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USC scandal sparks a reckoning in gynecology: How to better protect patients?

USC scandal sparks a reckoning in gynecology: How to better protect patients?
Doctors and medical ethicists are debating how to address the USC scandal and make patients feel safer and more educated. (Los Angeles Times)

For some USC students who visited campus gynecologist George Tyndall, it was obvious right away that something was wrong. They said he touched them in inappropriate ways, made bizarre comments and acted unprofessionally.

Others said they left feeling uneasy but weren’t sure what to make of Tyndall’s behavior. It wasn’t until the Los Angeles Times revealed years of misconduct allegations against the doctor that these patients said they began to come to terms with those exams.

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The accusations against Tyndall — which the doctor strongly denies — have roiled USC, leading to the departure of university President Max C.L. Nikias and a criminal investigation by the Los Angeles Police Department as hundreds of women have come forward.

But it’s also becoming a moment of reckoning and reflection within the world of gynecology, as doctors and medical ethicists debate how to address the scandal and make patients feel safer and more educated.

Dr. Sheryl Ross, an obstetrician-gynecologist in Santa Monica, said some doctors have gotten away with bad behavior because patients see them as superheroes, recognizable not by their capes but their white coats. For years, she has heard from women who have had uncomfortable or problematic experiences with doctors, much like those reported about Tyndall.

“When you have hundreds of people who either didn’t report it, or slowly reported it to only fall on deaf ears, it just speaks to a very broken system in medicine,” Ross said.

The scandal has been particularly tough for some male gynecologists, who say that even before the Tyndall case they were struggling as patients increasingly opt for female doctors.

Dr. Tim Bilash, an OB-GYN in San Diego, said he worries the Tyndall case, combined with the #MeToo movement, might make it harder for him and other male doctors to find work.

“We’re really in a quagmire of how to deal with what’s appropriate and what’s not appropriate,” Bilash said. “As a male physician right now, I feel like I’ve been excluded from that conversation, and even from employment.”

Since a Times investigation last month reporting allegations against Tyndall, more than 400 people have notified the university about troublesome incidents, such as the doctor repeatedly sticking an ungloved hand inside them and pressing his face against their vagina and declaring, “It looks beautiful.”

The LAPD said it has been in contact with 135 women about Tyndall and served search warrants at the doctor’s home earlier this month.

Zack Buck, a health law expert at the University of Tennessee, said the recent realizations speak to a power imbalance within medicine. Patients allow doctors to do whatever is medically necessary because they’re experts, but that means patients are left somewhat in the dark — unable to ascertain what’s normal and what isn’t, he said.

“You’re in a very weak position,” Buck said. “And it’s at its height when you’re a first-time patient.”

Gynecologists say that patients can request that another person, such as a nurse, be in the room with them during an exam or can interrupt an procedure or a line of questioning if they feel uncomfortable.

“Patients can always ask, ‘Why are you asking me this? Why is that pertinent?’ or ‘Why do you need to do this exam?’ ” said Dr. Trammel Cox, who begins OB-GYN residency training at the University of Missouri-Kansas City this month.

But even when patients want to speak up because something seems off, experts say, they may feel too vulnerable to do so.

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“Are a lot of women going to do that? From my experience, probably not,” said Guy D’Andrea, an attorney in Philadelphia who represents sexual abuse victims. “They’re like, ‘Is this actually happening? What is this? Is this abuse? Is this legitimate?’ ... It’s a reality of how this horrible type of thing occurs.”

And the stakes are particularly high when it comes to OB-GYN exams.

The intimate procedure involves vaginal penetration, something that if done without consent could be considered rape, according to legal experts.

Many OB-GYNs said that they felt it was their duty to explain every step of an exam to patients, especially to young patients, but acknowledged that other physicians might leave women without needed information.

Dr. Julie Cantor, a law professor at UCLA, said university student health centers could help students by providing brochures detailing the steps of a normal gynecological exam so they can detect any issues.

“You don’t have to put people on the defensive. Just say, ‘Here's what to expect,’ — have it right there in the clinic,” she said.

The scandal now roiling USC seems to confirm many women’s worst fears about going to the gynecologist. In recent years, patients have been increasingly skeptical of doctors’ authority — while women in particular are more often seeking female OB-GYNs.

Marissa Dimitrion, a 22-year-old USC student, wasn’t treated by Tyndall when she went to the clinic. Nonetheless, she said she would probably never visit USC’s university health center again. In general, Dimitrion said, she now plans to stay away from male OB-GYNs.

“Going to a gynecologist is already an uncomfortable process,” Dimitrion said. “I’m more wary now.”

In recent years, many doctors have started bringing a nurse or other health professional into the room while they examine patients in an effort to make them more comfortable. Studies have found that male doctors are more likely to use chaperones than female doctors are.

“There are simple ways to fix institutional sexual abuse, and in the gynecological setting, that’s one of them,” D’Andrea said.

But experts say that even if chaperones suspect a problem, they may be unlikely to speak up because they typically work for the physician.

“She’s going to, in the middle of exam, call out the doctor in front of the patient? That’s a really hard thing to do — she could get fired,” said Cantor, who is also a medical doctor.

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Ultimately, it was a chaperone whose complaint to the campus rape crisis center prompted Tyndall’s departure from USC.

Dr. Brigid McCue, an OB-GYN in New Orleans, recommended that women bring a relative or friend into the exam room with them. Having a companion there can comfort patients and also provide a witness who doesn’t work for the physician.

“It’s absolutely the patients’ prerogative to say, ‘I want someone here with me.’ — That can be the mom and that can be a girlfriend,” she said. “She sits up by the shoulder, she can’t see anything, but she can read your response.”

Doctors emphasized that patients should report physicians to the medical board if they have a problem with them. McCue said that she thinks women can determine what is creepy and what isn’t.

“Women have to trust their gut because it should not be an exam that makes you feel uncomfortable in any fashion,” McCue said.

But many women said they felt unequipped to judge for themselves whether a doctor’s actions were in line, especially given the sensitive nature of a gynecological exam.

Hannah Zhang, a USC student from Beijing, said she grew up with little sex education.

“We never learned about sex, let alone what happens during a gynecology exam,” said Zhang, 19.

Many doctors said they believe the USC scandal and other cases will help keep doctors more accountable.

“We’re changing things,” Ross said. “We’re creating higher standards for doctors and all these professionals who’ve gotten away with it for so long.”

Times staff writers Sarah Parvini and Melissa Etehad contributed to this report.

June 27 3:30 p.m.: This story was updated to make clear that USC student Marissa Dimitrion wasn’t treated by Tyndall.

This article was originally published at 5 a.m. June 25.

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