Guest Post: A Doctor on Transvaginal Ultrasounds

A friend of mine is a physician who wants to speak about transvaginal ultrasounds but whose position makes it precarious to speak publicly about it. So I’m letting this doctor borrow my site for an entry to speak anonymously on the matter. Obviously, I will vouch for the doctor being a doctor and being qualified to speak on the subject.

Update, 9:14pm: This post is being linked to far and wide, so we’re getting lots of new readers and commenters. It’s important that before you comment you read the site disclaimer and comment policy. I delete comments I find particularly stupid. Try not to write one of them.

Update: 12:13am, 3/21: I’m going to bed, so I turned off the comments for the night. I’ll turn them back on when I get up tomorrow. Night!

Update: 1pm, 3/21: As a head’s up to people, at 8pm eastern time tonight, I will turning off the comments for this thread permanently. The reason for this is while I can spend a day moderating the thread, I can’t spend the next week doing so. Sorry, folks, I have a book to write. So consider this fair notice. Thanks.

Update: 8pm, 3/21: Comment thread is now closed.

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.

768 Comments on “Guest Post: A Doctor on Transvaginal Ultrasounds”

  1. It should probably go without saying that the Mallet of Loving Correction has been placed into its special warming chamber and will be used when I decide it is necessary. So please, stick to the issues raised, be polite to each other when discussion the subject, and otherwise be the exemplary people I know you can be and not just because I’ll whack your comment into oblivion if you are not. Thanks.

  2. I just want to say thank you, both to your physician friend for articulating this so well, and to you for giving him the space – and online exposure – to do so.

  3. I recently had a transvaginal ultrasound done for medical reasons (not coerced, not related to pregnancy). You can have my shriveled uterus image for protest purposes!

  4. Thank you so much, Scalzi and Doctor Anonymous. It’s a great thing to have a broad bandwidth for a message like this. (Shouting on Facebook doesn’t seem to do much…)

  5. Hear, hear.

    If this legislation doesn’t result in the GOP getting massacred in the current election cycle then I’m going to have to readjust my faith in humanity drastically downward.

  6. Dear Internet, doctors of the US who are going to protect their patients need a suitable ultrasound image. I wonder how effectively the “Problem?” trollface could be merged with a suitably copylefted ultrasound image.

  7. Dear Dr. Anonymous thank you. And for every woman you protect in the face of ridiculous legislation thank you.

  8. Thank you Doctor. I wondered if any doctors were ever going to say anything about this.

  9. Speaking as a woman and as a nurse: THANK YOU. And I too would like to know why we aren’t hearing more outrage from physicians being told by the government how to practice medicine. And being told they are mandated by law to rape their patients.

  10. As another physician (but not an ob/gyn), I applaud you. Thank you so much for saying what needs to be said. I wish we could charge every one of these legislators with trying to practice medicine without a license.

  11. Thank you so much, Dr. Anonymous. I wish you could be the doctor in all states with mandated ultrasounds.
    Thank you, Mr. Scalzi, for letting his voice be heard.
    Now…how do we get this out to all doctors? Or to all women who need to show it to their doctors?

  12. Thank you, Dr. Person.

    I believe I will print this and put it in my wallet to carry around in case I’m ever faced with a government mandated test.

    I’d love to read your take on the latest Birth Control fiasco.

  13. I live in Mississippi, which has a bill on the table which would both require transvaginal ultrasounds and ban abortion after the heartbeat is detectable (which happens about 10 days after the earliest possible time you can get a positive pregnancy test, about 6 weeks LMP).

    Thanks to infertility treatment and two hideously complicated pregnancies, I’ve had.. oh, I don’t know, a couple dozen transvaginal ultrasounds. (After a while, you stop counting.) I’m pretty blasé about the procedure itself at this point, but I will be damned if I let the state force me to have one.

    There’s a lot of outrage about this bill here, a good bit of it from self-designated pro-lifers. I think what we’re seeing is that a lot of people like the label “pro-life”, and like to vote for politicians who label themselves “pro-life”, but who don’t want to actually do anything to change the status quo. Ditto for the politicians — you basically can’t get elected if you don’t claim to be pro-life, but we have an awful lot of pro-life politicians who do not actually want to advance the pro-life agenda.

    Ultimately, I think the heartbeat bill, mandatory ultrasounds, and personhood are going to break the pro-life movement apart. It’s one thing to dislike abortion in the abstract, but the concrete applications of these laws rub a lot of people the wrong way, even here in Mississippi. The movement is doubling down by forwarding these measures, and I think it’s going to be a bad bet in the end.

  14. I too, could not agree more with this article. Seriously, weren’t we just condemning the police in Egypt for something like this?

  15. Two quick things to note.

    1) In your tweet containing this story, you used the term “mandated.” While not used in the article, I want to clear up any misconception. I’m assuming all this is related to the drama in Virginia surrounding abortions. As someone who lives in Richmond, Virginia, let me clarify that the state congress passed a law that did NOT require mandatory transvaginal ultrasounds. A doctor can recommend it, but the patient has the right to refuse it.

    2) There are doctors on the opposite side of the topic. It would be interesting to see that viewpoint presented. Personally, I know a doctor who was sued after he refused to prescribe a woman “plan B.” I’m sure most of you (as followers of a liberal blog) would probably side with the woman, we do have to realize that there are always two sides of the coin. I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.

  16. I would ask you to reconsider your stance on being anonymous. I understand that it is a personal decision and a form of risk management (with the worst possible outcome being run out of town); but if you stay anonymous, then when what chance is there for us to get behind you and change this, especially if all the actions taken are passive-aggressive? What chance is there for you, as a profession, to use your group strengths to prevent this if physicians stay silent?

  17. I have nothing profound to say, or significant to add, simply ‘bravo’. I am glad there are physicians like you out there.

  18. Thank you, Dr. Anonymous, for your advocacy. John, thank you for giving the space to this on your blog.

  19. I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”.

    Just wanted to point out that this isn’t just a moral issue about being reactionary, it’s the law. The sad thing is that a) it took until earlier this year for this law to actually happen, b) it came about because of the despicable attempts of elected representatives to tell us otherwise, and c) that in some places like Texas and Idaho transvaginal ultrasounds are already mandated. It’s also worth considering that every GOP candidate for president either supported or didn’t speak out against this, and that the governor who was going to sign the Virginia law is the likely VP choice for the current frontrunner of the primaries.

  20. What happens if a physician objects to this kind of medical rape on grounds of conscience? Does the physican have First Amendment rights, or are those limited to evangelical politicians?

  21. HOLY CRAP.
    Well said.
    When will we live in a world when Dr Anonymous won’t have to be anonymous?
    We all know why he/she has to remain anonymous in today’s insane environment. But we need more of this and we need it public and protected.

    I guess the first test cases of these retarded laws will start soon. Both the women and the doctors will refuse to follow these laws.

  22. Marie Henry:

    “I say sign your name.”

    And I say that people who are overly focused on the fact this post is anonymous are missing the point by a rather wide margin, and possibly wanting to derail the discussion into irrelevancies. My assurance that this person is a doctor and qualified to speak on the subject should be sufficient for credentials here. Likewise, people should accept this particular doctor has a good reason to wish to be anonymous.

    Focus on what’s being said. It’s the important part.

  23. Like Dr. K, I recently had the procedure done for medical reasons. The images turned out to be pretty boring (thank goodness), but I’d be happy to sign up for you to use them for protest purposes!

  24. I should clarify. I don’t mean for you to out yourself to us, but to speak up within your practice/profession, so that all physicians can band together on this issue and get the support from the public that we can offer.

  25. 1) In your tweet containing this story, you used the term “mandated.” While not used in the article, I want to clear up any misconception. I’m assuming all this is related to the drama in Virginia surrounding abortions. As someone who lives in Richmond, Virginia, let me clarify that the state congress passed a law that did NOT require mandatory transvaginal ultrasounds. A doctor can recommend it, but the patient has the right to refuse it.

    The transvaginal requirement was in the original version of the law, and not only that, mandatory ultrasounds are in the version that passed, which is still fucked up.

    There are doctors on the opposite side of the topic. It would be interesting to see that viewpoint presented. Personally, I know a doctor who was sued after he refused to prescribe a woman “plan B.” I’m sure most of you (as followers of a liberal blog) would probably side with the woman, we do have to realize that there are always two sides of the coin. I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.


  26. I want to know, if a freaking pharmacist can claim a religious exemption for birth control pills because his religion requires him to deny a woman medicine prescribed by her doctor, where’s the GOP mandated conscience exemption for doctors to avoid having to rape patients?

  27. Sadly a lot of doctors will comply if the legislation goes through because they’re sheep, they’re afraid or because they see personal advantage (financial, career etc) in compliance. As a former counsellor who lost her job because her superiors broke the law, I have very little faith in professionals these days. However, I’d like to thank John Scalzi for providing a forum and Dr Anonymous for his passionate and ethical argument.

  28. I’ve seen the amount of press and other exposure this issue has gotten over the past few days and the more I think about it, the more I am coming to the conclusion that forcing the ultrasound on women is not really what is at stake here. Before you light up the flamethrowers, please hear me out. Of all the various political topics, ones that deal with women’s reproductive health are probably the most sensitive across the widest political base, which I certainly don’t have an issue with. In fact, this sort of thing is guaranteed to get liberals, moderates and a number of conservatives so spun up that they can’t see straight, and that certainly seems to be the behavior that is occurring. So, what I propose is that this is a smokescreen to obscure the public’s attention to something else that is going on. I don’t know what, but looking at this from a strategic standpoint it makes no sense to try to get this passed if the intention is to actually have this law on the books, but it makes a lot of sense as a diversion to direct the media and the public’s attention away from something else. By nature I’m not a particularly devious person and even to me this looks like nothing but a distraction.

    Mr. Scazi, I’m a big fan of yours and having read your books, I’m confident that you are capable of thinking much more deviously than I am. If you can get past your outrage, which is well deserved, and look at this from a purely strategic standpoint, what do you think?

  29. Do anything else you can think of to protect your patients and the integrity of the medical profession. IN THAT ORDER.

    I would say that those two things are the same. If you’re protecting your patients, you ARE protecting the integrity of the medical profession.

  30. Bravo. Bravissimo. You, sir, are the type of physician that I would wholeheartedly recommend to my daughter, when she comes of age.

  31. Finally, a doctor I wouldn’t want to kick! And no need for me to seek a second opinion. ;)

  32. Sam:

    “I’m assuming all this is related to the drama in Virginia surrounding abortions.”

    Your assumption is at best incomplete.

    “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    When doctors and nurses are required by law to perform abortions on women without that woman’s consent, you let me know.

  33. I hope that this word gets out to more people. Thank you for writing this and inspiring more to stand up against this war on women. Let’s all stand up on April 28 for the March Against the War on Women –

  34. Allow me to stray off topic for just a second, with due apologies to Dr. Anonymous and Scalzi:

    Peter Cibulskis: “retarded” laws? Really? I generally agree with what you have to say, but as someone who’s had 17 brain surgeries and is, fortunately, not mentally compromised by nothing more than sheer luck…”retarded” is not a nice word. Please reconsider your choice of phrasing. Thanks.

    Scalzi: Thanks for posting this.

    Dr. Anonymous: Thank you for saying it.

  35. I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.

    @Sam: And your point? Being “uncomfortable” with abortion is not equivalent to vulnerable women being slut-shamed via an invasive and humiliating procedure of dubious medical value. If the members of the Virginia and Texas legislatures wish to argue the toss, I have a jumbo box of rubber gloves and a tub of lard to help draw the distinction.

  36. As a European I don’t have a dog in this electoral fight but I find the whole idea of mandatory invasive medical procedures utterly repellent. Way to go, Dr Anonymous! Thanks to Sr Scalzi for giving him the platform and to Pierre Trudeau for bringing the issue to international attention. Land of the free? Please come home.

  37. Thank you, Dr. Anonymous; thank you, Perfesser Scalzi.
    Using physicians to perform politically-motivated dirtywork has long been a hallmark of totalitarian regimes. I am reminded of the mandatory ob/gyn visits during the days of the late Roumanian dictator Nicolae Ceaușescu, and even less excusable participation of some physicians in interrogations.
    It’s very much time for patients and their physicians to step up and refuse to be violated. I suspect these laws will be found to violate principles of HIPPA, possibly SOX, and possibly even RICO. I’m thinking about how to bring suit.

  38. This is a small point to quibble with in an incredible post (thank you so much for voicing this strength of conviction), but in point 3 “Hell, document that you attempted but the patient kicked you in the nose, if you have to.” – it worries me that this could be used to put the blame on the patient for not complying. Of course, the last line of defense for the patient is not the doctor, it’s the patient herself, and I wouldn’t be surprised if many patients do precisely this (protect themselves). I certainly would. But in the case where the doctor is protecting the patient from this ridiculous law, take responsibility or at least don’t place blame on the patient when it’s not true.

  39. Thank you for writing this! So very much…….

    Please share this as widely as possible. This is an important perspective that has been missing.

  40. Thank both of you. Every one of us who stands up for what is right and moral and just,restores a part of my faith in America that the GOP has worked so hard to erode. I’m typing this thru tears of gratitude at both your voices and sorrow at what is happening to women today. THANK YOU…

  41. [Deleted because the people informing this doctor that the decision to remain anonymous is somehow impeding the message here are not seeing my hit meter BLOW RIGHT THE HELL UP.

    Folks, anonymous political comment has a long and illustrious history in these here United States. Deal with it, please — JS]

  42. How come the American debate on Abortion is so deliberately obtuse of the views of the other side? Here in Canada, abortion is Legal and Publicly funded for the most part, but the debate is reasonable (also for the most part). Shouting RAPE! COERCION! CONSENT! without even acknowledging that some people (most people here, according to polls) believe there is two people involved, one of whom is being murdered, seems ridiculous. I would scrap this argument and start over, to be OUTRAGED! over an ultrasound when the other side believes they are talking about murder is not winning converts. What that other argument should be I have no idea, but it needs to be reasonable.

  43. I love this doctor, and I wish I knew who this was (though I understand their need for privacy) because they are awesome and I want someone like this to be my doctor.

  44. Like Dr. K and Cassiepants1, I have also had to have the process because it was medically indicated, and it truly is an intrusive experience – and that was my experience of it when I knew that it was necessary for my health. I can only imagine how it would feel when it was being forced upon me and was not medically necessary.

    Dr. A’s post also makes me think of the medical “collaborators” – those who endorse reduction or elimination of mammagrams in younger women, for example. (As an aside, it’s interesting how many of these recommendations deal with issues of women’s health. I don’t hear any clammoring to increase the recommended age for prostate screening.)

    @Sam: your point is valid: a doctor should be permitted to refuse to provide a service that violate his or her personal beliefs…seems to me that you are making Dr. A’s point for him/her. Why should that right be limited to those who would deny requested, desired medical care on moral grounds, and not be extended to those who wish to deny a procedure that is not indicated and is not desired on the basis that forcing such a procedure is amoral – regardless of the political or religious affiliation of the doctor doing the denying? The big difference that I see here is that a doctor who refuses to do a procedure hasn’t prevented a person from receiving care – he or she has just prevented a person from receiving care from him or her. Whereas once a doctor has performed an undesired procedure, that can never be undone.That’s a whole different kettle of fish.

    Thank you to Dr. A for saying what so badly needs to be said, and to John for giving him a safe forum to say it.

  45. Sam says: “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    False equivalence: No doctor or nurse is forced by legislation to do an abortion against a patient’s wishes. The legislation discussed here legally requires a medically-unnecessary procedure against the patient’s wishes.

    I continue to be amazed at the widespread inability of so many people to understand the distinction that consent makes, whether it has to do with being unable to distinguish same-sex relationships from bestiality and pedophilia or seeing the difference between making ones own medical decisions and someone else making those decisions.

  46. I agree that these politically motivated mandates constitute state-sanctioned and enforced rape.

    And I appreciate ONE doctor standing up and calling it out.

    What I take issue with is this doctor (with the best of intentions) speaking on behalf of his profession and making it seem like there are other doctors like him or her.

    “Where Is The Physician Outrage?” There is none except for this doctor. Why? Because medicine long ago stopped being focused on the patient.

    It’s all about the doctors and the medical establishment making as much money off patients as they can. And it’s about the politicians agreeing to support the building of a medical-industrial complex (that keeps doctors and insurance companies rich) so that the politicians can use that machinery for whatever ends they want. Whether its raping women and turning them into baby factories by force (the Right), or controlling us, our lifestyle and habits “for our own good” (the Left), this entire system has been built and maintained with a focus on everyone but patients and real people.

    I’ll note too, it’s another way the 1% is controlling the rest of us.

    Yes, you’ll find some good people working in free clinics and who still believe like this Dr does. But next time you’re in the hospital and no one knows you by anything more than your patient number and insurance carrier think about it and tell me that you’re not some cross between a human guinea pig and cargo being shipped around.

    In the end, what these politicians are doing is a problem. But the real problem is that we’ve created a system that they can utilize in the first place. Until that changes, we’re not safe from politicians using the medical-industrial complex in service of their “good intentions”.

  47. Jesus Christ (in the exclamatory sense, and irony certainly very much intended), that was well said. I’m not a doctor, but I was close to becoming one. I feel like I want to take this posting, storm into hospitals of states having legislatures and governors who actually think this kind of mandate is acceptable, and just shout it out.

    It’s ridiculous to delegitimize the author’s point because he/she remains anonymous. The fact is there are extremists and unstable people out there that will act instead of think (the law itself is an example of that), and the author is right to fear repercussions. It does not change the impact of the words though. If it indeed a call to action, I will gladly assume this author will be responding to his/her own call as well.

  48. If you’re a doctor just coming out of medical school, would you want to practice in a state where procedures are dictated on a political instead of a medical basis? Laws like these are going to result in a shortage of ob/gyn physicians in those areas in 5-10 years, but by then it’ll be too late to do anything about it.

  49. Folks, I’ll be deleting further comments criticizing the doctor for choosing to be anonymous. It’s a choice made for personal reasons, and one I support. Further discussion on that particular topic is henceforth deemed an attempt to derail the conversation at hand.

  50. Thank you, Dr. Anonymous, for being an ethical doctor (which means putting patients first).

    John: this is one of the reasons I love you.

    But what can I say? I’m from the country that — according to one of your GOP Presidential candidates — euthanizes elderly people the moment they enter a hospital. My mother, 76 years old, ex-head nurse, who recently was hospitalized for a (successful, thankfully) cataract surgery, respectfully disagrees. And every one of the Dutch doctors I met through her would absolutely agree with Dr. Anonymous.

  51. Thank you so much, Dr Anonymous! And thank you Scalzi for allowing and encouraging the Doctor to have a platform! It is important for folks to know that there are doctors who see this for what it is, a medically unnecessary power grab. There is a doctor here in Alabama who is working with several legislators to try to get the a bill passed that would outlaw mandating any medically unnecessary procedure, including the ultrasounds for abortions. Unfortunately, given the current state of the legislature right now, its doubtful that it will make it out of committee.

  52. “Where Is The Physician Outrage?” There is none except for this doctor. Why? Because medicine long ago stopped being focused on the patient.

    Coming from a family of doctors or people involved in other various health and medical fields, I heartily disagree with this statement. Individual doctors feel different ways about both their patients as a whole and individual patients.

  53. I applaud this! I would LOVE to see all who agree with this to repost on the social media of their choice. Civil disobedience is a choice.

    Thanks for giving a forum for this person’s voice.

  54. Christy:

    The big difference that I see here is that a doctor who refuses to do a procedure hasn’t prevented a person from receiving care – he or she has just prevented a person from receiving care from him or her.

    I take your point, and apologies to John if this is slipping off-topic, but that’s enough for a lot of people. I spent a good chunk of my adolescence in a rural area where there was only one doctor and the nearest big(-ish) town with a hospital was over an hour away by car. If you’re on a low- or fixed-income (or unemployed) the free market isn’t quite so free anymore.

  55. I’d really like to learn more about the consequences doctors and medical professionals face for speaking out against this. Yes, this Dr. Anonymous has good reasons for being anonymous, I accept that, but I’m uneducated as to why he would want to be so. Assuming there are many more doctors who feel this way, what kind of repercussions do they face for speaking out publicly?

  56. Well said! Please pass along my thanks to your friend, and thank you for allowing it.

  57. rob:

    The fact that people want to use rape to discourage what they happen to believe is murder does not magically make it not rape. Whether it’s “reasonable” for people to be outraged about that is not your call.

  58. I’d really like to learn more about the consequences doctors and medical professionals face for speaking out against this. Yes, this Dr. Anonymous has good reasons for being anonymous, I accept that, but I’m uneducated as to why he would want to be so. Assuming there are many more doctors who feel this way, what kind of repercussions do they face for speaking out publicly?

    David Gunn
    John Britton
    James Barrett
    Shannon Lowney
    Lee Ann Nichols
    Robert Sanderson
    Barnett Slepian
    George Tiller

    And that’s just for starters.

  59. Sam @ 3:52: 1) In your tweet containing this story, you used the term “mandated.” While not used in the article, I want to clear up any misconception. I’m assuming all this is related to the drama in Virginia surrounding abortions. As someone who lives in Richmond, Virginia, let me clarify that the state congress passed a law that did NOT require mandatory transvaginal ultrasounds. A doctor can recommend it, but the patient has the right to refuse it.

    Ever hear of a little state called Texas? They have a law on the books that’s pretty much the same as the proposed law in Virginia. I’ve heard some awful stories coming out of that one, including a woman who had a (wanted, mind you) non-viable fetus who needed an abortion to, y’know, not die and/or suffer personal physical trauma. She still had to have the entire sonogram/description of the developing fetus thing. It was awful for everyone involved, including the hospital staff who did not want to put the poor woman through more trauma but did not feel that they had any choice in the matter.

    2) There are doctors on the opposite side of the topic. It would be interesting to see that viewpoint presented. Personally, I know a doctor who was sued after he refused to prescribe a woman “plan B.” I’m sure most of you (as followers of a liberal blog) would probably side with the woman, we do have to realize that there are always two sides of the coin. I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.

    You can see that viewpoint presented all the time. Just look for someone calling women who want proper access to birth control “sluts.” Weirdly, that position is usually defended by politicians, pundits, and pastors, not physicians.

    Oh, and ask your doctor friend if he’s taken a principled stance against prescribing Lipitor. Gluttony is one of the Seven Deadly Sins, after all. We wouldn’t want to be allowing non-Biblical behavior by just handing out medication to people who have suffered from heart attacks after a life of eating greasy cheeseburgers and doughnuts.

  60. This doctor is spreading lies about what the laws actually say. The laws do not specify what type of ultrasound is to be performed. Planned Parenthood has testified that they already charge for and perform ultrasounds before all abortions. They just don’t show the images to the woman. Maybe if he didn’t Get his information from a comic strip he’d know what he was talking about.

  61. I am so glad to see this. I’ve been wondering what doctors thought of some of this legislation- not just the ultrasounds, but other birth control related stuff where they’re saying doctors have to do this or that and it doesn’t really seem to gel with doctors doing what’s best for their patients. I’d bet there are more doctors who feel this way and just plan to keep it between themselves and their patients, as it should be.

  62. I live in the desert under a rock. I’m not sure what a transvaginal ultrasound is or why one would be required by the Gov’mint. A little background anyone? My hearty thanks in advance.

  63. As another Virginia resident, I’d lie to point out that what Sam @3:52pm fails to mention is that the law originally DID require transvaginal ultrasounds, until the outcry from Virginians state-wide “encouraged” the lawmakers to not mandate state-rape in the Commonwealth.

  64. @Jesse: Of course. I wasn’t being clear enough, my apologies. I’m wondering about *professional* ramifications. Can they be disciplined by their hospitals for speaking out? Are licenses at risk?

    I think there’s a difference between running a clinic that evil people can target, and speaking out about a law. I’m assuming there is more to this than the threat of violence.

  65. @Dr. Anon

    As regards point #4, if I lived near you, I would be more than pleased to let you take and ultrasound of my testicles that could be used far and wide free of charge. That would surely through a fit of consternation in to any review board checking patient files.

    Thank you for speaking out, and I personally hope that more doctors will also speak out against state mandated, medically enforced rape. Good show Sir/Ma’am.

  66. Kudos to the doctor for this call to action.

    Karl writes:
    [quote]Laws like these are going to result in a shortage of ob/gyn physicians in those areas in 5-10 years, but by then it’ll be too late to do anything about it.[/quote]

    Something tells me that the proponents of these laws see nothing wrong with worsening women’s access to reproductive health, since they’re happy to wield pregnancy and any attendant difficulties or complications as a consequence (read: punishment) for women having sex.

  67. I ‘m litteraly crying tears of relief right now.
    Relief that someone directly implied in this terrible farce is finally taking a stance to protect the women in their care.

  68. Matt,

    So, what I propose is that this is a smokescreen to obscure the public’s attention to something else that is going on. I don’t know what

    Probably the economy. They don’t actually want to fix it; they and their backers are making too much money off its dysfunction. Naturally they’d rather the public not pay a lot of attention to that.

    But really, the fact that a distraction is in play here isn’t what matters. Politicians have always used distractions; it’s basic political strategy. What matters is what is being used to distract, which in this case is women. I’m not really surprised; after all, these are the same folks who regularly try to use brown people, LGBTQ people, poor people, immigrants, etc., as distractions. Their usual modus operandi seems to be “in case of societal dysfunction, don’t fix it, just look for someone to throw under the bus.” Women have actually been on their list of bus victims for a long time now, but they’ve finally gotten bold enough to be overt about it.

    So I’m hoping that they’ve finally pissed off enough people that the strategy of using human beings’ lives as a distraction finally goes out of style.

  69. Thank you for this much-needed and much-appreciated post! Question: if the government is not allowed to invade our medical records, based on privacy laws in place to protect us, who the hell are they to tell us what medical procedures we are required to get? And how is not an invasion of privacy to force doctors to provide the government the information & results from said procedures? Do they think for one second that anyone in their right mind would give them, idiots that they are, access to those medical records for public exploitation and their own purposes? Are HPA laws and similar pieces of legislature next on their list? Give me a break. My grandfather was a doctor for over 50 years and I can assure he does not support this kind of outrageous behavior by our government on “behalf” of women.

