Full article on link below. Long read but well worth it.

http://tiny.cc/f5kfg

Are all women who are put under general anesthesia in a hospital practiced on by students while unconscious?

All women in the OB/GYN department at most teaching hospitals and hospitals affiliated with a medical school are. If you’re anesthetized and you’re in the OB/GYN department, you probably have had students practice pelvic exams on you regardless of what you’re in the hospital for – even if the procedure you need doesn’t require a pelvic exam!

Additionally, while doctors don’t go to other departments — such as general surgery patients, neurosurgery patients or cardiac surgery patients — if your surgeon is an OB/GYN, odds are there’s going to be a team of hungry medical students waiting for you to fall asleep.

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Can you explain what happens during these non-consensual pelvic exams?

They are usually “bi-digital” exams. This means students insert two fingers as deeply as they can into the vagina with one hand and use the other hand to feel around the outside of the abdomen for the ovaries. What they’re trying to do is trap the ovaries between their two fingers and their hand and feel for the internal organs from the inside. Sometimes, speculums are also used in the exams.

And what does this teach the student?

Very little in terms of how to do a proper pelvic exam. The art of doing a pelvic exam is how to do it while making the woman feel comfortable. When a patient is unconscious, obviously she can’t tell you what’s uncomfortable, what you’re doing right or wrong, what hurts. And, it feels completely different because the musculature is completely relaxed because of the anesthesia. So it doesn’t feel the same when you do a pelvic exam on a woman who is awake.

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So, how can a woman prevent non-consensual pelvic exams happening to her?

All you can do is ask and hope that your doctor will honor your request. Once you’re asleep, however, you have no power. And what a powerless thing for women to know this goes on and think, “Well, I’m just going to have to trust my doctor.”

What if you don’t trust your doctor?

Women can write on their bikini line, “I do not give consent for medical students to practice pelvic exams on me” in marker. Then as soon as the clothes come off or the robe is lifted and all the medical students are getting on their latex gloves they can see that message. And that will stop them.

I was inspired to think up this tip because of patient advocates like Bernie Siegel, M.D., who recommend that patients use a magic marker to write “Wrong leg” or “Wrong arm” on their healthy body parts to prevent them their doctor from performing surgery on the wrong limb – a common mistake.

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How do the attending physicians who require the students to perform non-consensual exams feel about the practice?

The attending physicians are almost without exception supportive of the practice, haven’t even thought about it, or don’t consider anything wrong with it. I’ve seen female just as likely as male attendings support the practice.

In fact, the only people who are fine with not asking permission are doctors. They’re so out of touch with the world and society. This is where they’re weakest.

Why do attending physicians feel this way?

I’ve been told that they don’t see anything wrong with it. They don’t see anything unethical about it at all. They think, “Huh, we just never thought anyone would mind.” In fact, a quote in a recent article in the response written in response to the American Journal of OB/GYN article this month [March 2003] quoted the residency director of Johns Hopkins as saying “I don’t think any of us even think about it. It’s just so standard as to how you train medical students.”

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One of the comments made me feel better:

this interview apparently was 7 years ago
i was a medical student from 2004-2008 and like most schools around the nation this was always brought up in ethics debates. when i did my ob/gyn rotation as a 3rd year student I was in the OR and delivery room a lot, pulling 80 hours a week sometimes like the residents. I was never put in this situation. We had the paid fake patients who would let a train on medical students practice on them on a wed night, and there were times when the resident/attending would ask the patient beforehand if the student could examine during the procedure when it was an OR procedure with anesthesia, or on the labor and delivery floor before baby time. they could always say no, and everyone respected their wishes. This is one person’s experience but in my opinion this is not the widespread problem that it used to be. I don’t know, I went to school in Philly, where you can get sued for looking at a patient the wrong way, so maybe everyone was just very careful.

Another comment:

Actually, all the articles and legislation in the other post (Yes, It’s True…) are also from 2002-2004. There’s only one link from 2007 and that’s in Canada (not that Canadian women shouldn’t have the same rights). But I really don’t think it’s as common as it’s being made out to be, at least not now. Admittedly, it shouldn’t happen AT ALL, but I also NEVER saw it done in med school. Especially the part about multiple med students examining one patient…on all our surgical rotations (including OB/GYN) it was one student in the OR at a time, and no, we didn’t all get rounded up to go into the OR of one patient for anything like this. Should women be aware of this issue? Yes. Should women who are having surgery ask about med student involvement, including to what extent? Yes, as should anyone having any surgery, because you can say no med students are allowed. Should med students/doctors ask consent for anything like this? Absolutely. Are all med students at all med schools doing these exams during all GYN surgeries? No. Not even most of them. I definitely agree that it shouldn’t happen at any, but to say “If you’re anesthetized and you’re in the OB/GYN department, you probably have had students practice pelvic exams on you regardless of what you’re in the hospital for” is incorrect. When I introduced myself to patients I never introduced myself as Dr. while still in med school, though I did usually say “student doctor” to distinguish myself from a nurse (because that’s what patients always assumed I was). Did I ever perform a procedure on a patient without consent and/or telling them I was a student? Yes…but in the setting, for example, of a trauma in the emergency room where technically everything was without consent and also what I did was part of the necessary care of that patient, never “just to learn.”

Seems like this was the case a long time ago but may not be an issue now:

I am an MD. This is not the norm! It WAS the norm in medical schools 10+ years ago but now is a common case study in medical ethics for all medical students. Hospitals have been sued and lost over this. Everyone knows doing something invasive without permission is wrong.

At my medical school we specifically discussed this case during our education on the consenting process. THATS WHY SHE EXPLICITLY STATES IT WAS AN OR NURSE AT AN INSTITUTION NOT AFFILIATED WITH HER MEDICAL SCHOOL who offers the un-consented pelvic exam.

To me its criminal for a doctor (in this case a medical student) to wrongly paint other physicians as heartless. It is in fact part of the Hippocratic oath to not do so. Let me just put this out there… doctors spend all day thinking about and trying to do what is best for the person we are caring for RARELY does money or any other consideration come in to play. Thats reality. I’m tired of people accusing docs of being in bed with this or that. We show up and do our jobs as best we can.

Also, there was a GOOD REASON for doing a pelvic on this patient. Doing a focused physical exam prior to surgery is REQUISITE FOR EVERY OPERATOR. For many good reasons not least of which is… uhh… HOW ABOUT KNOWING WHERE YOU ARE GOING WITH THAT DILATOR?? This medical student should be reprimanded for not having had the sense to speak to the patient prior to surgery to 1) get consent 2) do the requisite physical exam. It is a serious failing on her part. How exactly did she assist without knowing the anatomy?

As most patients prefer to delay the pelvic exam until anesthesia that would be fine but you first obtain consent. This to me is clearly a case of an incompetent medical student misunderstanding what she is seeing and should be doing.

Still, something to be aware about…

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