EP. 188 — Confronting Medical Assault with A’magine Goddard

Jameela Intro [00:00:00] Hello and welcome to another episode of I Weigh with Jameela Jamil, podcast against shame. I hope you’re well and thank you so much for so many lovely messages about my deeply candid and personal episode of Ask Me Anything. I really did answer everything with as much personal truth as possible, and I appreciate how responsive you’ve all been. So give that a listen if you want to just have a sort of one on one chat with me in the car, maybe. But generally, you’ve just been such a dream and I’m so happy that you’re also happy with the episodes. This week is a very, very intense subject, but one of the most important subjects I feel like I’ve ever learned about. Not just during the time of making this podcast for almost four years. Wow. But ever. I had no idea that this thing was happening in the United States, and it has possibly changed the rest of my life to learn about it now. I was told to watch a film a few months ago called “At Your Cervix.” It is an award-winning documentary that exposes the hidden practice of medical students learning to perform pelvic exams on anesthetized patients without their consent. And we’re not talking one or two cases. We’re talking thousands and thousands and thousands of cases of this for decades, the decades in the United States of America. And so my guest A’magine Goddard has made this incredibly brave documentary as a whistleblower who learned from the inside that this is what’s going on and has now made it her life’s purpose to bring awareness that this is happening to people under anesthetic without their consent and to help legislate against that happening because currently we don’t even know that this is happening. We don’t know what our rights are, and we don’t know how to get out of this happening to our bodies. This is a violation against our bodies. And speaking of violation, I want you to just have a little trigger warning here. There is mention of sexual assault because, of course, there would be connotations of that feeling when your body’s being invaded without your consent, but we do talk about that. We do have mentions of sexual assault in this episode, but we try not to get into it in any way that feels very gratuitous, of course, and we try to just make it as kind of helpful as possible rather than traumatizing. But I just always have to make sure that you’re ready for that in case that’s something you need to opt out of. But this is a fascinating episode. She’s an extraordinary communicator, and she talks to me about the history of gynecology and how the speculum was designed, which some of us know, some of us don’t. A lot of it happened, again without consent, on enslaved people who were experimented on in order to design the things that we use today in modern medicine. And we talk about what has been happening, how it’s been happening, and how it’s not just traumatizing for the patient who I may go as far as to call the victim, but also it’s traumatizing to the medical student who is performing an act on someone’s genitalia or within their genitalia without their consent. That is traumatizing to be forced to do something like that and to be pressured by your medical school into doing it or being threatened that you may not actually have a career then in medicine. This is so hyper-normalized within the medical industry, and the only way it can stop is if enough of us know about it and talk about it and help rally against it legislatively. And so I urge you to watch the documentary. We will be providing links on the I Weigh platform on our Instagram, which is @I_Weigh, and I want you to watch this documentary. I want you to listen to this chat. It’s going to blow your fucking mind and it may actually protect you in future from this happening to you because she gives me actual constructive advice as to how to prevent this from happening to you when you are going under anesthetic. I’m not trying to freak you out about health care. I know that especially women already feel so reticent because of all the gaslighting and the mistreatment and how invasive and terrorizing so many of the procedures that we need are. I don’t want to scare you away, but if anything, this will make you feel and literally be safer to be armed with this knowledge. I care very deeply for you, and I feel that this is such a tremendous injustice that’s just been happening under our noses with us having no idea. And we have to stop it. And we can do that. And we can only do it together by knowing about it and then fighting it as one. And we have to fight it because this cannot continue. I can’t fucking believe this is going on. So please enjoy this chat. I know that sounds weird given that it’s about quite a terrorizing subject, but it is fascinating. And she is an extraordinary human being. So take a deep breath and please listen to the excellent and vital words of A’magine Goddard.

Jameela [00:05:32] A’magine Goddard. Welcome to I Weigh. How are you?

A’magine [00:05:41] I’m good. I’m happy to be here. I just came off of the road for a month of screenings and delighted to talk to you. Thanks for having us.

Jameela [00:05:51] Thank you for being here. Your documentary has changed, I think, like my brain forever is changed. It’s very rare that a documentary so immediately has such a profound impact on me, but I felt very deeply emotional during and after. And it made me feel like it was very important to have you on to discuss this subject because we need to raise the alarm as fast as possible that this is happening. Can you explain what your documentary “At Your Cervix” is about?

A’magine [00:06:24] It is about medical education. It’s about consent. It’s about, it’s about racial justice. It’s about reproductive justice. It’s really about a lot of things. And we look at those things by showing people the way that medical students are learning or practicing their intimate exams and specifically pelvic exams on patients who are under anesthesia, who most of the time have not consented and have no knowledge that that is happening. So I’m going to, I’m going to rephrase that again, because I know that every time I tell people what it’s about, they kind of say, “Wait, what? Did I hear that right?” You’re hearing it right, and so-

Jameela [00:07:08] And just to clarify, because some people might not be familiar with what a pelvic exam is, something about saying it’s pelvic makes it feel like it’s on the outside. You’re talking about an internal examination-

A’magine [00:07:20] Yes.

Jameela [00:07:20] Or pap smear or procedure that happens without someone’s consent while they’re under anesthetic. And there are multiple medical students who are taking turns on their bodies and they never find out a lot of the time.

A’magine [00:07:36] Yeah, sometimes it’s one student, sometimes it’s many. It generally happens on OBGYN rotations where students are, you know, they, as medical students, they go on a variety of rotations so they can figure out what is their specialty going to be.

