Consented, p.25
Consented, page 25
Imagine a system where safety needs no advocacy. Where trust-based consent requires no prerequisites.
The night before I wrote this final chapter, I lost my voice to a viral illness. A lot depended on me having a voice: over thirty patients scheduled for the next day; a physician assistant in training whose twenty patients’ care I was overseeing; and three medical assistants who would have to cancel every appointment if I didn’t show up. The thought of calling in sick made me feel defeated and irresponsible: Am I really sick enough to call in sick? Am I weak for calling myself sick? What would my workplace think of me? A bad employee? Too fragile to be trusted? Should I force sounds from my inflamed vocal cords and try to make it through a day with fifty patients, many of whom had waited months to see me? What would they think of me? Unreliable? A bad doctor?
Beyond what work demanded and what people expected of me, my reluctance to take time off was also a symptom of medicine’s culture of self-sacrifice. In residency, I prided myself on delivering the most babies, taking the highest numbers of C-section calls, and working the longest shifts. In fellowship, I was praised for seeing all my attending’s patients while maintaining my own full schedule. I said yes to everything. I did research on weekends. I even boasted on my résumé about only calling in sick for 2.5 days in three years. Medical education teaches that needing rest is weakness, and not showing up equals slacking. Ableism in healthcare says that advocating for oneself is selfish, and the only way to be a good doctor is to give more and complain less.
So I wore self-neglect as a badge of honor, until the day I burned out. I stared at the unsent message on my phone justifying why I deserved a day off and saw the truth: I didn’t lose my voice.
It was taken from me—the day I felt too disempowered to whisper stop; the day I was told to hold my tongue; the day I was called the smart girl, the young girl, the Chinese girl, the never-the-doctor girl; and the day after day after day my identity was chipped away and my sense of self crumbled. I was made to forget I had a voice, until the day I watched my parents become collateral damage in the same system that marginalized my patients; the day I cried in front of the mirror and struggled to recognize the emotions that made me human; and the day I remembered my own trauma of standing in vomit, holding a bag of shame.
But it was in these broken moments that I found the strength to reclaim my voice, the same voice that carried me through towering gates and onto rides beside those who dared to smile against the wind. Through telling the stories of my patients, my voice merges with theirs, speaking a language that humanizes us all in words that shatter the tactics of medical rape culture.
And let us be heard: As long as the power hierarchy in exam rooms and on operating tables outweighs humanity, as long as dismissal and gaslighting shape the conversation about health, and as long as the violation of bodily autonomy remains normalized and trivialized in medicine, we will not be consented.
Acknowledgments
To all my patients: Thank you for your courage, your trust, and your stories. You have taught me how to be the same person inside the exam room as I am outside of it. You’ve reminded me what it means to show up with honesty, humility, and heart.
To my immigrant patients and your families: Thank you for your grace, your resilience, and the fierce beauty of your presence. You’ve shown me, again and again, that hate must be alienated, that bigotry does not deserve to be documented, and that xenophobia has no legal or moral standing. It is an honor to walk beside you.
To my readers, online and offline: Thank you for your honesty, your transparency, and your encouragement. You remind me that I am never writing alone.
To my teachers, attendings, fellow residents, nurses, midwives, and clinician mentors from the Geisel School of Medicine, Mayo Clinic Health System in La Crosse, and the University Health Robert B. Green Campus: Thank you for shaping the doctor I am and inspiring the one I am still becoming.
To Dr. Jim Withers: Thank you for modeling what it means to treat people like people.
To Dr. Richard Usatine: Thank you for being my friend and mentor for life.
To Dr. Dennis Costakos: Thank you for teaching me to work smart while staying kind.
To Dr. Chloe Ackerman, the first person who told me I was a writer: Thank you for giving me the nudge, the space, and the friendship that helped me begin.
To Kathryn Willms, my agent and steadfast cheerleader: Thank you for believing in this book even before I did. Your support has been a lighthouse.
To Shayna Keyles, my editor who pushed me to speak up, then speak louder: Thank you for sharpening my voice and helping it ring clear.
