I just found a newspaper aritcle from a few wks ago... And i'm absolutely disgusted.
This article tells of a woman going into surgery to have an ovarian cyst removed. She asked her surgeon if medical students would be performing pelvic exams while she was under anesthesia, and guess what he said? Yes. Even tho she had not consented to such ...
quote:"...an overwhelming majority of the nation's 400 teaching hospitals use the generalized consent form as permission to perform the exams..."
Fair? I think not. I had an ovarian cyst removed a few years ago, and i'm just thanking my lucky stars right about now that it was not at a teaching hospital.
The main fear is that if women were asked, most would say no. Would you? W/o patients to practice on, medical students aren't getting the practice they need to become competent doctors. Do you think it's fair to go along w/ the general consent form?
One nurse from Va. works as a trainer. That's right lady's and gents ... She undresses, gets up in the stirrups, and lets medical students practice pelvic exams on her. Sounds like a great idea to me, but this too has it's disadvantages. We're assuming people that work as trainers have healthy vaginas ... as in, no abnormalities. Now they're able to spot a healthy vagina and reproductive tract, but they're not able to identify abnormalities (only that there IS an abnormality ... not being able to tell one abnormality from another)
So this takes us back to square one. If women aren't willing to consent to these 'unconcious practice pelvic exams' (and this hasn't been shown yet, as most women don't even know they're happening), how are medical students supposed to learn this extremely vital skill ...?? More trainers like the nurse from Va.? Should this kind of practice be allowed to continue?
I'd say just put something on the form asking outright if they consent to let students examine them. I'm not sure I'd mind, so long as it was just examinations and not having them attempt to treat anything.
Posts: 105 | From: Bryn Mawr, PA, USA | Registered: Sep 2002
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My partner, a first year intern in Australia (he'll be fully admitted at the end of the year), has never done a pelvic exam before, because during his five years of training at a hospital, no woman ever consented to having one being performend on her. These days, he is on night shifts alone at a large country hospital being responsible for the emergency services of a small town, and admits to being ill-prepared should a woman come in with unexplained vaginal bleeding for example. He knows what to do, but has never done it before. At the end of the year, he could start working as a physician, and would be responsible for doing pap smears. - Even though he has never done one before. I find this scandalous.
Regarding consent (and I won't get into the legal issues here), it would depend on what consent the patients are signing in the case you mentioned. In general, one would think they'd have to give specific and explicit consent to exams by students when under anaesthesia. Some people argue that in countries with free healthcare delivered at teaching hospitals, consent should be general to all exams done by students (or at least not done based on looks), and while I wouldn't like that approach, I can see the reasons behind it.
The remdy to the poor training of young docs regarding pelvic eyxams? It's easy, chicas: once you're comfy at the gyno (and really, it isn't such a deal, I'd take the gyno over the dentist any time) and are at a teaching hospital, consent to being checked by medical students, if you're approached and it is at all possible. You're training tomorrows docs. How are they supposed to know it well, and do it well, if they've never done it before?
that's an interesting contrast, alaska, 'cause under the system Smurf describes, pelvic exams are one of the first things medical students are taught.
Personally, i think i prefer the way things are conducted at American teaching hospitals right now. The fact that the hospital is a teaching hospital more than implies that students will be working with patients. While that's not a great assumption to make, i think it's a fair one. I think the importance of properly training the med students outweighs the occasional objection. and for those who object, that option has always been available to them, it's up to the patients to make that decision (hence the importance of reading stuff before you sign it).
Besides, it's not like the students are making the diagnosis themselves. The instructor goes first, does the procedure, makes a diagnosis, and then lets the students have a go at it.
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Posts: 12677 | From: Los Angeles, CA ... somewhere off the 10 | Registered: Jul 2000
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I agree that I would feel a little uncomfortable with a patient performing an examination on me, but thats only because i hate getting it done in the first place and i certainly wouldn't want it done twice. But I think that it should definately be expected at a teaching hospital. If it is really a huge deal to you then you should probably choose a facility that only allows the actual physician to perform. Posts: 87 | From: TX | Registered: Dec 2002
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Would there be the same outcry if students were allowed to observe an operation on somebody's arm or foot? The real issue here is that our genitalia and reproductive systems are seen as some source of shame, as something we have to hide at all costs. If we get rid of that, then I think this becomes a non-issue.
However, at the same time, while genitals and reproductive systems are viewed in a negative light, however wrong that might be, we do also have to deal with the fact that individuals should have autonomy over their own bodies, and as such I think that explicit concent forms should be the policy for ANY surgery or examination in which students might want to observe, whether it involves reproductive systems or not. These consent forms could also educate the patients as to the benefits of allowing students to observe the procedure in questions- ie, we DO need to train our next generation of doctors.
Next semester I'll be learning to check the dilation of womens' cervices to see how they're progressing in labour. They'll be concious, alert and very aware of what's going on. I'm not really sure how i'd feel if that weren't the case ... ?
I think BlueRose is right ... It needs to be put out there bluntly. Very blunty. "While you are under anasthesia, there may be medical students performing exams on you, but they will be supervised at all times."
And the objections aren't really "occasional" ... I read in a seperate article (can't seem to find it right now ...) that up to 50% of people refuse such exams. Does that make it right for doctors to 'avoid the truth' about what's really going on? I don't think so.
Sure, to us it's only genitals ... To them it's a big deal. And it's their bodies, it gets to be a big deal. Everyone going into surgery in a teaching hospital should be asked, outright, if they're okay w/ these procedures. Obviously it's not okay to assume they'd know, b/c they don't.
Beppie they aren't just observing the procedures, they're actually examining the unconscious women. Personally I see nothing wrong with observation without consent -- after all there's going to be several people (doctors, nurses) in the room to begin with so a few students doesn't really make much difference to my mind.
However, I do see a large difference between simple observation and actually performing an examination on an unknowing and thus unconsenting patient. As you said, people should have autonomy over their bodies. As it is most people do consent when given the choice (according to the article at least) so I think the simple formality of asking would merely be a show of respect, not a devastation to medical training techniques.
Of course, in any case where students perform an examination on a patient, permission should be obtained, but I still think that a bigger deal is being made of this instance because it involves genitals. If it was an examination of somebody's throat while they were under general anesthetic, I doubt it would be in the news.
Posts: 2710 | From: Australia | Registered: Jun 2000
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quote:I still think that a bigger deal is being made of this instance because it involves genitals
But that's not necessarily illogical or irrational. Most people do consider their genitals to be a more intimate and private part of their body than their throats, for example.
I think it's worth bearing in mind that, under normal circumstances, touching the vulva and inserting fingers into the vagina of an unconscious woman who has not given her consent would be considered "sexual assault".
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