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Thread: Time to end pelvic exams done without consent

  1. #1
    Elite Member Honey's Avatar
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    Default Time to end pelvic exams done without consent

    A recent poll of Canadian medical students found 72 per cent had done exams on unconscious patients, without consent. REUTERS

    Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious

    Imagine that you are undergoing a fairly routine surgery – say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.
    Do you consider this okay, or an outrageous violation of your rights?
    Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.
    Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent, at least in Canada.
    Guidelines in the United States and Britain say specific consent is required but, by contrast, Canadian guidelines state that pelvic examination by trainees is “implicit.”

    The practice – one of those dirty little secrets of medicine – has been exposed in a thoughtful, professional manner by a young doctor.
    The story goes back to 2007 when Sara Wainberg was a medical student at McMaster University. Her younger brother Daniel, also studying to be a doctor, phoned for advice: As part of his rotation in obstetrics and gynecology, he had been asked to perform a pelvic exam on a woman who was under anesthetic. He refused, saying doing so without consent would be unethical.
    “It got me thinking,” Sara Wainberg said. “I had done this numerous times in my training and it had never occurred to me that it might be unethical.”
    She polled her fellow students and found 72 per cent had also done exams on unconscious patients, without consent, confirming that it is routine.
    It is essential for medical students to learn basic techniques, including pelvic examination, in well supervised settings.
    The long-standing argument in favour of allowing these exams to be done on surgery patients is that it provides a unique opportunity for students to practice the delicate, invasive examination without causing the woman pain or embarrassment.
    There is also an assumption that women would never accept pelvic exams by students while conscious so sneaking them in, while not ideal, is acceptable.
    When Dr. Wainberg took a position as a resident at Foothills Hospital in Calgary, she decided to study the issue further. She and fellow researchers polled 102 women who were patients at the Calgary Pelvic Floor Disorders Clinic.

    The results – reported in The Medical Post and in the Journal of Obstetrics and Gynecology – are as fascinating as they are troubling.
    Dr. Wainberg and her team found that fewer than one in five women were aware that a student might do a pelvic exam in the operating room. At the same time, 72 per cent expected to be asked for consent before such an exam was done.
    The patients – unlike medical educators – seem to be quite clear on the concept of informed consent.
    You don't probe, poke or otherwise invade the orifices of a patient without their permission, regardless of how educational it might be. Period.
    The most intriguing part of the survey, though, is that it showed that women are quite willing to undergo these gynecological exams – if they're asked.
    Sixty-two per cent of respondents said they would consent to medical students doing pelvic exams, and an additional 5 per cent said “yes” but only if a female student was doing the exam.
    This lays to rest the notion that it would be impossible for medical students to get this training unless they were doing it in the current surreptitious, unethical manner.
    But let's be clear: Even if all the women surveyed had rejected exams by medical students, the current approach would still be wrong.
    There are other ways to do this training, using simulation models, paid volunteers and consenting patients in other settings such as clinics.

    Patients have a right to say “No.” They are not merely a collection of body parts to be practised on. Patients are due respect and ethical treatment, whether they are awake or anesthetized, and no matter how potentially embarrassing the procedure may be.
    The research done by Dr. Wainberg and her colleagues, in passing, exposed something else important: Patients have very little idea what goes on in the operating room. Most have no idea that, in addition to the surgeon and nurses, medical residents or medical students may be present and may even participate actively.
    This is the result of a failure to communicate. It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture – this notion that “we do the surgery and the details are none of your business.”
    “It's definitely the patient's business who does what to them,” Dr. Wainberg said. “They have to be informed and they have to give consent.”
    In fact, if she was starting over again as a medical student and was asked to perform a pelvic exam, Dr. Wainberg has no doubt she would refuse.
    So too should every medical student and every teacher.
    A good doctor does not merely possess good technical skills, she or he must behave ethically and treat patients with the utmost respect.

    Time to end pelvic exams done without consent - The Globe and Mail

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    Elite Member Brookie's Avatar
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    Outrageous? Definitely. Surprising? Sadly, no. These unconscious patients are obviously considered pseudo-cadavers. Makes me curious how many times I was poked and prodded during my hysterectomy.

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    Elite Member ManxMouse's Avatar
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    Jesus. That's a terrible violation. I would freak if I found out a bunch of med students were down there poking around, looking at my bits, and penetrating me while I was out cold. Particularly if there were guys there.
    Santa is an elitist mother fucker -- giving expensive shit to rich kids and nothing to poor kids.

