As a medical student I had at most, an hour of training on obtaining informed consent and only for medical procedures - not medication use. That consisted of making sure you read a patient the risks of a procedure and had them sign the form confirming this. It did not include actually explaining the risks - just reading a list of them to someone who was feeling unwell and vulnerable, but at the same time, influencing them by telling them how much they need the procedure. The implications of the risks tended to be minimized, rather than personalized - as in this is what this could really mean for you if this horrible thing happens. No breadth of alternatives were given.
In the clinic, pharmaceuticals, invasive tests, and procedures were usually afforded much less informed consent time - if any. Usually a prescription is just written, it's assumed the patient will take it, and no risks are communicated.
Comments like "I'm just going to do a little snip because I don't like your baby's heartbeat" (l heard that one not too long ago; I stopped the OB from doing it; baby was born 30 seconds later, no problems), the vaginal exam someone went to do without even waking a sleeping mother (that person got stopped in their tracks, too!); the medication put in the IV without the patient being told....ALL NOT OKAY.
EVERY exam, EVERY procedure, EVERY medication REQUIRES your INFORMED consent (unless a dire emergency or you're medically unable to give consent, like you're unconscious, or delirious and it's a lifesaving intervention). That means you get to ask questions until you understand AND you can SAY NO. Or I'd like to think about that. Consent doesn't just mean someone reads a list of possible risks or tells you it's needed. It's a full explanation of RISKS and ALTERNATIVES. AND what happens if you say no or wait.
Yet this is not happening!Let's take hysterectomy, for example: AT LEAST 20% are considered medically entirely unnecessary, and only 30% of women advised to have a hysterectomy, of a study of over 5,000 women, were informed of non-surgical alternatives by their doctor. Women in their 30s were the least likely to be informed!
Join me for a pithy and powerful conversation wiith Emily Nagoski author of Come as You Are. Here are just a few of the juicy topics we cover (this is an adult content episode):
• The problem with heteronormative research
• Positive changes in sexual health in recent years
• What turns your sexual break on, your sexual accelerator off, and how to get it kickstarted.
• What really causes low libido most of the time (hint: it’s not your hormones).
• How to keep the sex-spark alive in a long-term relationship.
• Why putting down our own baggage is important for our kids’ sexual health.
• Why we need to stop apologizing and teaching girls that other people’s opinions about their bodies is more important than their own internal experience.
The conversations we’re having about sex need to change to a woman-centered, woman-positive model, not a medicalized model in which manufactured conditions like Female Sexual Dysfunction (we talk about what the means in our convo), or a media-driven one that creates entirely unrealistic images and expectations about women’s arousal, pleasure, and satisfaction. Also, unpacking our own sexual origin story - what we learned from our parents or other role models about our body and sex, influences our children’s sexual health and safety.
I’ve become an Emily-fan; I think you will, too! Check it out!
In Come As You Are, sexual health educator, Emily Nagoski, PhD, says that the most important factor for women in creating and sustaining a fulfilling sex life, is not what you do in bed or how you do it, but how you feel about it. This means that things like stress, mood, trust, connection, and body...
Mansplaining is a term you may have heard. It was coined by feminist author Rebecca Solnit to describe the phenomenon of men describing something to a women - that she might even already be an - or THE - expert in - in a condescending, infantilizing, arrogant way. We've all had it happen to us. So it was to my great amusement- that self-acclaimed "vagina expert" Jen Gunther, an ob/gyn who built her now very large platform, including a NYT column, on a goop takedown campaign, named her TV show (Canadian) JenSplaining. She clearly doesn't get what it means - but it's a perfect example of what she's actually doing.
She's doesn't understand that she's actually a mouthpiece for conventional obstetrics and gynecology practices - which are inherently anything but feminist or woman-centered. OB/GYN is BUILT on mansplaining - even when it's coming from a woman doctor.
Gunther misses so many points - including the big WHY women are seeking outside of the box - but also the importance of what's available outside that box for safe, effective, affordable, empowering treatments. She sees conventional medicine, or only those therapies with her approved level of evidence, reliable, ignoring inherent risks and side-effcts, hazards, and the very real anti-woman bias operating in medicine. She has become a voice for the patriarchy, masking as a voice for women.
My colleague, author Jennifer Block, who wrote the excellent book Pushed on US obstetrics practices, sent her latest article to me this morning - and I have to admit - I'm a little jealous that I didn't write it myself. She says everything I've been thinking - for months. So well done! And in Scientific American, no less! Jennifer Block
The number of women I hear from who have been dismissed by, mistreated by, or subjected to some form of actual abuse in a medical setting is astonishing. A new study published in Adademic Medicine, confirmed that there are numerous ways in which women's authority is undermined in everyday medical interactions, and that furthermore, men are unlikely to notice or be aware of these - even when seeing videos of them happening in a study setting.