  70. Rob:

    I would scrap this argument and start over, to be OUTRAGED! over an ultrasound when the other side believes they are talking about murder is not winning converts. What that other argument should be I have no idea, but it needs to be reasonable.

    Would I be correct in presuming you don’t have a vagina that’s ever going to be subjected to this kind of bullshit? This isn’t really the time or the place for guys to drive by and tell women and health professionals to stop harming their cause by being all hysterical etc.

    Because you know what: If anyone tries to insert an object into my rectum or urethra without my consent and a damn good, medically sound reason I’m going to get extremely pissed off. Anyone who has tone issues with that can go get stuffed.

  71. This doctor is spreading lies about what the laws actually say. The laws do not specify what type of ultrasound is to be performed. Planned Parenthood has testified that they already charge for and perform ultrasounds before all abortions. They just don’t show the images to the woman. Maybe if he didn’t Get his information from a comic strip he’d know what he was talking about.


    The [Texas] law, enacted in 2011, requires abortion providers to perform an ultrasound on pregnant women, show and describe the image to them, and play sounds of the fetal heartbeat. Though women can decline to view images or hear the heartbeat, they must listen to a description of the exam.
    So far, six of the 50 U.S. states have passed laws requiring abortion providers to perform an ultrasound on each woman seeking an abortion and provide the woman an opportunity to view the image, according to the Guttmacher Institute in Washington, which studies reproductive health issues.

    While most of those states allow women to decline to view the image, Texas, Oklahoma and North Carolina require women to hear the provider’s verbal description of the ultrasound.

    Before you accusing others of lying, perhaps you should check your own facts.

  72. My concern is in the physician protecting herself by documenting that the patient refused the ultrasound. Yes, the physician will not be in violation of the law, but the woman would then likely be denied the abortion she is seeking – that is the nature of these mandatory TV ultrasounds statutes – no ultrasound = no procedure. It still leaves the woman stranded without healthcare. A poor solution at best.

  73. Thank you for this blog. I fear we are headed straight back to the coat-hanger-on-the-kitchen-table days.

    I believe it is in Arizona that legislation is proposed that would publish the name of women receiving abortions and name the doctors providing them. This violates doctor/patient confidentiality and is a violation of HIPAA laws, as well.

    Yes this issue diverts attention from the economy and jobs in this election year.

  74. Oh, and by the way, here’s the specific text straight from the Texas law:

    Perform an obstetric ultrasound on the pregnant woman, using either a vaginal transducer or an abdominal transducer, whichever would display the embryo or fetus more clearly.

  75. Thank (both of) you for this. Truly.

    Also, it’s rather depressing (if not, perhaps, surprising) to see at least two comments above assuming that Dr. Anonymous is male–when neither the post itself nor John’s careful introduction reveal the poster’s gender. Doctors and vagina-having people: not mutually-exclusive sets!

  76. twgibson:

    The law doesn’t specify the exact method, only that it must be done. The fact that in some cases it would *have* to be via a probe makes your objection disingenuous.

    Planned Parenthood does *not* do ultrasounds before all abortions.

    Maybe if you got your medical information from a doctor rather than Fox News, you’d know what you were talking about.

  77. twgibson:

    Wrong and wrong. The law mandates getting an ultrasound image, and the only way to an ultrasound at that state of pregnancy is to use the rape wand. Your ignorance is doubtless politically motivated.

    rens @3:41pm:

    I’ve got a dollar on the Democrats being too disorganized and cowardly to get the story out there and keep hitting on it. It’d hardly be the first time.

  78. I have an ultrasound image of my son at about 20 weeks giving a thumbs-up that any and every doc around the country is more than welcome to use as much as he/she wants to in protest. Email me on Facebook (Veronica Oh Happy) to get in touch.

  79. Thank you, John, for giving this doctor a platform to be heard. Speaking out effectively requires a lot of plates to be spinning in the air: an audience, the courage to say what you think, the ability to communicate what you are thinking and the expertise to to speak knowledgeably.

    Dr. Anonymous, thank you for seizing this opportunity and saying what needed to be said. I honor you.

  80. When a soldier refuses to torture captives, because it violates their personal moral code, they are charged with a court martial. A Hippocratic Oath for doctors is just as binding. So if they conduct medicine by their personal beliefs, as these politicians want them to, they should be charged as criminals.

    Excellent post, Dr. Anonymous, and thank you, John.

  81. Maria O’Connor says:
    “Standing ovation from my daughters and me.”

    Maria, I’m sorry, when I first read your post the second word appeared totally different than what I was reading! But it brought out a good laugh.

    This physician’s stance is perfect and sound. Doctors shouldn’t let themselves be political pawns. (Of course some do, Ron Paul).

  82. Thanks for posting this. Isn’t there a federal medical practitioners association that can take this up? A few years ago, the (former) Australian Government tried to implement a program of compulsory examinations of Indigenous children for signs of sexual abuse or disease. Doctors across the country mobilised and refused to comply and the program was quickly abandoned.

  83. @twgibson: Planned Parenthood and other responsible women’s healthcare providers perform an ultrasound before performing an abortion to confirm that there is actually an intrauterine pregnancy – as opposed to ectopic (outside of the uterus). This is a medically indicated procedure, to ensure that the woman is properly cared for and the procedure is properly done, unlike the ultrasounds with extensive verbal description, listening to the heartbeat or watching the images on the screen as required by various of the bills/statutes under discussion. The two are not even in the same ballpark.

  84. Also: I highly respect Dr. Anonymous for having the courage to request that doctors speak out on behalf of the rights of the patients. Doing so could put not just their medical licenses but their very lives at risk, not to mention expose their families to censure. It takes a lot of guts to walk the right path. Kudos to you, Dr. Anonymous.

  85. Thank both of you for this post, so much! (And… I’m sorry if this is off-topic JS, and I don’t wish to derail at all, but fellow readers: I don’t think the sex/gender of our Anonymous Doctor was specified. I don’t think we can automatically assume the doctor is male.)

  86. Thank you for this, John. Important and timely.

    And in addition to the idea of “where’s the physician outrage,” where is the liberal/democrat outrage?

    It wasn’t that long-ago the right-wing-spin-machine was talking (knowingly and incorrectly) about “state-sponsored death panels.” Why the hell isn’t anyone turning this back on them with a (far more accurate) “state-sponsored rape panel”?

    And thank you doctor, for reminding us that that is, by definition, what it would be.

  87. Well said, Doc. And where ARE your colleagues? Is it ok with them that women will be forced to undergo an unnecessary procedure like this? Who exactly is going to pay for it (my last one was a couple thousand dollars)? As a patient, you can bet I won’t! The Hippocratic Oath protects you (and me, thank goodness!).

  88. As a Vagina-American and a physician, I wholeheartedly approve of this call to civil disobedience! We progressive docs are out there, but we’re not politically organized. :(

  89. pedantic peasant says: “… where is the liberal/democrat outrage?”

    It’s all over the damn place. Well, not so much from most of the supposed leadership, of course, but certainly from lots of other folks.

  90. Thank you very much too, and your friend. I’m saddened that he/she has to do this anonymously. I’ve written to one of the prominent MSNBC show hosts asking them to try and get a spokesperson for the AMA in to speak on this ridiculous overreach by so many state legislatures. I’m fortunate to live in NY, but it doesn’t mean I can ignore crap like this.

  91. Well sure we all love physicians. If any profession deserves anyone’s respect, that’s the one. I’m not an expert on ultrasound techniques (I’ve only ever been present for veterinary ultrasounds) so I’ll take your word for it that the technique under discussion is rape when used without consent. I am completely opposed to rape or indeed any coercive act. (Please don’t get sidetracked onto the hoary old “the fetus shouldn’t be coerced into dying” line; that’s not what we’re talking about.)

    That said, would the doctor like to comment on the following?

    If the only comment is, “that’s BS because that stuff never happens”, I’ll accept that. If instead she can confirm that she has never performed pelvic exams without permission but yeah most ob/gyns have then I’m going to continue to be concerned about this issue. However, if the answer is more along the lines of “well rape is OK in that case” then we all have to think a bit more deeply.

  92. The only difficulty I can see is in the case where doctors work in a clinic like Planned Parenthood. There are already so many people watching them closely and looking for any excuse to shut down the clinics. The doctors will be in the very difficult position of doing what is best for their immediate patient and risking not being able to help others in the future or following the law to perform an unnessesary, mentally painful procedure but having more of a chance of helping other women in the future. People who are ant-choice would love it if clinics were closed down for violating the law, if abortion doctors were unable to practice because they violated the law or ifewer and fewer doctors were willing to perform abortions because of the difficulties involved.

  93. to sam @3:52 above, from virginia: the mandated transvaginal ultrasound is law in texas. it was passed, to much local dismay but little national notice, during the 82nd legislative session (2011), as an emergency measure propounded by current gov rick perry. I believe he did this in anticipation of his running for president, and yes that would be as cynical a ploy to capture the far right-wing of his party as you can imagine. so yeah, this procedure is in fact mandated and is a law in texas. and even though the american medical association told their pet legislators that they didn’t much like the bill, it’s pretty obvious that they didn’t invoke any penalties or real muscle on this issue because lo and behold, it is law.

  94. @Sam: Right. Many women are uncomfortable with transvaginal ultrasounds. Many medical professionals are uncomfortable with abortions, birth control, treating women as people, etc. The difference is that no one is forcing wands up the latter’s collective private parts against their consent.

    Also, I’m sorry, but if you join any kind of medical profession, your first duty is to the patient. Not to your concept of an almighty deity, not to your own ideology. Don’t like it? Don’t be a goddamned doctor. Or nurse. Or pharmacist. Or dentist, if you believe in the sanctity of each and every tooth and will not therefore perform extractions or root canals. There are plenty of jobs where your ideology will not get in the way. Find one.

  95. Thank you for posting this. Doctors, we want you to speak up (even if anonymously). We need you to speak up, for the silence is eroding our trust in you.

  96. Love it! We barely escaped this in Virginia, but as long as it is happening anywhere in the country, it is NOT OK. Don’t you know these idiot legislators are the same people who are trying to scare their “base” by telling them sharia law is on the way. Well, they oughtta know.

  97. This is incredible. I’ve been wondering when the physicians were going to come forward about this. It’s great to see there is at least one who is willing to talk about the insanity of these decisions from a professional standpoint.

    I’m sorry he has to remain anonymous, however. I only hope more docs take the time to shout about it, too. We need to hear from them and they need to be heard.

    Thanks, Doc. This is so heartening to those of us who are fighting these actions with all our might. Yours is the voice of reason, and it’s up to all of us to take this public and get the word out.

  98. Mr. Scalzi, thank you for giving this doctor a platform to speak out, and thank you to the anonymous doctor for doing so. It means so much to see someone in the medical profession speak against these heinous invasions of bodily autonomy.

    @ Rob: “I would scrap this argument and start over, to be OUTRAGED! over an ultrasound when the other side believes they are talking about murder is not winning converts. What that other argument should be I have no idea, but it needs to be reasonable.”,

    Really, how is outrage and anger *not* a reasonable and rational reaction to this sort of bullshit? If you aren’t mad about this, then you are clearly not paying attention.

  99. Oh Rob, really? There is a huge problem when people on both sides of this issue feel forcing women to do something they neither want nor need and is enshrined in law by their government is wrong. This is rape, plain and simple. Government mandated, legally sanctioned rape. We may have legal abortion up here in Canada and yes, you may be correct in that most people believe there are two people involved. The difference is that they don’t believe in forcing a person to do something against their will in order to salve their own beliefs.

    It seems to have become a real issue for those in the US to have things like this happen or be proposed in so many places. I truly hope that candidates that support many of the insanely invasive laws that have been proposed, adopted and/or are before the courts being disputed already, are shown the door in the upcoming elections. I am under no illusions, however, that people will suddenly grow backbones and stand up for their rights. As long as it doesn’t affect them they will not care. Until these ridiculous laws go so far as to affect a majority of people, they will be ignored in fact while they are being debated in theory and written into reality.

    John, thank you for providing your friend a place to express his views in a way where his health and career will not be affected.

    Doctor A, if you don’t mind making less you could always come up here to practice. It may not be perfect but Doctor’s like you would be welcome.

  100. This is the heart-rending story of a Texas woman whose much-wanted child was diagnosed in utero with severe abnormalities; she was then forced to go through the ultrasound procedure described previously. If you’re not sure what exactly we’re talking about here, please read this.

    “[The doctor] started with an apology, saying that despite being responsible for both my baby’s care and my own, she couldn’t take us to the final stop. The hospital with which she’s affiliated is Catholic and doesn’t allow abortion. It felt like a physical blow to hear that word, abortion, in the context of our much-wanted child. Abortion is a topic that never seemed relevant to me; it was something we read about in the news or talked about politically; it always remained at a safe distance. Yet now its ugly fist was hammering on my chest.

    My doctor went on to tell us that, just two weeks prior, a new Texas law had come into effect requiring that women wait an extra 24 hours before having the procedure. Moreover, Austin has only one clinic providing second-trimester terminations, and that clinic might have a long wait. “Time is not on your side,” my doctor emphasized gently. ”

    It gets much worse from there.

  101. Thank you, thank you, thank you.

    This is a personal story. I hope it counts within issues raised, because I’ve seen very little discussion of this sort of situation. If it does not fall within guidelines, please delete.

    I had a medical abortion a few years ago. I had a missed miscarriage. My baby died, but did not pass from my uterus, which means we were going to have to take medical steps to pass the fetus and gestational sac – in other words, an abortion, chemically induced by taking “abortion drugs”. In the horrible conversation after finding out we had no heartbeat, my physician had to tell me that in order to fill my prescription, I was going to have to call the pharmacies ahead of time to find out who was on duty because she’d had miscarried patients refused by pharmacists due to the conscience clause. If the drugs did not work, I was going to have to have a D&C. Negotiating all of this was hard enough for me on one of the worst days of my life. Because of this, I am very sensitive to how these “compassion” laws turn back on women.

    Reading the text of some of these laws, if they were passed, my situation would have been even worse. They require more burden and more paperwork and more documentation and more signatures and more images (many discuss the screen pointed at the patient, which very few physicians are going to do in the case of a potential nonviable fetus) and more description of exactly how dead my very wanted baby was before I could have the medically required abortion.

    And that’s just the unintended spillover, for a nonviable pregnancy. The intended context is so horrendous that I haven’t seen much attention paid to “borderline” cases other than a few statements that politicians “might” amend the bills in some of the states to eliminate miscarriages and ectopic pregnancies.

    We call our health care a patient-doctor relationship for a reason. It’s not a patient-doctor-politician relationship.

  102. What I want to know is: why are the right wingers so fixated on one particular kind of ultrasound, the most invasive kind, that actually involves penetration? That “preference” speaks volumes about what this is really about.

  103. This topic is certainly rage-inducing and thank you, Doctor, for this post.
    Beyond what you’ve said, I’ve been worried not just for women’s health rights, but the precedents this type of legislation would be setting. Not just for issues of reproduction and women’s health, but of all health issues. Because this type of law can be used to leverage into other avenues. Just for the health insurance side, precedent being set for exemption for any reason to cover birth control could be used to argue any elective procedure or prescription should not be covered.

    Not to mention the ethical precedent.
    Doesn’t it matter any longer if you can trust your doctor to give you sound advice?
    What about the laws being proposed to tell doctors how to talk to their patients? To lie? To not perform life-saving procedures if a woman’s and/or unborn child is in danger?

    This is an honest question. If my doctor lied to me, destroyed my trust, didn’t inform me, didn’t ask my consent for a procedure, should that doctor continue to have a license? My answer is ‘no’. But how would the medical board of each state answer that question? It scares me to think they might answer ‘yes’.

  104. Thanks, Bearpaw.

    Yes, I meant the outrage by duly elected liberals and those who represent or otherwise tend to speak for them.

  105. Love it! We barely escaped this in Virginia, but as long as it is happening anywhere in the country, it is NOT OK. Don’t you know these idiot legislators are the same people who are trying to scare their “base” by telling them sharia law is on the way. Well, they oughtta know.

    I don’t know about you, but I don’t think Virginia “barely escaped” much. The ultrasounds are still mandatory, just not in a way that is defined as rape by federal law. It’s still not a woman’s choice as to the level of her informed consent.

  106. Sam says, “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    As a Physician, I can tell you that dealing with uncomfortable problems comes with the job description, but I believe that Sam is missing the point. I don’t think that he is saying that an OB/GYN would be uncomfortable doing the actual procedure (I assume that this is understood and I am just clarifying for the record), but the issue is not personal comfort. The issue is that the ultrasound is legally required regardless of medical need. This is wrong, but unfortunately commonplace.

    Already there are many legal requirements in our profession that require medical interventions that are not medically indicated. For examlpe, to obtain a TENS unit (a medical device for back pain), a patient has to come in for a face-to-face visit initially and then after a thirty day trial to validate the order. Both visits are usually superfluous since by the time I order a TENS unit I have reams of documentation that the physical therapist and/or specialists have used the device on the patient many times and have validated its efficacy. The visits are essentially to fill out Medicare documentation. We physicians put up with this because an office visit is not so onerous an “intervention” and we are trying to help the patient get the device. I have often wondered, however, where we draw the line.

    Do we draw the line at invasive tests such as blood tests? No. Blood tests are often legally required. Do we draw the line at vaginal ultrasounds? Apparently not. So will we have to do legally required surgeries? Sterilizations? Disconnect life support? These may seem ridiculous, but where do we draw the line? I object to government intrusion into the medical decision making process. I believe that most physicians, regardless of their stand on abortion, will agree with me.

  107. J.D. Rhoades:

    Actually, as noted previously, it’s not specifically required to be the invasive ultrasound. It’s that in some cases that’s the only method that would meet the requirement. It’s not so much that they *want* it to be the most invasive kind — though that may be true for some of them — it’s that they don’t care how intrusive it is.

    In some sense, it really doesn’t matter. Even a externally-performed ultrasound is invasive if the patient doesn’t want it done.

  108. I am appalled that this should ever even be an issue. Don’t they realize that going to a doctor is a choice we make. To scare women away from the help they may need in other aspects of their physical well being is not only stupid, but counter productive. I know if I had to face the choice of going for help and being violated, or living with an issue and retaining myself respect. The doctor would never even see me. I would have to feel like my life was threatened before I would even darken the door into a doctors office.
    Thank you Dr Anonymous for having the convictions to let us know how you feel about the subject. It is encouraging.
    At this point in my life I am just glad I am past my reproductive years and I lived in a more enlightened era. I feel for the young women that will have to deal with this stupidity!

  109. A friend of mine from a family of religious conservatives tells me that the ethos on the subject is very simple: anything is acceptable to prevent abortion. By that logic this is just another means toward that end.

    Personally, I am beginning to see some rather perverse sexual ideations creeping into the GOP base. I’m not sure exactly what is at the root of it, but things like this, or describing your sexual activity level to your supervisor, strike me as the sort of thing designed to fill someone’s “spank bank” as it were. Something is rotting in there and the smell is just starting to leak out.

  110. I don’t need to comment. The post says it all. My grandfather was a doctor before medicine was owned by insurance and pharmaceutical companies, I and suspect he’s rotored his way to the core of the earth by now.

  111. Idea — When the State mandates a medically unnecessary procedure, the State should have to pay for it, including travel expenses and loss of pay. I don’t know what a transvaginal ultrasound costs, but it doen’t sound cheap and doesn’t sound like the sort of thing that would be available in a country doctor’s office.

  112. @Scribe:
    When a soldier refuses to torture captives, because it violates their personal moral code, they are charged with a court martial.

    No… just plain out no. As an ex-soldier I can promise you (at least in the U.S.) not only is soldier allowed to not torture prisoners, he is legally bound NOT to torture prisoners, and is also legally bound to report any soldier who does said actions and any ranking officers or NCO’s who order such action.

    In fact, any soldier who DOES commit such acts or fails to report such facts could find themselves in courtmartial proceedings–at worst–or at least subject to Article 15 punishments… although I would bet on CM over A-15.

    This is NOT a sound argument, and is in no way equivalent to doctors and whether or not they are morally/legally responsible for commiting state mandated rape, nor the baloney surrounding the “religious” beliefs concerning such things as birth control or vaccinations.

  113. Also, to add to what Jesse said at 4:20 pm, the state legislature in Tennessee is considering a law that would required publicizing not just statistical data about all women getting abortions, but details about every doctor who performs this procedure. This is clearly going to have a chilling effect on the willingness of doctors to perform a legal medical procedure, and creates cracks in the principle of doctor-patient confidentiality.

  114. Hear Hear!

    I can not begin to describe how out of place and utterly callous these new laws looks, and how sensless and stupid the arguments are that are brought foward to support them.

    As an outside observer and European national I am not directly effected personally, but as a member of humanity, I cry.

    I hope that you will be able to rapidly reverse them.

  115. Thank you for speaking out against these abominable laws. I really like one of the previous comment’s idea of prosecuting for practicing medicine without a license. Make sure to indict everyone who voted for them in both houses of the legislature and the governor who signed it into law.

  116. APPLAUSE!!! Thank you, Gentlemen for standing for women and those that love them.

    I think that many things in our country and the world are better for women than they have been historically. Medically required rape and labeling a woman a “slut” for using birth control is more than 2 steps back into the dark ages. Doesn’t this sound much like “rape and pillage”? Perhaps we should call this mandate exactly what it is: Torture!
    We women are not chattel and we should have the same rights as our male counterparts to enjoy intimacy. With 6 billion people on this planet why would anyone want to limit birth control? Idiots?
    Small rant.

  117. I suspect your medical friend would probably be up in arms about the legislative twitch in Kansas which would allow doctors to legally lie to patients regarding diagnoses during pregnancy. It’s suspected this particular bit of legal fiddling is intended to allow doctors to withhold information about pregnancy complications, or the existence of a pregnancy, in situations where they suspect the female patient in question might request a termination. Similar legislation exists in Oklahoma and Arizona.

    Now, as an Australian, I don’t really have a dog in this fight. However, I must note it really does seem that there’s a strong element in US politics which effectively wishes to reduce women to the status of domesticated animals, or worse.

  118. Dr. Anon, thank you for this. Very well spoken. Scalzi, thanks for posting it.I feel as though I should say something more, but just… thank you.

  119. I can only say thank you for writing this, for giving the space for publishing and for allowing us to read it and comment. As a woman I remind a people all the time choice is the full range of choice, to say yes or no through the entire course of our sexual maturity and fertility. No one should ever demand we give up our body control, not for any reason.

    Thank you again.

  120. @twgibson:

    Would you care to drop by and apologize to the guest poster for calling him/her a liar? Won’t hold my breath waiting, but it would be the classy thing to do.

  121. One of the reasons I am so enraged and disgusted by the transvaginal ultrasound law in Texas is because it was the physicians who challenged it in court, on freedom of speech grounds. Just as they challenged the previous law that required them to give women medically inaccurate information (the old “abortion causes breast cancer” bullshit, and it was passed well after numerous studies debunked it, after the AMA condemned it). And they lost both challenges. The Fifth Circuit has decided twice now that forcing physicians to lie to their patients, either verbally or physically, is no restriction on their freedom of speech. I haven’t read the full decisions because I really do not want to know what twisted mockery of reasoning lead them to that conclusion. Under this law, noncompliance puts their licenses at risk and while the Texas Board of Medical Examiners historically hasn’t revoked licenses for anything short of blatant criminal activity and possibly human sacrifice in the hospital lobby, you can bet that the lege (Molly Ivins’ national laboratory for bad government) will go to great lengths to ensure any noncompliant doctor is hauled up for revocation hearings. So really…what can they do? Maybe they have recourse as the good doctor/author suggests in other states, but in Texas they’ll be hunted down like wild hogs.

  122. Thank you! This is the first time I’ve read this blog, and even though this is a guest spot, I will be back! Fantastic!

  123. Patients, if your doctor doesn’t refuse to perform this procedure, find another doctor. If enough of you do this, the doctors will get the message and do their duty to their patients, as Dr. Anonymous above describes.

  124. I would suggest that many doctors are ignoring this issue because they won’t have to do the actual rape-procedure. That will be handled by a Radiologic Technologist and the MD only has to look at pictures.
    And I can call it rape because I’ve had one (wasn’t told ahead of time that I needed a full bladder in order for them to look at my uterus from outside). It is invasive and painful.

  125. I love the simple non-compliance tactic. The more these fools and their rules are ignored the less power they wield.

  126. I am a physician & I agree 100%. I worry that, realistically, most physicians and medical institutions will look at this as one more opportunity to do a procedure for which they can bill.

  127. Megpie71: A state legislator in Georgia actually made reference to his own barnyard animals in comparison to women needing abortions for nonviable fetuses.

    To add an echo to others: Many thanks for this post, and like others, I had wondered where the voices of physicians were in all the political tumult.

  128. I’m leaving the house for an event with my daughter. During that time I won’t have a full range of editing tools, so if I find something I need to Mallet I’ll drop it into the moderation queue. When I get back home I’ll return it, with the reason why it was malleted.

  129. I just wanted to add my thanks to the many other expressions of gratitude here. Doctor Anonymous, may you go forth and heal for a hundred more years. Scalzi, when there are casbahs which need rocking, you arrive, and you rock them all.

  130. Regarding Item #4…

    If we were at all geographically close, I would volunteer to have my empty uterous imaged. I’d even sign a waiver giving you rights to distribute it with one caveat. It should have the caveat “There are no fetuses here. This is not the womb you’re looking for. Move along.”

  131. I am a physician and I agree 100%. I worry that many physicians and institutions would view this as yet another procedure for which they can bill.

  132. Thank you John, for being the man I was sure you’d be, and thanks to the anonymous doctor for reinforcing what anybody who takes the Hippocratic Oath should already know in his or her bones. An unwanted procedure IS rape.