Jameela [00:07:53] Mhm.

A’magine [00:07:54] And so when they get to that OBGYN rotation, a lot of times they’re going to be in OBGYN  surgeries where patients have been put under anesthesia, and then students will be brought into the room or they may be a part of the quote unquote care team because they’re there to learn. And it has been a long standing practice essentially since gynecology started that patients that are available to medical facilities are used for student education. And there’s nothing wrong with students learning from patients. Students learn from patients all the time. The problem is that there are not clear consent processes with this. Patients don’t know that this is happening. Of course, if you’re getting a gynecological surgery, they’re going to be doing some kind of confirming exam to make sure they understand where the pathology is, what they’re going to be doing. The surgeon would always do that exam before before starting a surgery, but then having an additional one, two, maybe three students come in to do exams for their own education, that is completely different. And that is not for that patient’s care, that is for those student’s medical education. And that’s where this gets very, very dicey. And most people just don’t have any idea that this happens. And because patients are under anesthesia when it happens, most patients don’t have any memory of it. They don’t realize it’s happened to them. And that is why this has persisted for so long.

Jameela [00:09:23] One of the things that I think further shocked me, which I didn’t think it was possible, is that this isn’t just people who are coming in for gynecological procedures who are under anesthetic. Some of the people in your documentary had come in for abdominal issues-

A’magine [00:09:41] Yes.

Jameela [00:09:41] Or they’d come in with a broken knee and woken up and found gauze over their genitals, which is how they found out that a gynecological procedure had been done on them or some sort of exam had been done on them, even though they have something wrong with their knee.

A’magine [00:09:58] Yes.

Jameela [00:09:59] How is this, how is this happened? How is this gone under the radar for so long?

A’magine [00:10:05] I think it’s gone under the radar for so long, I mean, A) as I said, because patients don’t know and then B) because it’s really, it’s sort of like seamlessly included in the way that they move students through this educational process. It’s like, okay, you’re going to come in now and you’re going to do this and everything’s moving really fast and okay, we need you to come over here, okay, we need you to do an exam now. Go ahead and practice this pelvic exam or go in and feel this pathology. And, you know, it certainly could be a good learning experience to experience some kind of pathology as a student and to have those opportunities. But patients need to be asked for that. And yes, sometimes, you know, I have heard stories of, you know, nasal surgery. I’ve heard stories of people, you know, having things done to their bodies that actually have nothing to do with that part of the body. And it is far more concerning that that is happening because that indicates something much bigger. What I can say at this point after having researched this issue really for almost 20 years now, this is a systemic issue. This is people that are in medicine and have been in medicine for a long time and who might be preceptors for students who are guiding them through that rotation. They’re like the attending that’s in charge. They don’t see it for what it is. They don’t see it the way that patients see it. They just see it as “What’s the big deal? This is just part of their education, this is part of the student’s or this patient’s care and why are we making such a big deal about this?” But it’s a very big deal to patients. It makes a difference whether one person is examining us or three people are examining us, and it makes a difference for people whether they’re asked.

Jameela [00:12:01] There’s about a thousand things to unpack from what you just said, but I think first and foremost it’s important to illustrate that one of the things that is the most disturbing is that there is a very fine line between sexual assault and whatever we would class this as. That because the act isn’t sexual they consider the fact that they’re doing it to not be an act of sexual assault. But it doesn’t change the feeling for the person whose body has been entered and violated without their permission. Is that correct?

A’magine [00:12:31] Oh, exactly. I mean, you saw in the film the patient stories that we do have in the film, which part of why it took us a long time to make the film was it took so long to find those patients. But what we see in every single patient in the film that shares their story is that they all experienced PTSD. They all had previous trauma, sexual trauma, which is common. And then all of them had all of this PTSD that was retriggered after this experience, which then, of course, led to them not trusting their medical care and a whole host of other things that they talk about. So, so I think it’s, it very much mimics exactly what they had experienced when they had experienced sexual assault. There was a new article that was put out this year that, it was published in a feminist bioethics journal, that is calling this “Medical Sexual Assault.” And the point of the article, it’s a 17 page article, it’s very well researched by Stephanie Tillman, it outlines why we need to be calling this what it is.

Jameela [00:13:36] Mhm.

A’magine [00:13:36] And obviously people in medicine don’t want to hear that. And I get that that would be a very hard thing to hear if you’ve been practicing this way for so long and didn’t see that there was anything wrong with it, that that’s loaded language. But certainly, if this were any other context where a person was under the influence of a drug where they were-

Jameela [00:13:58] Unconscious.

A’magine [00:13:59] Unable, unconscious, unable to consent, and you inserted something into their body, that it’s very clear that that would be a sexual assault. And so I’m not sure what it’s going to take. I hope that my film can help really move the needle. I mean, that is why we stuck with this film for so long and why I stayed committed to this mission because this does need to change. And I do believe in the power of film to raise awareness and to make change. And we are doing that. But it’s egregious. You know, most patients really, really bristle when they hear this. And, and so I want to acknowledge that this is a hard conversation for many people to hear. And this is important because if we aren’t speaking up and we aren’t pushing back and we aren’t saying that this is not okay, then it’s not going to change.

