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Monday
Sep062010

Comment of the Week: Not in my hospital

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By Jill—Unnecesarean

Sorry for the delay in posting the Comment of the Week.

In this comment, a medical student tactfully refutes the claims of the doctor whose 2003 interview was posted here. I am particularly interested in item number three on his list.

 

i am a male medical student at a reputable institution where this is practiced.  however, this article provides a highly dramatized depiction of what actually happens.

1. only occurs in OB/GYN cases.  only.  no appendectomies (performed by general surgeons)

2. entire team meets the patient pre-op.

3. informed consent includes language informing patient of what the procedure entails, including pelvic examination

4. the “line of medical students” consists of no more than 2, usually 1 (and the part about the “male students especially” is complete BS)

5. a resident guides the student

most of this article is fear-mongering and in many places just plain incorrect.  its not as if I don’t see the moral dilemma and understand people’s concern/outrage.  that’s a discussion for you to have with your medical team prior to the procedure, but please don’t think that this article accurately reflects the atmosphere of a GYN OR.  if it did, i too would morally object. 

final point, i was taught during my 2nd year training session on the pelvic exam to treat the patients as i would want my own mother or sister to be treated.  i would have no hesitation about referring my family to the hospital where i currently work under their current practices.

 

ps - not that its meant as consolation, but the same thing occurs with rectal exams in male GU patients

 

 

If you work at a teaching hospital or have been a patient at one in the last few years, please send us the verbiage in your consent form. Transcribe it, scan it or take a picture with your phone and send it to unnecesarean (at) gmail, please. We would like to see examples of forms in which non-diagnostic (educational) pelvic exams and other specifics are explicitly expressed in the form.

Moving past the comments here and in other forums discussing the practice along the lines of “Who cares? They’re asleep anyway.” and “But how will they learn?!”, there is an longstanding assumption that patients who go to a teaching hospital already know that medical students will be involved in their care and therefore know that students will be practicing something on them while anesthetized. I would argue that, unless it’s spelled out explicitly, many, if not most, people have no idea what that means. To take it one step further, it is reasonable to assume that some patients would really appreciate the chance to opt-out of certain things if they were explained clearly in advance. One can’t exercise their right to refuse if they don’t know what is happening.

Help educate the public by showing everyone what informed consent looks like at a teaching hospital in the U.S. and abroad in 2010. It’s one thing to say that one’s hospital always obtains consent. It’s another to show what patients sign off on.

 

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Reader Comments (19)

I was just told by a ( spanish speaking) mother who had a difficult birth in a NJ hospital that they had a room full of people , all taking turns to do an exam, When she protested they told her .. " What do you care, you have an epidural." They did not stop.

September 6, 2010 | Unregistered CommenterB

This whole issue horrifies and disgusts me. I am almost nauseous from B's comment. That is rape, over and over again.

September 6, 2010 | Unregistered Commenterkateisfun

there is a whole discussion on the The Unnecesarean facebook page,,, more stories like that.

September 6, 2010 | Unregistered CommenterB

I understand the need of that med student to protest, but unless he knows for a FACT that ALL hospitals operate the exact way he describes, he's also full of BS. Perhaps his hospital is better about it... that doesn't mean they all are (this is the same sort of argument as "I had a great natural birth in a hospital, therefore anyone else can, too".)

Claiming someone should just "know" they'll have stuff done to them b/c they're in a teaching hospital sounds like a cop-out.

September 6, 2010 | Unregistered CommenterMarcy

I would take this a lot more seriously if he had the balls to name his institution, and knew how to use the shift key.

September 6, 2010 | Unregistered CommenterKatherine Anderson

this is horrifying........

September 7, 2010 | Unregistered Commentermedical malpractice

Thanks for sharing this into. It's okay to protest if there things that you think are not proper but before you do such action, make sure that you can really justify yourself and be ready for the consequences. Most practices are common in all hospitals though they may differ in some aspects but we also have to consider that all of them follow a certain rule.

September 7, 2010 | Unregistered CommenterBlessed Herbs Australia

How many men would be OK with digital exams performed anally while they were under anesthesia for a non-related surgery? In fact, why aren't anesthetized male patients routinely used as practice for medical students who are specializing in proctology? Maybe they are and we don't know it, but I'm guessing that very few men, straight or gay, would accept the "you're asleep, why should you care?" defense when it comes to the idea of other men probing their nether parts while they're under.

September 7, 2010 | Unregistered CommenterAnonymous

I just can't get past the idea that we presume doctors are only going to perform procedures that we consent to, or that are required as part of our care (i.e. something goes unexpectedly, but you're unconscious so they can't obtain consent). Saying that consent to unnecessary vaginal exams is buried in a legal document someone signs isn't the same as meeting the woman, saying, "Hi, I'm going to perform a completely unnecessary procedure on you while you're out. Do you mind?"

I take it that no one has the documents Jill is asking for? I'm very curious to see what turns up.

September 7, 2010 | Unregistered Commenterlarissa

Can I just make the point that he's a med school student and he doesn't even capitalize the first letters of his sentences. My child is in 2nd grade and gets a big red x for that.

September 8, 2010 | Unregistered CommenterTina
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