  133. *stands and applauds*

    Today I have two new heroes: Mr. Scalzi and Doctor Anonymous.

    Thank you both.

  134. Apparently either the universe or my computer really, really wanted that message to go out. I must have clicked something because it auto sent.

    I still stand by my offer. As long as I you add the caption. I heartily approve of individuals who go Henry David Thoreau on laws they don’t approve of. I just want mine with a little bit of geekery.

  135. I would like to thank both Dr. Anonymous for his/her call to action, and John for allowing his blog to be a safe platform. This proposed legislation is morally reprehensible. The government has no business requiring rape. Ever.

  136. Before I write I would like to say I applaud the doctor and his/her stance.

    My statement is trying to clarify the argument at hand. It seems to me that while the transvaginal ultrasound phrase is what people seem to be keying in on, that this is an argument all about patient consent. If this law wasn’t in place the women in question were still seeking a procedure that would require vaginal insertion of a medical device. But the Doctor’s objection was to being told, by someone with an agenda that included considerations other than the patients health and wishes, that they had to do A for/to the patient before they could do B. From a purely legal standpoint I would say this would be equivalent to telling people that they had to get a blood transfusion before broken bones could be set.

    I feel that people seem to take everything up a level when reproductive organs get involved.

  137. I am mindful that I took not the Hippocratic Oath upon finishing medical school, but the Declaration of Geneva.

    The latter does not explicitly forbid abortion (as, interestingly, the Hippocratic Oath *does*). However, in both one swears to uphold a patient’s wellbeing and, for pete’s sake, do no harm.

    And, I swore that I would treat my fellow doctors as my brothers and sisters. Not knowing your gender – right on, sibling. :D

  138. [Deleted because comparing innoculation to forced transvaginal wanding is both dumb and derail-y — JS]

  139. I have an ultrasound scan from my blighted ovum, proving there was no baby, that I would happily donate for this cause. Feel free to email me if you would like a copy of it.

  140. Your Intrepid Blogger:

    Patients, if your doctor doesn’t refuse to perform this procedure, find another doctor. If enough of you do this, the doctors will get the message and do their duty to their patients, as Dr. Anonymous above describes.

    “Find another doctor” is all well and good if there’s another doctor to find. In the world where I live, that’s just not an option for a lot of low-income or rural women. And to be entirely cynical, I think the framers of this kind of law know full well that they’re pulling this “slut-shaming” nonsense on women who are often already severely anxious and just want the whole horrible mess to be over with. Contrary to the bile of the usual suspects, I’ve never known of a woman who had an abortion for shits and giggles — but I guess when you throw around terms like “murderer” and “baby-killing whore” you don’t give a damn how much harm you cause to them.

  141. It’s nice to see a Doctor take a stand against this outrage. We can only hope that the majority of physicans feel and act the same way.

  142. Kudos to Dr. Anonymous for writing this and to you for giving him a platform to do so. I will gladly share this far and wide!

  143. Scalzi: It is not quite the same, but try googling US Sterilization Laws. Starting in the early 1900’s, there were several states (Virginia among them) who passed laws requiring the sterilization of those deemed too mentally ill or feeble-minded. Men, women, and children were sterilized. California alone sterilized nearly 20,000 people, Virginia sterilized over 6,000, and there were many other states. This was in a day when common belief was that non-whites were a lesser race. Therefore, even though plenty of mentally ill were sterilized, plenty of blacks and Amerinds were also sterilized.

    What’s even scarier, is that in 1935, Virginia’s Registrar of Vital Statistics and the big push behind Virginia’s eugenics policies wrote to the director of Nazi Germany’s Bureau of Human Betterment and Eugenics, applauding his efforts and asking to be placed on his mailing list. In 1938, the director of Western State Hospital in Staunton, VA (another leader in eugenics) publicly bemoaned the fact that the US had only sterilized 29,000 people in 20 years, while it took Germany only 6 years to sterilize 80,000. In 1939, one of UVA’s leading eugenicists became Dean of Medicine, and influenced the thought of doctors in that state for decades.

    And the Supreme Court? They upheld such laws, with one opinion stating that, “The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”

    The sterilization act was not repealed until 1979. Tens of thousands of people had been sterilized without their consent and without their knowledge.

  144. I read this imagining Dr. McCoy’s voice and despite a lack of swearing and colorful idioms IT WAS GLORIOUS.

    Thank you. Thank you so much for this. (For, you know, more serious reasons than JUST the mental image of Bones fiercely guarding my vagina’s rights, but thank you for that, too.)

  145. This was very well said. And just a note on the doctor’s anonymity, doctors who perform abortions are targets for murder by some “pro-life” extremists. If this doctor is one, or is perceived as one for speaking out like this, it could very well put their life in danger.

  146. Dude – I’ve had to have about 20 of those for fertility and other lady issues; I’m sure that I have a spare one that I could give you the rights to so you can use it nationwide as a protest.

  147. What if an ob/gyn doc’s personal religious beliefs prohibited rape?
    Would they get a religious exemption?

  148. Someone needs to photoshop a Guy Fawkes mask with either a Surgeons mask or one of the silly head mirrors for Doctor Anonymous.

    Great post and I’m linking to this every where I can to get it spread as much as possible.

  149. [Deleted because even though this person clearly believes their nit-picky pedantry is relevant, I’m not obliged to agree, or to allow derailing based on that nit-pick — JS]

  150. Most of the comments have already said what I feel so I am just going to say…Rock on doc. Thank you for taking a stand.

  151. As a woman who has had to have this procedure because of ovarian cysts it is embarrassing and uncomfortable to have a doctor (who you may or may not have developed a rapport with) to stick a 10 inch ultrasound wand up inside you and fiddle around with it until they get the image they want. All you can do is hold your breath and stare at the ceiling hoping that the technician does not try to make small talk and make the situation even more awkward. I had to have this procedure for valid medical reasons, but to force this on a woman with no medical justification.. even with medical justification is just wrong, It is rape…. maybe someone needs to perform an inter-anal ultra sound on a male so they understand.

  152. Reblogged this on janiswings and commented:
    “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.”

  153. JD says: “I feel that people seem to take everything up a level when reproductive organs get involved.”

    Gee, I wonder why that would be.

    Note that it’s especially true when it involves questions about who has *control* over reproductive organs.

    This seems perfectly understandable to me.

  154. Thank you, Dr. Anonymous, for speaking out not only on the behalf of women, but also on behalf of physicians being placed in an impossible position. May you stay safe from harm, and may there come a day when you don’t have to hide to speak out.

  155. well said. i am a nurse practitioner. first, we should do no harm. thanks for this post.

  156. Just a note: a couple of you responded to a post I put into moderation pending deletion (see previous comment from me) and so they are in the modern queue too. It’s not you, it me keeping the comment thread clear.

  157. To those not understanding the anonymous nature of this, you have no idea what doctors are up against. I’m married to one and it’s staggering. Doctors can be sued for going against what is called “The Standard of Care” and if you’re not performing what legislation mandates you perform, that definitely qualifies. It’s not just about the crazies who might shoot you. It’s about your family, your livelihood, your peace of mind. Imagine trying to protect your kids’ college funds from attack by people you interact with at your job or the government. That’s the potential here.
    Doctors have been tracked down online and found, even with anonymous accounts/comments, and this information has been used against them in a court of law. I hope for this doctor’s sake that posting this important rebellion remains anonymous. Thank you so much for speaking up.

  158. I am a Texas internist and I have spoken out about both the misinformation law and the transvag ultrasound law-of course, as an internist, I don’t actually have the odious responsibility of abiding by the law. I use my criticism as a tool to prove to those “small government” conservatives that there is nothing “small” in the creeping theocracy being imposed by the GOP. Dr. A has plenty of compadres in the medical field. Unfortunately, our voices are squelched by the media’s preference for listening to the AMA as a source for all things “medical”. The AMA is heavy with retired docs and specialists who tend to vote Republican. Are they going to say anything? No-most traditional conservatives believe that abortion rights are set in stone and won’t be changed. They are busy hiding their collective heads in the sand.
    And, Sam…if I am uncomfortable with administering a certain treatment, I am still required by law to provide care while I find another doctor who will provide care to transfer the patient to.
    As for changes in mammograms, yearly mammograms between the ages of 40 and 49 will result in a 100% chance of being diagnosed with a false positive finding. Changing the frequency to every other year doesn’t affect the test’s ability to diagnose cancer. So, to USPTF, the choice was clear-minimize the risk of false positive testing with all the extra costs and emotional burden of biopsies and additional testing AND not miss actual cancers, of course, every other year testing was recommended. As for prostate cancer testing, funny you should bring that up. PSA/DRE recommendations are in flux right now with no specific testing recommended. Reason-PSA can be normal in 25% of cancer and 10% of men are found to have cancer at autopsy-eventhough they died of other causes. Would I necessarily recommend treatment for prostate cancer, knowing that the treatment may not extend life and can lead to incontinence and impotence? Not really…

  159. Thank you so much to both of you for sharing/posting this! The voice of outrage from physicians is a very important one here, and one that until now seems mostly to have been silent. We need to hear from more physicians like this one!

  160. Your statement has gone a long way with me – and hopefully millions more – in restoring faith in the noble art of healing.

    Truly, powerful interests have done incalculable damage to your profession. I hope more like me will express their absolute support for all medical professionals who will take a stand for their patients. My heartfelt thanks for your words.

  161. I don’t know what to say other than thank you. I had my first transvaginal ultrasound this month to have an IUD put in place. I was horrible uncomfortable but I agreed to have it done to be sure the instrument was truly in place. I can’t imagine being forced into it! Thank you! Thank you! Thank you! I am a woman! NOT an incubator!

  162. @rob, way upthread: Our argument is entirely reasonable: Other people’s religious beliefs about personhood do not trump our rights to bodily autonomy. Even if the fetus were actually a person in some objective fashion, which it isn’t, another person does not trump our rights to bodily autonomy. Other people’s religious beliefs do not give them the right to rape us for the same reason.
    What is unreasonable about that?

    And everybody suggesting that people just find another doctor need to get educated about real life. Not everyone can do that, for the reasons other people have given. And, as has been pointed out, reproductive health clinics like PP are very closely monitored, and with far-right fascists trying to shut them down, they will have to comply with the law, or face losing the ability to provide any services to anyone. Those clinics are where most women know to go for abortions, and are the only places a lot of women can afford to go.

    Sorry everyone else, that utter BS was bugging me, and I had to say something.
    Thanks, Dr. A and Scalzi, it’s a good piece.

  163. Thank you so much for posting this! You’re a credit to your profession and I hope this message reaches other doctors and potential victims of this legislation everywhere.

  164. I, personally, would like to see this enacted into law.

    I would then like to see the women, coupled with sympathetic judges, have the legislators responsible for this heinous, reprehensible concept arrested and prosecuted for rape, conspiracy to commit rape, and aggravated sexual battery. A statement needs to be made and I can think of no better statement than an OB/GYNE’s entire contingent of pregnant patients each levying one count of the above upon someone that dares vote for a bill like this.

  165. Sam says: “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    Others have said that the false equivalence here is that medical professionals are not forced to perform abortions against a patient’s wishes. And this is true. But the statement Sam is making reads more, to me, as if he believes there are doctors who are forced to perform abortions even though they, themselves, have a moral objection to it. And this is simply not, nor has it ever been, true. Certainly, in an emergency situation in a hospital, doctors who normally might have reservations about the procedure are forced to perform it in order to save the life of the woman. But, by and large, abortions are scheduled procedures and those professionals who provide this care have very definitely chosen this work. Those who object to it, don’t make it there specialty in the first place.

    And, as a woman in Texas, I’d just like to state, AGAIN, that trans-vaginal ultrasound is the LAW in this state. It was signed into law in May of 2011 though it was in the courts for several months. But it became active early this year. The legislation in Virginia is just when this issue caught national attention but it is not the first, and likely not the last, time we’ve seen it.

    So, count me among those standing in ovation to this doctor and to Mr. Scalzi for providing the platform.

  166. @JD – Taking it up a level? It is not only about reproductive organs. Lies, invasions, torturous and unnecessary applications of medicine, and last but certainly not least more removal of women’s rights as people. Damn it all! Women are people and I am truly sick of being treated as if I have less brain function than a gerbil!!

  167. @Melodee

    You should–and best–be sick of being treated like a 7th class citizen. Get all of your sisters in sex together and make a rucus… some of us guys will be willing to crack some heads for you if that is what is needed.

  168. Somehow I suspect that if all the doctors in the entire country rose up as one and refused to do this procedure, then… the law wouldn’t change, effectively outlawing abortion – which, after all, is one of the three main purposes of this law.

    The other two purposes go to a problem of philosophy. Most (but astonishingly not all) people opposed to abortion rights have an ethical system which asserts that the fetus is a “person.” (Interestingly, they neglect the necessary step of then proving that the needs of a fetus to an human incubator outweigh the right of a woman to bodily self-determination, and just assume it to be the inevitable consequence of person-hood.). ON THE OTHER HAND, some people in favor of the right to choose abortion disagree and say the fetus is NOT a person, and some agree that the fetus IS a person but do not believe that the need to supply it with the means to accomplish a live-birth** outweigh the woman’s right to bodily integrity and the right to decide for herself whether carrying to term is warranted. (**The reason I worded it this way is because there seems to be little concern for the so-called person after its birth, or even any consideration of whether the prevention of a live birth would be more merciful.)

    These two ethical positions are built on assertions that are, in essence, religiously (or philosophically) based. This country is supposed to guarantee freedom of conscience for that kind of thing, but if you look at the various state laws encumbering women trying to get an abortion (must be given info about fetal development, must have an ultrasound, must look at ultrasound pictures, must even listen to fetal heartbeats!), it’s obvious that their purpose is to change the woman’s mind not only about whether to have a particular medical procedure, but to change her personal system of ethics.

    So the second main purpose of the mandatory ultrasound laws is forced education. (“How many times do we have to yell ‘It’s a person!’ before you agree with us?”) The legislators enacting such laws can’t seem to understand that people in this country are allowed to disagree with them on matters of conscience, or that to mandate this kind of coercive philosophical persuasion is a violation of religious freedom.

    And the third, most important main purpose of the rape wands? Why, it’s to punish those women who have the temerity to resist the shame indoctrination, disobey the people who know better, and follow their own consciences. After all, rape isn’t about sex – it’s about power. And someone has to show those sluts who’s in charge.

  169. Thank you so much for this post. We have been debating this topic in my honours class at the moment and this post really helps me to coalesce my own opinions on this topic.

    Also as a woman who has had a transvasginal ultrasound I’d like to recommend that all of the politicians subject themselves to anal probing before suggesting that the process isn’t invasive and demoralising regardless of the context!

  170. Thank you Doc Anonymous. I think it’s time for the AMA to take such an honourable & intelligent stance on the issue & that they tell the governments considering such horrific legislation to cease practising medicine without licenses.


  171. These are scary times to be a woman. Thank you Dr. Anonymous for postulating on something I have been wondering. What are the physicians feelings on this? Where is the outrage? We seem to be on a path where woman are deemed unfit to make decisions regarding their health and their bodies. I never thought that my daughters might not have those rights that I, at age 42, have taken for granted.

    I just read that Arizona is evaluating a bill that would allow doctors to keep crucial information from pregnant women, if giving them that information might lead to abortion. Removing civil penalties for doctors who intentionally withhold information from pregnant woman. So, if a woman gets prenatal testing and it’s discovered that that the fetus has severe abnormalities either incompatible with life or that will have birth defects, it’s okay to not tell the mother. After all, it might lead to a woman making a decision, that some (certainly the ones proposing these laws) might not like. I’d like to know how Dr. Anonymous feels about that one? I know that as a woman and a mother of daughters that this is almost surreal to me. What is going on in our country? I can only hope that the GOP will be affected by these extremists in the upcoming election. The problem seems to be that all of these proposed bills taking away our rights are happening on the state level.

  172. i AGREE WITH ALL THE POINTS MADE BY THE VERY WISE AND ANONYMOUS DOCTOR! I think a VERY important point is being missed though!. The intent of the regulatory requirement for transvaginal ultrasound procedures is to PREVENT WOMEN FROM HAVING ABORTIONS. It is my understanding that the law would make it illegal for a woman to have an abortion without first submitting to the transvaginal ultrasound procedure. If Physicians refuse to perform the ulrasound, the woman would then be legally prevented from obtaining the abortion and any physician performing such an abortion would be doing so in violation of the law and could have licensing revoked.

    The politicians who wrote the legislation are smart enough to have recognized this “Catch 22.” Those same potiticians could care less if women have transvaginal ultrasound procedures or not, as long as the women are prevented from aborting pregnacies!

  173. Apologies to John for the ultra-long comment above – I would have edited it down had I realized how big it had become.

    And it case it seemed in that first sentence that I was critical of Doctor Anonymous’s opposition to these horrible laws, let me say THANK YOU to Dr. A for speaking out and BRAVO to you! There are a lot of bigots and crazies out there, and your bravery in standing up for your patients does credit to your calling.

  174. Thank you, thank you, thank you. I have been wondering where the voices of the physicians were in this argument, as well as any other legislation that does not benefit the patient. When the issue about mammograms came up, I knew I liked my doctor when she insisted I get one every year even though it wasn’t recommended. She had cause, she died later of breast cancer. I do wish, Dr. Anonymous, that you would weigh in a little about the reality that sometimes abortion is best for all involved, for the health of a mother at risk, or for a child that wouldn’t survive very long even if brought to term. That is an element that confuses me in this whole debate, are they saying that the value of a fetus that can not survive without the mother (I’m talking early abortions here) is more important than the woman carrying the child? I guess that is what they are saying, if they insist that it is better to rape a woman with medical instruments than allow her to have an abortion.

  175. as a vagina-bearing (northern, but nonetheless) virginian and healthcare professional, THANK YOU.

    perhaps the sonogram of the commenter’s son’s “thumbs up” can be easily photoshopped into a middle finger!

  176. It seems that these fanatics have so focused upon their belief that an unborn fetus is a “person”, they forgot that the woman is a Person. A viable, thinking REAL person. She is not an incubator nor is she mentally deficient.
    I would like to use some foul language now but I can’t find anything that would be vile enough.

  177. You rock, Dr. Anon! And you rock, too, John, for lending the doctor your soapbox.

    I find it rather symptomatic of the current political climate in the US that the doc felt he needed to be anonymous, presumably because he did not want to be stoned for heresy – or whatever the US equivalent is these days.

  178. I didn’t read all the comments. I would like to have seen a link or something to the legislation that said Doctor is referring. It may be coming from a doctor but any person could have written this.

  179. Thank you SO much for posting this, John! It is reassuring to hear this from a sympathetic physician’s perspective. I have shared on Facebook and hope it become viral.

  180. If you refuse to perform this invasive test, and go on to perform the termination, you have failed to jump through the hoops that make it a legal medical procedure.

    That failure would make you a criminal, facing a lengthy jail term: and the authorities will make it ‘hard time’, in with all the others that their ideology considers murderers. Good luck with that: I hear that anal rape is bearable, once you have resigned yourself to a lingering death by AIDS and drug-resistant rectal syphilis.

    It will certainly get you struck off the medical register. I hear that the insurers have work for nonpractising physicians, advising on rescissions: beats tossing burgers for a living, after the indignities of poverty succeed in grinding down your conscience.

    If, on the other hand, you refuse to carry out this legally-mandated sexual assault, refusing as a consequence to carry out the termination, you will count in the statistics as a medical professional refusing to take part in abortions as a matter of conscience.

    Which is, of course, what this is all about. Many in the ‘Pro-Life’ camp derive some satisfaction in the thought that women in distress will have blunt instruments rammed into their vaginas, very much against their choice; but those women aren’t the target of this action.

    You, the physician, are the target: the measure is intended to be so repugnant to your principles that you will withdraw from all participation in terminations.

    You lose, every which way: and acting by your conscience will leave everyone worse off.

  181. As an fellow obgyn, I would ask commenters to respect this doctors anonymity. Is it not because she opposes this legislation that she has to remain anonymous, it is because she is an abortion provider. She may have to walk through picket lines, wear a bullet proof vest, or have her own children that she needs to protect. What she does every day is brave enough.

  182. Awesome post! Thank you Dr. Anonymous, for reminding other doctors of the ethical issues involved in complying with this kind of law . . . Many doctors have already abdicated their responsibility to provide adequate pain treatment to suffering patients, please don’t allow yet another unethical law rupture the bond of trust between doctor and patient even more.

  183. Thank you, thank you, thank you!

    I am glad that it has not been missed that the choice is and should always be the person’s (the woman’s) and no one else… Absolutely no freaking politician can tell me or tell a woman – my wife, sister, daughter, etc… – what she can or can’t do regarding her reproductive health. The minute that changes, we’ve descended into a dangerous world from where there is no escape.

  184. Having had more than one transvaginal ultrasound I can honestly say that this is the most invasive test there is. There is no dignity with a transvaginal ultrasound and should only be done when medically necessary. I am so sick of having my body lesgislated by people who have no freaking clue.

  185. Thank you, both John and Dr. A.

    Q) What’s the difference between a Corporation, a fertilised egg, and a woman?
    A) The woman’s not treated like a person in Oklahoma…

  186. Just as a note to folks: I’m deleting what I consider contentless flyby idiocy. There will likely be a lot of it. My suggestion is not to respond to it.

  187. Well, I’ve found a new hero. Thanks Dr. Anonymous for helping to restore a shred of hope for the future of women’s healthcare in this country.

  188. I wish that doctors who agreed with this Dr. Anon would be on CNN and Fox News (yeah right) talking about this. They’ve been noticeably absent.

  189. It’s my understanding that there’s a nationwide shortage of doctors.

    If states that pass such laws see an exodus of physicians to other states… I think they’ll have to change the law. Civil, and not even disobedience.

  190. Thank you, Doctor. You have truly upheld the ethics of your profession. I have been wondering where the American Medical Association has been hiding. Primum non nocere…

  191. I am currently twelve weeks – I am happy to provide either my 8 or 11 week ultrasound with full permission if he’d like to used that. I thank him for his integrity.

  192. For those wondering why the American Medical Association hasn’t spoken up about this issue, please be aware that they have. They spoken out against measures like this for years, as has the American College of Obstetricians and Gynecologists.

    Now ask yourself why the opinions of *medical professionals* on this topic get so little media coverage that most people haven’t heard them.

  193. Dr. Anonymous, we should all be so fortunate as to have physicians like you, with your priorities squarely in order, along with your willingness to stand up for what is right. I hope you continue to speak out, and encourage your peers to do the same. You are indeed our last line of defense.

  194. Here’s a drawing of the procedure:

    Having had this done to look for polyps, I can tell you it is NOT fun. There is a fair amount of discomfort, especially as the technician moves the end wand around to get images of everything. It may be easier for a woman who has given birth previously, but I was not in that category. Despite prescription pain pills and muscle relaxants taken before the procedure, I still had a lot of discomfort and some pain.

    Being forced to undergo this procedure before getting an abortion qualifies as cruel and unusual punishment.

  195. [Deleted because it’s a response to a deleted comment. Dawn, your comment was fine, but it’s just my general policy to delete follow-on to deleted comments — JS]

  196. SO GLAD you gave this Doctor this space — having the guts to say this is IMPORTANT – and enabling an environment where this message can get out there is critical

    Until some people stop viewing women as breeding machines, we will always be fighting this battle…….

    thanks for posting this


  197. Thank you Dr. Anon and Mr. Scalzi.

    and on a lighter note, “contentless flyby idiocy” should be the name of someone’s next band.

  198. @mfordrn

    Care to let us know about the last time someone was forced to have a medically unnecessary colonoscopic exam? Citation please?

  199. I live in Australia – what on EARTH is going on over there? How does this even become a topic that needs to be discussed? How do you let your politicians and religious groups get away with this stuff.

    Do I dare research this to find out why it has become a topic of discussion? Is this one of the Romney/Santorum things? Most of us over here have pretty much ignored that stuff once we realised how just plain crazy most of the Republican nominees appear to be. Don’t get me wrong, we have ours over here as well (big Gay marriage debate over here too) but legislating forced unnecessary medical procedures would, I’d like to think, be howled down the instant it was brought up in public discourse.

  200. Fantastic.

    And I have a couple of ultrasounds from when I was pregnant with my children (they are now 12 and 15). These were transvaginal ultrasounds taken at my request, and depict embryos at roughly 7 – 8 weeks gestation.

    I would be willing to give you those. That way you’d have an image you’d own (after all, I’m giving them to you), and you could put them in every chart. EVERY CHART.

    Just sayin’

  201. “It’s very strange to be a US citizen and have to fight for your civil rights.”

    – James Baldwin

    Thank you, Dr. Anonymous.

  202. Thank you. Thank you. A million times, thank you. I pray (and I never pray) that doctors everywhere find their collective voice.

  203. [Deleted because the poster doesn’t recognize how stupid they sound. Fortunately, I do! Hey, ADP: Go away now. Thanks — JS]

  204. Thank you. I am a retired nurse and would have expected to lose my license to practice had I allowed any such procedure to take place without the patients informed consent.

  205. maybe someone needs to perform an inter-anal ultra sound on a male so they understand.

    Hey, Jessa, while I take your point (and agree with it) there’s a male survivor of rape here who’d really really folks to really not push the anal rape analogies any further. Thanks. You might want to Google a little invasive procedure called a colonoscopy – which would make the same point without triggering any male assault survivors in the neighbourhood.

  206. More doctors like this!! Ok, rest of you – now it’s your turn to speak up! (A sin & a shame that this doctor felt the need to hide, and a big thank you to Mr. Scalzi for hosting said doctor)

  207. I’m Australian so this does not – thank God – affect me but I have had a number of transvaginal ultrasounds for medical reasons. They are painful and humiliating and, even with the best ob/gyn specialist doing it for entirely appropriate reasons and with my consent, I have felt violated. Congratulations to Dr Anonymous for speaking out. I hope that it will lead to others doing the same and these reprehensible laws will be repealed.

  208. “Physician, do no harm” This letter is outstanding, and applies to other procedures that are pushed
    simply for monetary gain, or CYA.

