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  • FRIDAY MARCH 23 2012 9:26 AM

A Doctor On Transvaginal Ultrasounds: Where Is The Physician Outrage?

There’s one group of people that has been strangely silent when it comes to the current War on Women, and more specifically legislation that requires women to have a state-mandated transvaginal ultrasound before an abortion. Before being allowed to practice, physicians take the hippocratic oath – a promise that they will do no harm. This politically driven policy clearly forces medical practitioners to violate that oath, since the procedure is invasive, uncomfortable, medically unnecessary, not to mention highly emotionally distressing for many women. Here, in a post that was first published on Whatever.scalzi.com, an anonymous doctor speaks out against what’s been dubbed “state-rape.” – Nicole Powers, SG Ed.



Where Is The Physician Outrage?

by An Anonymous Doctor

Right. Here.

I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.

I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.

I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.

In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.

After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.

Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation.

They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.

It’s time for a little old-fashioned civil disobedience.
Here are a few steps we can take as physicians to protect our patients from legislation such as this.

1. Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.

2. Reinforce patient autonomy. It does not matter what a politician says. A woman is in charge of determining what does and what does not go into her body. If she WANTS a transvaginal ultrasound, fine. If it’s medically indicated, fine… have that discussion with her. We have informed consent for a reason. If she has to be forced to get a transvaginal ultrasound through coercion or overly impassioned argument or implied threats of withdrawal of care, that is NOT FINE.

Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.

3. If you are forced to document a non-indicated transvaginal ultrasound because of this legislation, document that the patient refused the procedure or that it was not medically indicated. (Because both of those are true.) Hell, document that you attempted but the patient kicked you in the nose, if you have to.

4. If you are forced to enter an image of the ultrasound itself into the patient chart, ultrasound the bedsheets and enter that picture with a comment of “poor acoustic window”. If you’re really gutsy, enter a comment of “poor acoustic window…plus, I’m not a rapist.” (I was going to propose repeatedly entering a single identical image in affected patient’s charts nationwide, as a recognizable visual protest…but I don’t have an ultrasound image that I own to the point that I could offer it for that purpose.)

5. Do anything else you can think of to protect your patients and the integrity of the medical profession. IN THAT ORDER. We already know how vulnerable patients can be; we invisibly protect them on a daily basis from all kinds of dangers inside and outside of the hospital. Their safety is our responsibility, and we practically kill ourselves to ensure it at all costs. But it’s also our responsibility to guard the practice of medicine from people who would hijack our tools of healing for their own political or monetary gain.

In recent years, we have been abject failures in this responsibility, and untold numbers of people have gleefully taken advantage of that. Silently allowing a politician to manipulate our medical decision-making for the purposes of an ideological goal erodes any tiny scrap of trust we might have left.

It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.

Because we are their last line of defense.


Reprinted with the kind permission of John Scalzi at Whatever.scalzi.com.

 

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Comments
Selene

Selene

SUICIDEGIRL

Oregon, USA

APR 02, 2012 01:34 AM

TwiggyTheSpider said:
I think its possible to use emotional arguments to make a logical point and I think Calico did a pretty good job of it tbh.

I can understand where you're coming from Selene but I think you've missed the point, of course a vaginal ultrasound rape is not the same as being set on fire rape (personally it was a great physical comfort to me while being raped not to also be on fire but YMMV) but where you've missed the point is that although they are differnt they are also equal or potentially equal in the effect they can have on a person and it isn't anyones right to guess or judge what level of affect one act will have as compared to another when it comes to sexual assult and rape.

In some ways the way I feel about this issue is stronger than I feel about my own rape experiences, it was pretty shitty being raped tbh but at least it wasn't state sponsored, at least no one tried to tell me it was ok or that it was part of my right to know. What is getting me about the whole situation is the violation of the trust that a woman should be able to have in her government, I hope that if this piece of legislation moves forward more medical professionals stand up against it.



You are right and your response is very informative and I think I understand your meaning perfectly. Thank you for not insulting me or talking to me as though I am not a survivor because of my opinions.
And Psyche, you tell me I'm wrong in a very civil manner also, thank you. smile

The reason I am posting: In case you didn't know (I didn't), the Boards are public...to everyone, not just SG members. And what you post, including Spoilers, can be read by anyone, anywhere. Some posts were very personal so I hope that the ladies posting their experiences in here are comfortable with that information being so public; I had no idea about this until yesterday (I would mind, but I am very gaurded with such personal information).

