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.