Time to end pelvic exams done without consent

34 posts / 0 new

Sun, 2010-01-31 21:41

Refuge

Globe and Mail wrote:

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.

Full article

Sun, 2010-01-31 21:55

yarg

How in the hell could it not be unethical, it should be unethical to perform any unecessary procedure without consent, i read a lot of things here that i don't believe, and then some things I do accept and still can't believe it, how is this ok with anyone, i've never heard of this, it's shocking.

Sun, 2010-01-31 22:03

Unionist

There's nothing in the article about performing an "unnecessary procedure" - it's talking about examinations. I'd like to see what the consent form says before commenting. This is an op-ed, not a news article.

Sun, 2010-01-31 22:28

Michelle

I think I remember a med student in the comments section saying that somewhere in the fine print of the consent form you sign for any surgery, they have some sort of vague language around med students possibly observing or being involved. I highly doubt they highlight that a line up of med students will be trooping through and shoving things up your vagina while you're out like a light.

And clearly, from the vast minority of women who knew this could happen to them in the hospital, if it IS in there somewhere, they're not seeing it, and I'm sorry, but that's not good enough to be considered "consent" at such an invasion of our bodies.

Sun, 2010-01-31 22:34

Michelle

P.S. The article does so say the exams are unnecessary. It says the examinations are unrelated to the surgery. That means they're not necessary. It also says that in Canada, you don't have to get "explicit consent" to do them, and that consent is "implicit".

What really bothered me when I first read this article a few days ago is this:

Quote:

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.

If this "delicate and invasive" exam would cause a woman pain if she were not unconscious, then they're not doing it right and could be hurting her. If you're inexperienced at doing this sort of exam, then surely the woman's pain response would be essential to ensure that you are not damaging anything.

Think about it. When I'm getting an internal exam done, if anything is painful, I let the doctor know right away so he can immediately adjust what he's doing. With an unexperienced med student who doesn't know what they're doing yet, they could scrape or bruise a woman and not even know it.

I just realized, I've been clenching my teeth for the past 5 minutes while reading and typing about this. It's so infuriating. I would feel raped if I found out that med students had done this without my consent - my completely explicit, informed consent.

Sun, 2010-01-31 22:37

Unionist

I wasn't objecting to the word "unnecessary", Michelle - just to the word "procedure". And I'd still like to see what the consent form says. I'm no expert on what the "teaching" means in "teaching hospital".

Sun, 2010-01-31 22:58

Refuge

Unionist wrote:

I wasn't objecting to the word "unnecessary", Michelle - just to the word "procedure". And I'd still like to see what the consent form says. I'm no expert on what the "teaching" means in "teaching hospital".

Just google pelvic exam procedure and you will see that it is the medical community which refers to it as a procedure in medical site after medical site. Wikipedia says a very good concise definition

A medical procedure with the intention of determining, measuring or a diagnosing patient condition or parameter is also called a medical test.

If you question this look at the references for the various definitions

As a woman who has gone through this every year I would also say psychologically that it is a procedure because it is very invasive and I go through to find out if I have cancerous cells, STD's etc which makes it fit into the above definition. Practicing or actually doing the tests it is still practicing a procedure that is done on women.

Sun, 2010-01-31 23:09

Unionist

You're right, Refuge. Thanks.

Sun, 2010-01-31 23:11

Michelle

I agree with you, Unionist, that I'd like to see what the consent forms say too! The writer of the article says that they don't spell anything out specifically.

Sun, 2010-01-31 23:19

#10

Refuge

No problem and in terms of consent here is what the college of pysicians are saying about the way consent is obtained according to the study by Dr. Sara Wainberg that these articles are based on

Quote:

As a result, the College of Physicians and Surgeons of Ontario plans to speak with Ontario's medical schools about patient consent.

"It was a surprise," said Kathryn Clarke, spokesperson for the college. "That practice, even occurring on a small scale, is intolerable."

Sun, 2010-01-31 23:35

#11

Refuge

The other thing that disturbs me is if the exam is necessary for the procedure than is the patient told the exam can be done before undergoing anesthetic because I would personally do that before going under and I would only have it done once by the surgeon. Not an additional two unnecessary times. I go to teaching hospitals all the time but I would stop at unnecessary pelvic exams being done personally. It is just a little to close for comfort.