Psyche

Psyche

SUICIDEGIRL

California, USA

APR 02, 2012 01:48 AM

^^I obv can't speak for all or any survivors, but I'm certain some of them attain some strength and unity in coming out about it publicly. Some posters have been here for years, so I am pretty certain they would have known that the forums were public, so I am only assuming that nobody on here is embarrassed to divulge in the details that they did. Maybe?

PHB

PHB

Chicago, IL
May 2007

APR 02, 2012 11:35 AM

I like it when people share information, opinions, interpretations, perspective and life experiences without trying to "win" an argument. Nobody holds a monopoly on the "right" answers here, but it's important that we don't focus our efforts on making people agree with us or admit how wrong they were, as much as to persuade those with an open-mind to consider that your point-of-view may have some validity (and that our own open-mindedness may result in our discovery of new information and perspectives to respect and consider). Yes, that is targeted primarily at Selene but I think others could benefit from taking a moment to take a breath and not falling into a trap of trying to "beat" others in an argument. Someone's articulation of their point may be awful and their style may turn us off, but hopefully there is a shred of worthwhile truth to be found somewhere in what they're trying to share with us. If not, seek clarification. If that clarification is insufficient or unsatisfactory, at some point you have to move on.

Though I am totally against the right-wing anti-choice constituencies that are trying to throw up any and all roadblocks to women having access to abortion and other family-planning options, my initial inclination was to think that those who talk about "the war on women" and equate an "mandatory transvaginal ultrasound" with rape were being alarmist and using hyperbole to demonize their opponents, but as I've learned from the community here, it doesn't matter what you call it, it doesn't matter what degrees have been granted to the person who's holding the inanimate object, etc. the trauma is real and its lasting impact leaves those women subjected to it as victims. So I'm still not 100% comfortable with the language of calling it "rape" myself, but I don't object to those who want to go that route and am not going to contest the accuracy of the statement when someone does. All factors of what circumstances led the woman to that exam room aside, the decision about any medical procedure should always be up to the patient. In another scenario, your doctor may say you need an x-ray, ct scan, mri, ultrasound, etc., but it's still up to you whether you pursue that course of diagnosis and treatment.

I've always taken the position that carrying a pregnancy to term is that particular woman's decision. Full stop.

It should be based on sound medical advice from a doctor acting on a motive of solely "what is the likely medical impact of this pregnancy on the woman". It is totally her call about whether to seek input and advice from any additional parties... another doctor, parents, man who contributed sperm, significant other(s), friends, clergy, psychic, astrological advisor, academic adviser, financial planner, etc. but it is up to her whether they get to have input and it is up to her whether their input influences her decision. Anything that disrupts what I just described and gives anyone else a degree of determination that the pregnant woman herself did not choose to grant them is an unwelcome coercion. That includes parental consent laws, "education" requirements, waiting period requirements, lack of access due to geography, financial barriers, etc. Anything.

I look at it in the extreme scenarios and try to think of the life circumstances of the person at the middle of it...
- If a minor female is raped by a relative and impregnated, should she have to get parental consent before the procedure?
- If a woman is in an abusive relationship and gets pregnant and having a child would prevent her from severing ties with the abusive man, should she have to get his consent?
- If a woman is impregnated by a married man that is not her husband, should she have to go forward with that pregnancy?
- If a woman has serious addiction and chemical dependency issues, is it responsible to proceed with the pregnancy?
- If a low-income woman juggling more than one job decides she wants an abortion, should she have to take time off work to make multiple visits to a clinic for screening, education, waiting period, etc.?
- If a woman is at the point in her career or education, in which motherhood would be an unwelcome barrier to her career advancement, then should she have to proceed with the pregnancy?

