Sadly…slut shaming can come from physicians. Female physicians. In reference to innocent pediatric patients.
Back in medical school, I did a rotation in pediatric hematology. In clinic, one day, we saw an 11-year-old girl with hemophilia. The patient was being given medication to aid with blood clotting, but even with this medication, the blood loss from her menstrual periods was still a significant medical problem. As a result, her mother and doctors deemed that taking daily oral contraceptive pills (OCPs) would be helpful for decreasing the risks associated with menstrual bleeding in a hemophiliac. This seemed reasonable to me; however, her mother was adamant that her daughter not be told about the birth control medication.
The patient, a bright-eyed, inquisitive girl, became puzzled when her mother and the hematology attending began speaking about her “hormonal therapy” in vague terms. She asked questions, but was repeatedly ignored. Her mother was trying to ask the hematologist if the OCPs, when taken for the indication of suppressing menstrual periods, would “still work for its intended purpose.” She was trying to ask if the contraceptive would be effective in preventing pregnancy, even if it was not being taken for that reason.
It was such a strangely-worded question that my attending initially did not understand. I interjected with “Yes, yes it will still work for that purpose. It will.” My attending understood and nodded. The girl looked at us and asked, “Why isn’t anyone explaining anything to me?”
This strategy of hiding a medical treatment from an astute pediatric patient seemed like a bad idea to me. It seemed particularly silly since there was absolutely nothing to be ashamed of; this girl has hemophilia through no fault of her own. Outside of the room, I confronted my attending, asking her why we were keeping the prescription and use of the contraceptive a secret from the patient. The patient was obviously old enough to understand that we were keeping a secret and could easily look up the information on her own.
My attending did not have an explanation.
Instead, she GIGGLED: “Oh, you know what the kids will say about a girl on birth control!”
Wait. So. We are not disclosing the reason for a medical treatment to a patient, because of the possibility that ignorant middle school students will slut-shame her for taking birth control pills?!
Aren’t we the grown-ups here? Shouldn’t we be the driving force to empower her with knowledge of her own medical condition, as well as give her the strength and support to stand up to bullies? Her particular medical condition is rare, but her need for oral contraceptives to deal with debilitating menstrual periods is fairly common. She, and we as doctors, should be on the front line in dispelling myths about birth control. Maybe if we did a better job of educating the public, we would have fewer ignorant rants about women’s health…like the disgusting tirade from Rush Limbaugh to slut-shame and insult Sandra Fluke when she spoke out in support of insurance coverage for women’s health. (And now, a summary of Rachel Maddow’s fabulous take-down of Rush Limbaugh, explaining basic anatomy.)
This was a day in medical school when my main take-away message was not a pharmacologic or disease mechanism (though there was plenty of that during the hematology rotation): I learned that as physicians, we can’t silently condone the bullies. We must empower our patients with knowledge to defeat ignorance.