Has #MeToo reached the doctor’s office yet?

There’s been some forward movement in parts of the medical community due to #MeToo. Much attention has been given to the high profile abuse case involving Larry Nassar, a former doctor for the U.S. Olympic gymnastics program convicted of abusing more than 150 women and girls, and there’s been recognition of the leniency with which doctors accused of assault are treated (source). There has also been some change regarding laws. Last year California became the first state requiring doctors to inform patients before an appointment whether they have been disciplined for sexual assault or other misconduct (source).

The attention, acknowledgement, and efforts to implement changes are improvements, but the movement doesn’t appear to have had much of an impact on women’s routine doctor office visits. Routine visits to the doctor account for many of the encounters women have with the medical community and yet what happens to women in this context seems to have been largely overlooked in the #MeToo movement.

Women are often vulnerable when they visit a doctor and the context in which screening tests and exams are presented increases this vulnerability. Some women believe they need to do what the doctor instructs them to do and others might be concerned if they aren’t compliant they won’t have their health care needs met. Women who are not going to the doctor for the purpose of a pap test or pelvic exam might find themselves having one anyway because their doctor has told them they should have one or that they need one.

Some doctors use coercive tactics, asking the woman about her last pap test or exam before addressing her health needs, instructing her to undress then quickly leaving the room without giving her an opportunity to speak up, and carrying out the pap smear or exam before attending to what she needs. In these cases women have been given no opportunity to consider options or to decline, instead ending up naked with legs splayed, feet up in stirrups, undergoing an invasive exam that they had no intention of having.

All exams and screening tests are elective; women have always had the right to decline pap tests, pelvic exams, and breast exams. Unfortunately some women remain unaware of this fact. Some doctors fail to disclose the fact all tests and exams are elective and instead present screening as if it were a mandate (source).

Meaningful change could be made if doctors were mandated to start disclosing to women that they have a right to informed consent regarding all screening tests and exams. This would help ensure doctors disclose balanced information about the pros and cons of screening and exams, and enable women to make up their own minds.

The mandate would address the coercion women face, such as some doctors’ tendency to withhold healthcare or medications when women question or refuse pelvic exams and pap tests. Rather than prioritizing pap tests or other invasive exams, doctors would need to disclose balanced information about the pros and cons, invite discussion, and respect the woman’s decision if she decides to decline.

Mandating doctors to disclose women’s right to informed consent would better equip women with the means to protect themselves from sexual abuse when attempting to seek health care. Currently women are often not offered information or a choice, leaving them without any way to protect themselves from non-consensual, penetrative exams.

Until these changes become visible it seems the #MeToo movement has not yet reached the doctor’s office.

More on this topic:
Informed consent for pap smears missing
Pap tests are not mandatory
The other side of the speculum: A male doctor’s point of view
What some male doctors do when women say no
Media messages about screening
Sexual abuse under guise of healthcare

7 comments

  1. The #metoo movement needs to reach the doctors office.

    Dr V. and his practice nurse G.G. are both culpable of sexual assault. In fact all those connected to the NHS cervical screening programme are culpable of sexual assault.

    Historically women were given no choice whether they had smears or not. Like me, they have been tricked, conned or just plain bullied into having smears. The invitations that were posted out made it seem like getting smears was mandatory for all women.

    That is why PHE are panicky about insisting smears are a women’s choice. They know how the programme was operated. It operated like this unquestioned for about 30 years.

    I wonder how many NHS doctors should have their names recorded on the #metoo website. The numbers must be in the thousands.

    • Linda while I agree with everything you said..I think PHE have started announcing it’s a choice and always has been to try and ward off legal action. Yes women have been treated appallingly and we know it but by insisting oh it’s a choice……
      The word is getting out online it’s a choice and a pretty useless test at that
      Someone posted a template opt out letter online
      I think the medics are running scared…

  2. I had an idea for something it might be interesting to feature on this site: do readers have information regarding healthcare providers who *don’t* push paps/pelvic exams, or at least, respect their patients’ decision to opt out?? Is it too optimistic to even imagine that doctors like this exist??

