/ February 13, 2018

Addressing Patient Rights and Expectations in the Wake of Nassar

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It takes a lot of courage to come forward when injustice and abuse has taken place. For many who have experienced trauma, recent news about the Nassar case has not been an easy topic to read or follow. I appreciate this season of women rising to bring awareness to sexual abuse and violations of trust in the medical field but with that also came fear and anxiety about how to protect ourselves and our daughters.

I have been requested to address what you can expect from pelvic floor physical therapy. But I think it important to mention that these are your patient rights not just with a physical therapist or with pelvic floor treatment, but with anyone with the authority to touch any part of your body. I hope this will give you the confidence to continue pursuing the treatments that you desire for your health and the health of your loved ones.

1. Consent, Privacy and the Right to Question

First of all, all medical practices should have a consent form with information about your rights as a patient or client. You have the right to refuse treatment, request more information and ask for a second opinion. Questions should be encouraged. Alternative treatments and recommendations should be available. There should also be a statement of privacy and confidentiality guidelines.

2. Your Practitioner’s Scope of Practice and State Regulations 

Different states have different regulations on what a practitioner can do. There are more and more providers interested in women’s health. Not everyone with a doctorate degree is a licensed or board certified medical doctor nor are they certified or have the training to do internal pelvic floor work. If internal pelvic work is suggested, take the time to find out if this is something that is legal in your state and within their scope of practice. States have boards that govern a particular practice, whether it is physical therapy, chiropractic, massage therapy and other healthcare providers. They handle licensing, examinations and disciplinary actions. They have information available about the practitioner you are seeing.

3. Minors and Chaperones 

Anybody under the age of 18 requires a parent or legal guardian to sign a consent form for any medical treatment, regardless of what the medical procedure is. It is not common for a practitioner to suggest internal pelvic assessments and treatments to a minor. Alternative evaluation methods and treatment are available specifically for the pediatric population. Not all pelvic floor specialists work with the pediatric population so if you have a child who is experiencing pelvic floor issues, make sure the practitioner is trained in pediatric pelvic floor disorders. All doctors and practitioners of the opposite gender should have a chaperone when performing any pelvic procedures. All procedures should be thoroughly discussed and understood with signed consent before proceeding.

4. Hygiene and Comfort

Hygiene is pretty straightforward. Practitioners have standard procedures to prevent infection and injury to the human body. This includes preparing the instruments and equipment, preparing the area where the procedure takes place, hand washing, using gloves and disposing of soiled material appropriately. All measures of comfort should be attempted to minimize trauma to the area treated. This includes informed consent, an explanation of what is expected and checking sensitivities and allergies to any materials, including gloves and lubricants used. Privacy and confidentiality is also practiced in an assigned space with appropriate supervision and chaperones when applicable.

5. Duration and Frequency 

Practitioners are required to have a treatment plan. Even though it may vary between patients, practitioners should inform you of the expected duration and frequency of the treatment. With that, there should also be a discussion of what to expect and what to do if the treatment did not go as planned. It is very unlikely that pelvic floor treatments are done on a daily basis or over a prolonged or undefined period of time.

Most of us go into the medical field because we want to help people. Cases of sexual misconduct and abuse are infuriating and a disgrace and disservice to those who have work so hard to achieve the license to touch. However, the only way practitioners are able to get away with such a wide scope of abuse is because they had colleagues and a community who condoned their behavior or because the people who disapproved did not speak up. Predators are cowards and they cannot thrive alone.

In my experience, when I spoke up and brought unethical treatment or inappropriate recommendations to a medical board, my own character and academic history was often questioned and investigated as they pursued my complaints. But with ethical and law abiding practitioners, the pain that we observe in our clients and patients often overrides the fear of being misunderstood or questioned. I have sat with many women in my clinic who have experienced trauma, abuse and unexpected pain from medical procedures to their pelvic floors. Nevertheless, I have also seen healing that takes over when a woman starts to gain the strength, not just physically, but emotionally, to connect with her body, sexuality and relationships.

I would like to conclude with a quote from Tami Kent, MSPT, founder of Holistic Pelvic Care, author of Wild Feminine and a visionary women’s health physical therapist.

“And let me be clear, the female body and energy system are far too powerful to be damaged by these acts–but what is damaged is the woman’s connection to her own body, to her own knowing of her body as sacred. That connection between herself and her body is what must be repaired to heal. But once the shame is cleared––the shame that belongs not to her but to each perpetrator that was so empty he had to steal the light of another––she returns home to her body to find that it was waiting for her. The medicine she needs is there in her pelvic bowl. Her creative essence flows over the assault lines like gold. I welcome this rise of the feminine light in the growing fault lines.”