Also every time I go to teaching hospitals I have been conscious and sometimes have had to ask for the doctor not the student or resident when I didn't like what was happening or what I was being told. Most times I have been right to ask and have gotten a different response from the doctor (like the over eager resident who wanted to x-ray me and 3 other people that went in for the flu and it was worth the risk even though I was 6 weeks pregnant just to make sure that our lungs were clear. I said I wanted to talk to the doctor and he didn't even blink and said no, no x-ray especially since I had no cough or chest congestion at that point.). I have also had some of the most excellent care by students and residents, far superior to what I have ever gotten from even experienced doctors but again I am awake to make that decision for myself and as I mentioned earlier for me, personally, I would stop at pelvic exams myself.

Mon, 2010-02-01 12:11

#12

Michelle

Yeah, I love how the Hamilton doctor tries to rationalize it by claiming that because the surgeon, intern, and student are all on the "medical team," it's a matter of "safety" for all three of them to do an internal exam, and then in the same sentence says it's a learning experience for the student.

Like, dude, if the student is just "learning" how to do it, then clearly it's not a matter of "safety" that the patient has the student do the exam. It's a matter of "teaching", not "safety".

And wow, check it out, Margaret Sommerville comes out on the side of the woman in this case, saying that consent is important because it's sexual assault otherwise. Too bad she doesn't have respect for women's autonomy over their own bodies in other circumstances.

Mon, 2010-02-01 12:47

#13

remind

This lack of conscent is a huge problem, say nothing of doing a procedure several times over that is not a necessary one....in an area that is a mucous membrane and is easily damaged.

Vaginal damage causes scaring, infections, other female reproductive system disorders and having several trainees doing the procedure several times over can even further compound any damage done.

IMV, the best way for a student to "learn" to do one is to do one while the woman is awake and responsive, on a one to one basis with a Dr and perhaps a nurse supervising..

Even if a woman gives conscent to having this procedure done repeatedly in a teaching hospital, I do not believe it would be "informed" consent, as most do not realize that damage could occur while they were unconscious and non-responsive to pain indicating damage to, or impending damage to tissues. Nor would they perhaps realize the full potential that said damage could wrought upon their lives.

Mon, 2010-02-01 12:54

#14

Star Spangled C...

I've worked at three teaching hospitals - in three different states. I've been there as a medical student, as an intern and now as a physician who supervises medical students and I have never heard of this being done in any hospital/med school that I've been involved with.

There is a consent form that patients sign which IS "implied consent", I suppose, given that it's a teaching hospital. I specialize in a particular type of knee surgery and often have a med student in the room and I'll explain to them what I'm doing, etc. But this is with patients who come in specifically for this knee sugery and assume that several people will be in the room - the surgeon, the anaestheseologist, a nurse and, sometimes, students. It wouldn't occur to anyone (in fact, we'd all find it completely inappropriate) to say, "Hey, student, while we've got this woman knocked out, why you don't you go to a gynocological exam? Great opportunity to learn."

Mon, 2010-02-01 13:02

#15

Ghislaine

SSC - it notes in the article that other countries, the US included, are not allowed to do these pelvic exams without explicit consent. We need a similar change here. I had absolutely no idea about this until the Globe covered it, and it seems the majority of women are the same.

It just sickens me.

Mon, 2010-02-01 13:15

#16

Star Spangled C...

Very, very odd to me. Like I said, all of my experience is in teh States but I'm going to ask my mother, who practices in Toronto, if she's ever heard of this policy or seen it occur.

Mon, 2010-02-01 13:32

#17

Michelle

Well, there seems to be a discrepancy between the original article and the Hamilton Spectator article on the point about whether it's unrelated or not. The Globe writer says that this happens even when it's unrelated to the surgery (but he still mentions examples of surgeries that have to do with a woman's reproductive system. The Hamilton Spectator article says that it happens when the pelvic examination is done as part of the surgical procedure (so it is related). So it doesn't look like either article is claiming that women get knocked out for knee surgery and then get pelvic exams done (thank goodness).

However, even if the pelvic exam is part of the procedure, certainly it shouldn't be considered to be "implied consent" that several pelvic exams get done when only one is necessary to the procedure. Having the student do an EXTRA pelvic exam is hardly "necessary" or "part of" the procedure, even if you do say that a student can assist the procedure.