Jameela [00:14:54] Yeah, and there was something quite telling in the documentary that insinuates that they do understand they’re crossing a sexual barrier in that one of the people who this had happened to was also a previous victim of sexual assault. And she was told by one of the attending practitioners that they would never have done it if they’d known her trauma history. So that’s very telling because then they’re saying “we didn’t mean to violate you twice.” They know it’s a violation. The fact that there would be a double standard for if you’ve been sexually assaulted before means they understand that this is therefore a very traumatizing and invasive thing to do. That, to me, just feels like an admission of guilt and accountability because they are-

A’magine [00:15:43] Mhm.

Jameela [00:15:44] Registering how traumatizing it is. And so what are they saying? They want to be the person to traumatize someone or violate them or enter them without permission for the first time? It was damning to me that that was said.

A’magine [00:15:56] Yeah, I mean, that story is particularly horrible. That person was a nurse, and she was having surgery. It was abdominal surgery in the facility where she works.

Jameela [00:16:11] Mhm.

A’magine [00:16:11] And the surgeon doing her surgery is like, you know, one of the best in whatever the procedure was that she was having done. So not only, you know, not only will they just do this to any patient, like they don’t even care if they’re their employee.

Jameela [00:16:26] Mhm.

A’magine [00:16:26] You know? And then that surgeon actually when she brought this forward to her because the resident admitted to having done it and the surgeon also admitted to having done it. So this was very, very clear. They admitted to it openly. And then her responses to her were just diminishing. She got angry with her. She ended up, you know, some of this is in the film and some of it didn’t make it in the final cut, but she ended up not doing her follow up care for her surgery with her. She ended up sending her to another surgeon because she just didn’t want to deal with this patient. So she does not share her identity in the film because she was worried about losing her job.

Jameela [00:17:10] Jesus.

A’magine [00:17:10] That was a particularly awful experience and just the arrogance of the surgeon that, you know, and as you say, that this idea of like, well, if I would’ve known that you had been sexually assaulted, well, then I wouldn’t have done it. It is ridiculous. It’s really appalling that someone wouldn’t see how dehumanizing that is for a patient.

Jameela [00:17:34] Mm.

Jameela [00:17:44] How is it legal? That’s, I think, what a lot of people who are listening to this want to know. Like how is it, what’s the legal loophole here?

A’magine [00:17:53] Basically, when you go in for a surgery, you’re going to sign a consent form and there’s usually, you’ll sign a lot of consent forms generally, but there will be some kind of blanket statement that is on many consent forms. It’s like, you know, “you agree that the doctors, nurses, physician’s assistants, yadda, yadda, yadda, you know, and, you know, and other affiliates of the hospital may be involved in your care.” And it’s usually worded in a very vague way like that. I’ve seen many of these forms. And so I think they think, “well, the patient has consented,” but that doesn’t mean we’ve just consented to anything and everything. That means we’ve consented to what we need for our own care. And so I think we can, if we get really clear about this and that there’s a difference between what they’re doing for a patient’s care vs. what they’re doing for student education. Those are two different things. And what we know is that many patients will say yes if they’re asked, but they want to be asked and they deserve to be asked. They deserve that opportunity, and they deserve to know what’s happening to their bodies. Another thing that’s often told to students, and you also see this in the film and some of the stories of the students in the film is, “well, you know, yeah, yeah, they’ve consented. It’s fine, you know, this is a teaching hospital. They know that this is a teaching hospital, so therefore, because it’s a teaching hospital, we can just do whatever we need to do for, for education.” And that’s just not true. At this point most hospitals are affiliated with some kind of university or some kind of medical school. And sometimes it’s hard to tell whether a hospital is or not. Sometimes it’s not clear in the name, but there still might be students who are working with preceptors that work in that hospital that are on rotation. And even if it’s not owned by a university, for instance. So, you know, none of those things hold water. But I think that’s really, you know, how they’ve justified it for themselves, I think, in medicine. And then again, because patients don’t know about it, most of the time, they’re not going to be able to come forward at all. But then in the case, like the one you brought up where she did know and she was told even by them that it had happened, she spoke to three different lawyers and they all told her there’s nothing you can do because there’s no law on the books. There’s nothing, there’s no legal leg for you to stand on, which is why we’ve begun to work on legislation around this.

Jameela [00:20:30] So could you give me some practical advice if I or someone listening to this podcast were to go in for an operation and I’m handed that consent form, do you have to sign it otherwise they won’t do the procedure? Are you allowed to amend the consent form? Like what are our rights as patients? How can I take that language out that says that absolutely anyone is allowed to be a part of my additional care? Will they, will they come back at me and say, “well, if there was an emergency, we might need a different type of specialist? You’re taking out the chance of that happening if you do not consent to additional care by the rest of the hospital.” Like what can we do to challenge that language in the moment when we’re there in a hospital gown, you know, already afraid?

A’magine [00:21:15] Yeah.

Jameela [00:21:16] About the fact that we’re about to go under.

A’magine [00:21:17] I will give you the best things I think we can do, and it doesn’t mean that it’s all foolproof. I actually had major gynecological surgery myself this summe in an ironic turn of events. I had a hysterectomy, and so when I went in for my pre-op with my surgeon, which you will, you will always have a pre-op appointment, ask a lot of questions. And so I asked him, are you working with students? Tell me how you’re working with students. What is the capacity? What, what, will there be students on the team that day? What will their roles be? So I always ask open ended questions. I’ve been through this a few times, and so I will ask very open ended questions to see how they respond to me first. And then I will ask a much more direct question, and I will let them know what I want and what’s okay and what’s not for me.