To Joy Stevens and Barb Malwitz: Thank you for extending a hand when I was a lost international student, still finding my way.
To all those who offered kindness in my early years in a land unfamiliar to me: Thank you for reminding me what welcome feels like.
To Portia Fitzhugh and John Karol, my landlords turned family: Thank you for giving me a home when home was far away.
To my mother, who “stole” me out of the adoption facility and gave me a second chance at life: You are the reason I know what love can do.
To my father, who holds his own kind of scholarship without ever having gone to school: Thank you for your quiet brilliance.
To my husband, Matthew Cloutier, my rock, my partner, my love: Your steady presence makes this work possible. Thank you for holding me when the stories got too heavy, and for believing in this one from the very beginning.
And to my first dog and loyal companion, Moshi Moshi: Woof. Woof. Woof.
Glossary
The terms here are defined as used in this book and contextualized within the framework of medical rape culture. Some terms are preferred by certain communities but not by others. Language is constantly evolving, and these definitions may be improved by the time of publication.
AAPI. The abbreviation for individuals of Asian, Native Hawaiian, or Pacific Islander descent. Although many Asian immigrants aren’t US citizens, they are typically included in AAPI health data. This is not always the case in other contexts, such as in higher education, where international Asian students are often excluded from Asian American metrics. Since medical data often do not distinguish between foreign-born and US-born individuals, this book uses AAPI throughout.
bad consent. The defining tactic of medical rape culture. Whether by ignoring a “no,” selectively pushing for a “yes,” or reducing consent to a checkbox, bad consent manufactures compliance while masking coercion and power imbalance. It strips patients of their autonomy, disguises domination as care, and quietly sustains medical rape culture. It takes four main forms: non-consent, forced consent, inadequate consent, and contractual consent.
body objectification. The practice of reducing patients to a collection of organs in need of fixing, rather than seeing them as whole persons with lived experiences and bodily autonomy. Often, the “fixing” and the “fixers” are allowed to dictate a patient’s dignity and health.
fat. Used as a neutral adjective, in line with the preferences of size acceptance activists. When the terms overweight and obese appear, they do so in quotes (typically as part of quoted material from other sources) to highlight their stigmatizing nature.
gender; gender identity. Gender is a cultural designation assigned at birth (e.g., boy/man or girl/woman). Through a complex process of socialization, often aided by medical or surgical intervention, individuals may come to identify with or diverge from their assigned gender. One’s internal sense of gender is referred to as gender identity.1
immigrant vs. migrant. As defined by the International Organization for Migration: Immigrant refers to someone who moves to and resides in a country other than that of their nationality. Migrant refers to someone who moves—within a country or across borders, temporarily or permanently—often for work or better living conditions. For example, José, who intended to temporarily work in the US, is a migrant or migrant worker. I, who permanently reside in the US, am an immigrant.
intersex. Refers to individuals born with sex characteristics that do not fit typical or idealized definitions of male or female. These characteristics may involve internal or external reproductive anatomy, chromosomes, genetics, hormones, and/or neurodevelopment.2
Latine vs. Hispanic. Latine is an inclusive, gender-neutral term that refers to people from Latin America or the Caribbean. Hispanic refers to people from countries where Spanish is the primary language. For example: José, from Mexico (a Spanish-speaking country), is both Latino and Hispanic, even though he primarily speaks Mixteco. A person from Brazil, where Portuguese is spoken, is Latine but not Hispanic. Most epidemiological data use the terms interchangeably. The US Census Bureau currently lists “Hispanic/Latino” as a race category, alongside white and Black—a classification that is under ongoing scrutiny, particularly from Afro-Latinx communities. This book uses Hispanic/Latine in epidemiological contexts and Latine in patient-centered narratives. For simplicity, white refers to non-Hispanic white and is lowercased per AP style.
