervical cancer is a problem, routine screening of a large population is a bigger problem. What a lot of us don’t understand is that in an econometric model, a population may still derive benefit in a normal distribution by averaging out the cost and benefits. However the distributions are not normal, and were you to split the data given our typical individual, the individuals themselves would not derive benefit, and in fact might be harmed. It is always so fascinating to me how statistics can be so easily manipulated. (BA Economics, major in Cost Benefit Analysis and a minor Econometric and Statistical models, and now work for medical license maintenance and work to update Canadian health guidelines, you can imagine the junk I see in a day). As mentioned in previous posts, testing for HPV from age 30 onwards every 5 years, and if the results are positive a pap can be given to see if there are cervical abnormalities. In the case of abnormalities treatment can be sought. Isolation of those subsets will fix this widespread problem.

      I remember seeing a campaign somewhere in Toronto where they said “Cervical Cancer is not sexy. Get a Pap.” Or some sort of rubbish along those lines. All I have to say that while CC isn’t sexy, neither is being ignorant and stupid.

      • Victoria says:

        “However the scenario does exist where a woman who may be high risk in every category opts not to screen just simply because she sees this blog and does not do her research taking herself into account.” To carry that line of thought on further: anyone who reads this blog will see that we want women to do their research and apply it to their own situation. Therefore the high-risk person should learn they’re high-risk and may not choose the same path as a low-risk person. As you say, I’d like to think any visitors are smart enough to take away the “informed choice” message 🙂

        I’m reminded of something Margaret McCartney wrote about, which is that when people are told the full picture about screening, the screening rates go down because of course the test isn’t presented in a perfect light. From this, the health service doesn’t learn: “We need to improve the test.” They learn: “It was the negative information that made people turn away, so we need to removed (or drastically downplay) the negative information.” The full information is blamed for people not having the test, rather than the inaccuracy of the test itself. In a similar vein, some people would definitely blame this blog for people choosing not to have smears and other screening and exams, rather than deal with the enormous issue of the screening test itself (and the scientific, financial and political issues that changing the test would bring).

    • Victoria says:

      I think that quote by (forgets first name) Cochrane re. cervical screening: “never has there been more appeal to emotion and less to reason” applies here! The doctor who had cells removed has a strong emotional tie to the screening and over-treatment process. When it’s affected her personally that’s a very strong emotional link to break and now she passes that onto her patients.

  23. ladyprotips says:

    I find it funny (and by “funny” I mean “crushingly sad”) that some of y’all were harassed for exams over leg and hand issues, yet I have chronic pelvic pain so severe that I can’t keep anything down and I can’t get anyone to do a pelvic exam ¯\_(ツ)_/¯ (and I’m 20 and in the US!)

    *side note: yes, the blood vessels in your pelvis can become congested, though it is currently unclear what other side effects this can cause, if any

    • Alex says:

      Try looking up Mayan Uterine Massage. It’s basically a stomach rub that you can do you yourself & sounds like it would be useful. How to do it is explained in Rainforest Home Remedies by Rosita Arvigo.

      • ladyprotips says:

        Thank you, but I don’t support naturopathy for the same reason I don’t support routine bimanual exams-there is no evidence backing it. Much like with bimanual exams, I would be willing to change my position were a large, peer-reviewed study to come out showing that naturopathy is an effective treatment for endometriosis (what I likely have). Also, it ultimately doesn’t change the fact that my levels of pain are 100% not normal and are 100% worth checking in to, and my providers not being willing to evaluate it is extremely unacceptable.

      • Alex says:

        Well, you’re right about them being unwilling to evaluate it. I never got how they feel that their “willingness” was as important as it is- if someone decided not to bring someone what they ordered at a restaurant, they’d be GONE!

        Anyway, it seems like that Mayan thing has a lot to do with circulation (like other massages), so it might be useful.

