But this month we almost have to give Cosmo some credit. (Almost!) They are still a really fucked up magazine in many, many ways... but it seems as though they might actually be trying to be a little bit better. Or, more likely, they're trying to seem as if they're trying to be better. But they're still just not getting it right.
For example, in this issue (April 2012) there's an article about crazy and/or inappropriate comments that gynecologists have made called "The Crazy Thing My Gyno Said to Me":
Although you never expect a ride in the stirrups to be fun, you certainly don't plan on being harassed. But these women were on the receiving end of snarky one-liners, weird compliments, body put-downs, whacked-out diagnoses, and just plain inappropriate comments.We have to give them credit that they actually acknowledged that these comments were inappropriate and in some cases could be considered harassment. But at the same time, they compiled a list and turned it all into a big joke (the photo caption says "These girls all just had their hoo-has insulted") without really addressing the examples that were more than just "crazy" and crossed the line to actual harassment. Also, having these more serious anecdotes mixed in with sillier ones (like "she called my cervix my 'pink doughnut'" or "she said I have the smallest uterus she'd ever seen") makes light of the whole situation when really some of these incidents should've been taken seriously and even reported.
There's a sidebar that asks the question "Are Female Gynos More Judgy?" and a suggestion to send your personal stories to them on Twitter under the hashtag #CrazyGyno, when they really should've included a sidebar telling their readers what they should do about these kinds of inappropriate comments.
We did a little research on where/how you can report a doctor for bad behavior and found the American Medical Association's Code of Medical Ethics. You can use this as your first step of determining whether or not your physician acted unethically or unprofessionally (as opposed to just unofficially "weird" or "creepy"). The AMA's Council on Ethical and Judicial Affairs has developed guidelines for physicians who strive to practice ethically, which can be found here.
The AMA recommends approaching your physician directly if you have a concern, but in certain extreme cases you might not feel safe doing that. If your doctor is part of a group practice, you also can speak to one of the physicians in the practice, or if they are associated with a hospital, there may be a formal system for which to voice grievances or lodge complaints. Then there's also your state's licensing board, which should be able to review your doctor's conduct and take disciplinary action at the local level. You can find contact info for licensing boards in each state here.
The AMA also recommends contacting one or more of the state and national specialty society or association for more insight into policies or guidelines specific to your concern. In this case, that might be the American Congress of Obstetricians and Gynecologists or the American Gynecological and Obstetrical Society. (For more resources, try here.)
If all else fails and it's determined that your doctor's behavior - while creepy and inappropriate - isn't technically an ethical violation, there's still the option of leaving a review for that doctor online, warning future patients. Some online review sites for medical professionals include HealthGrades.com and RateMDs.com. (There are also doctor reviews on AngiesList.com and Yelp.com.)
So we thought we'd pick out some of the examples that really did cross a line from "weird" to wrong and give the advice that the "author" Annie Daly should've given.
"I was on my grad school's medical plan and needed a birth-control refill. I ended up getting a rambling lecture from the health-center gyno about how I had to be extra careful with my fiance because, as she said, 'He will cheat on you one day. It's just a matter of time.' When I assured her I trusted him, she called me naive." -- Virginia, 30
"I was 18 and at the gyno for the first time. Before asking me anything about my sexual history, he stated, 'I'm glad you've chosen to practice abstinence. It's safer in the long run.' I was too shy to correct him and make it clear that I wasn't abstinent. When I saw him the next year, he repeated the same thing, and then again a year later! I guess it was his stock phrase, but what kind of doctor would not accept the fact that young women have sex?" -- Hannah, 21The first example might not qualify as a breach of ethics as far as the American Medical Association is concerned, but we would've filed a complaint with the school's administration.
The second example, we feel might fall under "intimidation". The physician has an ethical obligation to place his patient's welfare above his own self-interest/obligation to other groups, but by deciding for her that she's chosen to practice abstinence (without asking her if this is in fact her choice) and doing it in a way that's possibly intended to shame her into abstinence, he's not providing her with the care she needs. That is, there's no discussion of safe sex, birth control options, STD tests... all basic parts of gynecological care that she's being deprived access.
According to the International Federation of Gynecology and Obstetrics' Code of Ethics:
The principles of medical ethics applied to all individuals, such as beneficence (maximize best health outcomes), non-maleficence (do no harm), autonomy (ensure rights of persons to make informed choices about their own health care), and justice, are derived from and consistent with general human rights.[...] These rights imply a need to inform public opinion and to promote a respectful public dialogue, including different ethical and religious perspectives and noting that freedom of religion includes the requirement that no one religion or belief can impose its values on others." [emphasis ours]The doctor really should be trying to serve the best interests of his patients, which would include asking her questions about her sexual activity/history, not telling her that she is practicing abstinence.
Now, a lot of this comes down to a patient's need to self-advocate. Ask questions, correct misconceptions, and demand the care you need. But at 18, at your first visit ever, when you're probably still under your parents' health insurance and possibly still living at home with your parents... it's definitely easier to be intimidated into making choices that aren't your own. A good doctor should know better and shouldn't try to impose his own values on his patients (and should maintain a level of confidentiality with his patients as well).
