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Note: This issue of pelvic exams while under anasethesia has been explored in the research in the past (click on 'read more' to see viewers comments)
Please take the poll and add your views on this issue.............................................
Conclusion: "The majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure."
Sorry for being so naive, but I am shocked to find this out!!! Hell no I don't want anyone doing anything to me while I'm out cold, without at least ASKING first. Jeeeezzzzz.....
ReplyDeletewhen I click on article, I get the damaged file message.
ReplyDeletedg
Try again, please. I have tested this and it seems to work fine. Thanks.
ReplyDeleteIn California teaching hospitals, the patient signs a consent form that states that medical students and other people in training will "participate" in the operation. If the operation is gynecological where a pelvic exam is part of the pre-op standard of care, then a medical student can practice the exam under supervision without explicit patient consent. If a pelvic exam isn't necessary, then there has to be explicit consent for a student to practice that procedure on the patient.
ReplyDeleteMost patients aren't aware that they can be used as props in the operating room and I'm sure the hospitals and doctors want it that way. The operating room has always been known to medical students as a great place to "steal" their learning from the patient. I think what's unnerving is the vision of many students waiting their turn in line to practice on an unconscious patient.
I would really like to have med students as well as board of director members jump in here on the issue of 'vaginal cue jumping'.
ReplyDeleteoh my, this is awful. next time i need surgery, i will write "i do not consent to medical students/interns/residents performing pelvic or other examinations" all over my consent forms.
ReplyDeleteWhat's with "it will first be necessary to determine the feasibility of seeking consent specifically for this procedure"?
ReplyDeleteHow could this possibly be an issue or a problem? How could it NOT be feasible to require prior consent? Likely the feasibility question concerns the medical schools' fear that if they ask patients for consent, they'll get more refusals than they can abide.
I'm very disturbed by this article, especially as a women who had a gynocological procedure under anesthesia 3 years ago. Had I known that it was even a possibility that they might use me as a guinea pig, I would have chosen to have the operation while awake, or to have someone in the room with me while I was unconscious.
ReplyDeleteI consider this practice to be extremely unethical and leaves women open to abuse.
I don't understand how they could practice ANY procedure on an anesthetized person without consent!
ReplyDeleteWhere are the ethics committees when it comes to issues like this?
I am also interested in opinions from the breast, colorectal and other cancer communities. By this I mean - is it common practice when women are undergoing any procedure to have pelvic exams while under anaesthesia? Husbands and partners opinions on this issue?
ReplyDeleteWhile I was aware of the general processes around student ed in teaching hospitals - such as observing or scrubbing into surgeries - I am very disturbed to discover what I consider at best fuzzy ethical processes.
ReplyDeleteIf it is not ABSOLUTELY CLEAR to the patient that a specific exam is part of the process, AND that participation means a supervised student may do such an exam, then you don't have informed consent. Period.
And you sure don't get that by having the patient sign a pile of forms a few hours ahead of a procedure, or assuming they know what "participate" in operation means. Stand and watch? Help monitor? Hold a kidney? I don't object to being a learning tool, but I expect to be asked specifically, simply and clearly.
This is shocking news that this could become standard practice. It sounds like we are moving backwards. In 1981, I served as a "pelvic model" at UC San Francisco and was paid something like $25/hour for my time. This was strictly voluntary; I was awake,signed a consent form for serving as a teaching model, and was able to converse with the student about the pelvic exam.
ReplyDeleteSandi, re: your comment
ReplyDelete"is it common practice when women are undergoing any procedure to have pelvic exams while under anaesthesia?"
My heart sank when I read that question. I would love to know this too (while at the same time I dread the answer).
I'd also like to know, are men's bodies used in this experimental way? Do students practice examinations on men for testicular or prostate cancer while they are unconscious?
Sandi, I hope you'll keep us posted if you hear anything about this. Thank you.
