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.
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