        I remember hearing more than once that endometriosis gets caused by having too much estrogen. A suprising amount of American food is fucked with in that way- seems to be causing things for men, too (impotence & shrinkage, at the very least). Supposedly to make the meat more tender, it’s shot up into a lot of animals (which happen to be female frequently) and packaged in things that have a lot of chemicals that imitate estrogen. There’s also various things that get added into one thing or another that screws around with someone’s own hormones.

        I know you’re not that into naturopathic stuff, but it seems that a lot of female issues actually stem from the liver & it not being able to filter things out enough. There’s a lot of plants that help with bolstering the liver’s function, so it might be worth looking into.

        Specifically, there’s the doku plant (I just ordered some of that on Amazon- the full title is Ten-Chi Cha Dokudami Cha). Haven’t tried it yet, but it gets good reviews & it seems the ninjas actually used this doku plant when they got poisoned (it helping the liver would help it to counter the poison). Don’t know if it always worked, but a lot of poison wasn’t like the movies- some of them would kind of have a gradual effect that would shut the body down if it wasn’t countered.

        Anyway, it’s food for thought.

  24. Anonymous says:

    When I was 16 I went to go get on birth control. I wasn’t sexually active yet but I was planning to be and wanted to be prepared. Well my mom took me to the gyno and they said they were gonna have to do the test. My mom told them that I was really nervous about it and she didn’t want me to be overwhelmed and that I wasn’t sexually active yet so she didn’t see the need for it. Afterward they asked her to leave the room and they told me to be honest about whether I was a virgin or not. I said yes, I really was. They (the lpn and the doctor, lpn mainly) looked at me in disbelief. They said they really need to do a Pap smear and wouldn’t give me the depo shot until I let them. I was only 16 and I shouldn’t have had to go through that just to prevent an unwanted pregnancy. Maybe if I had been sexually active for a year or so I would’ve been more okay with it.

    • Alex says:

      It’s actually illegal for them to back you into these tests for birth control. Off the bat, it’s an interface with a sexual area as a product of someone else’s decision-making (given the situation, I think the proper term for that would be “coercive iatrogenic assault”). There’s also the aspect of “reproductive & biological endangerment” (see, these things don’t work as advertised- there’s plenty of risks & inaccuracies that are not disclosed & the same goes for alternatives). I think imposed penetration that might cause a miscarriage down the line or lead is a bit of a serious thing.

      You having been sexually active wouldn’t make you okay with someone self-electively probing you. Outright hookers aren’t fine with someone forcibly “playing doctor” on them! Don’t mean that to yell at you, I’m just making the point that there is a negation of self-determination in one situation & there isn’t in the other. Not for nothing, but reality doesn’t take a coffee break for doctors.

    • Elizabeth (Aust) says:

      “Maybe if I had been sexually active for a year or so I would’ve been more okay with it.”
      Anon, pap testing has nothing to do with the Pill, depo shots or anything else.
      Also, pap testing is not recommended for sexually active women until they’re at least 25, the evidence says 30. I know America says 21, but the evidence clearly shows that’s far too early, this recommendation will lead to many young women having excess biopsies and being over-treated.
      I’d consider any doctor doing a pap test on a teenager to be either incompetent or taking advantage. In either case it’s a serious matter.
      Also, informed consent is your legal right, pap testing can never be more than optional, extreme pressure to screen can negate all consent and arguably, turn into an assault.
      That test simply risked your health, 1 in 3 women under 25 will produce an “abnormal” result, false positives, that test could have led to some ugly places like excess biopsy and over-treatment.
      I hope that fewer American doctors are behaving this way and that more women are aware any doctor suggesting such a thing should be challenged, reported or consider it a signal to get out of there as quickly as possible….run!
      These traumatic experiences tend to stay with us. My advice is to do your reading, informed women are much harder to overwhelm and deceive.

  25. Kleigh US says:

    Its wrong.