Jameela [00:22:06] So how do you get that written down to make sure? Because it doesn’t matter what you say as much as-

A’magine [00:22:10] Yeah. Then you add it to your consent form. You absolutely put it on your consent form. But I think it’s both the conversation with the surgeon to be very, very clear and then, write, you absolutely take control of your consent form. You don’t have to sign everything. You can cross things out. You can write in the margins and initial. You can say, “I do not,” you know, “I do not agree or I do not consent to students doing any kind of exam on me or doing pelvic exams or intimate exams on me while I am under anesthesia.” Or if you are someone that wants to be able to help a student and you’ve had that conversation, you can say “I consent to one student doing this or I consent to two students doing this” or whatever, you know. That is absolutely your right to do that. But I would be very, very clear, be as specific as you can be about what you’re okay with and what you’re not. Initial it, any changes you’ve made on your form, initial. And then make it really clear with your surgeon. Whether that surgeon will respect what patients say or not really I think a lot of it depends on their integrity.

Jameela [00:23:21] Hm. I mean, it’s not historically prevalent for women to feel like they have the right to and not just women, but anyone, especially with a uterus or with a female reproductive system, to feel like they have the right to advocate for themselves. It’s still like incredibly modern for us to feel that we’re even allowed to complain about pain. But I do want to talk to you about the fact that this has highlighted the lineage of the mistreatment of those of us with female reproductive systems. And from the very beginning of gynecology, and and how this actually just perfectly tracks. This isn’t left of center. This perfectly tracks with the entire attitude towards this part of our bodies. Can we take it back to, because I think a lot of people have a kind of vague understanding that maybe it was something to do with the times of slavery? Can you take us back to the beginning of gynecology?

A’magine [00:24:25] Absolutely. We have a whole history section in the film because people will say to me all the time, well, I don’t see how this, this is a thing of the past. This can’t possibly still be happening. How is this, how is, as you said, how is this legal? How could this be possible?

Jameela [00:24:39] Mhm.

A’magine [00:24:39] All you have to do is look at the history of gynecology as a discipline and also just the history of medicine and medical education in general to understand how this is happening. This was done from the very beginning, and gynecology as a discipline was started by one very well-known doctor, but certainly other doctors. He was not the only one. But J. Marion Sims in the South had enslaved women who were living on his property in basically a shack in his, you know, behind his house that he called a hospital, and he would perform exams on these women and procedures and deep violations of their body, like experimentations on their bodies with no anesthesia. These were black enslaved women, and he made his name as the quote unquote, “father of gynecology” through those experimentations and those violations.

Jameela [00:25:39] That’s how we came to have the speculum, is that correct? Like, that’s how the speculum has been kind of designed-

A’magine [00:25:45] Yes.

Jameela [00:25:45] As upon the bodies of enslaved people.

A’magine [00:25:48] Yeah. He was the designer of the Sims speculum that was then later adapted and modernized a little bit. But yeah, he made the first speculum out of spoons and performed all kinds of procedures on these women. Some of them had up to like 30 procedures. And so these women are now often lauded. Some of them their names we know: Anarka, Lucy, Betsy. They’re often now lauded as the mothers of gynecology because gynecology as a discipline was essentially developed through this work on their bodies that he was doing as he saw it. And it was theater. He would bring people in to watch. Harriet Washington, who wrote “Medical Apartheid,” we interview her in the film. She talks about how he would often bring in people that were there also  to hold the women down because he was doing these very painful experiments on their bodies without anesthesia. So, I mean, I can’t even imagine the pain of that. And so I think we have to really remember that legacy, and this is not, this is a direct descendant of that.

Jameela [00:27:02] And we know this because it’s from his own words. He wrote a book documenting a lot of this.

A’magine [00:27:06] Mhm.

Jameela [00:27:06] Talking about, you know, he was having dreams in the middle of the night. He’d dream about a kind of procedure or an idea about gynecology, and he would go and wake up one of the enslaved women and practice a procedure on her and no anesthetic, no painkillers again and again and again until he could enact his fucking dream. And he spoke about it as if he’s some sort of genius who was being handed the messages from what? From God? And then just dehumanizing people so badly. But it does kind of, it speaks to when you think about the fact that that’s the lineage, it speaks to the fact that given that medicine has traditionally finally been recognized for treating black women in particular as if they have a higher threshold of pain, as if they have, quote unquote, “thicker skin” or literally thicker skin. It does not acknowledge their pain threshold. It is not acknowledge their humanity. It does not acknowledge that, that, you know, we hear so many stories of women in labor being denied painkillers if they’re black or being denied the epidural, all these different things. And so the brutality that is still today, gynecology, like some of the gynecological experiments, it speaks to the fact that it was designed on people who they did not consider to be human beings, whose pain threshold they did not give a shit about.

A’magine [00:28:29] Yep.

Jameela [00:28:29] There’s just no way that these massive callously used utensils or materials would be used on a male reproductive system or on a male body, in my opinion. And I still don’t think that we’ve come far enough in making these procedures painless. And I still don’t think most gynecologists are aware of the pain that they are inflicting upon patients. And something you bring up several times in the film that I thought, that really spoke to me, that because there’s so little empathy towards those of us who need to receive gynecological care, the procedures are so brutal that most people avoid coming in for them and then they don’t get the vital care that they need. They, you know, I avoid my pap smear, which is very dangerous for me. I need to go in for regular pap smears. I’m supposed to go in between like every six months of the year, and I just don’t do it. And I’ll let a whole extra year go by until I’m forced or until something’s wrong. And that’s because I’ve been so traumatized by previous gynecologists who’ve treated me as if I’m not a human being, as if I’m overreacting or being hysterical because it’s incredibly painful. And I think that that’s incredibly concerning and reason enough to make sure that we raise the alarm. Can you tell me about how you got into this work, like how you even stumbled upon all of this?

