And you thought you only had to worry about pervy dentists

March 12, 2003 1:58 PM

Gynecological exams are changing as new students begin to question old practices. Medical students often perform pelvic exams when the patient is under anesthesia, not only without consent, but without informing them.
posted by Karmakaze (21 comments total)

I would feel so very violated if a pelvic exam was performed without my permission and it wasn't mentioned in the agreement I signed. I guess I'll never go to a medical school hospital. I'm glad to heard of the policies changing.
posted by rhapsodie at 2:53 PM on March 12, 2003

Okay, EWWWWW. That would so weird me out to find out I was on display without my knowledge.

There was a time when I have having a pelvic exam every two weeks for about 6 months, trying to figure out what was wrong with me. By the end of the six months, I would be lying there and parades of doctors would come in and look at me, like 5-6 at a time, and I didn't care anymore because it had happened so much. But that's only because I knew what was happening and I said yes or no to them taking a look-see into my most private area.

If they did it without my conset I would sue the pants off them. Ugh.
posted by aacheson at 3:11 PM on March 12, 2003

Some of the hospitals that changed their policy to ask for consent only state that an exam might be done. It doesn't state that it will be done by students and it doesn't state that it will be a freight train. One of those hospitals was John Hopkins... they've already gotten in trouble for other things so you'd hope they would have learned something.

If I ever go in the hospital, I will write on my consent form that only medically necessary procedures may be performed for patient care. The hospital will have to either accept or kick me out... then we'll be clear on what the agreement is and if we're not I'll be eligible for my million dollars.
posted by loafingcactus at 3:16 PM on March 12, 2003

From the post & the discussion, I had assumed that these exams were being done on women anesthetized for completely different problems. Now, if I was having brain surgery and students were doing pelvic exams, that would be outrageous.

According to the Salon article, though, these exams were only done on women undergoing gynecological surgeries. If that is the case, it really doesn't seem that inappropriate for women already anesthetized and having work done in that area to be examined by students. When you have a procedure done in a teaching hospital, I don't think there's really all that much wrong with having students examine someone who (1) has a problem that will teach them to identify that specific problem when doing pelvic exams in the future and (2) is already exposing themselves to a variety of doctors, nurses, and other medical assisting professional people.
posted by catfood at 3:27 PM on March 12, 2003

i find this utterly repulsive and completely violating. i would completely sue if this happened to me
posted by mabelcolby at 3:27 PM on March 12, 2003

Catfood, I have no problem with it being done if the woman has been asked if it's okay. If I were asked, I would absolutely say yes! I am all for training. But it being done without her knowledge is a gross violation of her rights.
posted by aacheson at 3:32 PM on March 12, 2003

I really don't see how it's a gross violation of rights or worthy of a lawsuit. It is nice that they are asking for permission, but I think the idea of having a pelvic exam done while under anesthesia for gynecological surgery is being blown into a far more terrible thing than it really is. It doesn't do any damage, cause any inconvenience, and it trains students to identify problems that obviously require surgery. I also think that there is a certain expectation that you might be used as a teaching tool when you have a procedure done in a university hospital.

However, people will always find things to be outraged over, especially when the opportunity to get monetary compensation is involved.
posted by catfood at 3:44 PM on March 12, 2003

catfood - it's the students who are complaining about this. Typically the patients never even know. When schools ask if it's OK, most patients say yes. It's just that they don't ask that seems like a problem.

Interestingly, while 70% of the students thing it's wrong, by the time they get through their OB/GYN training, that number drops to 50% thinking it's wrong.

What happens during that training (that doesn't happen during the rest of their medical training) to change their views towards patient consent?

And, it's not like oh, they needed to have this done anyway, may as well have a student do it. I got the impression it was like let's have 20 or 30 students do it since the patient is unconscious and relaxed and won't feel it when the student inevitably hurt her with their inexperienced technique. That does seem a bit creepy to me.
posted by willnot at 3:52 PM on March 12, 2003

Catfood: "Anesthetized women are the perfect subjects, doctors said, because they are relaxed, and unable to feel the sometimes painful mistakes that novice examiners make."