  26. Elizabeth (Aust) says:

    Here it is out of the horses mouth: a rep for ACOG has said they agreed the pill should be available over the counter (off script)…why?
    “We have taken this step because of the unintended pregnancy rate in the United States,” Joseph says. “Over the past 20 years the unintended pregnancy rate in our country has hovered around 50 percent and in all those years, we’ve done very little to improve that statistic.”

    Disgraceful statistic when reliable contraception has been available for decades,oh…except is wasn’t available, was it? Take off your clothes and get into the stirrups or else no pills for you . Shameful and damning that these practices were protected for decades knowing they were unnecessary, (I’d say abusive) and led to negative and serious health and life outcomes. How many lives and relationships were derailed because of these barriers? How many women were harmed, mentally, physically and emotionally?

    • Diane says:

      I really, REALLY hope that they get the Pill over the counter this year. It would end the practice of holding the pills hostage and forcing women into traumatic, inaccurate tests they neither need nor want. There was a bit of a wrestle about getting Plan B over the counter, but that eventually went through, so I have hope that this will, too.

      • Elizabeth (Aust) says:

        I really doubt it, Diane, I think it will take a lot longer because so many want to keep it on script, and they’ll be meddling and plotting behind the scenes to stir up trouble and scare women. The AMA (our medical association) is always the first to hose down any suggestion the Pill come off script, they’ve also, always promoted and protected our excessive pap testing program. I don’t think they have much respect at all for women, informed consent, they’ve never heard of it. One of their spokesmen made the extraordinary public statement last year that he doubted many doctors would prescribe the Pill without a current pap test on file, no one challenged him, yet I doubt he demands prostate checks before male patients can have Viagra or antibiotics.
        So hardly surprising women are treated so badly by the medical profession, these attitudes and outrageous conduct are now accepted by most women/people.

        Any American doctor coercing women into excess though must be getting worried, there is so much around now, the NY Times, Huffington Post and WSJ have all had several articles on the subject in recent years, so more women are aware these exams and test have nothing to do with the Pill. I know it’s harder in the States to change your doctor, but I’d put a copy of a few of the articles on the doctor’s desk and say given he/she is still linking these unnecessary exams and test with the Pill, I’ll be finding a new doctor, I’m not happy with excess, not prepared to risk my health. (delivered calmly, firmly, with a look of concern)
        When it means losing patients, more will realize the game is over.

  27. Eric says:

    Hi everyone Emily is my beautiful amazing girlfriend who will probably kill me if she finds out i snooped her laptop but im kinda glad she left this up…she talks about this stuff but i guess its just hard for me to believe it all. Are docs really like that?? and WTF is up with those horrible metal things? That awful, creepy torture tool looks it belongs in Pinheads dungeon NOT my beautiful angels sensitive precious lady parts. I know she’s so afraid of docs and has trouble letting anyone touch her…i guess this is one of the reasons she doesnt want to have kids. I would be so happy if she had a baby but not if it means she has to go thru all that. It’s not right and it’s not fair they can do that. i have NEVER touched her when she didnt want it and it’s complete bullshit that some asshole thinks he has the right to just because he went to med school. Also there was something else i was kinda wondering about but im not sure. Is it true that they put their fingers in the other hole too? At the same time? like DP? cause if so thats really really fucked up and i dont think i could bear my love being put thru something that horrible. With the issues she already has i think that would probably scar her for life and wed be lucky to even enjoy sex ever again much less a baby. Why does she even need to have any of that done to her? Is there anything i can do to protect her? i know it probably sounds really stupid to want to protect her from drs but it all just seems so fucked up on so many levels

    • Alex says:

      Well, right off the bat I’m a guy & have to ask you two questions off the line:
      (1) Did she “leave this up” in the sense that it was on the screen & in a blatantly obvious area? Was it like leaving a book open with the words up? I ask simply because that might have been kind of a way of getting it across without really bringing it up. Don’t go assuming that leaving her purse out is an invite to go through it or anything, but I figure this might have been a bit of a subtle signal.