A’magine [00:29:51] I would love to, just before we move from what we were just talking about, I just a couple of things I just want to share, too, is this issue is also a health disparity. We have new research that came out in 2021 that shows that black women, black patients are four times more likely to have this happen than other patients. So this is right in line with the, with that history and also with the extreme health disparities, the rates of maternal health mortality that we’re seeing in this country for black women. And I think birth is is a place where we just see tremendous violations and tremendous dehumanization of people and particularly black women. So I just want to say that even though any of us working in this field know that that’s the case, we actually now have research that shows that that’s the case and that came out of Yale.

Jameela [00:30:49] Can I just ask why they don’t just pay people to volunteer?

A’magine [00:30:55] They do. They do. So that is how I got into this. I by training, I’m a sexuality educator. I’ve been an educator for 25 years in many different settings. And one of the settings that I decided to train to work in was medicine. I wanted to work with medical students because I know how little they get about healthy sexuality. And when I found out that gynecological teaching associate work was a thing where there are teachers who go in and work with medical students in clinical settings using their own bodies to teach and guiding students through how to do an effective, comfortable, respectful breast exam and pelvic exam. That was work that I wanted to do. I feel comfortable teaching using my own body. The body is an amazing tool for people that can be self-possessed enough to do that kind of work. It’s very, very powerful way of teaching. And so that work has been around since the late seventies. And so we also chronicle that history in the documentary. So I worked for ten years in New York City, and all of the major medical schools in New York City with students. And when, when they would leave a session, you know, we would get them for like three and a half, 4 hours maybe. They would just be lit up. They had learned so much. It was oftentimes the first time they were actually even interfacing with a real body in their training. Usually we would get students in their second year of medical school before they went into their clinicals, and they would learn so much. You could just see that having such an empowered experience with someone who not only was comfortable in their body and comfortable using their body to teach, but could also guide them with humor, with care, and with confidence.

Jameela [00:32:53] Humanize the experience.

A’magine [00:32:55] Yeah, and part of it also is that we would turn it on its head because we would always guide them to ask questions of the person on the table. You know, sometimes they would want it, we would team teach, and so we would like demonstrate and exam. One person would play the provider, one would play the patient. And oftentimes if they had a question, they would turn to the person playing the provider. You know, they turn over here to ask the question and we would always say, “no, you want to ask the person on the table” because that person on the table is the person with the most information about that body. And that’s something that’s even radical in medicine. You know, this idea that the person with the body which you’re examining is the one that has the most information. And a lot of times experts are brought in, they’ll talk in a room with a patient on a table as if the patient isn’t even there, and they’re sitting there talking about the patient. Not all providers do that, but many people have stories of things like that happening. So we really-

Jameela [00:33:50] We’re all familiar with the like hierarchy of doctor knows everything, you know nothing. Even at 37, I get I get treated like by doctors like I have no idea what I’m talking about when I’m trying to tell them of the, of the pain. And then later they’ll find out that I was right, but they’ll never say, “Oh, you were right about that thing.” There’s always, like, doubt cast on women specifically. And there’s like an extra layer of that for women of color, especially black women. And I find that to be so unbelievably disturbing. And again, it’s why I almost never go to the doctor until I’m in a full on emergency, and I think a lot of my friends feel the same way. One of the things that you bring up that I think is so vitally important in the documentary, you know, talking about how empowering it is for the student to learn how to face this in a very humane way is the mental health impact on the students because we can, I think we can all like pretty easily understand and put ourselves in the position of someone who’s been violated, but someone who is pressured to do the violating when there’s no power when you’re a medical student like there’s, you have zero power. You cannot advocate for yourself. When you do, you are sometimes threatened or punished. And so these students are having to, a lot of them, some of them might think, well, this is just you know, how it is. But a lot of them realize almost immediately they’re doing this without someone’s consent, and they’re being forced to enact that. Can you talk about what that does to someone’s brain?

A’magine [00:35:23] I think it’s terrible what we’re doing to students. You know, I’ve really at this point become a advocate for medical students. We have several, several initiatives that we have begun with, partnering with medical student organizations, including the American Medical Student Association, because I think that the position students are put in is such an untenable situation for them, you know. And so there is something about OBGYN in particular. And one thing that we’ve also seen in research is that no matter where in a a student’s rotation schedule, like they might have eight or ten rotations, right? They’re going to go through all these different rotations to see like, what are you interested in? OBGYN might be the first one, it might be the fifth, might be the eighth, whatever. Wherever that fell in their rotation schedule, students believed that consent was less important at that rotation. So we know that there’s, there’s something that’s happening specifically in that rotation where consent isn’t being emphasized as not being modeled. And I think that students are needing to find a way to make what they have done feel okay. And so they, they and you see this, we have a story of a student in the film, Liz, and we see her, we see her when she’s at her GTA session and then we see her 15 months later.

Jameela [00:36:49] Can you tell us what’s GTA? What that means?