I'm sorry, but I can't help but feel that is something to be upset over. Just because you've said "Yes, I want you, and your chosen staff to mess with my repoductive system and remove cancer, or help me to have a child, or making me willingly sterile etc etc" does not in anyway mean "Oh yes, and while you're in the general area anyway, just use my body for whatever other purpose that's convenient for you because I'm knocked out so I won't know the difference."

A huge part of laying down on that table, and giving up control of what happens to your body through anesthesia, is an exchange of trust with your doctor: 1) they know what the hell they're doing and 2) that they will be doing something to help you. I see performing random extraneous examinations as a violation of that trust because the patient does not want nor medically need them.

I think it's great they use live patients to teach students, I'd even be willing to be one of them, but only with my prior knowledge, and with my prior consent. I just think there's an enourmous distinction between a doctor I know and have consented to do whatever prodedure on me, and a random, completely anonymous person I will never even known was involved.

Back to about the article: kudos to the students for challenging traditions they disagree with!
posted by nelleish at 4:13 PM on March 12, 2003

The more I think about it, the more I like and approve the change to asking patients for permission. However, after being led to mistakenly believe that the patients subject to these exams were any women undergoing any surgery, the idea of what is really happening is a lot less outraging in comparison.
posted by catfood at 4:22 PM on March 12, 2003

Creepiest thing I've heard all month.
posted by agregoli at 4:50 PM on March 12, 2003

I had all sorts of things I was going to say about this, but then I read nelleish's post and she said them all.

I'll add special emphasis to the part about not feeling pain. Pain is a bodily reaction to bad things. If these students are bad enough at this to be causing too much pain for someone to have to go through while conscious, then they're bad enough at it that they shouldn't be doing it to patients who haven't been informed of the risks.
posted by jacquilynne at 5:14 PM on March 12, 2003

Catfood, the reason many people sue is that money is the only thing corporations, hospitals, etc. will listen to. Not cuz they think money will make it all better.

Nelleish, I think your post was great. Hit it right on the head.
posted by aacheson at 5:18 PM on March 12, 2003

Despite pelvics being one of the least pleasant things about being a girl, I've consented to multiple exams in a single office visit so interns could get their practice in, and I'd still be seriously pissed if this happened to me. I can't imagine a guy being all that pleased to go in for hemmoroid surgery, and end up having a bunch of medical students stick their hands up his ass to palpate his prostate, since they happened to be in the same neighborhood.

I can't possibly see how pelvics on an unconscious patient could teach a medical student anything that they can't learn in anatomy practicals; part of the reason pelvic exams are so unpleasant is because many doctors just jam their hands in there as if there were nothing attached to the anatomy.

In my experience as a medical guinea pig, the student actually got the chance to determine how much pressure he needed to palpate an ovary to get the medical information necessary without putting me in agony- good for the future doctor, because he learns the procedure, and good for his future patients, because they won't suffer needlessly.
posted by headspace at 7:09 PM on March 12, 2003

I had gyn surgery (in a non-teaching hospital; no students) as a naive and scared 17 year old to remove an ovarian cyst. It was supposed to be laparoscopic (small incision and aided by a camera), but after I was under, a more aggressive pelvic than they would have done when awake revealed that the mass was too big to get at that way. Instead, I ended up with a nice long bikini cut, and ultimately one less ovary and tube than I had when I started (as a courtesy, they got further consent from my parents to open me up and to take the organs, although I am guessing the initial consent likely covered it).

For the most part, I don't think pelvics while under anasthesia are outside of what should probably be done anyway before any gynecological surgery (although I am obviously not a doctor, any GYNs out there feel free to correct me). If it is already medically necessary, it isn't a big next step to have students in teaching hospitals give it a go. That's what happens in teaching hospitals.

