Thursday, March 22, 2012

About those Ultrasounds: What if Doctors just say no?

I've been wondering--haven't you?--why primary care physicians, and especially OB/GYNs, aren't speaking out about the current creepy Rightward trend toward using ultrasounds as punishment against women who dare to sign up for an abortion.  Turns out some of them are.

They're angry, they're anguished, they're dumbstruck.  (Join the club.)  And they're speaking out anonymously--sadly--because we live in a country where medical doctors can no longer talk freely about abortion, a legal medical procedure, without fear of retribution.

This from a post called "Civil Disobedience" by palMD at his blog, White Coat Underground. (Take a few minutes to read some of his other posts while you're there.  Good stuff.):
"In the case of abortions, where time is essential and providers may not be easy to find, delays in care are unconscionable.  To enforce a waiting period violates the doctor’s ethical duty to provide appropriate, timely care and to avoid causing the patient unnecessary grief.  The law forces us to violate our ethics. To force us to perform ultrasounds, transvaginal or otherwise, is battery.

No procedure can be performed on a patient without their informed consent.  To make another important procedure contingent on an unnecessary one is a clear violation of medical ethics. Abortions can be safely performed without sonography, and should be unless their is compelling medical reason to perform one—with the patient’s consent.  To say that a woman can always refuse the ultrasound as long as they refuse the abortion is an immoral argument, one which removes all autonomy from the patient, and forces a doctor to make unreasonable choices."
 Another caring doctor used John Scalzi's blog, "Whatever", to lay out a plan for civil disobedience.  He says, in part:
"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."
 The doctor then offers a five-step plan designed to keep physicians from ever having to perform an unwanted ultrasound on a female patient, starting it off with a bang:
  "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." 
And ends it with a bigger bang:
"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."
Alrighty then. 

The Doc is actually echoing more forcefully the guidelines already set long ago by the American College of Obstetricians and Gynecologists--the very guidelines the state of Virginia so clearly and consciously aims to violate. ( The story here by Rick Unger in Forbes.).

In 2009 ACOG reaffirmed their recommendations on non-medical ultrasounds:
"The American College of Obstetricians and Gynecologists (ACOG) has endorsed the following statement from the American Institute of Ultrasound in Medicine (AIUM) discouraging the use of obstetric ultrasonography for non-medical purposes (eg, solely to create keepsake photographs or videos) (1):

The AIUM advocates the responsible use of diagnostic ultrasound. The AIUM strongly discourages the non-medical use of ultrasound for psychosocial or entertainment purposes. The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus or determine the fetal gender without a medical indication is inappropriate and contrary to responsible medical practice. Although there are no confirmed biological effects on patients caused by exposures from present diagnostic ultrasound instruments, the possibility exists that such biological effects may be identified in the future. Thus ultrasound should be used in a prudent manner to provide medical benefit to the patient."
 Of course, the states advocating this unprecedented invasion into women's lives aren't in the least impressed by protestations from anybody not connected with their own Koch-fueled, pseudo-religious circles--not even the medical pros, who are, you know, medical professionals.

According to the Guttmacher Institute, as of March 1, 2012:
  •  11 states require verbal counseling or written materials to include information on accessing ultrasound services.
  • 20 states regulate the provision of ultrasound by abortion providers.
  •  7 states mandate that an abortion provider perform an ultrasound on each woman seeking an abortion, and require the provider to offer the woman the opportunity to view the image.
  •  9 states require that a woman be provided with the opportunity to view an ultrasound image if her provider performs the procedure as part of the preparation for an abortion.
  •  5 states require that a woman be provided with the opportunity to view an ultrasound image.

There are signs that some state legislatures may be rethinking their actions (Idaho, for instance), but it's a cinch they're only rethinking them in order to get around any detours to their goals.  When they come up with something this nutty in the first place,  the chances that either common sense or common decency will prevail are slim to none.

So how do we get through to them?  We can't shame them; they're shameless.  We can't shun them; they're in charge.  But we can raise our voices in decibels loud enough to be heard above the din of old-testament retribution disguised as modern-day government.

This was never how it was supposed to be.


  1. As an RN I am also ethically obligated to advocate for my patient. I don't support conscience exemption because as a provider my first responsibility is my patient.

    THe other piece of this is that we must support patient autonomy and privacy. Providers are the first and last line of defense for patients.

    1. Absolutely. But I did wonder why we hadn't heard much from the medical profession. As you say, their first duty is to the patient. There is nothing in those laws that would benefit either the patient or the doctor. That should have been enough for doctors, nurses and providers to join together to say "no way."

  2. I can tell you who will speak out, the insurance companies when they get the bill for any medically unnecessary procedure which they will be expected to pay and that cuts into their obscene profits.

  3. The majority of woman that this law will effect will be the poor who don't have insurance, this is how it was ment to be. Also the repubs are doing this to prove in their backwards way how government will get involved in your healthcare when the affordable care act is implemented.

  4. Dear Anonymous (above)- If you check you will find the recent laws enacted require the patient to pay for the ultrasound procedure. I sincerely doubt that these Fascists are stupid enough to attack the medical cartels directly by requiring THEM to pay for these procedures...

  5. While I agree with the doctors sentiments on ethics, I do feel confused by the fact that as a highly educated member of society they just don't know the difference between 'their' and 'there'.

    1. Lol, Anon. When I first started working as an administrative secretary at the University of Michigan Hospital System, I was shocked by the number of bad spellers among the doctors. It was rare to find one whose words could be transcribed as-is. Sometimes it was just hilarious. Of course, if you teased them, they would tell you they had better things to do than worry about spelling.

      In other words, that was my job.

    2. Judging from the prescriptions I get, I don't know if Docs are bad spellers... I can't read their handwriting.

    3. Terrifying, isn't it? With all the electronics at arms length, why docs still insist on hand writing prescriptions is an absolute mystery.

  6. Just as a note, the doctor who posted on Scalzi's blog never disclosed his or her gender. You may want to correct for this - you refer to that doctor as "he" throughout and as a "man" somewhere and unless you have inside information that's a pretty unfortunate assumption.

    1. Jennifer, you're right. I did assume it was written by a man, for several reasons, but I have no proof so I've corrected it.

      Thanks for drawing my attention to it.


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