Time to end pelvic exams done without consent

User avatar
Bejvas
Lord of the Board
Posts: 3067
Joined: Dec 13th, 2009, 12:38 pm

Time to end pelvic exams done without consent

Post by Bejvas »

This concerns all Canadians, and we should do something about it. It is disrespectful!

Imagine that you are undergoing a fairly routine surgery – say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.

Do you consider this okay, or an outrageous violation of your rights?

Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.

Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent, at least in Canada.

Guidelines in the United States and Britain say specific consent is required but, by contrast, Canadian guidelines state that pelvic examination by trainees is “implicit.”

The practice – one of those dirty little secrets of medicine – has been exposed in a thoughtful, professional manner by a young doctor.

The story goes back to 2007 when Sara Wainberg was a medical student at McMaster University. Her younger brother Daniel, also studying to be a doctor, phoned for advice: As part of his rotation in obstetrics and gynecology, he had been asked to perform a pelvic exam on a woman who was under anesthetic. He refused, saying doing so without consent would be unethical.

“It got me thinking,” Sara Wainberg said. “I had done this numerous times in my training and it had never occurred to me that it might be unethical.”

She polled her fellow students and found 72 per cent had also done exams on unconscious patients, without consent, confirming that it is routine.

It is essential for medical students to learn basic techniques, including pelvic examination, in well supervised settings.

The long-standing argument in favour of allowing these exams to be done on surgery patients is that it provides a unique opportunity for students to practice the delicate, invasive examination without causing the woman pain or embarrassment.

There is also an assumption that women would never accept pelvic exams by students while conscious so sneaking them in, while not ideal, is acceptable.

When Dr. Wainberg took a position as a resident at Foothills Hospital in Calgary, she decided to study the issue further. She and fellow researchers polled 102 women who were patients at the Calgary Pelvic Floor Disorders Clinic.

The results – reported in The Medical Post and in the Journal of Obstetrics and Gynecology – are as fascinating as they are troubling.

Dr. Wainberg and her team found that fewer than one in five women were aware that a student might do a pelvic exam in the operating room. At the same time, 72 per cent expected to be asked for consent before such an exam was done.

The patients – unlike medical educators – seem to be quite clear on the concept of informed consent.

You don't probe, poke or otherwise invade the orifices of a patient without their permission, regardless of how educational it might be. Period.

The most intriguing part of the survey, though, is that it showed that women are quite willing to undergo these gynecological exams – if they're asked.

Sixty-two per cent of respondents said they would consent to medical students doing pelvic exams, and an additional 5 per cent said “yes” but only if a female student was doing the exam.

This lays to rest the notion that it would be impossible for medical students to get this training unless they were doing it in the current surreptitious, unethical manner.

But let's be clear: Even if all the women surveyed had rejected exams by medical students, the current approach would still be wrong.

There are other ways to do this training, using simulation models, paid volunteers and consenting patients in other settings such as clinics.

Patients have a right to say “No.” They are not merely a collection of body parts to be practised on. Patients are due respect and ethical treatment, whether they are awake or anesthetized, and no matter how potentially embarrassing the procedure may be.

The research done by Dr. Wainberg and her colleagues, in passing, exposed something else important: Patients have very little idea what goes on in the operating room. Most have no idea that, in addition to the surgeon and nurses, medical residents or medical students may be present and may even participate actively.

This is the result of a failure to communicate. It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture – this notion that “we do the surgery and the details are none of your business.”

“It's definitely the patient's business who does what to them,” Dr. Wainberg said. “They have to be informed and they have to give consent.”

In fact, if she was starting over again as a medical student and was asked to perform a pelvic exam, Dr. Wainberg has no doubt she would refuse.

So too should every medical student and every teacher.

A good doctor does not merely possess good technical skills, she or he must behave ethically and treat patients with the utmost respect.
"Just because you're angry, it doesn't mean you have the right to be cruel."
User avatar
justmyopinion
Lord of the Board
Posts: 3343
Joined: Dec 2nd, 2009, 9:45 am

Re: Time to end pelvic exams done without consent

Post by justmyopinion »

:ohmygod: I had no idea! I think this is a TOTAL obstruction of privacy!! and should be against the law unless authorized by the person getting surgery....I can't believe this is ok!!! :200:
User avatar
Bejvas
Lord of the Board
Posts: 3067
Joined: Dec 13th, 2009, 12:38 pm

Re: Time to end pelvic exams done without consent

Post by Bejvas »

exactly, I think it is absurd, something must be done after the awareness of this fact of what's happening has been brought to the public's attention
"Just because you're angry, it doesn't mean you have the right to be cruel."
User avatar
zzontar
Guru
Posts: 8868
Joined: Oct 12th, 2006, 9:38 pm

Re: Time to end pelvic exams done without consent

Post by zzontar »

Wow, if I'd have known that I would've become a medical student! Seriously though, that's a gross invasion of privacy and should never be allowed without consent.
They say you can't believe everything they say.
mrj222
Übergod
Posts: 1041
Joined: Jun 24th, 2006, 11:26 am

Re: Time to end pelvic exams done without consent

Post by mrj222 »