A’magine [00:36:51] That’s the gynecological teaching associate work, yeah, that I was speaking about. And so she she came in and she worked with GTAs. And then 15 months later, she’s on rotation. And when she was working with GTAs, she was the one that helped us get the cameras in the room. She rallied her fellow med students and said, “This project’s really great.” You know, let’s, you know, “let’s support this.” And then 15 months later on rotation, her very first day of her OBGYN rotation, she’s ushered into an ambulatory surgery room and told to put on gloves and examine a patient, and nothing is said about consent. And it was not just her. She was with other students, and so so that’s literally how her OBGYN started rotation. And so she, you see her grapple with this in the film. She’s trying to make sense of it, and she’s trying to feel okay about what has happened. And she actually says, “maybe I’ve switched to the other side.” And that’s literally what research shows happens to students. I speak to students regularly who, you know, they’re afraid, They’re, they don’t want to violate patients. They want to get consent. Sometimes they’re made fun of for asking for consent or asking about consent. “Oh, no, no, no. We don’t do that. We don’t have time for that.” We’re not, you know, or they’re they’re poked fun at, you know, oh, “bodily autonomy, oh whatever.” Literally these things are made fun of by many preceptors or other staff.

Jameela [00:38:17] And do you think that’s relatively gendered, even though this does happen to people who are, you know, nonbinary or who don’t identify as women? Do you think that this disregard for the consent is a a deep layer of misogyny of just like “we don’t have time for that, we don’t have time to go?”

A’magine [00:38:32] Oh, yeah, absolutely. I think that’s a big-

Jameela [00:38:35] That permission.

A’magine [00:38:35] Piece of it. Yeah, but we also do know that intimate exams, you know, other prostate exams, rectal exams can happen to people of all genders, prostate exams as well. We do know that those things happen. We focused on pelvic exams in this work because the research is very clear and that was the the work that we were focused on with the gynecological teaching associate work. But yeah, absolutely I think that misogyny plays into it.

Jameela [00:38:59] I just say that because gynecology is so laced with misogyny, like the whole way it’s carried out, and the attitude towards us and the lack of wanting to give us painkillers, even if they can give us painkillers, even if they can give us some sort of something to relax us, they choose not to and tell us to buck up. And it’s like, why would I ever opt in for discomfort and pain? It was actually on this podcast that I learned from a gynecologist that it’s not supposed to be agonizingly painful. A type of pap smear.

A’magine [00:39:24] No, no, it’s not.

Jameela [00:39:25] I had no idea. I had no idea. I, I started crying on the podcast because I was 34 and had no idea that it’s not supposed to be like that. I had no idea that you’re not supposed to have to be held down by four nurses. I, I, it just wasn’t it, it wasn’t something that I was aware of. And so I found out and switched my gynecologist immediately. And now, like, I’m much, much in a much better place, but still so traumatized by all those years of, like, terrorizing and, and like, cruel pap smears where the doctor would walk out of the room while talking to me just wouldn’t, like, tell me anything that they’d seen, wouldn’t check if I was okay. Would do it, create the, collect the sample, and then start talking to me while walking out of the room and wouldn’t come back. Just be like, “so we’ll give you results in a few days.” And that would be the last thing that I would hear. I had no idea, and nor did most of the people listening to the podcast. I got like tens of thousands of letters after that episode saying that they had no idea either that you’re not supposed to feel like you’re being attacked.

A’magine [00:40:31] Yeah.

Jameela [00:40:40] So I just want to circle back to you know, you were talking about the fact that you are someone who willingly volunteers your body for this for this practice as work. Why is it when we can pay, when we have a system in which we can pay people to allow their bodies to be used for teaching, is the reason they practice this without consent to save money so that they don’t have to pay loads of people? Is that what this is?

A’magine [00:41:08] Oh I- absolutely. I think it’s absolutely an economic issue, and it’s also, it’s also that in this culture and in many cultures, the idea that we just get to have access to vaginas, if we need to have access to vaginas, we get to have access to vaginas, you know? And I think that, but yeah, I think it’s absolutely an economic question of, “well, why would we pay these teachers if we can just use patients for free? And they’re never going to know about it and they’re never going to be able to fight back because it’s their word against ours, even if they did know.” And that’s really how this has persisted for so long.

Jameela [00:41:50] And there’s something very archaic about the idea that like, well, if they’re asleep, if they don’t know it happened, it can’t traumatize them.

A’magine [00:41:56] Yeah, and we know better than that now.

Jameela [00:41:58] Mhm.

A’magine [00:41:58] And there’s plenty of research now that shows that the body has a cellular memory. We have a memory in our body. I’ve heard countless stories of people saying, “you know, I don’t know if something happened, but I just had this weird feeling when I woke up” or, you know. And of course, that always gets dismissed, too, because, “oh, that’s just women having a feeling again” or something. And, you know, the body knows. And I think that, you know, to put, to entrust someone with your life while you are under anesthesia is truly the biggest trust you can put in someone. And to have that trust violated while they are literally in charge of your life and what happens to you is such an egregious violation, and it’s so damaging. And the last thing I want to do is scare people away from the care that they need. I want people to access the medical care that they need. And I’ve heard stories like yours from I mean, there’s very few people I know who don’t have stories-

Jameela [00:43:00] Mm.

