In Indre-et-Loire, has a gynecological practice “officially threatened to cancel the appointment of patients if they do not consent to all gynecological examinations”, as denounced by a collective? On social networks, a screenshot of instructions, posted on the health professional’s website, shocked. The gynecologist refutes this interpretation.
It first indicates what a complete clinical examination includes, with a palpation of the breasts, the placement of a vaginal speculum for the smear, a vaginal examination, possibly an ultrasound with a vaginal probe and a rectal examination for certain pathologies. And above all, it is specified, at the end, in red, that in the event of disagreement, the person must report it before the consultation “which will possibly be canceled”.
An “extremely intimidating” note
A precision that revolted collectives such as Stop obstetric and gynecological violence (stopVOGfr) or the Interassociative collective around birth (Ciane). “These instructions are contrary to the Kouchner law of 2002 on the free and informed consent of patients, which can be withdrawn at any time, indignant Sonia Bisch, founder and spokesperson of stopVOGfr. Consent cannot be obtained under duress, threat, pressure. »
For her, this note “makes patients think that they must accept everything from the doctor because otherwise, your appointment may be canceled. It’s extremely intimidating, she says. And what do they have to do in the office? That they say nothing, especially if they are in pain? Maybe he’ll cancel their date when they need it, if they have a complicated pregnancy? »
The collectives see it as a possible refusal of care
Another point has aroused the ire of the collectives: the fact that this note has been validated by the departmental council of the College of Physicians, as mentioned under the announcement. The publication of these instructions would have been accepted in a restricted office in August 2022, according to the National Council of the Order of Physicians (CNOM). The departmental council did not want to communicate on the subject, but the practitioner, whom we contacted and who does not wish to be named, indicates that the poster was validated on August 12, 2022.
StopVOGfr sees in this note a possible refusal of care and wonders how to report a doctor “when the procedure to follow is to contact the departmental order”. “Selecting patients on their therapeutic compliance is not very ethical,” denounces Ciane. For collectives, these instructions are also contrary to the gynecology or obstetrics consultation charter, adopted in 2021 by the National College of French Gynecologists and Obstetricians (CNGOF). This stresses that “the clinical examination is not systematic” and that it “must be able to be interrupted as soon as the patient expresses her will. No pressure, in case of refusal, will be exerted on it. »
The practitioner deplores “false denunciations”
We contacted the concerned gynecologist. He deplores “false denunciations”. “It is not me who makes the decision whether or not to cancel a consultation, but the patient, he explains in an email. Any woman has the possibility of canceling a consultation at any time if she considers that the examination itself is traumatic. It’s his choice and not mine, and I respect it. Any other interpretation can only be made with the intention of harming me”, he believes, indicating that he has filed a complaint for defamation with the gendarmerie.
He adds that this is, for him, “constituting the offense of slanderous denunciation”. And specifies that the CNGOF charter was also accessible from its website (under maintenance). The note has since been removed from the site. “At most, it is a problem of communication and understanding of a text, resulting from a knowingly serious and thoughtless lack of discernment on the part of the author of the tweet”, he believes, regretting the publicity of this case.
“To date, I have never been the subject of complaints to the Council of the Order, which, it seems to me, is the most competent to assess breaches of ethics,” he concludes.
The College of Physicians apologizes
If the departmental council of the College of Physicians did not wish to communicate on this case, the national institution apologized “to all the patients who were injured by the content of this poster” in a press release, which was emailed to us. “The Order wishes to inform that doctors do not have to cancel a medical appointment if a patient refuses one of the medically advised examinations”, it is specified.
The National Council of the Order of Physicians recalls the importance of “fair and appropriate information allowing the patient’s consent to be obtained during all medical examinations, in particular during gynecological and obstetrical consultations, […] at each stage of medical care”.
A clearer wording in reflection
Joëlle Belaisch-Allart, new president of the national college of gynecologists and obstetricians, says she understands the reaction of the collectives, but sees several ways to read the note. “The message is surely badly written since it can have several interpretations”, she points out, inviting to read carefully, word for word. She emphasizes that the clinical examination is first defined, “it is indeed what we are asked to do, she comments. It is not said that an examination will be done systematically or obligatorily. “The formula” which will possibly be canceled “, “may mean that everything depends on the reason for the consultation”, she believes.
And specifies: if a person consults for a reason where the clinical examination is useful and recommended (pain, bleeding, loss of urine from coughing or laughing), “we can explain to him that it will be a useless consultation if it does not wish to be examined and there will be misunderstanding during the consultation or at the billing and it is perhaps better to cancel before”. Personally, adds the president, she considers it preferable to always receive to explain “how the examination would provide elements to know if it is necessary to operate, what can be proposed”.
What wording could have been clearer? Joëlle Belaisch-Allart explains that the college is thinking about it and proposing as a line of thought: “The practice respects the indications for gynecological and pelvic examination as defined in the recommendations for the practice of the college and only offers the clinical examination in the cases indicated. If you do not wish to be examined when your reason for consultation requires it, the firm may offer to cancel the consultation. But, the formulation should be tested beforehand with users to ensure proper understanding, she concludes.