      (2) Do you two ever talk about this? I’ll give you some approaches to get things rolling, but I’d suggest you lead with the general conversation instead of the fact of you snooping on her laptop. It’s not the most severe thing you could ever do (and women DO snoop a bit themselves, at times), but it’ll probably piss her off a bit & might make it hard to get to other things.

      As far as things go: It’s actually ILLEGAL to back women into this for birth control or whatever. It’s also an interface with a sexual area as a product of someone else’s decision-making, which is an attack (technically, I think the term would be “iatrogenic assault”). Properties don’t change by designation, just like if a doctor poisons someone with a needle it’s still murder. This also applies to the fact that there are risks, inaccuracies, and alternatives (not to mention that there usually ISN’T full disclosure about these things & deception vitiates consent- it’s not someone making their own decisions if someone else is lying & that’s true with other kinds of fraud, as well).

      They don’t say “Hey, would you like a high-risk, low-utility test that may or may not detect an indicator of something that’s massively rare to begin with? How about all kinds of tests & surgeries for problems generated by these procedures or the ones that were falsely detected? Don’t forget all the probing that this entails!”

      Anyway, get back to me & I’ll give you some advice on how to broach the topic, as this is getting to be a long post.

  28. Here’s a gem that was gratifying to read, and that helps to explain why we continue to hear the same propaganda and misinformation over and over again in the media:
    Media Messages about Screenings and their Role in Overdiagnosis and Overtreatment http://engagingthepatient.com/2014/10/01/media-messages-about-screenings-and-their-role-in-overdiagnosis-and-overtreatment/

    • adawells says:

      Thank you so much for this. It really gets me down when you see so much of the pap crap in the media. It makes me feel so much better to read something like this.

  29. Elizabeth (Aust) says:

    Sue, that’s an interesting article with lots of great links. I’ve found the same thing here, we had the mammogram stunt on morning television and they interviewed a radiologist at length, sure, I’m going to take her advice on mammograms!
    It also, irks me the personal bias that creeps in, a pious reporter scolding women who “avoid” pap testing and it’s clear her only research is the Papscreen brochures. (often you find these women have had a “scare” themselves…great, yet another survivor) Interesting that more haven’t worked out that with screening we have huge numbers of women saved from cc, before screening there were VERY few affected by cc. Of course, I’ve heard the convenient argument that women are sexually active at an earlier age these days and have more partners so the risk from cc is greater. Or the even more convenient argument that screening has stopped an epidemic of cc.

    Also, the annoying headlines, “Doctors are concerned that more women are avoiding pap testing”….”Women risk their lives avoiding 2 yearly screenings”. Reinforcing that screening is a mandate for women, not an offer, and a complex one at that, one that requires a lot of thought. (and research)
    The latter has been in the papers a fair bit, apparently, many women have decided to wait for the HPV test to be introduced here in 2016, then they won’t be “due” again for 5 years. “Women may die if they defer their 2 yearly screening”…etc.
    So they continue to push and protect the current program, when we all know that 2 yearly screening just fills up waiting rooms and day procedure. IMO, they fear losing control of the herd, so they’ll continue to promote serious over-screening until it suits them to funnel the herd into the new program. Also, vested interests will want to “treat” and biopsy as many healthy not-at-risk women as possible before the new program starts. They’ll still get their share with the new program, we’ll do HPV testing from age 25 so that’s great news for them, BAD news for young women.
    I doubt (and pray) they don’t see the same level of business though under the new program.

    I suspect that’s the only reason they haven’t made a huge fuss about the new program, they got their pound of flesh with the non-evidence based decision to use HPV testing on women under 30, that condemns about 40% of young women to immediate colposcopy and (I imagine) at least a biopsy.
    I think more women here are realizing this program is not focused on what’s best for women and is more about keeping vested interests and politicians happy…anyway, thanks for the link.