A’magine [00:43:01] About a horrible pelvic exam or experience or whatever. And I’m really sorry that you had that experience for so long. And I’ve heard that from people as well, this idea of like, “I can’t even imagine it could be a comfortable experience because I’ve never had that experience” and that’s not okay. I can assure you that myself and the thousands of other GTAs across this country and also in other parts of the world who have done this work for decades and decades would not go to work every day to be hurt. I can assure you we would not. So what we taught was this is how you make a patient comfortable. This is how you make an exam comfortable. This is how you soften your wrist or you change your position or you communicate to find out what’s going on with your patient. You know, that’s a lot of what we taught as well.

Jameela [00:43:53] This is what’s also so fucking insane is that if you do these exams, if you practice these exams on people who are under anesthetic, then they are not going to flinch or show pain.

A’magine [00:44:06] Exactly.

Jameela [00:44:06] Or to give you any cues or signals, so it’s such an illegitimate way to do anything other than the functional practice of getting the speculum in. Like you have no idea if your technique is good because

A’magine [00:44:20] Exactly.

Jameela [00:44:20] You’re not able to get any feedback because someone’s un-fucking-conscious.

A’magine [00:44:23] Yep.

Jameela [00:44:23] It was insane to me having to, to, to reckon with the idea that some of the smartest people in the world can’t see that that doesn’t make any sense if you’re trying to learn. It just shows that the burden is not on the doctor, really to make sure that the patient is comfortable. It’s just to get the job done, which then means that then people aren’t going to come back, they’re going to be traumatized, they’re not going to get the health care they need. There’s a very serious implication in not making it a bearable experience.

A’magine [00:44:54] No, exactly. And the other thing that’s important for people to realize is this isn’t even a good educational experience for them. If we’re trying to teach them how to do a good pelvic exam, which is sometimes the goal. I think sometimes the goal is for them to experience pathology. Oftentimes the goal is for them to practice their pelvic exams and get a number of pelvic exams in so that they can meet their quotas on their rotations. If you want to teach a student how to do a good pelvic exam, you don’t do it on someone who’s anesthetized where all of those vaginal muscles are relaxed, every muscle in the body is relaxed. It’s going to feel completely different

Jameela [00:45:33] Mhm.

A’magine [00:45:34] From what an exam on a live, awake person would be. And then, as you say, they’re not going to be able to telegraph to the student if something’s hurting, if, if they need to adjust something because and so they could also really injure a patient, and that doesn’t get talked about either.

Jameela [00:45:52] Mhm. And also, as you were saying earlier, that there is no pathology to experience when someone’s come in for a knee operation. They’re not going to be able to see something that’s going on. It’s so breathtaking to me. I had no idea about this before your film. I cannot tell you how many people you are going to save because you are raising the alarm on this. I’m so grateful to you for the work that you’re doing. I would like to talk about what that is in a bit more detail. I’d like to know where you’re taking this and what your plans are and how we as a community could support you.

A’magine [00:46:30] Yeah, thank you. I mean, we’re doing a number of things. This is very much a social impact film. We want people to see the film because that is usually people’s reaction is like, “how can we, how can we shift this? Like, this is something that that needs to be addressed.” We’ve been doing a lot, as I said, we’ve been doing legislative work. We passed, we co-wrote and passed the strongest law in the country in the state of Colorado this year. I’m very proud of that bill. We got almost everything that we wanted in that bill. It is the most comprehensive bill in the country now. It includes whistleblower protection for students because students are not typically protected under standing whistleblower laws, because those are usually for employees and students are not officially an employee. So they actually would not have whistleblower protection if they were to speak up about this. And I think it is actually important to say the only reason we know that this is happening is because of students who have spoken out.

Jameela [00:47:33] Wow.

A’magine [00:47:33] That is really, really important to to highlight for people. Students that have been courageous, that have you know, and we tell several of their stories in the film. We share several of their stories in the film. They ducked out. They, they you know, Ari Silver-Isenstadt, who’s our main character in the film, he stepped out of med school for a year after being threatened and being told, “oh, maybe, maybe you’re not cut out for medicine,” you know, “why are you identifying so much with the patients?” Because he didn’t want to do this to his patients.

Jameela [00:48:03] Mhm.

A’magine [00:48:03] And so he was showing up late to avoid doing this. And so he ended up stepping out of medical school for a year. And he did the research and that was published in 2003 showing that 90% of students had done this to patients. That’s a lot of students, and that’s a lot of patients.

Jameela [00:48:18] And that a lot of them didn’t know that it wasn’t with consent. A lot of them assumed it was consent, with consent. Right? Because I think that’s another problem is that then you find out later that, “oh, no, actually that woman had no idea.” There were certain instances in the documentary where the student is talking to the patient afterwards and casually brings up that it happened, and then the patient’s visibly horrified saying, “why on earth did you, why were you even looking inside of my cervix to know I was on my period” and then the student just quickly gets out of the room because they realize, “oh shit, she didn’t know.”

A’magine [00:48:49] Yeah.

Jameela [00:48:49] That must be harrowing.

A’magine [00:48:52] It’s terrible.

Jameela [00:48:52] For everyone involved.

A’magine [00:48:54] Yeah, it’s, and it’s causing I think, tremendous moral injury to students. And so we’re doing this legislative work. There’s 24 laws in the country. And unfortunately, right now many of those laws are not effective. They’re not detailed enough. Very simple laws keep getting put forward or bills keep getting put forward. The law that we passed in Colorado is the most comprehensive law, and it passed unanimously.

Jameela [00:49:21] But what does it entail?