Please provide a link to a reputable source for this. If this turns out to be true I will be having discussions with a few doctors......
We can't stop here, this is bat country!
User avatar
Glacier
Admiral HMS Castanet
Posts: 34987
Joined: Jul 6th, 2008, 10:41 pm

Re: Time to end pelvic exams done without consent

Post by Glacier »

Last edited by Glacier on Feb 4th, 2010, 1:13 pm, edited 5 times in total.
"No one has the right to apologize for something they did not do, and no one has the right to accept an apology if the wrong was not done to them."
- Douglas Murray
mrj222
Übergod
Posts: 1041
Joined: Jun 24th, 2006, 11:26 am

Re: Time to end pelvic exams done without consent

Post by mrj222 »




Well then....... how is this not sexual assault? I will be notifying my girlfriend of this... she's going to rage.
We can't stop here, this is bat country!
User avatar
grammafreddy
Chief Sh*t Disturber
Posts: 28548
Joined: Mar 17th, 2007, 10:52 am

Re: Time to end pelvic exams done without consent

Post by grammafreddy »

Am I correct in my understanding this is only done in gyn teaching hospitals?

Not in any hospital anywhere in Canada where a female has some gyn surgery done?

As in, not in Kelowna (a non-gyn teaching hospital ?? ) even though gyn surgeries are done here?

Regardless, without consent, I would consider sexual assault and unethical. Trying to prove it had happened to you might prove difficult.
__________________________________________________________________________________________
We are a generation of idiots - smart phones and dumb people.

You cannot multiply wealth by dividing it.
User avatar
coffeeFreak
Guru
Posts: 5302
Joined: Oct 22nd, 2009, 6:06 pm

Re: Time to end pelvic exams done without consent

Post by coffeeFreak »

I am thinking there are interns in many hospitals, as are there gyn surgeries...mmm, makes you wonder what else these "trainees" check out in the name of "learning" while a patient is under?!
User avatar
Nebula
Buddha of the Board
Posts: 16288
Joined: Jul 6th, 2005, 9:52 am

Re: Time to end pelvic exams done without consent

Post by Nebula »

coffeeFreak wrote:I am thinking there are interns in many hospitals, as are there gyn surgeries...mmm, makes you wonder what else these "trainees" check out in the name of "learning" while a patient is under?!

Who knows, but I'm not going to get my appendix out at a hospital known for its proctology rounds.
You cannot reason someone out of a position that they did not use reason to arrive at.
User avatar
steven lloyd
Buddha of the Board
Posts: 19172
Joined: Dec 1st, 2004, 7:38 pm

Re: Time to end pelvic exams done without consent

Post by steven lloyd »

Nebula wrote:
coffeeFreak wrote:I am thinking there are interns in many hospitals, as are there gyn surgeries...mmm, makes you wonder what else these "trainees" check out in the name of "learning" while a patient is under?!

Who knows, but I'm not going to get my appendix out at a hospital known for its proctology rounds.

:200:
User avatar
kgcayenne
Walks on Forum Water
Posts: 14520
Joined: Aug 10th, 2005, 6:35 pm

Re: Time to end pelvic exams done without consent

Post by kgcayenne »

Isn't KGH going to be working with the UBCO Medical program as a 'teaching' hospital?
"without knowledge, he multiplies mere words."
Insanity is hereditary, you get it from your kids.
flamingfingers
Buddha of the Board
Posts: 21643
Joined: Jul 9th, 2005, 8:56 am

Re: Time to end pelvic exams done without consent

Post by flamingfingers »

kccayenne wrote:Isn't KGH going to be working with the UBCO Medical program as a 'teaching' hospital?


Then I would expect that patients would be informed about taking part in a training program for interns and clerks. And given the opportunity to refuse.

I worked for a specialist who was preceptor for some medical students. The students would come into his office during patient hours and certain patients would be introduced to the student and they were always asked if he (student) could conduct a physical exam. The patient virtually always agreed. And to ensure that there was no compromise of the patient's dignity and safety, the student was always accompanied in the examining room by the specialist and me.
Chill
User avatar
Bejvas
Lord of the Board
Posts: 3067
Joined: Dec 13th, 2009, 12:38 pm

Re: Time to end pelvic exams done without consent

Post by Bejvas »

flamingfingers wrote:
kccayenne wrote:Isn't KGH going to be working with the UBCO Medical program as a 'teaching' hospital?


Then I would expect that patients would be informed about taking part in a training program for interns and clerks. And given the opportunity to refuse.

I worked for a specialist who was preceptor for some medical students. The students would come into his office during patient hours and certain patients would be introduced to the student and they were always asked if he (student) could conduct a physical exam. The patient virtually always agreed. And to ensure that there was no compromise of the patient's dignity and safety, the student was always accompanied in the examining room by the specialist and me.


I think that if there is a consent, then it is ok, but not knowing what's going on after you're under anesthesia, is not right. Something needs to be done.
"Just because you're angry, it doesn't mean you have the right to be cruel."
User avatar
justmyopinion
Lord of the Board
Posts: 3343
Joined: Dec 2nd, 2009, 9:45 am

Re: Time to end pelvic exams done without consent

Post by justmyopinion »

I totally agree....it's one thing to give consent, it's another to be violated, which is all that is...violation of rights and privacy!!! :200:

Return to “Canada”