Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women.
Abstract
OBJECTIVE:
To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States.
METHODS:
A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception.
RESULTS:
A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5).
CONCLUSION:
Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.
PMID: 22484240 [PubMed - as supplied by publisher]
dg
Most 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.
How 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 consider this practice to be extremely unethical and leaves women open to abuse.
Where are the ethics committees when it comes to issues like this?
If 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.
"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.
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 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?
A 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
1) http://upalumni.org/medschool/appendices/appendix-37.html
2) http://upalumni.org/medschool/appendices/appendix-49.html