Physicians should rise up against mandated transvaginal ultrasounds

Where is the physician outrage?

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. 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.

This post from an anonymous physician originally appeared on John Scalzi’s blog, Whatever.

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  • http://profiles.google.com/harnessg Glen Harness

    So you’re refusing this because it’s not medically indicated? OK. How many abortions are “medically indicated”? Probably a fraction of the ones that are performed. So I’m happy you’re going to stop performing procedures that are not medically indicated. Good for you.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

       …and because the patient doesn’t want it done to her.

      Is becoming the coercive instrument of governmental rape more palatable if one happens to share government’s beliefs du jour?

    • stanley kristiansen

      I think the coercion is the big issue.

    • Pat Garrison

      There are plenty of procedures that aren’t “medically indicated” — any cosmetic procedure, for instance.  But that’s not the issue.  The issue is coercion.  The State isn’t forcing women to get botox injections or facelifts and writing it into law…

  • Anonymous

    Glen: if by “medically indicated,” you include the mental health of the mother, then ALL abortions are medically indicated. Not to mention, none of your X$#@& business. Period. End of sentence.

    • Anonymous

       I didn’t want to pay alimony, it was detrimental to my mental and physical health.  Did the courts give a damn?  You know the answer.  No.

      • Sarah Wells

        Bleeding out is not comparable to spending money.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

       Well, there you are then. The doctors don’t “rise up” because it’s “none of their X$#@& business” as you say. “Period. End of Sentence.”

  • Sarah Wells

    Glenn, a fact that might horrify you, but is nonetheless true: the risk of morbidity and mortality to a woman is lowered by induced abortion.   Even a pregnancy that is going well in an apparently healthy young woman can turn on a dime.    Risk and benefit is a personal calculation that is informed by a physician – and the only reason a woman has a right to an induced abortion is that physical risk and burden.

    • forPCP

      Hear my outrage! The very ones you justify ripping the unborn human will go out and chain themselves to the courthouse steps if someone destroys the eggs of endangered birds.To those of us who have witnessed the horrors of psychological truama of abortion to the prospective mother kudos to Glen. Ripping a unborn human being apart due to embarrasement, inconvenience or hardship in a country that supports the “born” is heartless and cruel, more women have died from abortion after legalization then every did from coathangers.  Anything to make the procedure harder to get, making sure the mother has “informed consent” of who they are destroying is valid. Those of you have aborted the next generation who will pay for your social security check, who will be inconvenienced then?

      • http://twitter.com/VanessaObRN VanessaObRN

         ”Ripping a unborn human being apart due to embarrasement, inconvenience or hardship in a country that supports the “born” is heartless and cruel…..”

        So, no problem with the 12 year old impregnated by her brother or father?  Or raped by an “uncle”?    What’s your advice?  “Look at the bright side, little girl.  You’ll have a real life dolly to play with.”

        • forPCP

          in answer to ObRn, Percentage of “rape/incest/life of mother” is low compared to number of overall terinated pregancies,and still yet many rape victims choose to carry their babies to term as they feel that something good came out of something horrible and it wasn’t the baby’s fault and doesn’t deserve the death penalty for their father’s horrible crime.  Planned Parenthood hides the “rapist” in many cases as proven on tape. Who is truely advocating for women? Don’t girls and women have a right to know what is involved when they “choose” to get rid of “product of pregnancy”? That is informed consent. A probe vs. abortion, hmmm which carries more risks?

          • Sarah Wells

             Lets show the 12 year olds abdominal scars, inverted uteruses, fourth degree tears, emergency hysterectomies….

          • forPCP

            What are the statistics of 12 year olds needing abortions? Were parents informed, police called when this child requested the abortion? Who investigates abotion clinics for these types of answers? Was the father prosecuted if an adult, or was it hidden by the abortion facilities? Who follows up with that child after the abortion is done? The same people who are angered about an ultrasound also do not want parental consent for the surgical procedure of abortion for that 12 year old so she can keep her secret. Again, who is advocating for women?

      • Sarah Wells

        It’s not about informed consent.  That’s not even what it means.

  • http://www.healthasahumanright.wordpress.com/ Erin Gilmer

    Incredible post!  I hope that all doctors will stand together and be civilly disobedient.  Thank you for taking the courage to speak out – may many more physician voices join together with you. We need to hear you in the public discourse – particularly on these issues where you are being forced to perform procedures that are so very harmful and unnecessary.

  • http://www.facebook.com/profile.php?id=655523194 Jeanine Satriano-Pisciotta

    Needed one for ovarian problems and that thing hurts! Stand your ground doctors. Thanks.