  209. Thank you, John Scalzi and Dr. Anonymous! Before reading this post I had not considered this perspective! Very eye opening. Thank you for taking a stand and fighting for your patients and their rights!!

  210. >(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.)

    I will volunteer for this and give up all rights to the image if it will help. I don’t have a uterus, ovaries or tubes so it should be interesting.

  211. @Joyce Roberts

    I offered my testicles just because I think it would REALLY make things interesting. ;-)

  212. I must add–I wonder if the RRRWers, famous for demanding the right to disobey laws if one’s conscience dictates it, would support this doctor’s decision. I imagine not.

  213. I am also a physician. As someone above alluded to, a transvaginal ultrasound is required (medically necessary) for any pregnancy, and particularly those that are scheduled to be aborted, since it is extremely important to 1) ascertain whether there is a fetal heartbeat (if not, then the pregnancy is non-viable anyway, and the abortion is not necessary) and 2) make sure the fetus is in the uterus and not a Fallopian tube or the abdomen (if either of the latter is true, significantly more extensive surgery is required, and if a surgical abortion is performed, the patient could subsequently die from a ruptured ectopic pregnancy without realizing she was still pregnant). Therefore, a transvaginal ultrasound IS medically necessary in all cases of pregnancy (transabdominal ultrasounds unfortunately do not usually provide the necessary resolution to determine either #1 or #2).

    And, as another poster also indicated, the process of having an abortion usually involves inserting many probes and then a large suction device into the vagina. Obviously, the process of informed consent should include a discussion of this – and should also include an explanation of why the transvaginal ultrasound is an important part of the procedure. If abortion clinics are not performing these ultrasounds prior to the abortions, they are in fact not following the standard of care – this type of legislation, although clearly intended to reduce the number of abortions, in fact only mandates something that should absolutely be a part of any abortion procedure.

  214. Thank you for that Doctor Anonymous, and thank you, John, for facilitating the posting of it.

    Just so you’ll know, someone (not me, but only because someone got to it before me) posted a link to this thread over at Ravelry, where all of us knitters congregate, so that more people can read this. A whole lot of us over there are sick and tired of the tomfoolery some state legislators are currently engaged in.

    Again, thank you so much for this post, both of you.

  215. [Deleted because the anonymity issue has already been tabled. Folks, please read upthread for my comments on anonymity here — JS]

  216. Thank you so very, very much for speaking up about this. As a woman, the things that have been going on the government lately are beyond bone-deep terrifying. Every voice that speaks out against those that seek to remove my status as a living, breathing human being is so very welcome.

  217. Thank you for this posting Mr. Scalzi, thanks for writing it Dr. Anonymous.

    I couldn’t help thinking that a lot of judges must’ve thought the same way when legislators started setting minimum sentences. I hate to be bitter (or earn the Mallet of Loving Correction) but look where we’ve slid down that slippery slope.

    Perhaps the knowledge-silo of the doctors will buy them room to civilly disobey. (Judges being too close to the legislators’ own skillset to be able to pull off a significant non-compliance protest.)

  218. Thank you Dr. A!!!

    I had a transvaginal ultrasound on Oct. 2, 1997, (which I was 8 weeks pregnant at the time and my birthday), I did not know they were going to use this device. I did not get any pictures of the ultrasound either. Then, 4 weeks later, I had a miscarry. The Dr. said that the baby’s heart stopped about 4 weeks before that. I was blaming the miscarry on the device because of when it was performed. Had I not have had it done, would I still have had the miscarriage?? I asked my Dr. if that could have been possible, he said no, that if so, then you wouldn’t be able to have intercourse. I said but my husband don’t have radioactive-waves or whatever it has, coming out the end of his ‘stuff’. He kind of giggled and that was it.

    Should I have filed a lawsuit? Are there any women that have had a similar problem or something like this?

  219. Thank you doctor! And I should think that one could find an informed, consenting volunteer to provide an image for visual protest. I know I would do it.

  220. I applaud you for standing up and speaking your mind! It is refreshing to hear the Doctor’s point of view, and to see that there are docs out there who agree this is absurd. I live in Texas, and I have had several TV ultrasounds, both for pregnancy and for non pregnancy related medical issues, and each time it has been a painful experience and honestly I did feel a bit violated, even though if I had the chance to go back and re do those instances, I would do it all over again for the simply reason that they were MEDICALLY NECESSARY. Medically necessary and politically necessary and two VERY different ideas. And quiet frankly, these MEN, these non-uterus having, non-vagina having, non-FEMALE politicians making these decisions on the “behalf” of the nations women, need to keep their opinions and politically driven “moral wars” to themselves and let the women decide what will happen to their body when it comes to ultrasounds AND birth control. Sorry, done ranting…….. Thank you for sharing this. Maybe if physcians could stand up and openly speak their minds about these decisions without fear of backlash, the tides would turn. Thank you for standing up for what is RIGHT.

  221. I didn’t get to read all of the comments, but if the doctor who wrote this lives anywhere near Baltimore, or San Francisco, I will be in both those areas over the next month or so and if he will comp the procedure (considering I don’t need it) I will do an ultrasound and sign the rights to the images off to him for exactly that purpose. My sister was raped, and is one of the rare, wonderful pro-life people who respects other women’s choice. Although she and I disagree on abortion in general, even she agrees this is unacceptable.

  222. AC:

    “As someone above alluded to, a transvaginal ultrasound is required (medically necessary) for any pregnancy”

    It’s funny, because, you know, I know someone who once had a pregnancy, namely my wife, and she tells me that she didn’t have a transvaginal ultrasound. Which is weird, because if it were medically necessary, then she would have had it, right? I remember the other ultrasound she had, however. It seemed to do the trick just fine. At least her OB/GYN at the time thought so.

    Also, mind you, calling a procedure that women didn’t have for thousands of years, yet still produced children, as “medically necessary,” seems a little shaky.

    Dear AC: I think you’re probably lying outright about being a doctor.

  223. On this being an anonymous post: It is a nightmare for our medical care that highly trained professionals who–far more often than not–have a deep desire to care, heal, fix, mend–to do their best for us, are now under the thumbs of hospitals, insurance companies, drug companies, and all of their accountants. How can we change that? What exactly can the public do to give doctors who would speak up for us a full voice?
    I see it in every profession these days: teachers, librarians, even journalists, I’m afraid. It isn’t just heartbreaking, but a black hole for health care if doctors aren’t free to use their best judgment and give their best care in every single interaction.

  224. @AC

    I am going to grant your assertion that you are a physician, but I have to call nonsense on your statement that transvaginal ultrasounds are required for every pregnancy. I’ve had multiple early pregnancy exams. None of them have ever required a wand to be inserted into my body. Perhaps that is your standard, but it is certainly not widespread medical practice.

  225. As a Canadian I am relatively safe from this sort of insanity but for my American sisters I am glad you are speaking out against this. I wish even more that speaking out against state-sponsored sexual assault was not a necessary part of providing ethical health care in the US.

  226. Thanks for the great post, and Cheers to Dr. Doctor. I’m still stunned that such a large swath of citizens aren’t rising up in arms about the ongoing assault on women’s rights in this country by the latest round of elected officials. The sooner we can get these American Taliban out of office the better.

  227. As someone who could be an ultrasound tech in a matter of years, YES! I REFUSE to perform a procedure that isn’t medically indicated; I would walk out on my job before I would ever be used as an instrument to harass, terrorize and shame patients. I’ve walked out for less. (Your doctor friend is the kind of physician I would want to work with and to have as my physician.)

  228. Thank you so much for this. I’ve seen several various medical groups vocalizing disagreement with such legislation, but I haven’t gotten to read or hear so much from one medical professional. I can understand the predicament such legislation places on medical professionals to be able to blatantly vocalize their disagreement due to risk of loss of patients due to disagreeing views. It is even more inspiring, encouraging and refreshing though to be able to hear a medical professional’s statements against such legislation. Please be sure to let the doctor know how much this entry is appreciated by countless women and men.

  229. AC:

    You are lying, mistaken, and/or a bad doctor.

    1) Many healthy pregnancies do not need *any* ultrasounds, let alone a transvaginal ultrasound. Ultrasounds are certainly common procedures during pregnancy for various medical concerns, but they’re not “medically necessary” for pregnancies as such.

    2) Ultrasounds are not needed for all abortions. They’re certainly recommended in most cases, but whether a ultrasound — transvaginal or otherwise — is specifically recommended depends on the circumstances.

  230. Reblogged this on mccrabass and commented:
    I’m helping this to go viral. If these aren’t your beliefs, you don’t have to read it. If this post angers you, good. Feel free to reblog. Thanks.

  231. Does the good doctor need a good transcription service? I would be PROUD to work for a doctor such as this, and I am sure any of those who work with me would feel the same. Guts and integrity in the medical community is a FINE thing for sure.

  232. “I’ve got a dollar on the Democrats being too disorganized and cowardly”

    And comments like that are why I don’t play in the party system at all. All it does is divide people up and make them fight. That and the stupid, nonsensical malice towards total strangers lumped into generalized groups. Very intelligent and mature.

  233. I doubt this will survive the pruning of the moderator since it isn’t part of the liberal lovefest going on.

    [Actually it didn’t survive the pruning of the moderator because it was full of strawman arguments and assumptions not in evidence. And just as a rhetorical note, trying to dare me to let a comment stand just because you announce it’s likely to trimmed clearly doesn’t impress me — JS]

  234. I know there was a minor outrage at the NC law that was recently enacted mandating the women view and/or listen to a verbal description of the fetus before
    Being raped is horrible enough. Having the state lay a guilt trip on me was more than I could handle when I found out I was pregnant. I literally could not have lived with that bastards baby growing in me. I did not want to see it or hear about it; I didn’t need another horrible memory attached to a memory of the rape.
    That’s why I ended up going “on vacation” for my abortion.
    I wish more doctors had the courage to stand up for patient rights, not government dictates.

  235. Dear Dr Anonymous, thank you! Normally I don’t care much for those in the medical field. I have seen too many OB/GYNs coerce women into unnecessary procedures during the birthing process. I have seen women subjected to unnecessary exams, pitocin, c-sections, etc because of the CYA society that we live in. I am tired of physicians that care more about themselves than their patients. So it is refreshing to hear from at least one doctor who cares about the women he/she treats. I can’t believe that more haven’t come forward refusing to follow orders that require them to preform exams against a woman’s will. You’re right, inserting anything into my body without my consent is RAPE! Can you imagine trying to talk a woman who was raped into consenting to a vaginal ultrasound against her will? What are these politicians thinking? Clearly they don’t care about a woman’s rights!

  236. Nice try, AC, but I’ve had two pregnancies, and didn’t have a TV ultrasound with either. Somehow I managed to come through just fine without your “medically necessary” procedure.

    Thanks to Dr. A for speaking up on this topic. Too many people are willing to assume that politicians must know what’s best, simply because they somehow managed to get into office. It’s time for everyone to start paying attention and reclaim the rights and responsibilities we’ve been taking for granted.

  237. Okay, I’m going to step in here, and, guess what, I’m going to do it anonymously. The reason for that is I work for the government in one of the states proposing this lunacy.

    First, kudos to Dr. Anon and the guts to speak out on behalf of patients.

    And here goes. Twelve years ago I had an abortion. I did it for personal and medical reasons. Before the procedure I was given an opportunity to speak to a counselor and given every opportunity to opt out – without any shaming. I was never pressured one way or another. I gave my consent at each step of the procedure. I received a vanilla abdominal ultrasound for medical reasons. I saw the image, and, it meant nothing to me. I had made my decision. I had a follow up abdominal ultrasound afterwards to make sure the procedure was complete. At all times, the doc and/or nurse practitioner kept me in the loop and explained what was happening and why.

    If I’d been forced to have an invasive procedure or made to listen to a pulse or a tortured description, it would have done nothing to increase my awareness or make my consent more “informed.” I went to school. I already knew all of the biology. Anyone who ever watched the Discovery Channel already knows all of that and the sight of that white dot had zero effect on my decision. No woman who has made up her mind is going to be shamed out of it. Slut-shaming is just another power ploy. It is another rape.

  238. I can see the issue from this perspective, and understand the resulting outrage.

    Contrariwise, regardless of the merits or failings of the pro-life perspective this argument, taken on its own, is not likely to convince a pro-lifer. If anything, from that perspective, it displays an astounding level of cognitive dissonance.

    I’m not going to waste any time on the line of argument that “no one is forcing a woman to have an abortion so she can get up an leave rather than submit willingly to the ultrasound”, but I do think that it’s important to take a step back and acknowledge the bigger picture that these ultrasounds precede an abortion.

    The likely pro-life reaction to this argument, then, specifically:

    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.

    Absolutely. And your right to swing your currette, saline syringe, or embryotomy scissors ends where the baby begins in the womb.

    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.

    Yes, your hands that are meant to insert “tools of HEALING, for the sake of all that is good and holy” will, instead, be used to insert tools of dismemberment, crushing, and/or burning.

    It is our responsibility, as always, to protect our patients from things that would harm them.

    …such as the trauma of abortion…

    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.

    Any medical procedure. Whatever the pseudo-justification. Including abortion!

    Given this, from a pro-life perspective it seems bitterly ironic that a doctor should appeal to “tools of HEALING” and protecting the patients in the service of murdering unborn children.

    And that is why this argument is unlikely to change any pro-life minds.

  239. AC: Others have pointed out your inaccuracies regarding transvaginal ultrasounds being medically necessary, so I’m going to ignore that. Instead, I’m going to focus on this statement:

    “And, as another poster also indicated, the process of having an abortion usually involves inserting many probes and then a large suction device into the vagina. Obviously, the process of informed consent should include a discussion of this…”

    I don’t see why this needed to be included unless you are trying to argue (as some other anti-choicers have) that because a woman is going to consent to an abortion, THE PROCEDURE SHE IS THERE FOR, she should be okay with any other things being inserted into her vagina, whether they are medically necessary or not. That’s a really disgusting argument to make, and you should be ashamed. Particularly since the women who would be required to have a transvaginal ultrasound under these laws, the ones who are really early in their pregnancy, probably DON’T need suction to have an abortion; a medical abortion will likely be sufficient.

    Maybe you’re actually an MD; that doesn’t make you any less of an uninformed jerk.

  240. Father:

    “Contrariwise, regardless of the merits or failings of the pro-life perspective this argument, taken on its own, is not likely to convince a pro-lifer.”

    However, the argument is not addressed to pro-lifers (in a general sense), it’s addressed to doctors. So your analysis here is largely aside the point, except to the extent that the doctors themselves are anti-choice.

  241. Thanks for this post. I think it’s important to keep this issue separate from the larger abortion debate–I mean, obviously it can’t be TOO separate, but requiring transvaginal ultrasounds doesn’t directly relate to limiting abortions–not like laws that limit the circumstances under which a pregnancy can be terminated, or even laws that require a waiting period.

    What does a transvaginal ultrasound do that an ordinary ultrasound doesn’t? It makes a woman feel like crap.

  242. @ AC I call BS on you being a doctor. I have had many miscarriages, an abortion and am currently pregnant (9 months) . I have had one TV ultrasound, and this was because I did not have a full bladder early on, my OB/gyn asked if I would like to come back another time but I could not be bothered so went ahead with the TV ultra.

    If a woman is suspected of having an ectopic pregnancy she would have an abdo ultrasound first. Your logic is absurd, you do not start with the TV ultrasound, you have a TV ultrasound if any problems are detected via an abdo ultrasound and require further information that another abdo could not provide.

    Luckily I live in NZ, I remember with my abortion having to have an abdo ultrasound to confirm dates, I was not shown the screen instead they had a tv going, the technician did not talk to me however a nurse came in and held my hand the whole time, distracting me from what was going on. Had I wanted to look I would of been able too.

    Also there is a medical abortion in which no instruments are inserted.

    I am so sorry to any woman that has to go through this procedure and to all women and men in America, it seems you are not living in the land of the free anymore.

  243. @Father –

    I don’t give a damn about changing any “pro-life” minds. I’m only interested in keeping their hands off the laws that allow me and mine my *legal* choices. It’s that simple.

  244. Caroline,

    While these laws may not directly limit whether women can obtain abortions, effectively they may have the same effect. At the very least, they make them harder to obtain. The ultrasound itself must be paid for, which is an additional cost. Also, to my knowledge, there’s a mandatory waiting period AFTER the ultrasound of at least 24 hours. So the woman must take 2 days off of work, get transportation for 2 trips, etc…. This adds a burden of cost and time that many women cannot afford; oftentimes that’s why they’re seeking an abortion in the first place.

    So no, the laws don’t say “Women can’t have abortions.” They just make them exponentially harder to obtain, for no reason other than to slut shame.

  245. I have been pregnant 7 times. I have 4 live children. I has 2 miscarriages that occurred without intervention and 1 that required a D&C. The only time I have ever had a vaginal ultrasound was when I was 5 weeks pregnant with my 5 pregnancy (my second live birth). I did not require a vaginal ultrasound to determine the location of any of my spontaneously aborted fetuses, including the one that required a D&C. An abdominal ultrasounds was sufficient in determining fetal demise and location of the fetal pole and sac. So I call bull on your assessment of a vaginal ultrasound being medically necessary for an abortion.

  246. Last year I was forced to have a trans-vaginal ultrasound for medical purposes not related to an abortion. It was supposed to be an external ultrasound, but due to several issues that was not possible and was told I either needed to submit to the invasive ultrasound or wait another month in hopes of being able to do the external one (without any guarantees of it working then either). As a survivor of rape I can tell you that is exactly what it felt like to me, especially based on the callousness of the provider during the procedure. I felt as though I was being raped and paying for it!

    I wish more doctors were standing up against these legislations, and applaud Dr Anonymous for speaking out. If only we could get more people to step forward to prevent the application of the bills that have become laws and prevent the current bills from getting that far.

    I live in Idaho where one of the state senators actually said that women lie about rape & incest in order to obtain abortions. It seems like there is no end to the disrespect being put forth against women and their health issues all in the name of “educating women” and trying to “prevent abortion” (which is a constitutional right per the Roe v Wade decision of the US Supreme Court).

    Thank you again Dr Anonymous for speaking up, and I hope that your patients know how lucky they are to have you in their corner. And thank you Mr Scalzi for allowing this forum to exist!

  247. [Deleted because it was already deleted once, and isn’t any less full of strawman arguments and bad assumptions the second time –JS]

  248. Knowing there’s at least a few doctors out there that care about their patients THIS much is helping me deal with the vitriol and misogyny. Thank you.

  249. I’ll say this too: Thank you, Dr. Person. I only wish doctors could speak up without risk of threats or reprisals.
    The irony. You mention your atonomy. I would like to mention my atonomy. Or at least the atonomy I thought I had as a natural born citizen who is (or was) protected by the same equal rights afforded to all other Americans. My mistake. I don’t remember any exceptions in those rights. Like…you have equal rights except if you’re pregnant. In which case some political nitwit somewhere will make his stand on your “body” and he will let you know what he decides. And by golly, if he can punish you in some punitive way for getting pregnant if the first place, (you slut!) so much the better. I can’t even comprehend this utter nonsense…let alone understand why women are suddenly under attack like this!
    American Woman

  250. Superior
    I applaud this doctor for coming out about the medically unnecessary trans-vaginal sonogram. There are many doctors that will blindly go along with the law.
    In my 30 years in radiology, 15 years I practiced diagnostic medical sonography. I learned that most doctors I cam in contact with were republicans. There are some that may share the views of this doctor. Others will follow the law without thinking. The ones that subscribe belief of the type of men that me up and passed these laws would not be doing abortions .

  251. Dr Anonymous thank you for saying what I have been thinking. My biggest mistake that I have ever made in my life was not becoming an abortion doctor like I planned. It was the one time in my life that I did what was easy and I regret it but the fact that you have to post anonymously is the reason I didn’t. Thank you for being braver than I was. Thank you again for taking a stand for what others equally brave have not. How disgusting is it that men who never fear being raped (not that they can’t be but most in this category haven’t been and certainly don’t fear it) can prescribe it for those who might have been and haven’t reported it. Even if you haven’t been raped why should you have the government dictate your medical treatment. Lastly it enrages me that anyone thinks that the government doesn’t have the right to mandate who gives money and how much money they give in elections but it is okay to coerce me into sticking a probe into my body. It is not a war on women, women of means will always find a way it is a war on poor women – which is ironic because when that baby comes out of the womb it will starve.

  252. Thank you for this post. I agree completely and I would add, when the law requires a woman seeking an abortion to fill out a questionnaire asking for private information about her marital status, finances, sexual behavior and choices, the doctor should counsel her that leaving a question blank is an acceptable answer.

  253. Thank you so much for speaking out. As a woman and a healthcare worker, I have been thinking “where is the physician outrage?” for some time. None of the doctors I know would want to stick a probe up a woman’s vagina without her consent. I thought doctors would be up in arms over politicians forcibly inserting their ideology into doctor’s work (much in the same way women are up in arms over the forcible insertion of probes into their vaginas). Thank you again for speaking out because I was starting to wonder about the status of “first do no harm.”

  254. As someone above alluded to, a transvaginal ultrasound is required (medically necessary) for any pregnancy, and particularly those that are scheduled to be aborted, since it is extremely important to 1) ascertain whether there is a fetal heartbeat (if not, then the pregnancy is non-viable anyway, and the abortion is not necessary)

    Liar. Liar on multiple counts. TV ultrasounds are NOT necessary for every pregnancy, and a fetus with no heartbeat still has a good chance of needing to be aborted, because they don’t all pass out of the body and carrying a dead fetus can kill you.

    And, as another poster also indicated, the process of having an abortion usually involves inserting many probes and then a large suction device into the vagina.

    That was the case some years ago, when I had my own abortion, but I just went with a friend a few weeks ago and sat with her while she had one. She did NOT have a TV ultrasound, and the procedure itself required only a speculum and a (very small) hand aspirator (looked kinda like a baby turkey baster, actually). In addition to being a lie, this statement is a red herring, because an abortion is either elective or medically necessary, and state-mandated TV ultrasounds are neither.

    You are a liar.

    And Father, regardless of what the anti-woman perspective claims, a fetus is not a baby; most abortions do not involve dismemberment, crushing, or burning; abortions are rarely traumatic for the person having one, certainly not as traumatic as the unwanted pregnancy or the defects incompatible with life that required an abortion to be performed; and abortions ARE healing for many of us who have them. Certainly mine was.

    If you’re anti-choice, anti-woman, be honest about it. If you’re pro-choice, stop making the other side’s case so very poorly; it does no one any good and makes you look like a nitwit.

    I think it’s important to keep this issue separate from the larger abortion debate–I mean, obviously it can’t be TOO separate, but requiring transvaginal ultrasounds doesn’t directly relate to limiting abortions–not like laws that limit the circumstances under which a pregnancy can be terminated, or even laws that require a waiting period.

    It does, though. First, it is a shaming tactic, meant to turn people away. Second, it is a fear tactic, meant to scare people away from the procedure itself. And third, it is an economic tactic, meant to cost people more money, which will prevent some people from being able to get an abortion.

  255. I go out to dinner and come back to 200 more comments and a Mallet swinging like I’ve never seen it swing before. Screw TV, this is true entertainment!

    On-topic: The problem with everyone trying to draw analogies to colonoscopies and other procedures is that pregnancy HAS no analog; it is the only life-creating medical condition we’re aware of. Any equivalency is therefore automatically suspect, at best. I think it is better to do as Dr. Anon has done (and I both agree with and admire him for his views expressed here), and start from first principles. You still won’t convince many people to switch sides, but your logic will be cleaner.

  256. Sorry for the double post, John, but I want to apologize for the use of “him” and “his” in referring to Dr. Anon, above. I could plead standard English or general tiredness, but the truth is, when I read the message, I “saw” a man, and that’s what I went with. Sexist, perhaps, and I will try to be more cognizant of what I write.

  257. [Deleted yet again, and Christine is about to meet the banned queue. Enjoy, Christine! — JS]

  258. Despite being a person who is, generally, pro-life (except in the cases of rape, incest, or where the health of the mother is in danger, sorry but for me pregnancy is a risk associated with the decision to engage in sexual intercourse) and is a moderate republican, I have to agree that these types of laws can not, and should not be on the books anywhere. To medically mandate these type of tests, or any medical procedure, starts us down a long and dangerous road. I would potentially argue that a state or government may have the right to put restrictions (right or wrong) on government funded clinics in regards to medical procedures, but not in the privately funded areas. For me personally, the best argument against these types of procedures being required is that I do not want to see women being being forced to get abortions done in the “back alley” by someone who is not qualified, etc. Even though I may be against the idea of an abortion this type of legislation can only have negative outcomes.
    This comes about, in my opinion, because unfortunately no-one (on either side) can effectively get elected without pandering to their ultra-liberal or ultra-conservative bases in today’s electoral process, if the politicians don’t do this they get “black listed” and their chances of winning an election fall to zero. I find this most unfortunate because the majority of the public (both democrat and republican) are much more central in their beliefs than most of the politicians. I, as a republican, can admit that republican ideas are not always the best and that an idea from (gasp) a democrat may actually be good for this country. If you are right or left and feel that the other side has nothing to offer and turn down all those ideas simply because they come from the right or left then you are the cause of the problem, not a solution. I hope that these types of legislation fail, however as long as we have such a polarized political system these types of ultra-conservative ideas (and the ultra-liberal ideas on the other side which are also generally bad for this country) they will continue to arise and that is a sad commentary. The system is broken, I don’t know how to fix it but we need to find a solution quickly and I’m not sure that is going to happen.

  259. Thank you for speaking out, even anonymously. This is such an important issue and there is so little intelligent dialog. Very few physicians have spoken up, pro or con. The medical community is being used (at great monetary and emotional expense) to punish women who seek *any* reproductive services. You are a credit to your oath and profession. I want you as my PCP!

  260. Another thank you.

    “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.”

    A good beginning.

    And at a time when people are so afraid of loosing their jobs that they fear standing up and helping others when needed, again thank you.

