Consented: A Doctor's Call to End Medical Violence and Reclaim Patient Autonomy

by Zed Zha

A physician’s bold critique of medical rape culture—and her call for a new model of care that centers consent and empowers patients

Medical culture has a problem with consent—and it’s not just a few bad doctors. That’s the conclusion of Dr. Zed Zha in Consented, a groundbreaking look at how the healthcare industry ignores patients’ agency and perpetuates violence.

Even the best and most caring doctors can fall prey to what Dr. Zha identifies as medical rape culture: a system of beliefs and practices that enable and normalize the violation of patients’ autonomy. Dr. Zha shows how this culture is historically entrenched—from the invention of the speculum to eugenics—and argues that we need a sea change in our healthcare system to stop repeating the same mistakes. She interlaces these hidden histories of medicine with first-hand patient stories and her own personal journey, identifying four key problems of consent within medical  

Non-consent (“Doctors know what’s best for the patient.”)
Forced consent (“If patients are noncompliant, their voices cease to matter.”)
Inadequate consent (“Doctors can decide what patients need to know.”)
Contractual consent (“Sign here, then forever hold your peace.”)

This fundamental misunderstanding of consent robs patients of the right to control what happens to their own bodies, and can cause serious harm. Instead, Dr. Zha offers a radical new vision of medical consent culture—one that embraces collectivity, accessibility, and compassion. This provocative book will validate anyone who has felt ignored, gaslight, or violated in the doctor’s office and inspire those working in the healthcare system to push for change.

291 pages, Kindle Edition

Published April 14, 2026

About the author

Zed Zha, MD, FAAFP is board-certified in family medicine and fellowship trained in non-cosmetic dermatology. Currently, she works to provide dermatological access to the immigrant and farmworker communities in rural America. Before that, she practiced full-scope primary care with obstetrics and hospital medicine during the pandemic years and served as the COVID-19 Task Force Physician Lead.

Medical School: Geisel School of Medicine at Dartmouth

Residency: Mayo Clinic Health Systems - La Crosse Family Medicine

Fellowship: Dermatology Underserved Fellowship in Family Medicine

Awards: Gold Humanism Honor Society Award, John F. Radebaugh Community Service Award, Residency Research Award

Reviews

[Stacey ˗ ღ ˎˊ˗ · Rating 5 out of 5]

Consented is a must-read for anyone with a body who participates in the American healthcare system - patients, providers, insurers. In particular would this be valuable reading for prescribers (current and future) who hold the power to start reversing the practices we read about between these covers.

As a non-prescribing member of the healthcare community working with marginalized pregnant women and their newborns, I was astounded by many statistics, practices and standards Dr. Zha shared. I feel more compelled than ever to advocate for equitable treatment and access for these patients, and to provide as much information and support as possible throughout my work with them.

It is my hope that this work will open dialogue with providers and systems to start making changes at the level of patient care immediately. Collaborative, shared decision-making that advocates for patient safety and autonomy over clinician comfort level or insurer coverage is the goal.

Greatest thanks to Dr. Zha, North Atlantic Books and NetGalley for the early copy to read and review. I will enthusiastically share this title with colleagues and friends alike.

[Em · Rating 5 out of 5]

Thank you to Dr. Zha for this thoughtful and unfortantely very necessary work. I appreciate Dr. Zha’s transparency and vulnerability in recounting her own missteps. A must read for medical professionals!

[Off Service Book Recs · Rating 5 out of 5]

A few bad apples will spoil the bunch, medicine is no exception. Even the best and most caring doctors can fall prey to what Dr. Zed Zha identifies as medical rape culture: a system of beliefs and practices that enable and normalize the violation of patients’ autonomy. Steeped in history, culture, and politics - from instruments such as speculums to national policies - Dr. Zha argues that in order to keep from repeating history year after year, there needs to be a systemic change to how we approach the idea of medical consent over four broad categories: non-consent, forced consent, inadequate consent, and contractual consent.

While demonstrating that misunderstanding of consent robs patients of the right to control what happens to their own bodies, and can cause serious harm, Dr. Zha peppers this part-memoir, part-call to action with patient stories, personal anecdotes, and an radical future that dares to embrace collectivity, accessibility, and compassion in medical consent. Informative and validating for anyone who's felt a need to hold their tongue at the doctor's office, Dr. Zha offers readers a both a condemnation of a system broken by its patriarchal past and a vision of what could be if we dare to challenge that system in pursuit of something better.

This was a very strongly-worded and compelling read in an era where we there are still daily reports of patients whose autonomy has been violated - personally and systemically. I was hooked from the beginning, and thoroughly enjoyed and was equally horrified by Dr. Zha's breakdown of medical rape culture and the various ways in which consent has and continues to be violated even by the most well-meaning of physicians. Though medical students today are taught at length about the importance of consent, it is all too easy to veer intentionally - or often unintentionally - into a grey territory of non-consent in the name of speed, efficiency, personal problems, or systemic demands. I caught myself reflecting a lot while reading this book and have definitely been much more careful in obtaining consent for even the smallest things as a result, which is a welcome outcome of this book.

One aspect of this book I really appreciated as someone raised in a system where admitting mistakes feels akin to admitting abject failure is the author's own willingness to confront her past in her writing. There were multiple examples throughout the book where the author reveals incredibly uncomfortable encounters she had and reveals the regrets she had in handling various situations throughout the book. This kind of writing to me opens up readers to reflect on times when they could have done better, and is truly part of the kind of ideal medical model where we turn our wrongs into plans for the future - identifying places where changes need to be made so the same kinds of mistakes can be avoided and pain can be forestalled. I continue to think about this book weeks after finishing my initial read, and hope that it becomes one of those staple books for healthcare workers along all parts of their training and laypersons as well!