  • http://twitter.com/christythomas Christy Thomas

    I recently experienced a transvaginal ultrasound as a first step to seeing if I have developed uterine cancer, and was horrified by how invasive it was–and the procedure was done with great sensitivity and gentle care.  I can’t imagine intentionally inflicting this on a vulnerable young woman who is in a terrible spot to begin with.  Thank you for writing this.

  • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

    Even though I am unable to have children (ok now I am too old, but I wasn’t able since 30ish), I am still outraged by this. We do have informed consent in this country. The government has no right to mandate any test unless there is a clear public health issue, this is not one.

    The funny thing is that I don’t really see how this would have any effect on the number of abortions. It’s just harassment and violation. Someone has to challenge this as unconstitutional.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Just to clarify, this is not a Federal law. It has only passed in Virginia. It has been introduced in other States though, and recently failed in Idaho and dialed back in Alabama.
      Other States, like Texas, require regular ultrasounds before abortions, which I think is equally outrageous, particularly since it only applies to women too poor to travel to a sane State.

      • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

         I understood it’s not federal law, still outrageous as you say.

  • Mary Pat Whaley

    Thank you for publishing this, KevinMD.

  • Frank Lehman

    Please everyone.  It may not be good policy, it may be painful, and it may be a lot of other things.  But it is not rape.

    • Adora Ng

      What exactly do you think rape is? I’m assuming you don’t have a vagina. Would you like an ultrasound inserted into your rectum, then, for something for which it is not indicated?

    • EmilyAnon

      It may not be according to the performing doctor who was “just following orders”, but the charge can certainly be laid at the feet of the politicians mandating the act as a fear and humiliation tactic. 

    • BostonMD

      Frank Lehman, 
      I doubt you have ever had a large probe forcibly inserted into your vagina, because you most likely do not have a vagina. But tell me, if someone forced a large object, a glass coke bottle for example, into your anus, against your wishes… to your protest.. causing you pain and discomfort.. but forcing the object up your rectum none the less, then moving it around despite your protests and humiliation… would that be rape?EVEN if there were some medical benefit to it, if it were against your wishes and caused you distress and humiliation, would it be rape?NOW, what if we KNOW there is no benefit at all, only the goal of causing discomfort and humiliation to individual we have decided we are better than, stronger than, smarter than.WHAT IF that individual were your daughter? sister? Forcing a coke bottle sized object (for WHATEVER reason) into their vaginas because they think they know what is better for them than they know for themselves? Because their religious views, political views, artistic views, any views differ. Because they were born into a different family than those in power who think they know what is best. what if they made it legal to force inanimate objects in your wife’s and sister’s and daughter’s vaginas?Just clarify what your definition of rape is.

      • NormRx

        If it was a medical procedure and it was against my wishes, i would simply refuse the procedure.  But, thanks for all of the information, my doctor wants to do an endoscopy, I don’t think it is medically necessary so I have refused.  I will now tell him I don’t want to be orally raped.

  • http://www.facebook.com/profile.php?id=1215914082 Wendy Felsenthal

    I think calling this procedure ’rape’ is the big issue….Really????

    • Sarah Wells

       Actually penetration of the vagina with an object without the consent of the penetrated person is a form of rape.  In VIRGINIA

      • GuardGirl_x3

        But it’s consent when she chooses to get an abortion. It’s the same concept as getting a pap smear, and that’s not rape. As a rape survivor, it’s insulting to compare the two actions. 

  • http://twitter.com/SeptemberMay Jessica Mendes

    One of the biggest mistakes a blogger can make is not contextualizing their rant and losing the reader. I have quickly read this over and yet still have no idea what “mandated” transvaginal ultrasounds” you are talking about. Mandated by who? Since when? You can’t assume that all your readers know about it, and you can’t expect people new to the subject to read past the first paragraph without explaining it. How do you expect people to give a crap otherwise?

  • Molly_Rn

    This isn’t policy it is punishment. Women are being punished for having sex. It really is that simple. We have gotten too uppity and out of line for the pasty faced old white men running Virginia and by god they are going to put us in our place. Since HIPAA says they don’t have the right to view the patient’s record just to check to see if a procedure has been performed, then don’t do it and just document that the machine was on the fritz. 

  • NeoNP

    Very good piece.  I was subjected to a trans-vaginal U/S when I developed a solid tumor on the pelvic floor.  what I needed was an ultrasound of the tumor on the perineum.  Instead I was FORCED to undergo this invasive and uncomfortable procedure against my protests.  The manipulations they went through with the wand trying to visualize the tumor was painful and they would NOT listen to me when I kept telling them they were looking in the wrong place.  This U/S was performed by the radiologist who was a female and she was rude and not gentle.  A terrible experience for someone who was already freaked out and frightened.  Once I forcibly took the wand away and pulled it out and plopped it on the area of concern myself the tumor was clearly visible.  No apology was ever given.  Just continued rudeness.  Unbelievable.