A’magine [00:49:22] In both houses. It entails a very clear consent process. It details who who the players are, who’s involved, who’s liable. There is actual liability in the law by an outside agency that’s not just a professional organization that oversees the surgeons. And so I think without that liability in the laws, without licensure and accreditation of facilities being on the line, this is not going to stop.

Jameela [00:49:53] Mhm.

A’magine [00:49:53] I mean, they’ve had 20 years to change this since that research came out. We’ve been talking about this. We have been talking about this. There have been articles. There will be waves of articles after Me Too happened in 2016 or began, I should say. You know, many laws have been passed since, but they still many of them are inadequate. So we have new research as of last year that shows that 84% of students have done this to at least one patient on their rotations. So they’ve had 20 years to change this. And we’ve seen a negligible, negligible change. I mean, 84%, 90% we’re, we’re still that’s a it’s a crazy statistic to think of. And we do some of the numbers with one of the students in the film. And I think that that really drives it home for people.

Jameela [00:50:42] Yeah.

A’magine [00:50:42] When they think about the numbers of people.

Jameela [00:50:44] How can we support you?

A’magine [00:50:46] Well, we certainly want to get better laws passed in all of the states. And our goal is to get laws in all 50 states. So we have a legislative campaign right now, and that’s all on our website. And then the other thing that we’re starting to do is to do work with students. As I said, we’re actually convening a group of students who are writing a pledge that we are working to get incorporated into their white coat ceremony, because we know that students as individual actors cannot take on a system. This is a systemic issue. This is. And we know that they face tremendous retribution oftentimes when they do. I’ve heard many, many stories of that. So, you know, finding a way to support them as a collective so that they have organizations behind them that are supporting them to say, no, I’m not going to do intimate exams to patients when they’ve not consented is really, really important. We’re a very small filmmaker team. We’re independent filmmakers. We’ve sort of become amateur lobbyists at this point, and we are working with legislators in many different states. And we’re doing, you know, we don’t have funding for any of that. So certainly if people want to support us financially, we very much need that.

Jameela [00:52:00] Where would we send those donations to?

A’magine [00:52:02] You just go to atyourcervixmovie.com and it’s very easy to donate on our website. Everything is there. You know, bringing us to your school. If people are at universities, colleges, medical schools, nursing schools, bring the film, bring us and let’s do events. You know, as we are doing these events, we’ve been on tour over this year. We’re going to be continuing to tour over the coming year. We would love to come and engage people in your community. People can bring us for community screenings as well. And if people want to work with us legislatively in their states, we absolutely welcome that. We cannot do all of it ourselves. We need people that want to collaborate with us. We’ve learned a lot in this process. I’ve learned a lot about how this works. And we’ve had the great benefit of working with some fantastic legislators. We have a really strong campaign happening in Massachusetts right now where there are four major medical schools. So that’s a very big state. And we have our eyes on all of the states right now that have the most medical schools. So we’re really looking closely at getting things passed in states like Massachusetts, Pennsylvania, Ohio, and Michigan.

Jameela [00:53:14] I know that I said at the top of this that this film is definitely harrowing in certain aspects. But it was also, I think, one of the most amazing documentaries I’ve ever seen. It was so informative. There are ties that we’re not going to get into right now because I actually want you to go and watch the film, between abortion and all of this and the history of midwife vs. gynecology. There’s so much understanding of patriarchy and misogyny in this. You really connected so many dots for me throughout the documentary where I could understand the history and see how we got here. And that made me feel actually genuinely hopeful that we can find our way out. And I really, I really would love to help you, and I hope my audience watched the film. It was amazing. I’m going to obsessively read my consent forms going forward, and I hope we all do. And I thank you for empowering us to take back our autonomy. You’re amazing, so thank you very much for coming today.

A’magine [00:54:18] Aw, Jameela. That means so much to me. Thank you so much. And yeah, thank you. Thank you for highlighting this and wanting to share this with people. And we are going to open up a screening for, a virtual screening for your listeners. So right now people can go to our website at atyourcervixmovie.com and you can just sign up to see it online right now. You don’t have to wait. But certainly, if you want to bring us for an in-person screening or a virtual screening, we will do those as well. But right now, as people might be listening to this, please come, come to our website, come see the film. And if you’re listening to this later on, the best way to find out when screenings are forthcoming is just to follow us on our socials and come to our website and join our community. Thank you so much. I really-

Jameela [00:55:08] Oh, this is just the beginning of us working together.

A’magine [00:55:12] Thank you.

Jameela [00:55:15] Thank you so much for listening to this week’s episode I Weigh with Jameela Jamil is produced and researched by myself, Jameela Jamil, Erin Finnegan, Kimmie Gregory, and Amelia Chappelow. And the beautiful music that you are hearing now is made by my boyfriend, James Blake. And if you haven’t already, please rate, review, and subscribe to the show. It’s such a great way to show your support and helps me out massively. And lastly, at I Weigh we would love to hear from you and share what you weigh at the end of this podcast. Please email us a voice recording, sharing what you weigh at iweighpodcast@gmail.com. And now we would love to pass the mic to one of our listeners.

Listener [00:55:51] I weigh my loyalty, being a good friend and partner. I weigh being a teacher to tiny humans. I weigh my education, my student loan debt, and the pride I feel when I walk into my classroom. I weigh the I Weigh movement and all of the good it has done for my mental health. I weigh my journey to self-love and my recent discovery of self-acceptance.