"I went in for a Pap test, and my doctor showed up with her lunch in her hand. When it came time to spread my legs, she took another bite and chewed while her hands were inside me." -- Sammi, 21
This one definitely is some kind of breach in our opinion. Not only is it gross, but you have a right to be treated in a sanitary facility. Your doctor should be wearing gloves to examine you and there should definitely not be food anywhere near your body! Most offices do have certain standards of care that they abide by. If this doctor was part of a practice, I would make a formal complaint to the office.
"I always get fidgety and nervous before a Pap test. I guess my facial expressions revealed my discomfort because my MD looked at me and said, 'Oh, come on. How many partners have you had? This thing is nowhere near as big as a penis.' I was completely appalled. 'Yeah, but a penis is not cold or metal, nor does it open up while inside my vagina, ' I responded. She was pretty quiet after that." -- Wendy, 20The first one may or may not be an ethical violation, but it's definitely not okay. That to us would warrant a change in doctor and at the very least, a formal complaint to the office or practice.
"My gyno said, while huddled over my vadge, 'You are very cute. Are you single? I have a son your age, and I think you two would hit if off." -- Samantha, 23
Whereas the second one is a little more of a gray area. Definitely inappropriate, definitely uncomfortable... but is it a breach in ethics? Maybe. Aside from the fact, that your doctor shouldn't be calling you "cute" while he's looking at your genital area, while it might not be an explicit violation, it most certainly leads to a whole slew of potential issues. Bad enough that she may have to fear that he will try to reciprocate or drop her as a patient if she says no, but if she does date his son... that just opens the door to so many possible problems.
Aside from the obvious issues of embarrassment (a lot of women might not feel comfortable talking to their boyfriend's father about sex and birth control.) For one, there's the issue of confidentiality. If she begins dating his son, she may be uncomfortable answering her doctor's questions honestly. If she discloses that she is sexually active with multiple partners, that puts her doctor in a strange position. And what happens the next time she's in for a pregnancy test or STD screening? Not only does this in some ways, indirectly, reveal his son's personal and/or medical information to his father, but it puts the doctor in a position where he may feel compelled to violate his patient's privacy.
While a doctor is permitted to contact a patient's past or current sexual partners to notify them that they may have been exposed to a sexually transmitted disease, the doctor is not permitted to reveal the name of the patient. However, if your dad's office calls you to tell you you've been exposed to an STD and you know your girlfriend/date is a patient of his, then it's not too hard to "guess" her private and confidential medical information.
Additionally, there is an ongoing debate over whether it is appropriate for a doctor to examine and treat his own family members. Obviously that doesn't necessarily extend to his son's girlfriend... but if things were to get serious and they were to marry, that would make her his daughter-in-law.
"While doing an exam, my OB-GYN, his face closer to my hoo-ha than it needed to be, told me how beautifully groomed I was, then patted my butt. I was so floored, I just mumbled 'Thank you' and prayed for the exam to be over." -- Emily, 32
"I went to my school health center for my yearly visit. During the breast-exam part, while feeling and fondling my boobs for signs of cancer, my gyno gushed about how smooth and pretty they were. Thanks, doc?" -- Morgan, 22
Almost everyone knows that it's unethical for a doctor to have (or try to have) a sexual relationship with a patient, but what is happening here goes well beyond that issue and is straight-up harassment. These two incidents are so blatantly inappropriate and wrong, that it really disturbs me that Cosmo has included them with the other "jokey" anecdotes. It's called sexual harassment and it's never okay, but it's especially awkward and violating when it's done by a gynecologist because of the already personal and sensitive nature of their examinations.
The doctor-patient relationship relies on trust and in this case, intimacy. A doctor should never "hit on" his or her patients, because it is virtually impossible for the patient to give meaningful consent. But what is happening in the two incidents above are not examples of doctors merely "hitting on" their patients. They are examples of doctors exploiting their power and positions, as gynecologists, to physically violate their patients.
Now, yes, I have heard cases of women who were so uninformed about their own medical care, that they honestly did not know what a pelvic exam or breast exam consisted of. Therefore, they may have mistaken actual, legitimate examination for inappropriate conduct. But in these cases, it is clear that the doctor's conduct is inappropriate. In the first story, there's no way to necessarily determine how close his face did or did not need to be... but his comment was inappropriate and his pat on the butt is clearly a violation. In the second exam, it's not clear whether they performed the breast exam appropriately or inappropriately (use of the term "fondling" makes me a bit uneasy), but the comments are obviously inappropriate and do potentially cross the line from "innocent compliment" to sexual harassment.
You are already putting yourself in a vulnerable position when you go to any doctor, but at an OB/GYN, the intimacy of the exams takes that a step further. Therefore those doctors need to have an even higher level of behavior and bedside manner. Stories like those above should never happen and when they do, they should never be included in light-hearted stories as Cosmo has done. They should be taken seriously, pointed out to be the sexual harassment and ethics violations that they clearly are, and reported.
We think that Cosmo's "reporting" (ha!) was not only insensitive but irresponsible. But of course, we're not shocked.