    • Elizabeth, I was overjoyed to find the article because it summed up what we have been saying here. It’s not often you run into another article that reflects complete agreement with our philosophies. The example of the radiologist giving advice on mammograms unfortunately seems to be the norm these days. “If it’s on the news it must be true” is a mindset that’s hard to get past. Some points in the article were outlined so well, like these:

      Emphasizing or exaggerating potential benefits while minimizing or ignoring potential harms
      Framing screening as if it were a mandate, not a choice
      Emphasizing patient anecdotes of people who claim their life was saved by screening – something that can’t be proven
      Missing the stories of people who make rational decisions not to be screened, or the stories of people who regret making ill-informed screening decisions

      Sound familiar? Also, the point that many women mistake the efforts to scale back on harmful screening as a bid to save money, was spot on. They don’t know the truth, and some practitioners are only too happy to keep them in the dark. Wonderful to see those points being made on another site.

  30. Alex says:

    You know what I just thought of as a good idea? If medical personnel were to be wearing patches like that “Coercion Is Criminal” on in the picture. I doubt they want to wear things that say stuff like “Your Body, Your Rules” or something like that, but that’s not important. They could always be forced & if they don’t go along, they can move along- occupationally speaking. Their replacements will more likely be better. Also, if they raised a huge fuss about combating coercive iatrogenic assaults & dictatorial medical personnel- it would just show them as supportive of that.

    I’d imagine that would be helpful & I don’t think they should have so many choices in how they do things- in this case, if they’d like to try to scam someone or push them around. Anyone that knows me even for a little bit knows I’d love to see the look on their faces & hear all their pissy little complaints, but confrontational value aside- it would serve as a kind of ambient patient-advocate.

    I truly do figure that they think “Well, I have a say in this- it’s my life & it’s my body, too” when encountering patients. No likely to be said (except in a dry humor-sounding way) & not overly likely that they’ll catch a “caught” look on their face. That & they don’t see the patient as someone that outranks them, so they don’t really care what they have to say or what their decisions are. No threat, so no need to not attack.

  31. Lily Lamb says:

    I don’t have relationships or sex because I don’t want to have to go to these doctors.
    I was destroyed at 6.5 and pieced back together. The surgery took 24 hours. I was septic, sticks and sh*t in my front part, sticks and my own vomit in the back part. But all the tissue in between both parts was shredded.
    Then, I was bullied and lied to at a very young age. I was forced to have a pelvic exam (the one who made me go said to me ‘to punish me’, and ‘sometimes we have to do things we don’t want to do’). I didn’t know I would be forced to show a man my genitals and let him touch me. I had my underwear on underneath the paper gown and Kleenex drape they gave me. I started shaking and my mind started dissolving (what is your biggest horror? Imagine that- and now it is being forced on you and they are enjoying it) when the nurse came back in and said,”What is this? How can the doctor examine you if you have your underwear on?”
    I basically had a mental breakdown, crying and wailing in the office and being told I couldn’t go home if I didn’t let the doctor rape/molest me. He used a big speculum, it hurt-and it hurt- and it hurt going in. And the nurse told me to ‘breathe big now’. And I cried so much covering my face with my hands in horror and shame, the doctor said,’I can’t do this.’ and left the room. At this point I was told I couldn’t go home if he didn’t rape/molest me. So I had to beg the nurse to let me beg the doctor to rape/molest me.
    Which he did.
    I had to beg him to come back and rape/molest me.
    And the impression that he was disgusted with me has lasted my whole life. And it was horrible. I didn’t know I would have to show him my boobs and let him touch them.
    Then they made fun of me at home. But I had disassociated. So until a week ago, I couldn’t remember any if it. Hard to be an abusive jerk to someone who can’t remember what you did to them.
    So I am 53 now. I hate those people.
    Actually I hate most people. I don’t like any of you.

Speak your mind

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s