  261. This is a great piece. I am only an observer of this debate (I live in Australia), but it’s been awful to watch, and this is an important point of view that I haven’t seen get any air time… and it really needs some. So thank you both.

  262. To those who besmirch the anonymity I remind you –

    “Common Sense” was published anonymously
    Benjamin Franklin used multiple pseudonyms
    “The Federalist” was published under the pseudonym ‘Publius”

    For all the same reasons this doctor chose anonymity. Those who demand to know the name – are you planing mischief?

  263. First, thanks John for providing the space here, and thank you Anonymous Physician for writing it.

    AC is no doctor. Any doctor would know that abortions sometimes ARE necessary when the fetus has died, in order to keep the woman from dying of septicemia. When it’s late in the pregnancy, the abortion required is the infamous “partial-birth” abortion. The laws about this procedure have caused more than one woman massive emotional trauma and risk of death.

    In fact there are several references in this comment thread to the case of a woman who didn’t WANT an abortion, but whose fetus died, and who was subjected to these horrors because of these asshole legislators (in this case the Texas Talibangelical assholes).

    Abortion is a legal procedure in this country, and has been since 1972. The Supreme Court of the United States has said that it cannot be outlawed constitutionally. These laws are attempts to end-run that decision. Possibly canny attempts to push the issue to a conservative (if not outright partisan) SCOTUS that they hope will overturn Roe v. Wade, I don’t know.

  264. This doctor is obviously NOT qualified to post this article if she doesn’t know that an ultrasound is required before ALL abortions for safety and that in early pregnancy transvaginal ultrasounds are the only option (abdominal ultrasounds cannot pick up the unborn child until a certain gestational age.) So, the reason physicians aren’t speaking out against transvaginal ultrasounds before abortions is because they are medically necessary to ensure the health of their patients.

    Its time for folks to stop playing political games and to stop calling this necessary procedure “rape.” It is a doctor’s job to protect and heal those he/she treats and anyone likening an ultrasound to a heinous act only serves to harm women. Are these folks going to call pelvic exams and breast exams “rape” and “molestation” next? I certainly don’t find these exams pleasant or comfortable, but I know I must have them for my health. OR, do you only come up with these ridiculous arguments when it has to do with abortion?

  265. I’ve been wondering where medical professional’s outcry has been. But then reading the following heartbreaking link, I think many of them are hiding behind “I could lose my license:”

    Thank you, Dr. Anon, and Mr. Scalzi. I will spread the word of your post, the one thing finally giving me some optimism in the face of all this, as far & as wide as I can!

  266. Drs will be dealing with not only the medical rape of women (actually that will probably be the least awful part) but also the fallout from women that seek abortion elsewhere, or not at all because they can’t face having to see the ultrasound. Drug addicted fetus’, disabled and brain damaged children, haemmorage, retained products, blood transfusions, women bleeding out at home, hysterectomies, malnourished and neglected children, abandoned babies – many of which will die.

    Talk to older physicians – I’m sure they’ll have many awful stories of the days of backyard abortions and too many unwanted pregnancies.

    More Drs need to stand up and refuse to implement these barbaric misogynist recommendations. for their patients sake and for their own sakes. First do no harm!

  267. Dr. Anonymous — I, too, have been wondering where the doctors are. Where the AMA is. Where medical ethics died and were buried. Why there is not already a suit against the new Arizona law that says doctors can lie about or withhold relevant medical information “if it might prevent an abortion.”

    As for that ultrasound image. If you’re anywhere near me, I will offer you my menopausal uterus to image and give you whatever releases you need in order to broadcast it to doctors to use. Ask John to give you my email to contact me. If I can get to your office, I’ll be there. This has got to stop.

  268. I think we should have a pool on how long it will take John to re-ban certain banned posters who keep going to another computer. Really, what a stupid fugghead.

  269. Thank you, Dr. A, and thank you, JS. Glad to see this is getting such wide recognition across the Intertoobz (though I’m sure it’s a bit of a moderating headache, to say the least).

    I had a TV at age 23 to check for polyps. I didn’t even know such a thing existed until the tech pulled the wand out. The idea of forcing that procedure on someone when not medically necessary is abhorrent. For the life of me, I can’t understand women legislators who vote for these bills in their states.

  270. Another woman chiming in to call BS on AC’s TV ultrasounds are required for all pregnancies. I’ve had two pregnancies and more ultrasounds than I can count, and not one of those was transvaginal. You know what were? The two that were necessary to figure out what the heck was going on with my fibroids.Those were painful, invasive, and left me cramping for days. I would not wish one on my worst enemy.

    Thank you, Dr. A for speaking out and Mr. Scalzi for giving you the space to do so!

  271. Myself and another Nurse helped secure the first permits for the marches at Virginia’s Capital and have been out front on this, speaking on this issue, and in the gallery of the state house observing its debate as my schedule allowed. I call on all healthcare professionals to lend their voices to this medically mandated malpractice that violates our oaths of professional practice and meet the standard of legal battery, coercion and object penetration assault. We also need to stand against the Blunt amendment, the personhood bill and the 1000 plus other bills nationwide that mandates healthcare professionals to do give care the way untrained legislators want them too, regardless of whether it mandates inferior care, does not meet professional standards of practice, or violates HIPPA. I sign my name= please join me- Eileen Davis,RN Richmond Va

  272. Who said “Letting congress practice medicine without a license endangers the lives and health of women. “? Whoever it was, I couldn’t agree more.

    I’ve had 2 transvaginal ultrasounds (done with proper communication and consent) and they’re REALLY invasive. That procedure should never be mandatory.


  273. As a fellow physician I feel exactly the same. Where are we now that our patients need us to protect them from the folly of ideologically driven psychopath politicians???

  274. As someone who has had more transvaginal ultrsounds than I can count (due to fertility issues), I applaud you. I wouldn’t wish that procedure on anyone where it is not medically necessary.

  275. As someone who lost his mother from a backyard abortion and especially since the pregnancy was due to a ‘rape’, I both understand and feel the anger against such backward , no obscene laws.
    I do have to make the larger point that this insult to human rights is merely the latest of a long line of politically (power) motivated divide and conquer legislation.
    I would appeal to the moderate Republicans to also give us back a party of note one that focuses on that with belongs to Caesar and people and leaves religion and souls to God’s capable hands.

  276. Also, I have had a transvaginal ultrasound with EVERY pregnancy and most women I know have had them as well. To say that they are not common with very early pregnancy exams is a lie–they are indeed common and the procedure is NOT as uncomfortable as one would think. Having a large, cold metal speculum inserted into your vagina and having your cervix scraped for an annual pap smear is much more uncomfortable than having a small plastic wand inserted for diagnostic purposes.

  277. A response to John, not because I think it needs to be addressed to you specifically, but because your comment happens to relate to the two cents I wanted to throw into this discussion.

    A transvaginal ultrasound is not required, but more practices are starting to make them standard for any pregnancy at 6-8 weeks. There was one for both of my children, ages 6 and 2. Is it medically necessary? No. Does it reduce risk? Absolutely.

    That’s why I have a problem with your last sentence. “Also, mind you, calling a procedure that women didn’t have for thousands of years, yet still produced children, as “medically necessary,” seems a little shaky.”

    Two problems. First, there are lots of medical procedures that people didn’t have for thousands of years that are now common place and save lives. It’s not that they weren’t medically necessary for thousands of years, just that the knowledge wasn’t there. Second of all, women for thousands of years didn’t have these procedures and guess what, the mortality rate was far higher than it was today. How many women died as a result of pregnancy who would have otherwise survived if a medically necessary procedure had been invented.

    On a separate note, in relation to what happened in Virginia last month, the whole legislative debate was more show that statemenship. Virginia Planned Parenthood already conducts transvaginal ultrasounds before any abortion (and in some cases two). If they bill had become law, nothing would have changed. Now that the bill isn’t law, nothing has changed.

    That doesn’t take away from the larger debate, which is namely that any patient should have the right to refuse any procedure that they don’t want and that no medical procedure should be legally required.

    Of course, that doesn’t mean that laws couldn’t be passed to say abortions couldn’t be performed without those procedures, but that’s a different discussion. And before anyone gets upset about that, requirements like that are routinely imposed. If you doubt that, investigate why the drinking age is no longer 18 years of age.

  278. Thank you for speaking out. I say put take out a page in the NYT, WSJ, etc and put this letter front and center!

  279. Thank you. This is highly commendable of you both and extremely helpful to someone considering medical school. I think it would be a really good idea to get this piece out and available to as many people as possible. If I can aid that process in any way, please let me know.

  280. Lisa:

    “This doctor is obviously NOT qualified to post this article if she doesn’t know that an ultrasound is required before ALL abortions”

    Actually, it’s not, unless that requirement is mandated by the state. Here’s a guide to that.

    “Its time for folks to stop playing political games and to stop calling this necessary procedure ‘rape.'”

    Actually, it’s time for people to stop playing political games and trying to force a woman to be vaginally penetrated by a diagnostic tool against her will.

    “Also, I have had a transvaginal ultrasound with EVERY pregnancy and most women I know have had them as well. To say that they are not common with very early pregnancy exams is a lie–they are indeed common and the procedure is NOT as uncomfortable as one would think.”

    How delightful for you. Have as many transvaginal ultrasounds as you like. Don’t force them on those who don’t want them.

  281. God, some people are DETERMINED to be ass backward, impolite and STUPID. Not to mention the outright liars.


  282. Lisa- you need to look up “consent” and try to understand it. Also – might I suggest – read the rest of the thread. Your argument is not persuasive.

  283. Honestly, I wish this stupid fucking jackhole would give it a rest. Your comment is unacceptable here. This is John’s space. You do NOT have the right to comment here if he doesn’t want to let you.

    Go away, go directly away, do not pass Go, do not collect $200.

    John, if this seems like a reply to the fugghead’s comment, I’m sorry and will offer my head to the MLC.

  284. On a separate note, in relation to what happened in Virginia last month, the whole legislative debate was more show that statemenship. Virginia Planned Parenthood already conducts transvaginal ultrasounds before any abortion (and in some cases two).

    Hm. That’s funny. I saw references that they did this in only specific circumstances. Reference, please?

  285. What I find particularly onerous is the “But Planned Parenthood are doing ultrasounds before abortions anyway!” argument.

    Personally, I think that only ideological blinders would make a person deny that a state-mandated transvaginal ultrasound is mainly an attempt to lay a guilt trip on the patient. That said, even if the doctors, the equipment, and the procedure are exactly the same as the routine PP pre-abortion procedures, the difference is huge: one way involves government coercion.

    Saying that a forced vaginal ultrasound is exactly the same as a medically indicated one as determined by a doctor just because they’re done in the same place, by the same people, and in the same way (but with different levels of details disclosed to the patient) is like saying that rape by a husband is exactly the same thing as consensual intercourse because the actors and the mechanics involved are exactly the same.

  286. @ Bearpaw

    What experience do you have that I am “mistaken or lying?” Post your proof here. As for my proof, Planned Parenthood itself has noted that it always provides an ultrasound before an abortion. And medical literature states that an abdominal ultrasound cannot detect a pregnancy in the very early stages. Heck, even this pro-choice page states that transvaginal ultrasounds are the way to go until after 6+ weeks gestational age:

  287. Would someone who knows how to do it pleas post this site on Twitter. I want everyone to be able to read this message.

  288. Thank you John Scalzi and thank you Dr.Anonymous. I wish more doctors were like you and I hope many of them take your word to heart. We need people of good conscience to start standing up and refusing to go along with this kind of outrageous legislation.

  289. Well said Dr Anon!

    I have had numerous transvaginal ultrasounds, I don’t find them all that bad. The first one was when I was about 8 weeks pregnant. The second being at my 20 week ultrasound…. that one I am truly thankful for, that one saved my sons life. It was then determined that I had a very bad incompetant cervix which could only be seen by using a transvaginal ultrasound. Shortly after that I went in for an emergency cerclage…. which stitched my cervix closed at a very thin 1/2cm that was already dilating. Luckily, thanks to that procedure (and a whole lot of bedrest), I have my darling 8 year old son. After the cerclage was placed, I pretty much had a transvaginal ultrasound every week (sometimes more) to check my cervix and cerclage. Did I love it? No, not really. But, I really don’t think they are as bad as some have described and I never needed pain killers or anything to combat the pain involved, it was a slight discomfort for a few moments. My second pregnancy, I pretty much had them weekly from about 12 weeks on for the same reason. So I would say I have had roughly 45 (maybe more) of these types of ultrasounds. Obviously, in my situation they were both medically necessary and recommended. I’m thankful for them since without them I likely would not have my kids.

    That being said…. Kudos to you Dr Anon for speaking out! I very much agree with you. On the other side of the coin, I have also had an abortion. I can safely say that I would have been horrified if I had to witness an ultrasound, go through all that, hear the heartbeat and be lectured about it. The way the law has been described, it is truly wrong on many levels. If they need to do a quick ultrasound to make sure of possition of the fetus and that type of stuff, then that I feel is ok. But, the rest of it is very uncalled for! I hope more Drs speak up against this law. It should truly be up to the patient and recommended only when a Dr feels it be important for the situation.

  290. Lisa, dear, your arguments are not internally consistent. And…try reading the rest of the thread.

  291. Could not agree more with you and the anonymous MD. I hope the moron level doesn’t increase overnight. But I fear it will.

  292. I am a sonographer. I agree completely with you! We should be able to refuse to participate in this procedure just as those who are pro-life have been able to refuse with abortion procedures .

  293. I agree with the sentiment expressed, that these invasive laws are politically driven to punish, and are likely unconstitutional or violate legal rights, and that physicians are probably in their legal right of refusal.

    But I don’t believe whoever wrote this a physician. The whole tone and verbage sounds suspiciously like a non-medical activist, not a physician. ESPECIALLY a physician who is ostensibly speaking to OTHER physicians. I work with physicians, practitioners, and other medical professionals and I’ve never experienced a physician employ so much hyperbole and common slang when speaking to other physicians on a professional issue. I mean, inserting any item into any orifice without consent, is “rape”? Otoscope in the ear, tongue depressor in the mouth? that’s rape? Yes, i realize my anti-example is extreme but no more extreme than the hyperbole I am pointing out /ad absurdum/

    If, for sake of argument he is a physician, then he should practice what he preaches about professional responsibility and sign his name on his position. Not hide behind anonymity of someone else’s blog. Sorry, physicians aren’t in “precarious” employment positions, I don’t buy that argument.

    I’m sure to get slammed for this, but my point is this: we’re being told here by this blog author that “Doctor Anonymous” is indeed a real physician, who is for whatever reason afraid to speak up on professional issue, so must resort to covert drive-bys on a random blog. And we’re out of bounds to question it.

    This is not like real journalism when an anonymous source highly placed in a particular institution is distilling public information at the risk of their career. Just some presumably average Joe Physician, maybe just a Doctor of Osteopathic or even Chiropractic, for all we know. But the burden of proof is on the author to present his credentials, and the readers are not required to suspend critical analysis.

  294. Great post. Thank you Dr. Anonymous, and thank you John for providing the space and wielding the Mallet with your customary skill.

    Count me in the “I’ve had a transvaginal ultrasound, and it was not something I’d wish on anyone” camp. (Emergency room for excruciating abdominal pain from what turned out to be a fibroid and an ovarian cyst. Tech: “It’s just like inserting a tampon!” Me: *stares at giant wand, thinks: What the hell kind of tampons are YOU using?*)

    I’m Canadian so I’m not affected by these bills directly. Unfortunately some of our less progressive MPs seem to be getting ideas. I’m watching nervously.

  295. Thanks for the article, thanks for giving it a venue, and extra thanks and love for The Mallet of Loving Correction.

  296. “This is an honest question. If my doctor lied to me, destroyed my trust, didn’t inform me, didn’t ask my consent for a procedure, should that doctor continue to have a license? My answer is ‘no’. But how would the medical board of each state answer that question? It scares me to think they might answer ‘yes’.”

    I have fired doctors for far less during a rigorous cancer treatment. But this isn’t about licensing, or telling politicians to stay out of our lives. Not at all. As the brilliant Dr. A suggests, there is really no way out except quiet resistance. The Underground Railroad was a very quiet one. It changed the world.

    Why seek a political solution to a personal issue? Several above posts are correct. This “War on Women” is smoke and mirrors. Are we, as women really going to allow it? Yeah. Right. (Suffragettes anyone?) And now, more than once, we’ve heard from the medical profession, correctly, anonymously. They too will stand.

    Problem solved. The issue STILL remains between doctor and patient because we BOTH refuse to allow it to be any other way.

    With many thanx (and I GOT this article from an oncologist!) and much relief,
    A Relieved Patient who knows she’s not alone.

  297. @Kathleen

    Are you saying that a woman should have an abortion without the proper diagnostic tests for it to be a safe one? If there is a “war on women,” surely it is being waged by all of you that would want her to go in for a “blind” abortion where the doctor has not been able to ascertain the age of the fetus and the method of procedure required. Up until a certain point, that cannot be done with an abdominal ultrasound. If a woman is farther along, then she can go the abdominal route but, otherwise, she’ll need the transvaginal ultrasound or will need to wait until she is farther along in her pregnancy and able to receive the abdominal scan.

  298. This is not like real journalism when an anonymous source highly placed in a particular institution is distilling public information at the risk of their career.

    No, just at risk of their life. Dr. George Tiller, hm?

    This was a particularly ill-informed comment.

  299. you still have no demonstrated that you understand what “consent” means, Lisa.

  300. First, I think the terms, ‘rape’ and ‘murder’ are used as a tool to outrage folks on both sides of this argument. I mean really, if it’s your position that a woman is being ‘raped’ because of this law then it’s disingenuous to believe that stopping a heart beat is not ‘murder’ when doing abortions.

    [Second part deleted because as noted several times before, I’ve stopped entertaining comments on the validity of the doctor posting anonymously. Please read the rest of the comment thread, folks — JS]

  301. Lisa:

    “Planned Parenthood itself” says that it generally *recommends* an ultrasound before an abortion, for *medical* reasons. There is a huge difference between that and the government *requiring* one for *non*-medical reasons.

    Thus, you are mistaken or lying.

  302. I work as a clinical psychologist. What hasn’t been voiced here is the reality check far too many are procrastinating on receiving-but one whose time eventually comes. In my practice, with a wide demographic, about 40% of my female clients report having had abortions also report they got by without the reality check until wanted pregnancies happened- and only then did they feel they even had a working concept about the enormity of their decision to terminate. Most report, if they’d seen an ultrasound of their to be aborted baby ” doing flips and rocket man jumps” inside their bodies, they’d have made different decisions or at least have processed the brutal reality of the death of their unborn in its own timeline— and not been subjected to the absolute grief and felt loss of their first child while seeing their first full term wanted baby for the first time. A decision to not look, not know, just get it over with and get on with life is not really a decision a future mom to be really gets to make. It catches up eventually – and unfortunately- it appears it chooses to reconcile itself psychologically during a wanted pregnancy – which optimally is a time of great expectations- and not regret. I’ve asked my clients who’ve had this experience of their past reproductive decisions catching up with them during a full term pregnancy how they feel about this current debate going on – and I’m not saying anything for or against or for what’s going on — but I doubt the coincidence that my clients psychologically failed to come to terms with their behavior, decisions, outcomes in a suitable timeline. The emotional torment or felt punishment those opposed to inflicting on already emotionally distressed women at the time of abortion via a trans vaginal ultrasound — appears to come eventually—with or without any political shenanigans of any interest groups wishing to project themselves into the lives of others or not.

  303. @Mary Lynn Reed – similar legislation is on the docket in Tennessee. Here, demographics (but not actual names) of women who received abortions AND the name of the doctor who provided that abortion would be published on the internet. And since the State of Tennessee has experienced something along the lines of 2-4 huge security breaches involving personally-identifiable data in the last few years, this is ridiculously risky. The names of the women behind those demographics would be made public by some well-meaning hacker in two shakes of the proverbial lamb’s tail.

  304. @ Bearpaw

    Please do your research and search for the many articles in which Planned Parenthood officials note that it is policy to do an ultrasound before an abortion procedure. Or, you can just go to Planned Parenthood’s own press release to see that they always do it:

    “Ultrasounds have been a standard part of abortion services and are always performed on every patient before any type of procedure is done.” (From the above link; so mistaken and lying I am not. Touche.)

  305. I mean really, if it’s your position that a woman is being ‘raped’ because of this law then it’s disingenuous to believe that stopping a heart beat is not ‘murder’ when doing abortions.

    No. It isn’t. Murder is of a living, already-born, legal person, which a fetus, heartbeat or no, is not. But non-consensual insertion of an object into a vagina is, in fact, rape. The FBI even agrees with me on this.

    A decision to not look, not know, just get it over with and get on with life is not really a decision a future mom to be really gets to make.

    Yeah, actually, it IS a decision we get to make. I had an abortion. No ultrasound would have changed my mind. I will never, ever be upset that I had one. And you are a terrible psychologist, if indeed you are not lying about it. There are NO studies that bear this idea out, either.

  306. Matt (March 20, 2012 at 3:59 pm) said:
    “what I propose is that this is a smokescreen to obscure the public’s attention to something else that is going on. … it makes a lot of sense as a diversion to direct the media and the public’s attention away from something else”

    Yes! I don’t know if I’d call it a smokescreen so much as a classical negotiation tactic. When you’re negotiating, you ask for more than you think you can get, so that getting what you want will seem like a compromise. So, you want all abortions to be outlawed after the first trimester? Propose outlawing them after the first heartbeat — you’ll look like you’re compromising when you retreat to your “more reasonable” position. Want to control all abortions? Suggest controlling birth control — merely banning abortion seems so level-headed by comparison. The states are just pixels in the big picture. Having extreme legislation on the table and in the news is what’s important. The goal is to shift the entire debate to the right. The goal is to overturn Roe vs. Wade at the federal level. They’re asking for more than they think they can get, to ensure that they get what they want.

    And for those who argue that abortion is murder: Denying abortion to women with life-threatening complications of pregnancy is murder. Shooting George Tiller was murder. If you want to conflate a living, breathing, human being with a partially differentiated cluster of cells, then be my guest–but don’t expect me to go along with it.

  307. Lisa, some of us are not impressed with your clumsy sleight of words. Trying to play a fast one in this crowd takes more skill than you can muster.

    And, yes, you are either mistaken or a liar. Ultrasounds are not all the same.

  308. yes, I’ve been ‘on record’ for years.

    And your life was actually endangered? Well, I’m impressed. What were you threatened over?

  309. “…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.”
    In quoting the above I have not missed the message but find there is a broader message which is missing all the time. I am referring to the Corporate greed of “Medical Institutions” which decide for me and for my Dr. that the state of my health is only worth 10 or 15 minutes of the greeds precious time every year or so. It also dictates that I talk to the back of my Dr.s head while he/she types their notes on my case. Appropriate health care mandates no only peering into infected or affected orafices but also looking fully into the face of the patient with interest, with curiosity and with authentic concern for both the spoken and the unspoken afflictions of that individual. Todays topic while worthy of outrage only addresses a sliver of the mass of suffering which corporate and political greed wants to load upon the back of humanity.

  310. Every doctor should sign on as “Doctor Anonymous”. It’s a very slippery slope from the doctor who performs state-mandated rape to Dr. Mengele, who after all was just carrying out ideologue policy.

  311. Thank you for allowing this post and thank you to the doctor who took the time to have this discussion in at least a cloistered forum. If I had a uterus anymore, I’d let it’s picture be taken to stuff in all those medical files…nationwide! This is the first time I’ve felt a glimmer of hope over all this bullying and abusive legislation against women. It has always puzzled me why doctors (and nurses) are not publically speaking out in our defense. Yes, I appreciate ‘career protection’ but, things have gotten out of hand! And I am puzzled that GOOD legislators are not jumping up and screaming. All this tarnishes their names, too!

  312. LISA: “Are these folks going to call pelvic exams and breast exams “rape” and “molestation” next?” If those pelvic exams and breast exams are state-issued and mandatory when a woman tries to exercise free will and self determination, yes, they would be. I’m glad I haven’t seen bills with such provisions proposed. These legislators can’t legally hand out an aspirin, but they can do this?

  313. A reminder to all and sundry that I’ve declared the issue of the doctor’s anonymity here settled, and am going through snipping out comments relating to it. If you’re new to the thread and need a reason why I’m doing it, read earlier in the thread.

    Also, a general note: I’ll be turning off the ability to comment on this read when I decide to go to sleep tonight (probably around midnight, although possibly after). The reason? Because obviously this thread need me sitting on it. I’ll reopen it after I wake up tomorrow. Just a fair warning (slightly) ahead of time.

  314. Thank you for sharing your blog with your physician-friend. Your site came to my attention via my fellow blogger Jules A. Gray reblogging you. It’s comforting to know that there are conscientious doctors out there that are outraged and find this legislation morally reprehensible. I’ve had this procedure twice for medical reasons. It wasn’t fun either time especially when the probe applied pressure near my bladder. That felt very uncomfortable. It’s too bad that every elected official that is a guy cannot slip into a woman’s body just to experience what a trans-vaginal ultrasound is like. If he could, I suspect this legislature would disappear faster than the speed of light.

  315. There are days I hate computer login systems. That’s a long rant for later.

    Thank you, Doctor Anon. Thank you, Mr. Scalzi.

    In my opinion, those of you objecting to anonymity are trying to, or at least hoping to, substitute attacks on the person of Dr. Anon for analysis of the position advocated.

  316. Thank you SO much for this post -it’s refreshing to hear from a doctor on this subject! It is important to remember the power the practitioners have in this regard -if they refuse to perform the procedures, it’s not like these ‘lawmakers’ are going to spend their days at the doctor’s offices to do it either.

    Off topic, slightly, but I have a question for the good doctor:

    “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.”

    Does this apply to routine infant circumcision too?

  317. For me, the issue is very simple and can be boiled down to four words:

    My body, my choice.

    Thank you, Dr. Anonymous, for speaking out. I have shared this in multiple forums.