[Amelia Bedelis · Rating 5 out of 5]

VCUG is severely traumatising for children. Shocking truths about this procedure have been buried and brushed aside for decades. It has taken until this moment in history for a member of the medical establishment to reveal the known sexual trauma being inflicted on children and bring the life-altering harms of this brutal test out of the shadows. Studies show up to 71% of children experience serious distress, severe distress or panic (1), and that many children experience this invasive procedure as "violent rape" (2).

There will be healthcare professionals reading this book who have witnessed firsthand the severely traumatic nature of this test, or heard children's bone-chilling screams echoing in hospital corridors...

Well done Zed Zha MD for your courage in exposing the profound, and often life-long, harms of pediatric VCUG, for calling out the systematic denial and gaslighting which, for so long, has obscured the truth, and for calling attention to the traumatic invalidation that is a cruel secondary trauma for survivors, obstructing and complicating healing from the severe, and often life-altering, impacts of this brutal, rape-like procedure.

As human beings we have a duty to safeguard children from sexual harm.

Thank you for this courageous work.

May courage call to courage.


1) Adv Urol. 2008 Jul 3;2008:498614. doi: 10.1155/2008/498614
Anxiety in Children Undergoing VCUG: Sedation or No Sedation?
David W Herd 1,*

2) Nephrourol Mon. 2014 May 1;6(3):e17168. doi: 10.5812/numonthly.17168
Oral Midazolam for Voiding Dysfunction in Children Undergoing Voiding Cystourethrography: A Controlled Randomized Clinical Trial
Anoush Azarfar 1, Mohammad Esmaeeili 1, Azadeh Farrokh 1, Ali Alamdaran 2, Aghilallah Keykhosravi 3, Mahboobe Neamatshahi 4, Alireza Hebrani 2, Yalda Ravanshad 5,*

[Hayley · Rating 5 out of 5]

This was an eye-opening assessment of the current failure to properly respect patient autonomy in today's healthcare system. It was a vulnerable account with the author admitting her own fallibility rather than merely judging others. I strongly resonated with the recognition of how the patient perspective is not fully considered and that omission of key health information strips patients of their ability to make informed decisions about their own health. The author emphasized the need for shared decision making and respect of patient input.

While I didn't agree with all of the author's opinions, the book addressed healthcare issues I hadn't considered previously. It underscored how true patient advocacy requires the defragmentation of medicine, whole-body care, and a movement against medical misogyny. Furthermore, the author had some quite interesting and novel ideas for the potential future of medicine and implementation of new protocols to better humanize patients and include them as integral drivers of their own health. I would dearly love to see some of her ideas implemented into medical practice.

Overall, I think everyone in the healthcare field should read this book to better understand and acknowledge their own biases, how these biases can affect patient care, and what we can do to improve. I highly recommend this fascinating read. *I received an advance review copy for free, and I am leaving this review voluntarily.*

[Randi Conti · Rating 5 out of 5]

This book covered many different types of discrimination, neglect, racism, and trauma in the medical community and a doctor who recognized it. I’m thankful to see someone speaking about the lapses in medicine and how it has impacted people all over, especially marginalized communities.

I listened to this book because of the VCUG mention in Chapter 8. I was given a VCUG 3-4 times from 18m to 6 years old. It wasn’t until later that I discovered that my sexual trauma stemmed from this. I can not explain what experiencing this young has done to me here but I spent years *knowing* I was SAd but not remembering specific events, trauma from the recurring nightmares, inappropriate feelings and play. I was 33 years old when I put it all together. In the end, this was not something fully communicated to my mother and incomprehensible by me. This chapter specifically covered consent and the importance of getting the consent forms signed, with the patient fully understanding the information not really mattering to most at all.

I really liked this book and will recommend it to other women.

[Sage · Rating 4 out of 5]

Review of advance copy received from Netgalley
This is a book about the lack of consent in medicine, how the culture got to this point, and what we can do to create a better future. This book is at times very heavy but is very necessary, and a must-read for both care-givers and patients alike. Zha, herself a doctor, calls out the culture of medical rape and owns up to times she herself has been complicit in it. This book explores how the culture of medicine- deeply entrenched in colonization, sexism, racism and eugenics- has evolved over time and lists specific ways that culture needs to change. The author calls for a new age of trauma informed care with a strong focus on consent.
Things to be wary of: this book opens with a rather explicit depiction of medical rape. Stories like this are sprinkled throughout and toward the end there is a very distressing depiction of the author's own medical trauma as well as depictions of a VCUG exam.
All in all, this was a very well written, thorough book that I would definitely recommend!

[George Anderson · Rating 5 out of 5]

Thank you for this long overdue call for Trauma Informed Care. The medical community has utterly failed in its moral and ethical duty to safeguard children undergoing invasive procedures involving their private body parts from the well-established harms.
What does it say that, in 2026, medical violence is routinely accepted for this vulnerable patient demographic?
I am a father of an adult child who lives with the enduring and profound traumatic impacts of their childhood experiences as a pediatric urology patient.
The medical profession must be held to account for failing to protect children entrusted to their care from iatrogenic sexual abuse.

[Tina · Rating 5 out of 5]

This was a very engaging and highly informative read. Dr. Zha does a great job of highlighting the inequities in our healthcare system and I especially loved her vision of how it should look. This is truly a call to action. We can do better!

[Denise · Rating 3 out of 5]

She tells it like it is, and it's not a pretty picture.