What this says is that microaggression against women is so endemic in our culture that it's taken as normal behavior.
And while women physicians are likely to be more aware of and sensitive to overt forms of aggression, numerous factors from burnout to the internalized patriarchal model of medicine from medical training can also impact women doctor's behaviors.
Recently, I had to make a call to another physician - a woman primary care doctor -on behalf of a mutual patient. The MD was so nasty to me as a colleague that I had to stop her and ask her if she talked to her patients that way, too! And therein lies the heart of this post: As women we're taught to ignore our own emotional response to interpersonal relationships and mistreatment , to suck it up, to ignore and keep moving on in the face of institutionalized oppression (sexism, racism, etc). And often we're so traumatized or exhausted or don't have the confidence to make waves that we don't say anything. We just move onto another care provider or drop out of getting medical care unless it's critical.
But when we don't write that letter, don't raise that grievance, don't call out mistreatment - it goes unaddressed - the doctor (or other provider) never learns what they should do better - and the same thing may happen to the next woman, and the next. If you've had a traumatic birth because of medical mistreatment, if you've experienced any form of medical #metoo, say it, stand up, write that letter - it doesn't even have to be hostile or legal - just informative.
Each time we stand up for ourselves, each time we say no more, this needs attention and I'm calling it - we can make a difference for the next woman.
Some years ago I worked for a powerful male doctor with the motto: Be you and don't apologize for it - ever.
As women, we're programmed to apologize for everything - and things men would never even consider feeling sorry for.
Women even apologize to their doctors for taking up appointment time with their symptoms, including for crying in pain in the emergency department for an ovarian rupture, chest pain in a heart attack, and in labor. Moms apologize for accepting big jobs with higher pay that might involve a move. Women apologize for making more money than their male partners, and yet we also apologize for not having homemade baked goods for the school holiday party. We apologize for being tired, sick, for not feeling like going to a party. We apologize for being 2 minutes late to a meeting or appointment - even when the circumstances that led to it were completely beyond our control. We apologize for mistakes other people make. We apologize for our feelings. We apologize for our hormones. We apologize for taking up space, speaking up, asking for what we need. Or the apology is that we ask permission or ignore our needs, voice, power completely feeling we don’t have the right to it. Some women even apologize for taking "too long" to orgasm (us women doctors hear it all in medical practice!)!
What would your live be like if you felt free to be unapologetically powerful, unapologetically yourself, unapologetically 5 minutes late for a meeting, unapologetically staying in for the evening, unapologetically declining to take on something at work that nobody else is raising their hand for, unapologetically taking a nap? Unapologetically asking for what you need?
Pay attention to how many times a day you apologize in one way or another. I'm not talking about not apologizing when you actually hurt someone. I'm talking about apologizing for being strong, intense, 'hormonally' honest, for having needs, for not fitting into the mold, for walking away, for saying no. And see what it feels like to stop. No apologies, no explanations needed.
Menstruation is so powerful that every human being on the planet owes their life to it. Think about that for a second.
Part of reclaiming our power is to own what our cycles teach us. Recognizing the premenstrual and early menstrual time as one of naturally heightened awareness and emotions can actually ease your menstrual experience.
Reclaiming our relationship to time and the world we live in - because the pace of life, the lack of sleep, the stress, and the coffee, sugar, or glass of wine or three at the end of the day that go with this crazy lifestyle are the opposite of nature's timing.
The key is to go within, so you can go WITH the flow that your body is asking of you, to work with your natural energy rather than pushing against it. I promise it's possible, and even if it's only possible in small ways in your life, taking small steps can create larger shifts.
When we're moving into our bleeding time, for example, we almost all naturally want to rest more and to go within, to experience more quiet. Ways to do this include journaling (including any PMS feelings you might be having); setting aside time during the week before your period to pamper yourself with a hot bath, a cup of herbal tea, and a good novel; splurging for a massage; taking a yoga or dance class; or having a night out with your girlfriends. Pay close attention to the insights and feelings that arise during this time and record those in your journal. They may give you insight into some of your deeper feelings and point to things you might want to change in your life.
Take the time to nurture yourself intentionally each month – eat better, rest more, move your body through exercise, and listen to your heart, mind, and spirit. Get together with other women for a monthly ‘moon’ ritual or gathering, or even join a “Red Tent” group in your community. Listen o and honor your body, needs, the messages you're getting from within, not just the demands coming at you. Honor your moontime as a time to replenish softly.