A Doctor on Transvaginal Ultrasounds

This article originally appeared on John Scalzi's blog Whatever. It was written by an anonymous doctor, and is reprinted with permission.

I'm leaving the comments open, somewhat against my better judgement, so please be civil. I reserve the right to close comments at any time, for any reason.

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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. 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.