In all of the cases I describe, everyone is free to have their own thoughts as to the morality of the choices and whether that's something that we endorse - either individually or as a society - and all the commentary that goes along with it. If you have a friend that makes a decision based on criteria that you find distasteful, then you can choose to no longer be friends with them. If there's a case of a woman having several abortions on a frequent basis due to anything - a promiscuous lifestyle or aversion to condoms and other birth control - you're welcome to find that despicable and condemn it in the strongest terms possible and judge her and think all kinds of nasty things about her, but you shouldn't get a vote as to what number is "too many", whether you draw the line at 0, 1, 3, 12 or more. The doctor's office can ask (probably in paperwork you need to complete) "are you sure? do you need more time to decide?" and make clear that there is no undoing this decision (and make available someone to discuss it with - if she chooses to), but that's as far as it should go. I don't think the laws of our society should force a woman to take on the physical, emotional, financial, etc. burdens of motherhood before she decides she's ready for that challenge. It's not fair to her, it's not fair to the theoretical child, it's not fair to those of us who would hurt for the child raised in an unloving family. While life isn't always fair, this is a case in which there is a potential remedy to rectify the situation.

And don't give me crap about "carry to term then give up for adoption" - that is still disruptive to one's life for at least 6-10 months and those in the woman's work environment, family, etc. will still respond to her with knowledge of what happened. It becomes part of her story and may in some ways limit her future and paint the context around existing relationships.

The only person the woman needs to justify this decision to is herself (and her god or gods, if she chooses to include them in her lifestyle).

Transvaginal ultrasound requirements are just another roadblock being proposed, therefore I object to it without any reservation or apologies.

Clidna

Clidna

Canada
January 2005

APR 02, 2012 09:08 PM

Selene said:
The reason I am posting: In case you didn't know (I didn't), the Boards are public...to everyone, not just SG members. And what you post, including Spoilers, can be read by anyone, anywhere. Some posts were very personal so I hope that the ladies posting their experiences in here are comfortable with that information being so public; I had no idea about this until yesterday (I would mind, but I am very gaurded with such personal information).


Yes, I'm sure most of us know that the Boards are public. The vast majority of those who post on the Boards have been around for at least a few years - most for 5+.

I'm not sure what you mean by 'the reason you are posting', though - the reason you are posting what? The last post, or throughout the thread?

Atlea

Atlea

SUICIDEGIRL

Quebec, Canada

MAY 03, 2012 09:51 AM

I gotta be honest I'm pretty upset I ended up reading all of this I probably should have stopped myself but I guess the train crash effect took it's hold on my mind. This entire 4 pages appart from 3-4 posts have done almost nothing to talk about the topic at hand and not only that, but has used descriptions and trigger statements without spoilers, or warnings.

I know it's the internet and all, but good god some things really need to be spoilered and put into context. I think this is possibly the most upsetting thing I've read on SG, EVER. And I clicked on the topic because it was something I think I should be informed on and a part of the debate, even with upsetting past experiences. Because there are things, as sensitive as they can be, that I need to be informed on, if only to help others in the future.

This has been a super fail, thanks.

Clidna

Clidna

Canada
January 2005

MAY 03, 2012 03:03 PM

This thread was a trainwreck a long time ago - that's why nobody has posted in it for a month. If the entire thread upset you, I'm surprised you didn't stop reading after the first page.

Otoki

Otoki

SUICIDEGIRL

Minnesota, USA

MAY 04, 2012 08:42 AM

Clidna said:
This thread was a trainwreck a long time ago - that's why nobody has posted in it for a month. If the entire thread upset you, I'm surprised you didn't stop reading after the first page.



Yeah prettymuch halfway through the first page the lack of spoilers in this thread was established rather clearly. I think here were several really great posts in here, but they had to do with rape, not the OP so much.

Thistle

Thistle

SUICIDEGIRL

California, USA

MAY 04, 2012 12:55 PM

Atlea said:
I gotta be honest I'm pretty upset I ended up reading all of this I probably should have stopped myself but I guess the train crash effect took it's hold on my mind. This entire 4 pages appart from 3-4 posts have done almost nothing to talk about the topic at hand and not only that, but has used descriptions and trigger statements without spoilers, or warnings.

I know it's the internet and all, but good god some things really need to be spoilered and put into context. I think this is possibly the most upsetting thing I've read on SG, EVER. And I clicked on the topic because it was something I think I should be informed on and a part of the debate, even with upsetting past experiences. Because there are things, as sensitive as they can be, that I need to be informed on, if only to help others in the future.

This has been a super fail, thanks.



I'm sorry that this thread upset you. You should be aware that on the Current Events board there is no protocol towards using spoilers or trigger warnings. If you are sensitive to triggering, this may not be a good space for you.

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