"Consent to treatment"

I was referred for hysteroscopy at Huddersfield hospital.  There was no way I was having without a general anaesthetic. I had a hysteroscopy at Royal Oldham Hospital 12 years ago and felt violated. I phoned Huddersfield gynae department to say I would not be having this procedure without general anaesthetic and was told I would be fine with 2 paracetamol, so I told the receptionist to cancel the appointment to which they replied that I had to attend. No, actually I don’t have to do anything as this is a hospital not a prison and the rules of informed consent apply.

I agreed to go to the appointment with my clearly stated intention that I would not  be having a hysteroscopy. Upon arrival there were large notices on the door of the gynae department saying No Chaperones which I thought in itself was a warning. I had a transvaginal ultrasound which showed no uterine thickening so I did not need a hysteroscopy, which was good as I had no intention of consenting to one.

I consented to a vaginal examination by speculum and two nurses commenced the ‘vocal local’ which is ineffective as pain relief and was more stressful than if they had stayed quiet. I could see that they had the hysteroscopy equipment in a tray under a cloth. The gynaecologist was silent, whispered something to the  doctor present and said they would refer me for a colposcopy at Halifax hospital. I told them I didn’t need a colposcopy because I had recently had a clear smear test but they insisted. Obviously I then worried they had seen something wrong. They would not disclose what they had seen and simply told me that I needed an urgent colposcopy. 

I received an appointment for a colposcopy at Halifax hospital and phoned the gynae department to say I did not need a colposcopy because I had recently had a clear smear test. I was again told I had to attend. I attended, not because I had to but because I was worried by the gynaecologist at Huddersfield. On arrival at Halifax colposcopy unit the  nurse told me I didn’t need a colposcopy because I had recently had a clear smear test. They refused to do the colposcopy. That was a waste of everyone’s time. 

I was then sent an appointment for a cystoscopy and ultrasound scan at Huddersfield hospital and phoned to say that due to my previous hysteroscopy experience I did not believe that this procedure would be “painless” and wanted to have pain relief such as Entonox or IV sedation. I was told to come in for a “chat” with the bladder consultant.

After waiting an hour a nurse took me into a room, grabbed my wrist and tried to put a wristband on me, asking if had had this procedure before. I said I was there for a “chat” with the consultant and they were not putting a wristband on me for a “chat”. They stormed out of the room and said in a  tone I found threatening that they were going to get the consultant.

The consultant came in and I reminded them of the principles of consent, which were displayed on the wall but which did not appear to be being followed. The consultant, who was very pleasant and kind, asked me to try having the cystoscopy without pain relief and said 99.9% of women experience no pain and they would stop if I felt pain. I agreed. 

I would not have agreed to a hysteroscopy under these circumstances because from my experience  the gynaecologist may not have stopped when I said stop. I understand this has been the experience of many women in different hospitals. 

The attempt at cystoscopy was intensely painful and the consultant was true to their word, stopped and scheduled me for a cystoscopy under general anaesthetic. I asked for a pad because I was bleeding, was given the type of pad that young girls are given at the ‘puberty talk’ and drove home in pain.

The cystoscopy subsequently went ahead under general anaesthetic and the anaesthetic team were excellent. I think Huddersfield hospital needs to learn from this. I am a cancer survivor and fully aware of the laws of this land regarding consent to medical procedures. It appeared to me that the medical staff at Huddersfield gynaecology and cystoscopy department ignore these laws. They are not in charge of the laws on consent. Procedures should not be forced  on patients who are saying no. 

I believe women are being gaslit into painful procedures by medical staff and misinformed about the pain involved. It is their right to receive effective analgesia for these procedures and I would suggest that when cancer is suspected there should be more compassion and kindness shown to patients. A hysteroscopy is nothing “like a smear test” as stated in their  leaflet. Nor, as I found out, is a cystoscopy “painless”.

I have never been fearful about smear tests or colposcopies but I will be reluctant to attend another smear test now. A hysteroscopy with two paracetamol, a photo of some flowers on the ceiling and nurses making hairdresser small talk calling it “vocal local” is not acceptable, because we are not in the Middle Ages. I would strongly suggest that women research the actual reported pain rates for outpatient hysteroscopy before consenting. Indeed, some hospitals are not even asking for signed consent. The RCOG guidelines state that it is a patient’s right to choose a general anaesthetic for hysteroscopy. 

I am grateful to the compassionate medics of the NHS who saved my life many years ago but I suggest urgent refresher training on infomed consent at Huddersfield hospital.