LGBTQIA+. An acronym for lesbian, gay, bisexual, transgender, queer, intersex, asexual or aromantic, and those whose identities and sexualities extend beyond this acronym.3
medical misogyny. Rooted in male-centric norms and perspectives, medical misogyny devalues non-male bodies as inherently “defective.” It includes bias against the suffering of women and girls, often manifesting as systemic disregard for their embodied experiences. It forces its victims to navigate a medical system that denies agency over their health, deprioritizes their perspective, dismisses their symptoms, and diminishes their voices. It also deeply harms transgender, nonbinary, and other gender-diverse individuals, who face compounded barriers to care.
medical racism. A cornerstone of medical rape culture and its systematic denial of bodily autonomy, medical racism dehumanizes Black, Indigenous, and other People of Color, as well as those from nondominant cultural groups, rendering their bodies less valuable and their suffering more permissible.
medical rape culture. A pervasive healthcare environment that normalizes or trivializes the violation of bodily autonomy. It enables the dismissal of symptoms and medical gaslighting, excuses vast power hierarchies in exam rooms and on operating tables, and hides unnamed beneath the illusion of care. It isn’t the conscious choice of “bad” doctors; it is the air we breathe when we practice bad medicine, turning us into the very monsters we once swore we’d never become.
nonbinary. Describes individuals whose gender identity is neither exclusively girl/woman nor boy/man.4
pathologizing vs. standing with gender and sexual diversity. Pathologizing gender and sexual diversity refers to medicine’s long-standing enforcement of rigid binary ideals of masculine and feminine, male and female—branding natural human variation as disordered. This framing has legitimized pseudoscientific practices such as conversion “therapy” and non-consensual sex assignment surgeries, and enabled outdated policies and profit-driven healthcare systems to delay or deny access to lifesaving, gender-affirming care, reducing people like Robin to mere medical cases. Standing with gender and sexual diversity means affirming patients’ agency, autonomy, and right to live fully and freely as themselves.
patient blaming. The unjust practice of holding patients personally responsible for their health struggles, chronic conditions, complications, or even treatment outcomes, while ignoring broader systemic, social, economic, and environmental forces that shape health. Patient blaming perpetuates systemic violence (e.g., racism, ableism, misogyny, anti-fatness, anti-LGBTQIA+ bias) and rebrands oppression as personal failure. Simply put, it says: “You’re responsible for your sickness.”
patients. Used as a general term to refer to those receiving medical care. For adults capable of making their own medical decisions, this refers to the individual. In cases involving fetuses, children, or adults unable to make medical decisions, the term includes both the individual and their caregiver or decision-maker.
sex. A biological/medical designation assigned at birth, typically categorized as male or female by dominant societal and medical frameworks.5
sexual diversity. Though often used as an umbrella term for both sexual orientation and gender identity, in this book sexual diversity refers specifically to the diversity of sexual orientations.
sexual orientation. The types of people toward whom one is sexually attracted.6
sexuality. What one finds erotic and how one experiences bodily pleasure.7
survivor vs. victim. The term survivor is not used in the immediate aftermath of sexual assault, as many do not yet feel like they have survived, especially within clinical settings. Victim is used to indicate a person who has experienced harm.
transgender. Describes individuals whose gender identity does not align, in a traditional sense, with the gender assigned at birth, regardless of their sexual orientation. This identity need not be binary.8
trivializing trauma. A three-part failure, trivializing trauma includes: (1) inadequate and insensitive care in the immediate aftermath of trauma, as in the case of sexual assault victims; (2) the widespread absence of trauma-informed practices across healthcare, which means trauma survivors are routinely retraumatized and forced to navigate a system that neither believes nor understands them; and (3) invasive, dehumanizing, and dismissive medical practices that violate bodily autonomy, erode trust-based consent, and inflict fresh layers of physical and emotional harm. In the short term, this shatters a person’s sense of identity, safety, and control within medicine. In the long term, it damages self-worth and the ability to trust others—or even oneself—beyond medicine.
women. When discussing medical misogyny, this term is used for simplicity. Though it is often stereotypically assumed to describe cisgender, heterosexual women, in this book it is used more broadly to refer to anyone who is not a cisgender, heterosexual man.
workplace inequity. Sustained by misogyny and racism, workplace inequity keeps women—especially women of color—underpaid, silenced, and vulnerable, while maintaining patriarchal status quos. It punishes assertiveness, rewards submission, and protects the very systems that expect our gratitude in exchange for their injustice. These dynamics not only harm women workers but also shape the care delivered in clinical settings.