Anonymous wrote: "Is it common practice when women are undergoing any procedure to have pelvic exams while under anaesthesia?"
ReplyDeleteMy heart sank when I read that question. I would love to know this too (while at the same time I dread the answer).
I think from some of the poll responses and comments, it is common contrary to what may think. Surgical patients of any kind, male or female should be getting on the bandwagon on this issue. The best way to bring this issue forward is to blog,email,FB and Twitter the ethics of the issue in the public domain. I wonder what husbands/partners feel about this?
In 2003, there was a segment on the TV show 20/20 on the subject of unauthorized pelvic exams in teaching hospitals. There was a real uproar over this that resulted in the passage of a bill in California intended to protect patients against this habit. A previous poster already brought this up. Unfortunately the bill didn't help the patient, but instead inadvertantly etched in stone that the patient didn't have to be notified in advance, let alone get patient permission, if a pelvic exam was part of the pre-op standard of care. These practice exams are done before the patient is prepped and are probably supervised by a resident or nurse. Most likely the surgeon isn't aware (or even cares) that these exams took place because usually the surgeon arrives in the room after the patient is draped and prepped.
ReplyDeleteA lot of debates resulted from the expose, but the doctors and hospitals were defiant in their "right" to use patient bodies in the OR as teaching props with the reasoning that a doctor can't learn just by observing. And that the patient isn't harmed. In any debate, they were uniformly indignant at revealing anything that goes on in the OR to the public because of the fear "one foot in door, what next will they demand. And the threat that if there is interference, then patient care will suffer.
Here are a few news links addressing this issue.
http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A36990-2003May9¬Found=true
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=880120
(yes, men are used as props too)
http://www.menshealth.com/men/health/other-diseases-ailments/are-med-students-practicing-on-you/article/fb2a99edbbbd201099edbbbd2010cfe793cd
http://findarticles.com/p/articles/mi_m0CYD/is_13_38/ai_105514181/
http://jamwa.amwa-doc.org/index.cfm?objectid=C7EE5996-D567-0B25-50D3DA2B7834FEE5
Other links sent in anonymously:
ReplyDelete1) http://upalumni.org/medschool/appendices/appendix-37.html
2) http://upalumni.org/medschool/appendices/appendix-49.html
I had a hernia operation a few years ago. The doctor suggested general anaesthetic, but me being paranoid insisted on a lesser drug. They told me I would feel no pain and be almost asleep and not remember what happened. I felt no pain but was aware otherwise. The doctor let a student perform the surgery which I didn't know would happen. I heard the doctor's criticisms of the student's work and comments like "next time do it more this way". Quite reassuring.
ReplyDeleteThanks Emily for taking that extra step in providing us with related information.
ReplyDelete
ReplyDeleteThis is a widespread issue and myself and my colleagues in the UK and Australia are currently analysing medical students' narratives of their behaviour during 'dilemma' moments (such as being asked to perform an intimate examination on a patient without consent) - we presented our preliminary findings at a US conference last year http://www.absame.net/conf/ocs/index.php/annual/2009/paper/viewPaper/58 More research needs to be done to understand the factors regarding why this happens - and it doesn't just affect women.
While Lynn's abstract is interesting, it is noteworthy again that these are not new issues as per the included references. I would disagree that further research is required. A root cause analysis is not going to add anything further to what has already been demonstrated. It is now a matter of policy.
ReplyDeleteSandi
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http://www.absame.net/conf/ocs/index.php/annual/2009/paper/viewPaper/58
“Come here. I want you to feel a normal rectum. Do it.”: medical students’ explanations of their behaviours during consent dilemmas involving intimate examinations."
Lynn Monrouxe, Charlotte Rees, Laura Rees-Davies, Kieran Sweeney
Building: The Lodge at Santa Fe
Room: Kachina Ballroom A
Date: 2009-10-10 10:30 AM – 12:00 PM
Last modified: July 7, 2009