  318. Some of you will choose to ignore the facts (You’re just going to ignore Planned Parenthood’s own words when I post them, but not when you post them? Strange.) so that you can continue pushing a political agenda. That’s fine. But as for me, I’m more concerned with the safety of the women who will be may be receiving abortion procedures without the proper diagnostic tests. Way to be hypocrites and act more like a page frequented by a bunch a bullies with blinders on than a forum for intelligent debate. If somebody has a view that is different than yours–especially when it is backed by cited evidence–and you immediately call that person out as being “fake” or a “liar,” it screams of a childish temper tantrum, not of an adult conversation.

    I mean, here are more documents from Planned Parenthood stating that an ultrasound will be preformed before an abortion (this time from the clinics in Arizona and TX). Regardless of what you are reading on the “what you can expect at a clinic abortion” page, the actual procedure literature states that an ultrasound is necessary.

    I’m not trying to dupe you guys here. I’m just telling you the truth.

  319. Sinead:

    Ooooh, let’s not have a discussion of infant circumcision in this thread, actually. It’s very much not on topic, and extraordinarily derail-y.

  320. THANK you Doctor
    This is what we American women who object to this assault -are treated like:

    We need the medical community to stand up in a show of force. This one blog post will not do it.
    Please create a petition stating your willingness to refuse implementation of this big government operational assault – and yes – it is rape on women. Use language appropriate to your profession – but PLEASE do it NOW. This is getting WAY out of control. Next The Handmaid’s Tale unless YOU join the fight for women’s bodily integrity.

    Do it for your daughters.

  321. A reminder to all and sundry that I’ve declared the issue of the doctor’s anonymity here settled, and am going through snipping out comments relating to it.


    However, the general tone seems to be speaks of a more general privilege that truly is not aware of the various issues that can be involved or are remarkably self-centered. The term “YMMV” doesn’t seem to occur to some folks. (For example, the invasiveness of transvaginal ultrasounds certainly seems to me a YMMV situation AT BEST—it seems just grotesque to keep insisting that it’s no big thing when there are post after post saying how individuals felt humiliated and invaded).

    Granted, the topic is emotional, but it’s also a topic where many folks aren’t well informed, and folks should take a step back and at least learn some of the background.

  322. Thank you for the insightful, rationalized, and detailed commentary. You are a brave and intelligent soul, Dr. Anonymous, and on behalf of women and a relative to many health care providers (none of whom are in the US, but are watching the developments from north of the border with baited breath and no little horror), I am grateful you spoke up. I don’t want to see an entire profession blacklisted and tarred by the political decisions of a small faction with a distinct agenda. You remind me yet again that the constant vigilance and care practiced by so many nurses, doctors, primary care physicians, surgeons, and so forth is integral to the health system operating correctly. We don’t always realize the choices which our health care providers make to give us choice, keep us healthy and safe, and in line with the Hippocratic oath and other codes of conduct.

    As a woman, I believe no legislation has the right to shove an unwanted device in my body to conduct an ultrasound I neither consented to or asked for. When I cannot or will not consent, it is rape. Full stop. It seems that many legislators in a few states, the majority men, have no comprehension of that. Physicians and medical professionals deserve a voice because, at the end of the day, they are the ones asked to perform these ludicrous procedures. The woman subjected to the situation may not think of her congress person or state representative when potentially violated, but the health care provider. Please, I hope those who read this are empowered to place the blame where it is due, and those who can stand up with courage — and community support behind them 100% — to challenge an antiquated, barbaric law on the books or proposed in many places in this country.

    Kudos to you.

  323. I’m American and I became pregnant while living in a country where abortion is illegal. After taking a home pregnancy test I went to a clinic to confirm that I was pregnant before desperately searching for an option to terminate the pregnancy. Instead of giving me a blood test at the clinic they insisted that I get a transvaginal ultrasound, made me look at the image, and turned on the sound to hear the heartbeat (I was 6 weeks pregnant), all against my will. They then printed out the image from the ultrasound and forced it in my hand. It sickens me that some of these things are being debated in the U.S. These laws won’t stop women from having abortions but they are cruel and dehumanizing. I was terrified, broke, and alone and people who had no idea about my situation in life were assuming that I must not be capable of making the right decision for myself and the unborn child. I have never regretted my decision to have an abortion (the woman who later performed the illegal abortion was incredibly caring and sympathetic), but the experience at the clinic traumatized me for a long time and made me distrust doctors. Thank you Dr. Anonymous for standing up against these sick laws.

  324. i’m not trying to dupe you guys here.

    Liar. You’re quoting from Texas, where it is currently legally mandatory to have transvaginal ultrasounds. Don’t use that to support your position.

  325. I’d like to thank Wil Wheaton for bringing this matter to so many people’s attention on his blog by retweeing John’s original link and I’d like to thank John for allowing the doctor a safe environment to state their case. As for the doctor, wow. I hope your patients appreciate how extremely fortunate they are to have you for a doctor. Your willingness to take a stand against this barbaric procedure proves you to be a doctor clearly living up to their Hippocratic oath. We are on the threshold of something truly terrifying, this malevolent groundswell of support attacking our civil liberties by those that would argue they’re simply acting on their faith & what’s best for this country. Kerry =)

  326. Lisa, Gwangung, et al:

    Let’s remember to try to be civil to each other as much as possible, please. I probably should have reminded people of that rather a while back, actually.

  327. Lisa, for hopefully the last time (and apologies to John if he’s getting as sick of this topic as the rest of us):

    The issue is not whether an ultrasound is (sometimes or always) medically necessary or whether Planned Parenthood sometimes or always provides ultrasounds before an abortion. The issue is the state REQUIRING an ultrasound, usually with a 24-hour waiting period and a description of the fetus, regardless of the physician’s opinion on whether the procedure is necessary and the patient’s consent. The issue is the state interfering in the physician-patient relationship and requiring invasive tests and, often, the provision of incorrect information (like “abortions give you breast cancer”). That’s the issue.

  328. Notice that Lisa’s PP documents come from Arizona and Texas. I’m not sure about AZ, but Texas already has this law in effect (see this past week’s Doonesbury), so it doesn’t really say much that PP performs ultrasounds on all patients there.


    From “There is not a recommended number of ultrasounds that should be performed during routine prenatal care. Because ultrasound should only be used when medically indicated, many healthy pregnancies will not require ultrasound.”


    “Ultrasounds are only necessary if there is a medical concern. As noted above, ultrasounds enable your healthcare provider to evaluate the baby’s well being as well as diagnose potential problems. For women with an uncomplicated pregnancy, an ultrasound is not a necessary part of prenatal care.”

  329. Gwangung, those documents are from TX AND AZ before the law was passed. Did you even go to the links?

    And as for “physician, heal thyself,” this is a serious topic that deserves our full attention and not a forum for you to advertise how snarky or erudite you can be. We get it, you’re cool. This is not about you, though.

  330. DR. P – By definition your subset of women who had abortions are people who “have issues” to begin with. I assume you cannot say that ALL women who’ve had an abortion have a crisis about it. I have plenty of women friends who would say NO.

  331. @gwangung: I haven’t been threatened personally for speaking my mind in a civil fashion. I don’t believe this doctor has either, he didn’t say that was his problem. He said it would effect his career as I recall. Referring to the procedure as a rape does not move the discussion forward any more than claiming a heart beat doesn’t mean proof of life in the womb.

    This entire discussion is tangentially related to the abortion discussion. Most pro-abortion folks assert that until the life is viable outside the womb it’s not a life with human rights; further, any new born child is not viable without intervention outside the womb either, they must be cared for. A child in the womb is being cared for, at the very least, while still in the womb but would die the same hideous death as any new born without intervention. I don’t see the difference. In both cases people have to decide to end the life either by ‘medical means’ or by depraved indifference.

    As for Dr. Tiller, no one who is reasonable on the left or right would ever say his tragic death was justified.

  332. Lisa: An ultrasound is not “required” before all abortions. Pro-life sites have been citing a study that found that 99 per cent of Planned Parenthood clinics already perform vaginal ultrasounds before performing an abortion … ignoring the fact that the some clinics said they performed transvaginal ultrasounds only under “certain conditions.”

    Under certain conditions, an ultrasound is essentially necessary — for instance, in the case of medical abortions where an ectopic pregnancy could present an enormous risk to the woman. But for some women, in some cases, an ultrasound may be completely useless. For instance, women who have already had an ultrasound for another reason, and/or who already know the precise gestational age of the fetus do not need a pre-surgical-abortion-ultrasound. Further, the law as it currently stands (I’m not 100 per cent sure on this, but I’m pretty sure …) mandates a 24-hour waiting period between the ultrasound and an abortion, a requirement that has absolutely no medical value.

    But all that is beyond the point. Health care should be between a woman and her doctor. The decision to perform and ultrasound, or not, should be between a woman and her doctor. Not between a woman, her doctor and a bunch of politicians.

    As to the original post: thank you, Dr. Anonymous.

  333. Here’s an ultrasound image of an eight-week embryo a.k.a. ten weeks’ pregnant. That would be a later than average gestational age for abortion. The embryo would be 36 millimeters or about 1.25 inches long On my screen it’s quite a bit larger than life-size.

    Anti-abortion folks get a lot of mileage out of confusing the two: officially, you’re two weeks pregnant at implantation. Pregnancy does not start at conception but a few days later.

    I second the notion that women should scream, curl up, and refuse transvaginal ultrasounds. While the legislation in Virginia no longer requires using the Wand of Punishment, it requires a clear fetal image, and generally the embryo is too small to get a clear image from outside the body.

  334. Lisa:

    Go follow the link in Scalzi’s reply to you above. Both Texas and Arizona are states with a legal requirement for an ultrasound prior to any and all abortions. Statements to that effect is really just PP indicating officially that they will comply with the law. Not very compelling for you claim.

    Second, you’re being incredibly naive, or remarkably disingenuous, if you think that these laws have anything to do with “proper diagnostic tests”. These are intimidation/shaming techniques, gussied up with pronouncements that “we just know that no dirty slut young woman would want to murder abort her baby unidentifiable blob after seeing it on a fuzzy screen.”

  335. And in the oath each doc takes….first, I will do no harm. This mandate conflicts with this oath every which way to Sunday…and then some!

  336. I am regularly amused and astounded at how much human egos need stroking and attention. Since when do I enter into a healthcare profession, which is to help other people, and all of a sudden it’s all about me and what I want and what I believe? If a patient comes in with an issue, it is my job, as a nurse, to care for them, without judgement and give them comfort and a safe space to heal. How they heal is really up to them, not me. What is best for them is really up to them, not me. It’s not all about me. So really, if I were opposed or “uncomfortable” with abortion procedures, then I simply would work in one of the million other jobs available to nurses, that don’t involve it. I can’t stand working in dialysis. Do I try to pass laws to make it illegal for people to get it? No. I worked in another area. Do I think when other people make decisions in their lives that I think are bad ones, that they are somehow infringing on MY beliefs simply because I can’t make them think like I do? No. Everyone is free to have their opinion. Your freedom does NOT get to include taking away someone else’s. Ego stroking rarely leads to anything productive and those that think they need to force laws on other people’s bodies to conform with their baggage need to spend a little more time focusing on what’s going on inside of THEM rather than everyone else.

  337. Lisa, Lisa! The issue is not whether or not transvaginal ultrasounds are a valid medical technique that can be appropriately applied by a licensed physician with a patient’s informed consent, if it is indicated.

    The issue is that in this case, the decision is being made by legislators, not doctors and patients.

  338. I *hate* this thing! It has never proved or shown anything more than a standard ultra-sound did. The process was degrading, invasive and after surgery, it was horrible! My hysterectomy surgery wound did not close, and with the ultrasound, it made the wound worse. I will never, *ever*, ever, ever do this again. I made that clear to my OB-GYN. She told me it was part of the process. I got a new doctor. Thank you for speaking out.

  339. I haven’t been threatened personally for speaking my mind in a civil fashion. I don’t believe this doctor has either, he didn’t say that was his problem.

    That’s inferring far more than is warranted.

    And, I repeat, Dr. Tiller was not an exception. Your argument is treating him as an isolated occurrence, when it was part of a pattern of harassments and threats, including personal, professional and familial.

  340. 1. Thank you, Doctor. I fully respect your choice to remain anonymous.

    2. I am, as always, unsurprised at how many people immediately assumed that Doctor Anonymous is a man. (Thank you to those who noticed that the doctor’s gender is not mentioned and commented accordingly.)

    3. Building on #2 – While I understand that it is more shocking for the media to make everyone see/assume that it would be a male doctor and his female patient, BUT what about a female doctor and her female patient? I know I personally prefer to have a female OB/GYN. I’ve been wondering why no one has mentioned that this morally reprehensible legislation could/would also force female doctors to medically rape their patients. What if that doctor was herself a survivor of rape? What if both women were? How is any of this ok?

  341. Thank you Doctor, so much! And thank you John Scalzi for lending him/her your space to post this.

    Btw, the comments are really interesting (except for a few Fox indoctrinated ‘bots & thanks, Mr. Scalzi, for your commenting commenting policies and enforcement of them, as well.)

  342. Folks, as promised, I’m closing up the thread for the evening because I’m going to bed and I don’t want this particular thread, being as it is on a highly contentious topic which requires careful comment moderation, to go completely bat-shit insane while I’m not around to prune it.

    Fear not, however, because when I wake up I’ll turn the comments back on. That’ll probably be around 7 or 8 tomorrow morning (eastern time).

    As an extra bonus, I’ll note that thanks to this entry, today has been the busiest day on Whatever since October 2008 at least. Not bad, considering how busy it gets here on average.

    You all have a good night.

    Edit: Thread is now open again for comment. Folks, remember:

    1. Stick to the topic at hand and try not to derail into irrelevancies (including the anonymous nature of this post, which has already been discussed and which I’ve tabled as a topic);

    2. Be polite to each other which commenting about each others’ posts;

    3. If it’s your first time here, read the site disclaimer and comment policy.

    The more you do each of these, the less I have to swing the Mallet of Loving Correction. Thanks.

  343. Thank you! To both of you. I hope this ‘fans the flames’ of the entire medical community to speak out. FINALLY we hear from a single doctor. I hope ALL the others follow and speak up in their outrage.

  344. Thank you. Well said. I have over the recent months have been wondering if the Hippocratic Oath still had any meaning. Thank you for letting me it dose.

  345. *slow clap*

    Thank you. If there is any way to get a TV ultrasound that looks like someone flipping the bird, I’m more than willing to voluntarily help with item #4. Just sayin’

  346. Wow. I’m a Canadian an had to do some background research to see what this was even about and am completely blown away. You’ve got some sick people running your states down there.

  347. John,

    “Mallet of loving correction”. Sounds like a euphemism that could also be used for the trans-vaginal ultrasound wand itself. I’m sure a similar term makes the rounds in the legislative halls when these bills are being crafted.

    Great article, I’m glad this doctor remembers his Hippocratic oath.

  348. Sorry about last night. I felt like you were a jerk to me, so I responded in kind, which was doubly wrong since it is your blog with your rules.

  349. Physician and abortion provider here (although not from one of these states). The sentiment to subversively rebel is lovely, but the fact of the matter is we are talking about a small number of providers in each state – which is already part of the problem. Do we really think that even if every one of this small number of doctors documents patient refusal or themselves refuse to comply that the state would have any problem sanctioning them or yanking their licenses and, thereby, closing down all abortion providers? That’s exactly what the state wants! It’s two means to one end – to stop anyone from providing abortions – whether by making it so hard to comply that everyone throws their hands up in the air and quits or by making it so hard no one *can* comply and they are either spanked until they lose their license or forcibly closed.

    We (public as a whole) have allowed this to happen by letting the vast majority of OB/GYN and Family Practice physicians off the hook by not providing this incredibly common procedure for their patients and therefore allowing this type of legislation to target a few physicians (and NPs!) who are already under immense pressure.

    I just wonder what the reaction will be when women wake up and realize they’ve gotten the country they’ve voted for and they have to travel to CA, NY or IL for an abortion… or maybe even just for contraception.

  350. Thank you very much, I really appreciated reading that and wish more people were willing to take such a stand.

  351. Pennsylvania is one of the states that has been considering this legislation (which would require women seeking an abortion to have an ultrasound and receive a copy of the image). I’ve been following the story carefully, and it is painfully obvious to me that many of the legislators involved (including, I believe, the woman Republican who introduced the bill) do not realize that a transvaginal ultrasound is necessary in the earliest stages of pregnancy, when the vast majority of abortions are performed. Gov. Corbett, when asked if he supported this legislation, said, ” As long as it’s on the exterior and not the interior.”

    It’s no-brainer that legislators would educate themselves on the medical facts surrounding this issue before taking a stance on it, but that appears to be too much to ask. Fortunately the legislation is shelved, for now anyway.

  352. Bravo! My daughter and I thank you for your conviction. I hope other physicians will follow suit.

  353. [Deleted because as I’ve noted at several earlier points the anonymity issue is tabled on this thread. Folks, it’s helpful to read the actual thread before commenting — JS]

  354. Thank you.

    Who is going to start taking legislators to court for practicing medicine without a license?

    Where are the State Medical Boards? Where are the physician professional medical groups?

    Why am I not surprised. It’s still a Big Brotherhood, isn’t it?

  355. I had somewhat jokingly suggested a FB page,”Doctors Against State-Sanctioned Sexual Assault.” This piece hits the nail on the head. Thanks for posting it.

  356. JS – As a fervent supporter of Dr A’s position, I think you should open another thread for the anonymity discussion. By simply deleting contrary comments, you are not “preventing the conversation from being derailed”, you are preventing the conversation from happening.

  357. I’m sure there’s an answer to this in the comments, and i’m immensely grateful Scalzi offered up his blog for the good doctor, but just why the hell os the AMA so damn quiet on this?

    Where were they in 2010 when Oklahoma codified doctors lying to their patients and indemnifying themselves against legal action if it is to save a fetus?

    I keep asking this as from what i can see it al flies in the face of AMA guodelines, but… wtf?

  358. Oh hey, but according to the governor of my state, TVU isn’t such a big deal, you can just close your eyes!

    Thank you for this post. I hope other doctors are reading it and taking heed. This needed to be said.

  359. Thank you for presenting this. I wish this doctor was taking on new patients.

  360. I don’t know why everyone’s in such a tizzy. I think this is a great idea. And while we’re at it, let’s also forcibly mandate colonoscopies for anyone considering politics. It’s in everyone’s best interests to check to see if there’s a head up there before allowing the patient to run for office.

  361. Most of the comments on this thread are now repeating earlier comments. Sarah Schneider @ 8:15am makes a good point which has not been well-made yet. I’d like to call it out so it is not buried in the dross.

  362. As a woman my entire life and a nurse for the last 30 years I am happy to add you, albeit anonymously, to the list of doctors I can count on less than my 10 fingers who I would go to myself or recommend to a friend or patient. Doctors like you are quite the rarity. Thank you so much for this. Knowing our field as I do, and the opinion of some members of our society, I completely understand why you chose to remain anonymous.I fear that you would be putting your career and life in jeopardy due to the insane, radical people that live among us. Thank you, Thank you, Thank you! I only wish there were more like you.

  363. All I have to say is that the Reactionaries MUST be shut DOWN if honest Conservatism is to survive. That means that it is the duty of each and every conservative, wherever located, to vote down every stupid or criminal idea presented in the name of conservatism, and to remove from office each and every politician who perpetrates such stupid and/or criminal ideas.

    That is the ONLY way honest Conservatism will be regarded with any respect – we MUST police our own, or sacrifice the moral and practical right to participate meaningfully in the political discourse of this land.

    CArry on smartly.

  364. First of all, let me say that I applaud anyone who stands by their convictions, even if their convictions clash with my own (which I’m not saying is the case here). There are too many people who fall victim to the consequences of the old addage: “You’ve got to stand for something or you’ll fall for anything”, letting themselves be pulled and tugged by the power of persuasive and misleading speech. Unfortunately, I think that’s what has happened here with the pro-lifers. Let me be clear that I am not extremely educated on this subject, as I’m sure a lot of Americans aren’t, but it doesn’t take a rocket scientist to figure out that this piece of legislation is linked to the abortion issue. For some pro-life advocates, sometimes all they have to hear is that the legislation will help stop abortion and they are all for it. Even if you don’t agree with abortion, you really can’t be ok with letting the government control our lady parts like they are a video game. I’m not sure what that really is solving anyway. What is the ultrasound supposed to accomplish? Whether you think it is right or wrong, the woman has already been through the grueling emotional process of deciding to terminate her pregnancy. I know several women that have had abortions and most of them did not make the decision lightly. Whether anyone else thought it was right or wrong, they had to decide what was best for their lives at that point. I don’t think an ultrasound would have changed their minds.

  365. More physician outrage here, and don’t forget the new Georgia legislation trying to expand the number of states forcing women to carry dead babies. It’s not just the ultrasound law. It’s an unprecedented assault on reproductive freedom and patient autonomy across the state legislatures ever since the tea party right-wing swing of 2010.

  366. Lisa, perhaps it is the law where you have been pregnant, but not where I live. I have been pregnant over a half dozen times and have four wonderful children. I had one tv ultrasound and that was when I was NOT pregnant and required it for a medical diagnosis. In each of my pregnancies I had at least one ultrasound outside of my body, including the one for the pregnancy that ended in a termination. I’m sorry your state and doctor considered it important for you to have a tool inserted inside you for their amusement. There is no good reason for this law. It is going to increase the medical costs for abortions, including those paid for by the government. If a woman has a private insurance that covers it (and there are a lot out there) it will just cost those companies more, or they will charge it off to the government. Which will result in higher taxes or programs cut for everyone.

  367. Playing devil’s advocate for a moment… This is not rape and saying it is is nothing but a political scare tactic. If a woman doesn’t want a transvaginal ultrasound, she doesn’t have to consent to it. Period. Under this law, if you don’t want the ultrasound, don’t get an abortion. You can carry the pregnancy to term and place the baby for adoption or go to another state.

    That being said, I think it’s a TERRIBLE idea to require the ultrasound. I imagine in most cases an abortion is not a decision that’s not made lightly and I think forcing a woman to see a beating heart will do nothing more than make it harder for her to deal with the guilt she’s likely feeling. I am anti-abortion in that I believe that life begins at conception and abortion is ending a life. I also recognize that not everyone shares that view and I would much rather see someone who wants an abortion get it done safely, rather than go back to the days of back-alley abortions. If you don’t like abortions, don’t have one. I don’t think requiring an ultrasound will have any positive effect. I think a better approach would be to figure out a way to prevent unwanted pregnancies in the first place.

  368. ihateflatnamespaces:

    “I think you should open another thread for the anonymity discussion. By simply deleting contrary comments, you are not “preventing the conversation from being derailed”, you are preventing the conversation from happening.”

    Nonsense. The world is full of blogs and other conversation spaces where people can have that conversation, if they want. I’m neither obliged to have it here, nor interested in having it here.

  369. Thank you! This is the most reasoned and practical response I’ve seen so far to the situation. Thanks to the doctor for writing and John Scalzi for posting! Ranting and emoting (and sarcasm and belittling)–however satisfying in the short term–are unlikely to provide us with the necessary outcome. It is unconscionable the physicians are becoming answerable to insurance companies and governments rather than ethics and their patients.

    My argument is–if we allow women the choice to bear children, if we truly provide that freedom–then every single child born in this country will be a wanted, chosen child.

  370. Dr. P – others have mentioned that your patient population is not exactly a random sample of women; I will add – have you considered the considerable percentage of women who have abortions who already have children? If I have an abortion (and if I ever get pregnant at this point in my life I will), having a completed pregnancy afterwards (not gonna happen, but suppose) wouldn’t teach me anything I didn’t already know from the two successful pregnancies/live births I already had. Not to mention the developmental biology class. Trying to force me to have an epiphany about what I would be doing would be paternalistic, condescending, and annoying as hell.

    @Lisa – There’s at least one glaring exception to your “all abortions need to have a preceding ultrasound for medical safety” already being linked all over the place – when a patient is there for an abortion because an ultrasound they just had showed problems. The existing doctor is unlikely to be able to provide an abortion, because we’ve largely decoupled abortion from other ob/gyn services, but an ultrasound has just been done, results are available, and having the new doctor have to give another ultrasound is both medically unnecessary, and often unnecessarily cruel. When it’s the call of the doctor or clinic, based on patient need, they can easily say “We have an ultrasound, even if we personally didn’t take it. We’re good to proceed.” When the state mandates it, they don’t have that leeway. Which is why the state should stay out of it.

  371. Doctor, your passionate response on this issue brought tears to my eyes. At a time when people, especially women, feel there isn’t anyone on their side, you’ve made a brilliant and caring point. I truly hope all doctors take up the gauntlet and stand up for themselves and their patients the way you have.

  372. If this has been mentioned before, I apologise, I didn’t read all of the 400+ comments (and more were probably add while I take the time to write this). I read this article two days ago, it was the first time I heard of this (I’m not from the USA), and it didn’t make me feel good at all. A woman’s voice about having to undergo this procedure against her will, while it only made her situation more painful:
    I take it this is about the same or similar legislation, and I’ll repeat the comment I posted with it when I put it on my social media page: The underlying message in this rubbish called legislation really bothers me, it very much comes across as trying their hardest to make women change their mind about their abortions, by amplifying how unpleasant an abortion is, and how many ‘options’ you still have. I don’t know a single woman, I think, who lightly made the decision to have an abortion (and those who do make the decision lightly are probably unfit to be a mother anyway). I don’t feel it’s right to try to discourage this so much (or at all, as I don’t believe it’s needed), it’s none of anybody’s business why any woman has an abortion.

    I hadn’t thought of this procedure as rape just yet, but I can certainly see how it could be considered exactly that. Thank you, Dr, for speaking up.

  373. Thanks to John and your anonymous doctor friend.

    My only concern is the piece and much of the commentary is overly focused on the TV Ultrasound. In Virginia, the uproar focused exclusively on that and the government magnanimously agreed, leaving us with forced ultrasounds.