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    Elite Member MontanaMama's Avatar
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    That's appalling. How could the medical instructors think that was ethical...it's one thing if related to the procedure, but unrelated? What a violation.
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    Elite Member ManxMouse's Avatar
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    Quote Originally Posted by Brookie View Post
    Outrageous? Definitely. Surprising? Sadly, no. These unconscious patients are obviously considered pseudo-cadavers. Makes me curious how many times I was poked and prodded during my hysterectomy.
    I hope that's not common here in the U.S. But it just made me think of something---I had a benign ovarian tumor removed laparoscopically last year, under general anesthesia. I noticed afterwards that they had shaved me bald down there. I wish they had told me they were going to do that, or better yet, asked me to do it ahead of time (didn't know it was necessary, since the incisions were well above that). Particularly since the two anesthesiologists were men, wonder if they got to hang around for that.
    Santa is an elitist mother fucker -- giving expensive shit to rich kids and nothing to poor kids.

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    Elite Member McJag's Avatar
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    They had damn well better have a signed consent form!
    I didn't start out to collect diamonds, but somehow they just kept piling up.-Mae West

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    Elite Member sputnik's Avatar
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    honestly, i wouldn't care. i'd be out cold, and med students need to learn.
    i was reading the article thinking, i should probably be outraged... but no outrage ensued. i just kind of went, meh, let them at it.
    I'm open to everything. When you start to criticise the times you live in, your time is over. - Karl Lagerfeld

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    Elite Member Chilly Willy's Avatar
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    Hello mother fucker! when you ask a question read also the answer instead of asking another question on an answer who already contain the answer of your next question!
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    Elite Member Aella's Avatar
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    An intrusive unnecessary medical exam done without the patient's consent? I can't even begin to describe how NOT OKAY that is.
    "Remember to always be yourself. Unless you suck." - Joss Whedon

    "The only thing more expensive than education is ignorance." -Benjamin Franklin

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    Gold Member 00Kimmi00's Avatar
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    Quote Originally Posted by sputnik View Post
    honestly, i wouldn't care. i'd be out cold, and med students need to learn.
    i was reading the article thinking, i should probably be outraged... but no outrage ensued. i just kind of went, meh, let them at it.
    ITA. People seem to overlook the fact that processes deemed distasteful need to be done in order to make progress within a specific field. The students have been learning about this shit for four years and have seen outlandish shit in textbooks...I doubt one womans insecurity over the state of her vaginas aesthetics is going to irk them or be the crux for judgement.
    People still have no problem complaining about doctors incompetancy though...wonder why...

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    Elite Member Aella's Avatar
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    Quote Originally Posted by 00Kimmi00 View Post
    ITA. People seem to overlook the fact that processes deemed distasteful need to be done in order to make progress within a specific field. The students have been learning about this shit for four years and have seen outlandish shit in textbooks...I doubt one womans insecurity over the state of her vaginas aesthetics is going to irk them or be the crux for judgement.
    People still have no problem complaining about doctors incompetancy though...wonder why...
    Of course students need to learn. Which can be just as easily accomplished by asking patients to let students observe a medical exam, or finding volunteers for free medical exams, or even paying people a small sum to volunteer to take part in such exams. A doctor's right to learn does not trump patient rights, which is why in most countries there are laws and medical ethics to prevent that kind of situation.
    "Remember to always be yourself. Unless you suck." - Joss Whedon

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    Elite Member Chilly Willy's Avatar
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    Students can learn how to do a pelvic exam on a conscious woman who gave her consent.

    I'm often asked at all kinds of doctors, if it's okay that a med student is present. I always agree.
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    Gold Member 00Kimmi00's Avatar
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    ^ Yeh, but what I was getting at is that alot of people say no because they think they're 'not normal' or they're embarrassed for no good reason. So many med students, so little opportunity.
    Who here would consent to it?

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    Elite Member sputnik's Avatar
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    honestly, if a med student is going to give me a pelvic exam, i'd rather be out cold
    i get your point, and i totally understand why it bugs a lot of women, i just can't bring myself to feel anything. maybe i've known too many med students or something but for some reason i just don't care about this.
    I'm open to everything. When you start to criticise the times you live in, your time is over. - Karl Lagerfeld

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    Elite Member yanna's Avatar
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    Have them learn on conscious women who can feel the pain and who have consented so they will make less of a mess of things later on. This is 100% not ok.

    Either way, I would probably consent if asked but it would be nice to be asked first. Just assuming that I'll play cadaver for their students makes me want to shoot the first doctor I see. Who the fuck do they think they are?

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