Yes, It's True: Med Students Perform Pelvic Exams on Anesthetized Women
Friday, January 29, 2010 at 1:24AM
Public health reporter André Picard published an editorial yesterday in the Canadian newspaper, The Globe and Mail, imploring the medical community to end the practice of performing vaginal exams on anesthetized women without their consent. The article about physician Sara Wainberg’s research and personal accounts of the practice has ignited comment storms, debate and outrage.
Pelvic examinations performed routinely in teaching hospitals on uninformed, anesthetized women prepped for unrelated surgeries is not breaking news. The topic bubbles up to the surface every few years, incites a media frenzy, then simmers back down into what Picard calls “one of those dirty little secrets of medicine” and again drops from the public eye.
The story is that the practice of digitally raping anesthetized female and male patients without their consent continues.
One of many articles on the ethics of performing pelvic exams on anesthetized women was written by Robin Fretwell Wilson, a professor of law at the University of South Carolina School of Law, who testified before the Federal Trade Commission and Department of Justice Hearing on June 10, 2003. In her article, Unauthorized Practice: Teaching Pelvic Examination on Women Under Anesthesia that appeared in the Journal of the American Medical Women’s Association in 2003, Wilson cites study after study showing that the practice is routine.
In February, Ubel et al reported that 90% of medical students at four Philadelphia-area medical schools performed pelvic examinations on anesthetized patients for educational purposes during their obstetrics/gynecology rotation. Although trumpeted as proof that physicians are lax in securing permission, the study was not clear on the matter of consent. Caldicott et al reported in January that 53% of students at a single English medical school performed pelvic or rectal examinations on anesthetized patients. Students acted without any written or oral consent in 24% of the exams.
Research in the United States, Canada, and Great Britain has shown that the unauthorized use of women is not confined to 1 or 2 medical schools. Using anesthetized patients before surgery to teach abnormal anatomy “has long been practiced.” Women are also used to teach normal anatomy. As late as 1992, Beckmann found that 37.3% of US and Canadian medical schools reported using anesthetized patients to teach pelvic exams.
Other data in Wilson’s article:
[In 2002], nearly half of Canadian medical students (47%) at the University of Toronto reported “pressure to act unethically” and named as the leading culprit the collision between medical education and patient care. Many were asked to perform pelvic examinations without consent.
Ninety-four percent of Oxford Medical School graduates learned to perform digital rectal examinations using male and female patients, many of whom were anesthetized.
Only 37.5% of teaching hospitals “inform patients that students would be involved in their care.”
Forty-two percent of US students are not forthright about their status when doing pelvic exams on conscious women.
Five percent of obstetrics/gynecology department chairs tell students to introduce themselves as doctors and just proceed.
Some states in the U.S. ban the practice of digitally violating anesthetized female patients. California Governor Gray Davis signed AB 663 into law during the first half of the 2003-04 legislative session which makes the performance of pelvic examinations on anesthetized or unconscious women without consent by doctors and medical students a misdemeanor and ground for the loss of their medical license.
The glaring limitation in the bill is, as Wilson wrote, ”[no] woman can enforce her own interests in being asked if she never knows an exam has taken place” and therefore the bill “suffers from the same limitations as existing causes of action for battery and the failure to secure informed consent.” While AB 663 increases the sanctions for unauthorized exams, Wilson argues that it does nothing to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission.
Ironically, under the subheading “Exaggerated Fear of Refusal,” Wilson cites multiples showing that women will consent to pelvic examinations for educational purposes, even while anesthetized or during birth.
Dr. Ari Silver-Isenstadt, co-author of the aforementioned study about Philadelphia-area medical schools appeared on ABC’s Good Morning America show on June 10, 2004 to discuss the study. He told ABC that the study was based on his own experiences in medical school when “[he] was asked to participate in some of these educational experiences and [he] felt very uncomfortable…”
Naturally, many patients take issue with the idea that their anesthetized bodies will be probed without their expressed consent and knowledge.
One such patient was Zahara Heckscher, who was interviewed by the Washington Post in May 2003. According to the article, Heckscher was preparing to have an ovarian cyst removed at George Washington University Hospital and asked her surgeon if medical students would be practicing pelvic exams on her while she was unconscious.
Shocked when she received a “yes” answer, Heckscher “wrote a note on her consent form forbidding anyone other than her attending physician to perform a pelvic exam on her while she was under anesthesia.”
Not all doctors agree that patients at a teaching hospital should complain about the practice.
Former ACOG president, Dr. Thomas Purdon, expressed concern “that an important quality evaluation that’s been a mainstay of evaluation in the operating room for more than 50 years is getting sensationalized,” according to OB/GYN News.
“It’s a crucial teaching point to see how a procedure is done, what the pathology is, and to tie that to the pelvic exam,” said Dr. Purdon of the Arizona Health Sciences Center in Tucson.
Purdon also argued that this type of treatment is implicit.
In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”
Purdon expressed frustration that people who go to university centers for care are “pick[ing] apart” something so important.
Although the practice of performing pelvic exams on paid volunteers has gained popularity in some institutions over the last 15 years, physicians are never going to get enough paid volunteers to adequately teach students, he said.
As an educator, “it’s frustrating for me that people who want to go to university centers for the latest treatments and technology pick apart something that’s an area of importance,” he said.