    Which are still traumatic and condescending. This is not take away from the well argued problems with a forced TV ultrasound. It looks weird to me to say, but the rape part of this public policy is not the only problem with its intent. A mandatory external ultrasound is still psychological abuse.

    Ultrasounds are a great tool, TV or external, to monitor the health of your baby. And it’s a great idea to talk with your doctor about it. Making either a requirement for an abortion is not about medical need. It is a shaming. And it is awful.

  374. I have a trans-vag ultrasound image of a 7-week fetus that I would gladly donate to this doctor, if he wants it.

  375. I applaud this physician’s remarks and his eloquence. Speaking personally, I have had a transvaginal ultrasound…It’s no big deal. If a woman or, or worse, a man, thinks that one’s Gyno is a guy feeling around her nether parts then she should get a grip, and find another Gyno. That we are still harboring these feelings in 2012 is obscene and a true indicator of how little we teach our kids .(in this case, mostly girls) – and for legislators, get real, and talk about something that might do something besides get people all outraged y their repeated stupidity..

  376. I’m old enough to remember a time, back in high school, when a girl in my class died because she had an abortion performed by some butcher with a metal wire. Of course it was illegal at the time but the risk was less to her than having to face her parents & community as a “knocked-up slut”. It didn’t stop kids from having sex and I doubt it stopped other abortions.

    Its a shame we can’t have a reasonable discussion of this topic in America. One side wants to make abortion legal, rare and SAFE, the other side wants to make it impossible, unless you are wealthy enough to travel or desperate enough to risk your life. Thanks JS, I can’t imagine this topic being handled so well on the Internet and thanks to the good Dr. for their input.

  377. Thank you for standing up for us ladies. I hope more doctors follow your lead and fail to comply with this degrading law. Congrats… Your article is going viral!

  378. @Sam (march 20 comment). This law is in place in Texas and it is mandatory with a few exceptions. We were able to hold this law up in court for a few months but eventually the courts sided with our state. :( I found it ironic that the party of less government continues to right laws that cause more and more government intrusion. Furthermore, my Republican friends are outraged by it but will continue to vote them in. Makes no sense to me. But then again I’m just a dim-witted woman that needs my husband and the government to tell me what to do.

  379. its good to know there are still doctors out there that care about the patients well being moreso than the thickness of their wallet for that one patients visit like so many around my area. im a lil confused and also unaware that something like this would ever become a law or why it would in the first place…even as a thought.

  380. As for the “I don’t have an ultrasound image that I own,” take an ultrasound image of something other than the contents of a uterus. A gall bladder with stones. Anything. And spread use of that. If I still had access to my gall bladder image from 15+ years ago, I’d donate it. It looked like it was full of stars. Thank you for standing up!

  381. I realize I’m at the bottom of the list, and probably won’t get a response, but when I posted my outrage about the issue on facebook, a pro-life “friend” retaliated with a claim that the National Abortion Federation recommends the ultrasound as standard best practices during any abortion. Now, this doesn’t give the government any right at all to decide that it should be mandated, but I’m curious about the recommendation and if there are in fact reasons why every woman should potentially have one before an abortion.

  382. Dear Doctor,

    I wish I still had my ultrasound image from when I had fibroids. I’d send it to you and you could use that…it’s not as if any of these perverted politicians could tell the difference. I had a nightmare last night about having an ultrasound and finding out that I had another mysterious mass. I have no doubt the dream was brought on by these news stories. I’m so glad to see a doctor finally speaking out and hope that more of your colleagues will join you. Thank you.

  383. Please, please gather your colleagues, create a petition and leave your names. I appreciate your thoughts but remain puzzled by the anonymity. Change requires risk. I will sign any petition and make any phone calls necessary to motivate people who remain unaware.
    Anonymity holds no power.

  384. Amy C @9:09: Thanks for sticking up for your own beliefs AND for the rights of others to believe differently.

  385. Women need safe, legal abortions. Getting the licenses stripped from doctors who provide them will eliminate that access. I don’t think a de facto ban on abortion is really the right strategy for protesting invasive restrictions on abortion. That’s what the antis want, for women to die in back alleys, as punishment for being “sluts”.

  386. I’m wondering if you could bring an MP3 player in and listen to music instead of the doctor. The doctor would still be in compliance as he/she would be able to speak about ultrasound, but it doesn’t specifically say you have to listen. (Obviously, this bill shouldn’t be passed and if it is should be repealed, but I was coming at it from another angle).

  387. Do you have a link to what the legislation is proposing? I am a Physician Assistant in FP and want more information. I am outraged that any woman would not have a choice in this matter. Thanks.

  388. As a nurse and a mother of 3, I am thrilled to see a doctor standing up for the rights of his (or her ) patients. The silence of the AMA on this subject has been both deafening and disappointing. Unless and until all of the legislators who vote for these asinine provisions earn their medical degrees, how DARE they get between doctor and their patient. Perhaps it’s time to propose legislation that would require transrectal Doppler exams as well full psych evils on anyone requesting Viagra.

  389. I also thought to offer an ultrasound for general use as a clear sign of doctor protest — maybe it could, uh, be ‘doctored’ with collage or Photoshop, and passed along people’s networks, so it can be used for demonstration purposes, wherever a doctor wants to take a stand against these laws. Thanks for speaking out, doctor!! I’ll have to get ultrasounds done every year from now on, because my mom died on Sunday — uterine cancer, the precipitating factor. In many ways a lifelong conservative, Mom always firmly believed no woman should ever be forced to bear a child against her will. She was disgusted by recent trends in her party — voted for Obama, to my surprise (and pleasure). I’m an artist by trade, and I’m on it…

  390. I didn’t make it through all the comments – so my appologies if this has already been pointed out/stated.

    It seems to me that these laws are designed to make it ‘uncomfortable’ for citizens to EXERCISE an existing right. We currently have the ‘right to choose’. Since efforts to remove that right have failed, an effort is now being made to throw up road blocks and hurdles.

    It can certainly be said that we are not being denied our right to choose. No no … You have the right to choose, but we’re going to make it as demeaning and traumatizing as possible.

    What’s next? Will we be required to post ‘intention to terminate’ in x newspapers over x number of days before the procedure can be performed?

    Make no mistake, it is our ‘right to choose’ that IS being attacked here.

  391. Thank you. I know my doctor would agree. She gave me 8×10 color glossies of my tubal (since she couldn’t give my husband the actual parts). I am shocked by all of this, absolutely astounded that any of this has moved past a sick and twisted idea, and that people are allowing it. Thank you for speaking up against this hatred. And shame on the AMA for not speaking up just as loudly as the opposition.

  392. Thanks for opening your blog for this discussion, John. And thank you, Dr. Anonymous, for your comments.

    You asked “where is the physician outrage” – the answer may be that a lot of doctors outside the state of Virginia are not aware of the issue. Some of us aren’t as current with issues as we should be and don’t comment on them if they don’t affect us or our patients directly.

    If this was happening in my state or, worse, at a national level, you can bet my legislators would hear from me. For now, I have to content myself with casting primary votes for people that, hopefully, wouldn’t support that kind of extremist legislation.

  393. Peter asks, “When will we live in a world when Dr Anonymous won’t have to be anonymous?”

    Well that’s the thing isn’t it? Religion has taken most of us hostage because speaking out will result in financial losses and rejection. This is why about half our politicians are hypocrites when it comes to religion. I don’t blame this good doctor for remaining anonymous. He/she worked extremely hard to become a physician. Why allow a bunch of clueless politicians to jeopardize a career?

  394. I apologize if another poster has addressed this; I was only able to get through a few hundred posts.

    Though it may seem somewhat off-topic, I believe this is very relevant when talking about sexism: several posters have referred to the Dr. As “he”. As far as I could tell, neither John or the Dr. indicatedthe gender of the anonymous Dr. I believe this is important because it reflects the societal sexism we have all internalized and if we continue to operate without constantly challenging our own speech, actions, thought, or perceptions with regard the any oppressed population, we can inadvertently cause harm. I doubt these lawmakers believe themselves to be oppressors or sexist.
    (this is not meant as a harsh judgement to those referring to the Dr as a “he”, rather a reminder of all our tendencies (including MINE) to make biased assumptions based on being a product of our society.)

  395. Thank you so much!

    John Scalzi, may I repost this entry in my blog, with appropriate references and links? You can reach me at geologyrider @ gmail . com. Thanks.

  396. I just love the fact that the Supreme Court is taking up the requirement for individuals to carry health insurance–an anathema for many conservatives–while at the same time, these same individuals want to dictate to women what they do with their bodies!

  397. 20 years ago, more or less, I became a clinic patient with my highly desired first pregnancy, when my husband lost his job. I had been trying for years, taken my temperature every morning, recorded every activity related to conception with a time stamp… I was fully documented. The doctor in charge had a new ultrasound machine to pay for, so he ordered me to have an ultrasound “to establish gestational age.” I refused, concerned about potential health effects of unnecessary ultrasound, and he refused to treat me. The State of New York, who paid his bills, just shrugged. I had no medical care.

    My point is that when we see laws like this they don’t just jump into existence to imperial the health and freedoms of middle-class women. The inroads on freedom are tested and entrenched on women at the lower end of the socio-economic scale first, before being rolled out on a population with more ability to fight back. If we are serious even about protecting our own rights, it behooves us to watch the canaries keel over on the lower levels, and to fight for rights we may not be using at the moment. The work of the doctor here is a good step in that direction. Thank you, John, for presenting it.

  398. Best. Response. Ever.
    Thank you so much for sharing this and I feel so terrible that you need to do it anonymously. That part makes me sad, but I understand.

  399. This makes me want to become a doctor just so I can heed this post and deny these jerkweeds. Thank you.

  400. women withholding sex (and others in solidarity) until these types of laws are changed seems, to me, a very effective method of protest. I am not an organizer, but would greatly support such an effort.

  401. Thank you! And might I suggest a photoshopped, blurry, grayscale image of the truck window sticker of Calvin (from Calvin & Hobbes) peeing – on something, or nothing – as the ultrasound picture?

  402. While I agree with what was said, I’m not sure I’m buying that a physician really wrote this. For one thing, he’s advocating lying, and most physicians don’t do that.

  403. We keep going around and around about whether transvaginal ultrasound is medically necessary for all abortions. This isn’t a statement that is up for debate. Evidence-based medicine does _not_ require tv ultrasonography for all induced abortions.

    As for Lisa’s assertion that it is needed to rule out ectopic pregnancy, the rate of ectopic pregnancy in the general population is only currently around 19–21 per 1,000 pregnancies, and data show it is even more rare in the population of women seeking terminations. The American College of Ob-Gyns states, “although ectopic pregnancy in a population of women seeking early abortion is rare, women with significant medical risk factors or history (eg, unilateral pain and vaginal bleeding) should have pretreatment ultrasonography” (Practice Bulletin #67, reaffirmed in 2011). So, yes some women do need ultrasound prior to an abortion, but not ALL women, and only when medically indicated. Not when legislatively indicated.

  404. Thank you, both to John and Dr. Anonymous. I’ve been wondering how doctors feel about all this, and while I’m sure their opinions are as varied as the rest of us it’s nice to hear from one. May your words reach millions of ears, and may people wake up on election day and remember them. And vote. For the sake of ourselves, our daughters, and their daughters.

  405. A brilliant and much-needed post by the physician…I have been angry since these laws were proposed and then implemented that the medical profession was silent and not speaking out against obvious breaches of medical ethics. I know that doctors have been threatened, harassed, and even killed for standing up for the rights of women to have the medical treatments they need–I understand fear. But they are, as this doctor says, the last defense–not only for women and reproductive choice, but for those being tortured, being mistreated in custody, and other situations favored by the same political attitudes that impose these laws on women. I hope this doctor sends links to this post to everyone on the AMA governing committees. Doctors need to take the risk *as a group.* (And if an individual doctor finds s/he cannot in good conscience treat women with the same compassion and respect as men–that doctor should not accept any female patients. No one in the medical profession has a right to commit malpractice in the guise of personal morality.)

  406. I think this is great, in theory. However, in some ways it’s naive and unrealistic to ask doctors to engage in this kind of civil disobedience. I am part of a very small minority of physicians who actually provides abortions. If I lose my license by overtly disobeying a state law, I may be helping one or two individuals, but what happens to the hundreds or thousands of women who are left without an abortion provider in the years to come? There is a severe shortage of abortion providers in this country, and we are under constant attack from anti-choice groups who use all sorts of tactics, including asking patients to surreptitiously record doctor-patient encounters to look for any wrongdoing that could be brought before the medical board. The reality is that if we aren’t careful, women could end up with no options at all.

    Yes, we should be vocal, and angry, and protest this kind of legislation that impedes upon the doctor-patient relationship. But actually disobeying these laws could have severe repercussions, leading to individual doctors no longer providing abortions or entire clinics being shut down if they are found out of compliance. The anti-abortion zealots are organized and will use any opportunity to try to discredit doctors and clinics that provide abortion.

  407. Using a single identical image will draw attention during any audit, even if it’s just for general record-keeping and has nothing to do with this topic. It’s a very common way to save money, and with electronic records it’s very easy to catch.

    Whether this sort of attention serves the cause or not is another topic.

  408. Just wanted to add my voice as another physician who completely supports and agrees with this post. Thank you for making it!

  409. BRAVO! BRAVO!

    This is the choice we all have — to not help implement bad laws. Thank you for reminding us all.

  410. Can I suggest you ask a vetenarian for an ultrasound image to attach to patients’ charts as your protest image? In view of certain politicians’ comments maybe one from a pregnant cow or pig :)

  411. in regards to whether or not this is a cover-up for something else behind the scenes: it is not a smokescreen – it’s politicians establishing cred with their party.

    think of a large faction of the republican party as a street gang. Supporting “pro-life” related legislation is their version of the beat-down prior to getting your colors. (Once you’re in, you can’t go back.)

    Same kind of BS as the Grover Nordquist no-taxes pledge: maneuver your crony politicians into a position they can’t renege on.

  412. Excellent post Doctor Anonymous. However, it is an abhorrent reflection of the society in which we still live when posts have to be made with anonymity.

  413. [Deleted because as I’ve noted MANY TIMES BEFORE IN THE THREAD, I’ve tabled the topic of the doctor choosing to be anonymous — JS]

  414. joe bob:

    I’d be willing to testify in court under penalty of perjury that the person who wrote this piece is a doctor.

    That the doctor is suggesting lying as a civil disobedience tactic should suggest to you their belief in the appalling nature of mandated transvaginal ultrasounds.

  415. Thank you, Dr. At this time, you are the only MD who has spoken out, albeit, anon regarding this issue. As a nurse, I am generally bound to follow the MDs orders. If I don’t, s/he’ll find another RN who will. Nurses can protest all they want; but it is up to the MDs to lead the way. Way To Go!!!

  416. The author is quite correct. As physicians we took an oath to “first do no harm.” This IS harm to our patients and we cannot allow politicians to dictate patient care that is in direct opposition to our standards.

  417. Thank you for this post. It is important to know that the medical community can think on their own! <3<3

  418. What I don’t get is, the anti-abortion movement comes from the Catholic Church, which also prohbits contraceptives. And the US has a Constitution which says Congress shall make NO LAW respecting an establishment of religion. What part of “no” is difficult, that women in the US are largely forced to comply with the Pope’s dictates?

  419. Scarlett and others, please note many doctors have spoken out on this. For just a few examples of what my brave colleagues have been doing about the ultrasound and other repro rights issues, see here:
    And here:

  420. I live in California and I am a graduate of a Police Academy. I want to comment specifically on this part of the author’s post:

    “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.”

    The author is not wrong. Kiinda, but the point that this is a violation, both morally and legally is correct. In California, Penal Code Section 289 outlines Unlawful Anal or Genital Penetration by a Foreign Object, and this legislation would quality. The CA Penal Code reads says that it is against the law to commit “an act of sexual penetration when the act is accomplished AGAINST THE VICTIM’S WILL by means of force, violence, DURESS, menace, or fear of immediate and unlawful bodily injury on the victim.”

    This qualifies. One could clearly make the argument that the legislatures are promoting making a sex crime legal, and that both they and the doctor could be charged with a felony for forcing women to submit.

  421. I thank you from the bottom of my heart (I’d go lower, but my uterus is long gone)!

  422. As a data analyst in the QA department of an FQHC, I have to say I’m horrified by the suggestion to add a false image to the medical record. Sorry.

  423. From above –
    Sam says: “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    Bear replies: False equivalence: No doctor or nurse is forced by legislation to do an abortion against a patient’s wishes. The legislation discussed here legally requires a medically-unnecessary procedure against the patient’s wishes.

    And me – The reality is that doctors are not forced to perform abortions period. They are not required by law to prescribe birth control, even when medically indicated. Pharmacists are not required to fill birth control prescriptions. Nurses are not required to give post-op care to abortion recipients. There are bills moving through the houses of many states that would allow doctors to lie to their female patients about their own health and the health of their fetus if sharing that relevant medical information MIGHT put the thought of abortion/pregnancy termination into the woman’s mind.
    As in – “This test that you paid $2,000 to have me do shows that your child is going to be born with severe disabilities.” If these bills pass doctors will no longer have to reveal the results of tests if those results might be “bad”. Sadly, this means that parents will also not be given the opportunity to prepare for that child’s special needs before they are born. Most parents I know get those tests done for exactly that reason – they are high risk pregnancies and want to be able to plan and prepare, not abort.

    What I have never understood about this debate is how the embryo and/or fetus (potential life) has ended up with more rights than the living, breathing woman carrying it.

    Thanks Dr. Anon and Scalzi for this post. I can only hope it will be read/heard by people in a position to do something about it.

  424. Hi, non-OB MD here. Just to point out to other non-OB MDs that there are things you can do to help your patients as well.

    Get to know your OB colleagues. Find out who is most sympathetic to women and takes his/her medical ethics most seriously. Send your patients there. Not just for abortions, but for OB care: if worst comes to worst and your patient has to abort a wanted pregnancy, at least she won’t face harassment or lies from her OB when it happens.

    When referring your patient for an abortion, caution them that they may hear a script from the state and that it’s a bunch of crap. Abortion has not been linked to breast cancer, depression or any other mental disorder, infertility, or any other medical problem. Abortion does have risks, like any procedure, but it’s about 33X safer than giving birth (risk of dying about 0.5 per 100,000 versus about 15 per 100,000) so all the verbage about how dangerous it is is mostly crap too. There are programs to help women raise children they can’t afford, but they are extremely inadequate and being cut by the very people who are requiring doctors to tell you that they exist. So don’t believe those promises either. And so on.

  425. Thank you to the physician who wrote this, and to all physicians who will have the courage to do as this person suggests.

  426. Two points:

    1) If the comments of Lisa @ March 20, 2012 at 11:09 pm need more refutation: two pregnancies, abdominal ultrasounds only with both; transvaginal ultrasounds for other medical reasons and FAR more uncomfortable than a Pap smear;

    2) That is ultimately a red herring. Yes, sometimes such-and-such thing is used in such-and-such way in a doctor’s office. You know what else sometimes happens? A person inserts a part of their body into someone else’s body. And it’s not how frequently that same series of events happens under other conditions (or whatever other red herring people want to wave) that governs whether any particular instance is sex or rape [*], but whether _in that particular circumstance_ the parties consent.

    Requiring patients to undergo unnecessary medical procedures to which they do not consent is wrong. It is particularly egregious when the procedures are physically invasive and uncomfortable, and where their forcing has such misogynist implications, but it is wrong regardless.

    [*] Or, since I deliberately phrased it very broadly, neither; the other options are left as an exercise for the reader. Similarly left as an exercise are the circumstances in which sex or rape takes place that do not fall within the above description, because it made the sentence too unwieldy.

  427. Sam says: “I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds.”

    And those doctors and nurses are legally exempt from performing abortions. Fallacious argument is fallacious.

  428. Find the book “Politics of Healing” and read it….very interesting. When a village in Africa wanted peace, the women of the village closed their legs. It seems that American women could take a lesson here. We are, after all, in the majoirity and it would bring this crap to an end!

  429. Amen. When I received my last transvaginal ultrasound (not without my consent) it brought back rape flashbacks . . . much worse flashbacks would ensue if a doctor inserted one of these probes into me without my consent. Thank you for publishing this above.

  430. To those suggesting women go on a sex strike of sorts in protest:

    But I -like- having sex. It’s fun! And really, stopping women from having sex is what all these anti-choice politicians are after anyway. Outlawing abortion (or making it so difficult to access that it might as well be illegal) serves the purpose of punishing women who dare to have sex without wanting a child.

  431. Sorry I had to laugh at this post. Never met a doctor yet who isnt in it for themselves. Oh sure, they care for patients, because they are paid too and if they dont they get sued. Most people work for a reason, and for many that reason is to make a living, ie – earn as much money as possible. If they were a doctor for the humanity of it all, in a pure sense, then they would provide their services for only the amount the insurance/gov would pay (thinking socialism here). I see this as purely politically motivated.

  432. @Jamie – I think you are making a big assumption on the reason and nature of the ant-choice group. Broad based assumptions are supposedly bad around here….

  433. While I do not have the time to read each comment, I felt it important to say at least something on the matter. Pardon please if it is repetitive of something already discussed.

    No matter the topic the main point is that all human beings have a choice. A choice to be who they are, believe what they want and do as they feel is right. Women have a choice to wear a sweater or a jacket. Men have a choice to eat cereal or toast for breakfast. People have a right to choose for themselves.

    People can choose to advocate to others to not have abortions. People can choose to have them or not. And in relevance to this post, Doctors had the choice to become doctors. They have a choice to act or not act.

    I think the key thing to remember is that no matter what any one person thinks, feels, believes or does it is all a choice that individual makes. I support anyone’s right to choose anything. Consequences of choice are another matter but we should all remember that all we do is a choice.

    Thanks for posting an opinion and expressing your inherent right to choose what you do and say. Thanks for having an opinion I can choose to agree with.

  434. My wife had a personal experience with transvaginal ultrasounds. Just an example of its justified use.
    She was having contractions at 29 weeks and wanted to know the state of her cervix. The doctor said the best way to measure the thickness of the cervix was with a transvaginal ultrasound and asked her permission to do it. She said “hell yeah”. Not her exact words, but it let us know the cervix was still 6cm thick at the time and it was enormous relief. The delivery was provoked at 39 weeks and we now have an adorable 2-months old healthy baby girl.
    Thanks for asking permission, doctor.

  435. This is a well written essay and I whole-heartedly agree with the statements in it. No politician should have any say in this matter and I wish more women were outraged in public about it. I will spread this article and I hope we can distribute it all over the country.

  436. @Yep – Between calling women who take birth control sluts, all the talk about pregnancy/babies as a “consequence” (which usually reads “punishment”), the attempts to impose mandatory abstinence-only sex education (which is usually filled with various lies/falsehoods), and all the anti-abortion nonsense, I really don’t know what other picture of their motives I’m supposed to be getting. If anti-choicers were actually just opposed to abortion, they would be all about easier access to contraceptives and sex education, because those are things that actually reduce the number of abortions. But they’re not.

  437. If they were a doctor for the humanity of it all, in a pure sense, then they would provide their services for only the amount the insurance/gov would pay (thinking socialism here).

    Yep, you may not believe me, but this is illegal. Specifically, if you charge insurance, it is illegal to not charge the insurance’s co-pay. I wish I were making that up for the sheer greed of it, but I’m not. The insurance lobby is frighteningly effective.

  438. For those who replied with “It’s the law” arguments, I’m sure I will not be the first to point out that the torture/experiments performed on female concentration camp prisoners in Nazi Germany were also “the law” at that time and that place. In future, please refrain from making such patently stupid and immoral arguments. I believe that there are anti-rape statutes in all 50 states. That is also the law. I only wish that a class action suit could be brought against all the legislators that voted for the trans-vaginal ultrasound requirement, but voting them out of office [and, hopefully, judicial intervention and refusal to comply by sensible doctors] appears to be the only practical remedy for this legislated atrocity.

  439. Thank you Doctor Anonymous for writing this. It is very sad that in our Country that you and the other doctors who have commented such as “As another physician (but not an ob/gyn), I applaud you. Thank you so much for saying what needs to be said. I wish we could charge every one of these legislators with trying to practice medicine without a license” do not have the FREEDOM of speech that we are supposed to have. Yes you could put your name to it, but I take it that would be giving up your career of helping others, and to me, is understandable. I have to sign consent forms for every procedure I have and there should be no reason for the government to force you, the Doctor, or the Patient to not have that right. It is unconscionable to do that to anyone, and especially rape victims. I would like to stand in line with the other volunteers if that would help, although I am early menopause woman. Thank you for bringing a doctors perspective to the public.

  440. If a woman is having the transvaginal ultrasound prior to an abortion, then what follows (metal probes and a vacuum with a sharp blade on the end that tear a baby to pieces) is the violent part. To say that a medical procedure by a physician is rape discounts and marginalizes women and men who are violently sexually assaulted. Shame on you Dr. A

  441. Response to Per Sam’s comment: Two quick things to note.

    1) In your tweet containing this story, you used the term “mandated.” While not used in the article, I want to clear up any misconception. I’m assuming all this is related to the drama in Virginia surrounding abortions. As someone who lives in Richmond, Virginia, let me clarify that the state congress passed a law that did NOT require mandatory transvaginal ultrasounds. A doctor can recommend it, but the patient has the right to refuse it. RESPONSE: Virginia has a legislature, not a congress, and that legislature mandated abdominal ultrasounds. So instead of being raped, women seeking abortions are simply being molested. Further, this blog entry is probably in reference to Texas, which did in fact mandate tranvaginal ultrasounds.

    2) There are doctors on the opposite side of the topic. It would be interesting to see that viewpoint presented. Personally, I know a doctor who was sued after he refused to prescribe a woman “plan B.” I’m sure most of you (as followers of a liberal blog) would probably side with the woman, we do have to realize that there are always two sides of the coin. I’m sure there are just as many doctors and nurses who feel uncomfortable dealing with abortion as those who feel uncomfortable doing these required ultrasounds. RESPONSE: Of course there are medical professionals on both sides of this issue. Those that oppose abortions have a choice not to perform them. Choice being the operative word here.