That said, I was pretty creeped out at the thought that they did a pelvic on me when I was under, even though I knew and expected that they would be cutting a hole or two into my belly region. Not to be too vulgar -- and guys, this might be hard for you to understand -- but I found it much more intimate/violative to have someone stick their fingers in my vagina without my knowledge than I did to have that same person cut a 6 inch line just below my belly.
posted by IPLawyer at 9:12 PM on March 12, 2003

this might be hard for you to understand -- but I found it much more intimate/violative to have someone stick their fingers in my vagina without my knowledge than I did to have that same person cut a 6 inch line just below my belly.
Why do you think that would be hard for some to understand? I doubt that there are very many people who have masturbated to images of 6 inch belly cuts. The vagina has special significance and you deserve to maintain control over how yours is used.
posted by HTuttle at 9:42 PM on March 12, 2003

It seems quite clear to me that doing something "routine" for my benefit while "in the area" is one thing, but doing something strictly for educational purposes without so much as a by my leave is completely wrong. Of course, gynecologists are not known for their sensitivity with regard to respecting the sovereignity of womens' bodies when they're not in positions to offer their opinions on the doctors' actions. But even when I'm under anesthesia, my body is still my own, and no one has the right to do anything which is not necessary for me without my consent, period.
posted by Dreama at 9:46 PM on March 12, 2003

To me, this is a gross violation of privacy, and if I was a woman who had this done to me, I'd sue the hell out of them.

I wonder if went unreported for years, because there weren't any female students to blow the whistle.

Actually, now that I think about it, gross violation of privacy seems to tame. It borders on institutionalized assault.
posted by Beholder at 10:48 PM on March 12, 2003

This diary of a 3rd-year medical student at Tufts will make you never want to go to a hospital again. Well, at least for me it made me extremely distrustful of the whole medical profession, if even just a fraction of it is true.

So if the patients already secretly know and wouldn't mind regardless, then surely the course director wouldn't mind me wasting my breath to ask the women permission. (For that matter, he shouldn't mind a quick letter to the Boston Globe either.) No, I was told initially, I am not to ask women permission to use them - their bodies - for our education. I shouldn't let them know. Why? "We would just confuse the patients," he said. "You don't ask permission for male genital exams, do you?" I was asked. "We don't get them to sign permission for every little detail?"

And, personal anecdote: one gynecologist I've socialized with acts completely like an immature frat boy, telling sexist, mysogynist jokes. I'm too polite, but I've been so tempted to ask him: "Just why are you in this specialty? You clearly have no respect for women as autonomous human beings worthy of respect, especially from their doctors." Bah.

I'm thankful that my health is generally good (knock wood) and I've only been under general once, in a dentist's office, where I'm pretty sure my clothes stayed on.

(And, by the way, when I've been in teaching hospitals for annual exams and the doctor has asked if I mind a student observing, I've always said "No, I don't mind." The issue is about consent, autonomy, and privacy, not necessarily modesty.)
posted by Medley at 4:07 AM on March 13, 2003

I would be extremely angry if this were done to me, even if I were in the hospital for a gynecological procedure.

It's one thing for the doctor doing the procedure to perform a pelvic exam to check out the lay of the land, as it were, it's something else entirely for students to perform that same pelvic exam to practice. The main issue, I think is consent. I would have consented to the doctor doing the exam for the purposes of confirming whatever needed to be done in the surgery. I would not have consented to the students doing the exam to learn something.

Now, if I were asked ahead of time, I'd be cool with it. I used to go to a clinic which was staffed mainly by residents and interns, and they'd do the initial examination and their diagnosis would be confirmed by their immediate supervisor, who was always a doctor.
posted by eilatan at 9:17 AM on March 13, 2003

From the "Diary from a third year medical student"

Dr. Tony Baird, chairman of the New Zealand Medical Association got on television and said, "Until recently it wasn't an issue.... I'm very sorry that women feel they've been assaulted and violated in this way. This was never the intention." He had no idea then, asked the reporter, that women might object? "All I can say is that there have been no objections...."

"Could the reason be," asked the interviewer, "that it's very hard for an anesthetized woman to know what's going on?" "That's absolutely ridiculous," snapped Baird.

Ah. Duh.
posted by aacheson at 9:47 AM on March 13, 2003