It’s common in a teaching situation for a medical student, one or two residents, and a faculty person to compose a surgical team. It’s not as if 12 medical students are in the operating room examining the anesthetized patient, he said.
Activist Michael Greger, MD, told the Washington Post that the voluntary guideline of having one or two students perform the exam is widely ignored. Said Greger, “If they have five medical students on an OB-GYN rotation, they aren’t going to let one do it and not the other four.”
Bioethicist and medical historian, Jacob Appel, analyzed the recent court-ordered hospitalization of then pregnant woman Samantha Burton for the Huffington Post in his article, “Medical Kidnapping: Rogue Obstetricians vs. Pregnant Women,” in which he stated:
Preventing a competent pregnant woman from leaving the hospital under these circumstances is no less egregious than compelling her to have an abortion. Forcing additional intrusive care upon her, such as unwanted vaginal exams or cervical assessments, is legally-sanctioned digital rape.
As André Picard wrote, “the problem 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.”
With sufficient evidence that the majority of women would consent to a pelvic exam if asked, the practice of medical students manually raping anesthetized women in the name of education is a pitiful relic of medical culture. Were it not for the many brave medical and nursing students over the years who spoke out against the practice of culturally-sanctioned digital rape in the operating room and in labor and delivery under the guise of frequent unnecessary cervical checks, this would remain a dirty little secret.
Reader Comments (72)
Georgina, I'd barf but I've heard similar stories so many times that I'm all barfed out. To me, performing multiple exams on a laboring woman is just as sneaky because the implication is that they are probing her for her health or for the health of the baby.
Jill-Unnecesarean:
Agree, re: social skills/bedside manner of many doctors being at play here. It is totally a manner of "situational awareness," as my husband would put it. You need to know what's going on around you and how you go there in order to properly decide whether chit-chat, or pelvic exams on an unconscious woman, or jokes about which doctor is sleeping with which nurse are appropriate (although I tend to think the last might need to stay on Yahoo entirely).
I like the tone-shifting regarding the section, although I admit I'd likely be too terrified to suggest any such thing. I appreciate the fact that the staff was willing to change the tone, though, to make it a better situation for the family in what was possibly a very scary time.
This is horrifying, I am physically ill. I woke up in the operating after gallbladder surgery to hear my doctor and the anesthesiologist talking badly about how nasty my gallbladder was and though I was still groggy, I was horrified, so utterly embarrassed that I couldn't handle it. I asked the doctor about it at my post op appointment and he denied it, but I am 100% sure that I heard what I heard. Because of that I already have a complex about being under anesthesia.
I'm beyond horrified by this. It's beyond my abilities to put together a coherent reaction right now (I obviously was not aware of this prior to reading...)
In light of that, all I can say is THANK YOU, on behalf of myself, but more importantly, my daughter.
Oh my God! I can't believe this type of thing happens in this day and age. I mean I wouldn't even believe it if I hadn't read it here. I feel a little sick now. So important for our daughters, for our friends and ourselves. Thank you!
"In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”"
But don't we have a right to know what procedures they are performing and shouldn't they be required to gain consent? The most appalling aspect is that sense of entitlement that I get from this Dr. Purdon. Of course, I am going to question the motives of someone who treats another person's body like an object. I would be much less concerned if patients were asked prior to exams, informed of what would be done and who would be doing it and then given a follow-up on the exam, because this would establish transparency in the motivations of those performing the exams. Not every patient would want to participate, true. However, not every patient would decline and by establishing strict codes of conduct, patients would have a greater sense of security.
Good open letter here. Let's keep spreading the outrage.
Absolutely horrific.
I have no problem *consenting* to procedures at teaching hospitals - because it helps the doctors learn. But unconscious equals inability to consent in EVERY courtroom, so why would anyone think that 'knowing that it's a teaching hospital' negates the need for giving *informed consent* in advance?
That's like saying that is someone who falls asleep at her college boyfriend's frat house should've known there were other frat boys there who might have decided to have sex with her while she was unaware because 'well, it's a house full of young men who would like to have sex.' Ridiculous logic at best. Criminal at worst.
so the medical community is raping people. WHAT ELSE IS NEW?
I delivered both my babies at a teaching hospital and was generally okay with the presence of medical students, as long as I was asked. I figured, they need to learn so they can grow to be good doctors, and if they've made it to medical school without seeing a vagina, well, you have to start some place. Plus, at the height of labor, my father in law could have walked into the room and I wouldn't have cared.
However...I tore pretty badly with the first one, involving follow up care a few days afterwards and pus and a painful flushing, and when I spotted a young guy I'd never seen before craning his neck to see, I asked who he was. "Oh, he's a med student." I asked that he leave. After enduring an induction and painful tearing, I was just not in the mood to have a medical student gawking at my torn up, bloody, infected vagina. He left without complaint.
Honestly, if I was in the hospital and the doctors ASKED if students could practice on me, I might say yes. Especially since there is no such thing as a "practice vagina" and it might help prevent students from becoming rough and unskilled physicians. But the idea of performing such an exam without consent, because the woman will never know, makes me feel like it's dishonest and dirty and unethical; Barf.
BTW, loved the "my vagina is not a science project" comment from a previous poster.