  442. Thank you! As a woman who has had many transvaginal ultrasounds for medical reasons with my consent I can say that even with consent it is an uncomfortable procedure and can leave you with a feeling of being violated. It’s not just a simple medical procedure, it is beyond invasive on the most personal level. To think that women will be subjected to such a procedure by force is infuriating. I applaud your frankness and for saying what no one else in the medical field is saying. Our elected officials have for the most part abondoned us to the conservative right and their agenda. Our doctors are silent. The female population is being treated like nothing more than personal property and our dignity is being traded at will for political currency and yet people don’t seem to care. When did we become so worthless that even our person is beyond our control and must be legislated?

  443. Here’s my question on the whole issue, very early in my pregnancy I was denied a transvaginal u/s because it was ‘too hot for the fetus’ and they were concerned about subjecting my child to that heat. Is that an unusual stance in medicine or is it true that a transvaginal u/s carries a risk for the fetus?

    If it’s true the only takeaway I can think of is the moralists want to rape women and fry their babies. So WTF?

    What I do with my uterus is between me, God and my doctor.


  444. Thank you, thank you, thank you! I have nothing more “insightful” to add than that. I am a woman who is planning on becoming a Naturopathic Doc (ND) and while this issue may (or may not) directly impact a ND, as I hope to be, it has certain sent me off the deep-end, thinking about the ethical ramifications of such legislature on physicians overall.

    Again, thank you Dr. Anonymous & Mr. Scalzi for getting this ball rolling. Specifically, I hope that you are one of many physicians who feel this way- that you are the snowflake. We all know what powerful changes can happen when you get a critical mass of snowflakes together (blizzard anyone?)!! I hope as more physician coalesce around this issue,find their voices and backbones- anonymity be damned- some balance and sanity can be restored to *this aspect* of the very personal issue that is reproductive rights!

  445. MrsM:

    “If a woman is having the transvaginal ultrasound prior to an abortion, then what follows (metal probes and a vacuum with a sharp blade on the end that tear a baby to pieces) is the violent part.”

    Leaving aside the standard rhetorical “baby” trope designed to marginalize the right of a woman to control her own body, note that by the standard offered here any medical procedure that involves medical instruments the probe, cut or vacuum is “violent.” I am going to make the assumption that you are not generally opposed to all medical procedures involving probing, cutting or vacuuming.

    “To say that a medical procedure by a physician is rape discounts and marginalizes women and men who are violently sexually assaulted.”

    Well, except for the part where the medical procedure is unwanted by the patient and the vaginal insertion of an object is forced upon her in order to undergo a different medical procedure entirely.

    Let’s actively try not to make a show of wringing our hands about sexual assault while actively ignoring the sexual assault in question.

  446. Mrs M- you are the one who is trivializing rape. The issue here is informed consent. Coercion is the heart of these new legislations. And with that coercion, informed consent is not legally possible.

  447. What is a Dr. supposed to do in the case of a rape patient terminating the pregnancy? Forcing this type of ultrasound could cause further psychological trauma, who is going to pay the therapy bill for that? Are there any other laws requiring medical procedures? Ridiculous, I’m sure there are more important things to be done with their time and our money.

  448. I am an adoptive mom who is eternally grateful for the women who chose life over abortion. So I tend to lean toward pro-life. However, as a woman, I don’t care to be part of an unnecessary medical procedure forced on me by misguided laws. But I’m a bit confused. Most of you are outraged that a doctor can be forced by law to perform an unnecessary procedure, and rightfully so. But at the same time, many have jumped on the post from “Sam” which suggested that there may be doctors equally outraged about being forced to go against their beliefs in order to protect their livelihood.
    So here’s my question…if you are outraged that a dr can be forced into performing procedures mandated by law…are you equally as outraged that a doctor can be sued, lose his practice, etc for not perscribing the morning after pill?
    I get the difference between following a law vs. making a personal decision/choice about what you do with your practice…but at the bottom line, are any of us concerned about protecting the rights of doctors who make decisions that just happen to lean toward pro life?
    I’m concerned about both but am scared to death that so many others aren’t. :-(

  449. 1) In your tweet containing this story, you used the term “mandated.” While not used in the article, I want to clear up any misconception. I’m assuming all this is related to the drama in Virginia surrounding abortions.

    To clear up any misconception, we are NOT talking just about Virginia. Some research would be helpful here.

  450. Dr. Anon, I am glad I ran into this post. Thank you for sharing it and John, thank you for giving him or her a platform to write about it on.

  451. Joe Bob, regarding your comment about doctors “lying,” there are several states who are MANDATING that doctors lie to their patients by (1) requiring them to tell patients that having an abortion can cause breast cancer, and (2) withholding information about the health or condition of a fetus in normal pre-natal screening that might “cause” parents to have an abortion. Guess it’s okay for the State to lie, but not a physician?

    Thank you John.

  452. As a pro-choice family physician who performs both medical and surgical abortions, I am saddened by all this anger and violent language surrounding ultrasounds. I strive to have the highest level of respect for all my patients, whether they are coming in for an abortion, a prenatal visit, or for their diabetes. In my mind there is no question that the standard of care is an ultrasound prior to an abortion. Let us not forget that while both medical and surgical abortions are very safe, neither procedure is without risk. Before I do a D&C on a patient, I want to be certain that I am not dealing with a fetus that is too advanced to be safely terminated in a clinic. Before I give a patient mifepristone to abort at home, I want to be certain that the fetus is not past the recommended gestational age, which would subject her to unnecessary pain and risk. Before I do any procedure on a patient, including ultrasounds, I explain to the patient the reason why I am recommending it, give her the opportunity to ask questions and express her concerns and/or fears, and then do everything in my power to minimize the discomfort of the procedure. Of course I do not think politicians should be involved in the intimate details of a doctor-patient relationship, and I strongly oppose any laws that try to mandate an invasive procudre. However the use of the word “rape” to describe an ultrasound obscures that fact that it is an important part of making abortions safer, and will likely create additional fear for women who are already going through an anxiety-provoking ordeal.

  453. I feel that we’ve been on this slippery slope for years. I can’t remember a time, as an American woman, that I ever felt I had full reproductive freedom, despite having been born after Roe v. Wade. This is just another step in the direction of reproductive enslavement. We should not be focusing on fighting this issue by issue, but on fighting the underlying belief that women are incapable of rational thought. So while I do applaud the doctor on speaking out, I must ask: why is this the issue that should bring civil disobedience? Trans-vaginal ultrasounds are rather unpleasant (in my experience), but they’re not any worse than the other horrible things that have been done in the name of preventing women from fully exercising reproductive freedom.

    When pharmacists were refusing to give medicines (ranging from birth-control pills to blood-clotting medicine for patients suspected of getting abortions) based on their religious beliefs, where were the pharmacists saying it was against their humanistic beliefs to provide life-saving medicines to those who seek to control others?

    When laws required medical practitioners to describe the fetus, or make a pregnant woman wait for an abortion so she could “think it over”, where were the psychologists standing up to say that this would have a negative effect on an otherwise mentally sound woman’s mental health, possibly triggering anger, frustration, fear, or feelings of despair?

    When a childfree woman walks into her gynocologist’s office, how many of them will paternalistically refuse her sterilization? Where are the researchers standing up to say that only a small percentage of women have regret over sterilization, and that gynocologists are denying women reproductive freedom on the basis of their own prejudices?

    When a woman is denied treatment which is medically indicated–such as removal of the uterus or ablation–for conditions such as PCOS or fibroids, because such treatments may render her infertile, where is the doctor pointing out that a woman may quite rationally choose sterility and an abscence of pain, and that women should not be treated according to their ability to become pregnant? Where are the doctors who refuse to treat women as “pre-pregnant” and as more than the sum of their reproductive parts?

    When parental consent laws limit underage women’s access to contraceptives and abortion, where were the people standing up to say that parents only have limited rights when it comes to determining what should happen to their children’s bodies?

    Of course, in all these cases, there have been people standing up to say these things…but not enough. I have difficulty feeling even remotely hopeful about this. I do not expect to feel secure in reproductive freedom unless I cease to have a uterus.

    After all, I am little more than a walking uterus in terms of the law.

  454. Thank you, doctor! I’m an RN and I have been screaming about HIPAA and medical ethics concerning this legislation on blogs all over the place! I could not understand why doctors and nurses weren’t coming out in droves against these reprehensible invasions into the patient’s privacy and the provider/patient relationship. I’m so glad to finally see a strong statement from a physician. Hopefully there are thousands more like you all over the country who won’t let moronic politicians tell them how to practice medicine. Thank you!

  455. Firstly, what a stupendous relief to finally see something like this. Dear gods and little piglets, has “managed” care and the anti-science meme neutered doctors so completely that they no longer rise up in collective outrage at such arrogant hatefulness and manipulation?

    Secondly, I’m touched by Maskman’s comment. I’ve often reflected that this is a hard time for true conservatives (root word being “conserve”, not “con”) and have no idea why the brand-loyalty of Republicans has exceeded their once-valued integrity. Someone had to let these fools into office, after all.

    I used to be an RN, dealt with several cases of medical rape including childhood trauma from invasive procedures done with the best of intentions. It’s still rape. The lifelong damage is devastating.

    Cherry on top: I had ultrasounds including a TVU that was indicated. After carefully warming the jelly for my belly, the tech had to explain that she was legally prohibited from warming the jelly on the wand. Why? Because there was a tiny theoretical possibility that there might be some minuscule alteration in the image if the jelly entering a warm body wasn’t cold. Go figure that one out.

    That was in VA.

  456. I so appreciate your writing this. I just wish more doctors had the guts to stand up about this issue and that they were able to do so publicly without repercussions.

  457. God bless you for this post. There are a lot of reasonable ways to look at the controversy of abortion. The requiring of a vaginal ultrasound in not one of them. Let’s be honest. Some nutjob wants to “punish” women who want an abortion. It’s as simple as that. “She was a bad, bad girl. She needs to think about what she’s done.” You know what? Judging is not our responsibility. Why can’t folks come to a point we agree on–abortion is not the best solution–and work from there. How can we PREVENT abortions? Requiring insurance companies to provide access to birth control, that’s one way. Helping educate people about sex is another. Coming up with a compassionate network to help people raise the unwanted child is yet another. And, no, I’m not saying the government should do all of this. I’m saying if you feel that strongly that women should not have abortions, then you should be willing to adopt one of those children. Or you (and I’m talking to these CEOs who make several times what their lowest employees make) should better pay your staff. Or you should work through your church or another charitable organization to help people get back on their feet so they don’t feel abortion is the only answer. And, and here’s the big one folks, you need to take the responsibility of talking to your children about sex, not bury your head in the sand and hope for the best.

    And all of that doesn’t even begin to cover the idea that Republicans–the very people who are against big government and against mandating things–want to mandate a test that isn’t needed and will ultimately be a waste of time, energy, and money. I even worry that women who actually need one of these procedures will refuse due to the stigma. Guess what? If you have ovarian cysts or who knows what else, you need to have one of these ultrasounds to make sure all is well. I don’t want to see anyone die because they associate this type of ultrasound as a punishment for “loose” women.

    Okay. Rant over. I’ve been holding it in for a while. As an English major and a Thoreau fan, I’m all about this Civil Disobedience.

  458. 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.

    Any prospect of suing the legislators for practicing medicine without a licence, or for impersonating doctors for fraudulent purposes?

  459. This brought me to tears. I am so thankful that their are physicians who take themselves seriously as healers and not tools of a warped political system. First do no harm. Thank you so much.

  460. Thank you Doctor. You clearly represent the ideals found in the Hippocratic Oath.\

    One of the modern versions of this oath reads:
    I swear to fulfill, to the best of my ability and judgment, this covenant:

    I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

    I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

    I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

    I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

    I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

    I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

    I will prevent disease whenever I can, for prevention is preferable to cure.

    I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
    If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

  461. Psychiatrists, MDs, archaeologists and a host of other professionals in Europe were vilified for their spineless acceptance of the politicization of their respective fields for decades after WWII. It might be wise, at this juncture in history, to remember that some morally repugnant behaviors are not subject to situational ethics.

  462. Thanks to the blog owner for sharing space for this important post. Thanks to the doctor for showing the courage to speak out. I wish more in your profession had the spine to follow suit.
    Now, for the rest of us.
    It’s time to stop being so demure and ladylike about the rape of our sisters. As little girls we’re told that if anyone touches our private parts we’re to scream as loudly as we can, kick the offender in the groin, run away and tell someone to call the police. Why should this change when we become adults?
    If you have the misfortune to live in a state where the pre-abortion trans-vaginal ultrasound is now the law, consider the following: The insertion of any object into any orifice of another, without their consent, or under duress, is rape. Period.
    The instant the probe touches any part of your genitalia scream as loudly as possible. Do not stop screaming until someone calls the police. If no one calls the police call 911 yourself and report that you are or were just the victim of a criminal sexual assault. When the police arrive demand that they arrest the person wielding the probe on a charge of criminal sexual assault.
    If the medical profession doesn’t have the courage to say no to these sexually obsessed legislators we must give them a very good reason to reconsider. Faced with the possibility of a charge of sexual assault on their professional record many doctors will refuse to perform this violative procedure unless it is medically necessary.
    I understand that many women will still be reluctant but, please consider this. If a man in a ski mask ordered you to undress, lie down and submit while he put something in your vagina would you comply? What about your daughters? Your sisters? Your mothers?
    I repeat my opening statement. It’s time to stop being so ladylike and demure about the rape of ourselves and our sisters.

  463. Excellent. Thank you for standing up for us. I hope others will follow. Julian Arancia made a very important point, but we all witnessed the result when the medical community stood with the American people for healthcare. It’s like we were punished for taking action. I’m happy to see that you and others are still fighting for human rights:) You are not alone. ~S~

  464. As a non-doctor, ordinary woman-who’s-had-children, I’ve had transvaginal ultrasounds and the pictures shown to me could have been pictures of the moon, for all the sense they made to me. So I cannot imagine what it is that women are supposed to be seeing on these scans that is supposed to be useful to them. My only conclusion is that the procedure is being used in exactly the same way ‘virginity tests’ were allegedly used to intimidate women protestors in the Arab Spring, or the way ‘venereal disease’ tests were used in the 19th century in USA and UK to deprive women of welfare support and incarcerate undesirables. This test has no medical function and is simply being used to oppress women.

    If you disagree with abortion, remember that two wrongs don’t make a right.

  465. Thank you Dr Anon, as an R.N. I completely agree with you. We, as medical professionals, are our patient’s last line of defense for so many things.

  466. She’s right. Who knew being a doctor (or in the medical field in general) would put you in the political arena. A doctor’s loyalty should be to his/her patients. There is so much wrong with the direction in which our country is headed.

  467. Folks:

    I updated the post to mention it but I’ll mention it down here as well: at 8pm tonight, eastern, I will be closing the thread to further comments. The reason for this is that I am happy to take a day out of my schedule to sit on the thread here and moderate it — and it does need more tending than my usual comment threads — but I also currently have a book to write. The comment thread is currently more than 600 posts long, so I don’t think anyone will complain there’s not a lot here to read and consider in any event.

    So, you have just under seven hours to get your thoughts in before I close the thread. Seems reasonable on this end. Thanks.

  468. Next session, the legislation-of-the-month will be Primae Noctis. After all, women that get married intend to have sex anyway, they might as well be forced to have sex with their GOP overlords. Not really rape since they were going to have sex with their husbands that night, right?

  469. Thank you. This issue has come up in Pennsylvania, my home state. Your comments reminded me of the position that the Pennsylvania Medical Society has taken and I thought it worth sharing: Politicians have no business deciding what procedures doctors perform and their patients undergo. I would only add that while the debate has inflamed over the issue of transvaginal ultrasounds, and rightly so, this is so much bigger. I believe that no person should be required to have any ultrasound, transvaginal or otherwise, or any other procedure, without their consent. My body. My health. My choice. Your body. Your health. Your choice.

  470. FWIW, I just forwarded a link to this discussion to my senator, Lisa Murkowski, who voted for the Blunt amendment, and to my representatives in the Alaska state house. It’s great to talk about it here, but unless everyone finally starts pushing back against the Neanderthals in our legislatures and in Congress, this is only going to get worse.

    Although I must say I never imagined it getting this bad in the first place.

  471. @sallyscribe
    “I even worry that women who actually need one of these procedures will refuse due to the stigma.”
    This is so incredibly important, as it ties into privacy and ethical issues that the doctor mentioned, as well as any of the commenters’ concerns about living in a small town with lack of access. I have a friend who lived in a small town, and due to having a procedure for an ectopic pregnancy, she and her loving husband faced shame for something that people refused to understand. How many women will be permanently harmed when they are too afraid of what the doctor won’t say, who the nurses will tell, how the neighbors will judge them for having a legal procedure? It’s a very slippery slope from regulating a distasteful elective procedure to effectively banning a medically necessary one, and this utter disregard for the autonomy of women and their judgment is pushing us well down that slope.

    Thank you John for hosting this discussion.

  472. I’m wondering when Republicans are going to actually call it what it is: state-mandated pregnancy.

    (And when they’re going to fully fund everything that state-mandated little person then needs.)

  473. @ Anonymous MD-

    While an ultrasound may be a useful tool in the patients you describe, I’m betting that all of those patients have given their consent to the tool being used prior to the procedure. THAT is the point you seem to be missing. I’m also pretty sure that none of your patients have been forced to hear you say to them “are you SURE you want to go through with this d&c? That that mass has such a bright future a head of it. “.

    @concerned and confused-
    No doctor can be sued or have their license taken away for refusing to order “the morning after pill”. It is available over the counter for women over the age of 18.

  474. Thank you so much for posting anonymously! I suspect the people who complained about the anonymity were doing so because they long to mark this doctor for harassment. By posting anonymously, this doctor makes it possible that they can put their ideas into practice and at least a few women will be spared state-mandated vaginal penetration before the doctor faces any kind of legal consequences.

  475. Thank you both so very much! A wonderfully articulated response and so important. I do question why it is up to a single anonymous physician to speak up here……. where, oh where, are the AMA (American Medical Association) and ACOG (American College of Obstetricians/Gynecologists)?

  476. John, Thank you so much for your courage in allowing the doctor to post these comments, and I thank my daughter who put the thread on her facebook so I had a chance to read it. I had NO idea that this was going on and am outraged. I appreciate your willingness also to take a day out of your life to monitor the site. Thanks again.

  477. BRAVO to you both! Thank “god” there are voices of reason out there! “All that is necessary for the triumph of evil is that good men do nothing”, Edmund Burke. More true now than ever.

  478. thank you, thank you, thank you. my only complaint is why you feel the need to write this anonymously. unless we make our voices heard – publicly – this will continue to hapen over & over again. i promise to share this link far & wide…

  479. fyi. I read the Texas legislation that covers this ( and found something that might be useful.

    In the definitions section, “Abortion” is referred to as (yada yada) …resulting in the death of the fetus”.

    My understanding is that, medically, an embryo is not a fetus and a fetus does not become such until about 8 or 9 weeks into the pregnancy.

    If that is the case, then the law would not apply for abortions conducted during that time frame, since the law (in TX only) addresses fetuses, not embryos.

    IANAL and all of that, but there might be enough legal maneuvering room built in there for some women and some doctors to entirely avoid going through this rhetoric – and perhaps even more wiggle room built in if there is a means to justify calling an embryo and embryo for as long as possible. (Mmmm, this is not an abortion, that looks like an embryo to me)


  480. @Jamie, but you see, you still are making a broad assumption about the population about those who oppose abortion. There is no way you can say all anti-abortion supporters are oppsed to sex, premaritual sex or anything else for that matter. That’s like me saying that you feel that abortion is the only birth control there is…..

  481. Re: Are trans-vaginal ultrasounds medically necessary during an abortion?
    When you walk into an abortion clinic and say “I’m pregnant”, they don’t just take your word for it. They need to positively diagnose pregnancy by visualizing with an ultrasound of either type, and make sure the fetus is in the uterus. Trans-vaginal ultrasounds have higher resolution than abdominal because the equipment is closer in proximity to the fetus. In fact, a very early-term fetus cannot be seen by either method around week 5, and can only be seen trans-vaginally at around week 6 (after conception). So if you have carried your pregnancy to term, sure, maybe you only had an abdominal ultrasound. The tools needed to verify a healthy pregnancy are not equivalent to those needed to prepare for a surgery.
    But whether it is medically relevant 98% of the time isn’t remotely the point. When I am having a conversation with my doctor, I want him or her to give me all the available treatment options, tell me all the risks associated with them, and then let me make a decision based on that. I don’t want them to be reading from the Rick-Perry-thinks-he-is-smarter-than-my-physician script, and then tell me to ignore everything they just said. And no, @Confused and Concerned, I don’t want them to factor their religious beliefs into that conversation either, because their beliefs are not mine, and I expect my doctors to put my interests ahead of their own. My understanding is that such a commitment is a pre-requisite to getting a license.

  482. Not quite anonymous @11:11 – I want to reinforce this comment, for any MDs out there, please do this. My experience looking for a good GYN doesn’t have to do with abortion but still reproductive choice. I wanted to get a tubal ligation, and after being turned away at Planned Parenthood because my office doesn’t do them, I asked my GP to recommend somebody SPECIFICALLY for a tubal. He gave me a name, and when I called I was again very clear about what I wanted. It wasn’t until I was in her office that she was condescending and rude to me about my choices, telling me that she was more knowledgeable and able to make the decision about my birth control options than I was. She also said that she had recently denied a 23 year old a tubal even after the woman’s third child because she was still “too young.” Needless to say, I found another doctor.

    This was five years ago. I said then that if a college educated, middle-class, married white woman couldn’t make her own choices about birth control and children, that the whole country was going to have a hell of a lot of trouble soon. I really really wish I wasn’t right.

    To everybody trying to excuse this law in one way or another: this isn’t just about the exact act of the TV ultrasound. This is about slowly but surely eroding women’s rights to their own bodies. It IS happening, and it will CONTINUE to happen. This isn’t a matter of “oh, it’s just women who want abortions.” This is an attack on every single woman and it is a clear statement from the government that we cannot be trusted with our own bodies and our own decisions. It will set a precedent, because it already has.

  483. I have nothing to say that hasn’t been said besides this: if you really want an ultrasound picture that you can use as a protest, I would gladly (and I’m absolutely sure my wife would agree) allow you to use an image of my son’s ultrasound for that purpose. Just contact me, and I’ll do what I can do.

    After going through a pregnancy with my wife, and seeing all that she went through with a totally healthy child and a normal pregnancy, I can’t even stand to see this kind of blatant abuse of government power. And I’m as far left as you can go without hitting the ol’ Communist title, so I have no problem with the government excercising it’s power – but only in the name of the PEOPLE that make the government possible.

    Government sponsored rape is disgustingly cruel and unusual. Contact me if I can help, please!

  484. @JS – I can only imagine that drain of sitting there all day watching this thread must be on productivity and life in general. Although I could picture this thread being almost being a whole chapter in and of itself in some future whatever compilation.

  485. When soldiers are given illegal orders, orders orders to commit crimes against humanity, the excuse that “I was only obeying orders” is not a defense.

    Rape, when directed against a civilian population by a government or organization is a crime against humanity.

    Probing a woman’s vagina against her will is rape and for a government to compel this is a crime against humanity. This is not a close call.

  486. Thank you, both for this! I had planned to say nearly everything Penny, just a few comments up, wrote. I’ll just second her.

  487. Thank You.
    You just gave me a faith in your profession that I never thought I’d have. I so appreciate that you agree that violation of a woman’s body with a foreign object without consent obtained free from duress is tantamount to rape. Thank you. Thank you. Thank you.

  488. Thanks to the good doctor for the comments. I entered nursing school in CA during the fight to legalize abortion. No matter what my beliefs are, I am astounded that 46+ years later women are still the target of political groups who have an agenda not entirely pure in the care of women needing the care they choose.. As my grandma used to say, ” it just gets woister and woister.”

  489. Thank you, John and Dr. A.

    Elizabeth R @1:53 pm, you hit the nail on the head with this: “To everybody trying to excuse this law in one way or another: this isn’t just about the exact act of the TV ultrasound. This is about slowly but surely eroding women’s rights to their own bodies. It IS happening, and it will CONTINUE to happen. This isn’t a matter of “oh, it’s just women who want abortions.” This is an attack on every single woman and it is a clear statement from the government that we cannot be trusted with our own bodies and our own decisions. It will set a precedent, because it already has.”

    It is horrifying how many people cannot (or refuse to) recognize how scary legislation like this really is.

  490. @Yep – I don’t really see how I’m making any sort of unfair judgement. If the anti-choice movement was really just about preventing abortion, they would -also- be in favor of increasing access to contraception and sex ed. Contraception and sex ed would have the benefit of actually reducing the number of abortions performed by reducing the number of unwanted pregnancies. Putting pointless, medically unnecessary restrictions on abortion just serves the purpose to stigmatize it, make it more difficult if not impossible for a lot of women t access, and increases the number of illegal abortions that will be occurring – in which case the pregnant woman is at grave risk in addition to the fetus she doesn’t want to carry to term.

    You could say that I feel that abortion is the only birth control there is, but that would be a lie. You would not be pulling that supposition from any actual information about me. I am very strongly in favor of access to contraceptives as well as education. In an ideal world, there would be no abortion because no pregnancy would be unplanned. Since that is not the case, access to abortion must be preserved. In the case of the anti-choice politicians, however, there is ample evidence to support my claim.

  491. Thank you, John, for posting this. And, thank you, Doctor, for the compassionate words from the other side of the wand.

  492. First, thank you. Second, I really hope this isn’t a hoax. But, even if it is – maybe medical professionals will be more vocal, and a little disobedient…

  493. @Yep – I just realized you may be misunderstanding me here. I’m not claiming that every individual person who is opposed to abortion is trying to punish women for having sex. I am claiming that that is the goal of the movement when taken as a whole. If you have another explanation for why they would be opposing contraception and sex ed (which, again, prevent abortion), please let me know.