    It might be nice to put together a state-by-state database of said providers. I’ve heard of people in the LGBTQ community putting together lists of providers who they had positive experiences with. This would be the same thing. I have lived in the Boston area for 11 years and have not had any success finding a healthcare provider I can work with, though at the age of 33, I would like to.

    • I would *LOVE* to have something like that available! I’ve had a few doctors in the past who saw me for something specific, or followed me for something specific, who never pushed paps (I left the question on the form blank, and they didn’t ask). Much more often, when I leave it blank, I have paps pushed on me to the near exclusion of the problem for which I came in. Look: If I wanted a Public Service Announcement about paps, I’d turn on a TV or pick up a pamphlet. If I’m seeing a doctor, I want something treated – not an unreliable test for a rare cancer hard-sold to me, along with the provider’s insistence that they have some right to get into my pants without my consent – using coercion at least.

      It’s not practical to see every provider in your area! A city such as Boston has plenty of providers, certainly, but multiply that out by about $150-$200 per visit, that’s a big chunk of change with a lot of aggravation. If you live in a rural area, such as I do, I don’t have nearly as many to choose from, but I’m looking at anything from 30-70 miles one-way to see them, with all the time, expense, and the cost of the visit. The alternative is to leave my diabetes untreated, and die a pretty gruesome death within 5-10 years.

      • BTW: I made a mistake. The reply below is me BH, the original poster of this comment. I accidentally put my email in the name field.

  3. Somehow, my original reply to this got deleted.

    I meant to write that I agree it would be very difficult to formally survey all providers in any area. I meant that maybe this site could informally ask women to write in with their informal experiences about how they were treated in various healthcare settings in regards to paps/pelvic exams and publish a compilation of responses.

    I actually got this idea from a post on a site called “Fearless Formula Feeder”–not looking to get into a debate about breast/bottlefeeding but keep in mind that some women with body image/trauma issues may have the same anxiety around gyn exams as they do around breastfeeding, particularly as it is coercively pushed in modern maternity wards. The site had a list state-by-state of various hospitals with reader comments about whether or not their feeding decisions for their children were respected. I was thinking this could be a similar thing.

  4. If anyone here is following “The Handmaid’s Tale” TV show, the most recent one (Season 3, Episode 9 “Heroic”) has June, our heroine, really pushed off-center when she’s in the hospital under orders to stay with someone who is brain-dead until her baby comes. It’s become obvious that women, especially handmaids, are nothing more than life-support systems for a (functional) reproductive system in this dysphoric near-future – which has all women pitted against each other by roles and competition for positions to which they are assigned. After the baby is born by C-section, the woman, who is apparently brain-dead, is essentially forgotten – taken off life support, and minimally cared for since she’s not dead.

    She is sitting in this hospital room, and a lot of little girls go by. Eventually she talks to one, and she finds out in another conversation that the girls are there for their menarche exam – which includes medically deflowering the girls who’ve passed menarche. From talking to the girl, her goal in life is to get married and have babies. Note that having babies has become a problem in this society, presumably from the nuclear fallout they’ve experienced, but they cannot test the sperm count of the men. June has decided that saving children from this life is to become her goal in the future.

    It’s clear to me that the menarche exams happen in wealthy countries today – people are encouraged to bring their preteen and teenaged daughters for “exams” even before menarche – but the pelvic exam is supposedly “usually” left until later. They’re still examined and seen as far as how far into menarche they are – or are not. I don’t see much of a difference.

    Oh yeah, the handmaids are ritually raped monthly by their assigned “commander” and his wife – they’ve got nothing to say about their bodies either, and are pregnancy tested a few days later, and given a proscribed prenatal regimen. Again, I don’t see this as much different than reality – even though you’re supposed to be able to give “informed consent” – but that won’t stop them from harping and pressuring you when you seek any other medical care – ignoring the problem for which you’re there.

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