Notes
Chapter 1. Medical Rape Culture—The Unifying Diagnosis
1 J. Chen, C. Guo, M. Lu, and S. Ding, “Unifying Diagnosis Identification and Prediction Method Embedding the Disease Ontology Structure from Electronic Medical Records,” Frontiers in Public Health 9 (January 2022): 793801, https://doi.org/10.3389/fpubh.2021.793801.
2 B. Lancaster, J. Goldman, Y. Kobayashi, and A. W. Gottschalk, “When Is Imaging Appropriate for a Patient with Low Back Pain?,” Ochsner Journal 20, no. 3 (2020): 248–49, https://doi.org/10.31486/toj.20.0077.
3 Roxane Gay, “Introduction,” in Not That Bad: Dispatches from Rape Culture, ed. Roxane Gay (Harper Perennial, 2018).
4 Office of Public Affairs, “An Updated Definition of Rape,” United States Department of Justice Archives, updated April 7, 2017, www.justice.gov/archives/opa/blog/updated-definition-rape.
5 Mary Ellen Gale, “Rape as the Ultimate Exercise of Man’s Domination of Women,” New York Times, October 12, 1975, www.nytimes.com/1975/10/12/archives/rape-as-the-ultimate-exercise-of-mans-domination-of-women.html.
6 Association of American Medical Colleges, 2021 Fall Applicant, Matriculant, and Enrollment Data Tables (AAMC, 2021), www.aamc.org/media/57761/download?attachment.
7 A. Seehusen, D. R. Johnson, J. S. Earwood, S. N. Sethuraman, J. Cornali, K. Gillespie, et al., “Improving Women’s Experience During Speculum Examinations at Routine Gynaecological Visits: Randomised Clinical Trial,” BMJ 333, no. 7560 (2006): 171, https://doi.org/10.1136/bmj.38888.588519.55.
8 D. Wright, J. Fenwick, P. Stephenson, and L. Monterosso, “Speculum ‘Self-Insertion’: A Pilot Study,” Journal of Clinical Nursing 14, no. 9 (2005): 1098–111, https://doi.org/10.1111/j.1365-2702.2005.01205.x.
9 “Cervical Screening Test Options,” Cancer Council Victoria, accessed November 12, 2023, www.cancervic.org.au/cancer-information/screening/cervical-screening/self-collection.
10 M. N. Asiedu, J. Agudogo, M. S. Krieger, R. Miros, R. J. Proeschold-Bell, J. W. Schmitt, et al., “Design and Preliminary Analysis of a Vaginal Inserter for Speculum-Free Cervical Cancer Screening,” PLoS One 12, no. 5 (2017): e0177782, https://doi.org/10.1371/journal.pone.0177782.
11 Food and Drug Administration (FDA) to Dr. Carl Youngmann (Director of Regulatory and Quality Affairs at FemSpec LLC, manufacturer of the FemSpec-SterileTM Disposable Sterile Vaginal Speculum), February 2, 2006, www.accessdata.fda.gov/cdrh_docs/pdf5/K052192.pdf.
Chapter 2. Bad Consent
1 Jessica Bennett, “When Saying ‘Yes’ Is Easier Than Saying ‘No,’” New York Times, December 16, 2017, www.nytimes.com/2017/12/16/sunday-review/when-saying-yes-is-easier-than-saying-no.html.
2 Jaclyn Friedman and Jessica Valenti, Yes Means Yes!: Visions of Female Sexual Power and a World Without Rape (Hachette Book Group, 2019).
3 UN Women, “When It Comes to Consent, There Are No Blurred Lines,” UN Women, November 18, 2019, www.unwomen.org/en/news/stories/2019/11/feature-consent-no-blurred-lines.
4 Cindy M. Meston and David M. Buss, “Why Humans Have Sex,” Archives of Sexual Behavior 36, no. 4 (2007): 477–507, https://doi.org/10.1007/s10508-007-9175-2.
