The authors respond re: consent/pelvic exams

The authors respond

Elaine Gibson, LLM,
Jocelyn Downie, SJD

Author Affiliations

The Health Law Institute, Dalhousie University, Halifax, NS

Margaret Morris has missed the point of our article.1^,2 We agree that some residents conduct pelvic examinations solely for therapeutic purposes (i.e., they are fully trained in conducting such examinations and the only purpose for the examination is the care of the patient) and the policy statement does not fail in relation to such residents. However, Morris ignores the fact (explained in our article) that some residents are conducting pelvic examinations solely for training purposes, or for a combination of therapeutic and training purposes. Our considered view, grounded in a careful review of the relevant law, is that patients must be asked for explicit consent to a resident's performing a pelvic examination in whole or in part for training purposes. On this narrow point we took issue with the revisions to the policy statement3 because of its shift from covering residents and medical students in this context to only covering medical students. We argued, and continue to hold, that residents should either be added back into the policy statement in relation to the conduct of pelvic examinations for training purposes, or a separate policy for residents (requiring disclosure of purpose and explicit consent for such examinations) should be developed.

We share Morris' goals of achieving "the best possible care for women in the academic environment" and ensuring that "all health professionals providing care for women are adequately trained." However, we do not agree that calling for disclosure of training purposes and explicit consent in residents performing pelvic examinations for training purposes can be characterized as "needlessly raising anxiety in the public and putting the clinical academic process in jeopardy." In a study conducted at the Calgary Pelvic Floor Disorders Clinic, a majority of women surveyed indicated that they would consent to a pelvic examination for training purposes if asked.4Further, even if the result would be fewer patients agreeing to have such examinations conducted, this is no justification for overriding legal rights and ignoring ethical responsibilities.

References

↵
1. Morris ML
. Consent requirements for pelvic examinations [letter]. CMAJ 2012;184:1393.
FREE Full Text
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1. Gibson E,
2. Downie J
. Consent requirements for pelvic examinations performed for training purposes. CMAJ 2012;184:1159–61.
FREE Full Text
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1. Liu KE,
2. Shapiro J,
3. Robertson D,
4. et al
. Pelvic examinations by medical students. J Obstet Gynaecol Can 2010;32:873–5. Available:www.sogc.org/guidelines/documents/gui246PS1009E000.pdf (accessed 2011 Apr. 27).
↵
1. Wainberg S,
2. Wrigley H,
3. Fair J,
4. et al
. Teaching pelvic examinations under anaesthesia: What do women think? J Obstet Gynaecol Can2010;32:49–53.
Medline

http://www.cmaj.ca/content/184/12/1393.3.short?rss=1

Sent from my iPhone

Consent requirements for pelvic examinations

Robert Byrick, MD, President

Author Affiliations

College of Physicians and Surgeons of Ontario, Toronto, Ont.

I write on behalf of the College of Physicians and Surgeons of Ontario, in response to the recent article in CMAJ "Consent requirements for pelvic examinations performed for training purposes."1We appreciate that the authors of this article were commenting only on new policy guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Association of Professors of Obstetrics and Gynaecology of Canada (APOG), and the "flaw" in that policy related to medical residents.

Gibson and Downie1 note that the new policy fails to require residents to obtain consent prior to conducting pelvic examinations for educational purposes. Although the policy does not specifically address resident responsibilities in this area, this college's policy — Professional Responsibilities in Postgraduate Medical Education2 — explicitly addresses the issue. Our mandate is to regulate physicians in the public interest, and our policy clearly states that patients must be given an explanation about the educational purpose of any proposed examination or clinical demonstration and that express consent of the patient must be obtained (whether the patient is conscious during the examination). The policy also clearly states that if, for any reason, express consent cannot be obtained, the examination cannot be performed. Unfortunately, Gibson and Downie1 leave the impression that the guideline of the SOGC and APOG is the only policy relevant to this issue. That patients are assured that in Ontario, and probably in most other provinces, this is not the prevailing policy is critical.

Although societies and associations should and do have policies that guide member behaviour, regulatory colleges have the authority to hold physicians accountable in a way those organizations do not.

References

↵
1. Gibson E,
2. Downie J
. Consent requirements for pelvic examinations performed for training purposes. CMAJ 2012;184:1159–61.
FREE Full Text
↵

The College of Physicians and Surgeons of Ontario. Professional responsibilities in postgraduate medical education. Toronto (ON):The College; 2011.