Mon, 2010-02-01 13:57

#18

skdadl

Unionist wrote:

There's nothing in the article about performing an "unnecessary procedure" - it's talking about examinations. I'd like to see what the consent form says before commenting. This is an op-ed, not a news article.

Sorry if I'm repeating what anyone else has said above, but Andre Picard is not an "op-ed." He is a very good medical reporter, and I have frequently been grateful to him in the past.

The only doctor I know well personally has told me of occasions when he has stepped forward to say that he feels bound by his oath to object to adventures in research being carried out on patients who couldn't have been giving fully informed consent, which is supposed to be the standard. Fine print and signatures don't measure up to the oath doctors take: the patient (or PA) has to be fully informed, which means a conversation between two conscious people, one of whom is medically competent and ethically responsible. (Obviously, emergency medicine can sometimes be an exception, but not for further research adventures.)

Mon, 2010-02-01 23:30

#19

Refuge

Michelle wrote:

Well, there seems to be a discrepancy between the original article and the Hamilton Spectator article on the point about whether it's unrelated or not. The Globe writer says that this happens even when it's unrelated to the surgery (but he still mentions examples of surgeries that have to do with a woman's reproductive system. The Hamilton Spectator article says that it happens when the pelvic examination is done as part of the surgical procedure (so it is related). So it doesn't look like either article is claiming that women get knocked out for knee surgery and then get pelvic exams done (thank goodness).

I took it to mean the pelvic exam procedure unrelated to the surgery were the two performed after the one that was necessary for the surgery. So any follow up exams were not related to the surgery but to teaching instead.

Mon, 2010-02-01 23:43

#20

Refuge

I was talking with a friend of mine about this article and she told me the same thing happened when she was awake. She was in her early twenties and went into a teaching hospital not really understanding what that meant. Complaining of pain she was first given a pelvic exam by a doctor. He disapeared and soon another came in and also gave her a pelvic exam. After he disapeared a third doctor came in wanting to do another pelvic. She wanted to know what was going on and this doctor admitted the first was a student, the second was a resident and he was a full doctor who was there to actually diagnose her. She felt violated and sexually assaulted because of the lack of diclosure of her being used as a guinea pig and then had to endure one more pelvic exam to try and actually find out what was wrong.

Wed, 2010-02-03 14:57

#21

MollyMcevil

OK.. so we are all disgusted and angry.. so what are we going to do about it? blogging is nice.. but action is better. Who do we write to? what can we do to spread the word? Wonder if the do the same thing with rectal exams on men?

Wed, 2010-02-03 16:08

#22

Michelle

I would think the College of Physicians and Surgeons would be a good place to start. Although in the Hamilton Spec article, it sounds like they're already on it, and writing to teaching hospitals telling them to be sure to get consent. BTW, don't you love how all the physicians quoted in the article who are defending the practice are men?

But it's these guidelines that sound like they're the problem, being so open to interpretation:

Quote:

In contrast, the Society of Obstetricians and Gynaecologists of Canada, in guidelines created in April 2006, say women give implicit consent for students to do a pelvic examination when they agree to have them take part in the surgery.

Perhaps a letter-writing campaign to them would be in order.

Contact info here.

Wed, 2010-02-03 16:10

#23

Michelle

P.S. I love your username, MollyMcevil. Welcome to babble! :)

Wed, 2010-02-03 17:07

#24

Polly B

This definitely is kind of icky in the whole no consent department. But I am thinking, well, it's just an exam. I have had four kids so I am definitely no stranger to the stirrups. And if I am asleep already? Meh. Go ahead. Examine whatever orifices you can, just don't hurt me or allow non-medical staff to be present. They have to learn somewhere I guess.

Wed, 2010-02-03 17:38

#25

skdadl

I think it's great that a woman who has been fully informed gives her consent, very public-spirited.

At the same time, as a veteran of the medical wars of the 1960s -- and they turned into wars, no question -- I think it's important that women continue to push back against the paternalism of the medical profession, and not just for us.

Some doctors still make presumptions about all kinds of patients. If you can't speak the language very well, eg, a lot of medical workers, just out of impatience (many are overworked and underpaid), will drive right over your timid questions. It is very hard for any lay person to stand on principle before a doctor, and it's obviously harder if you are feeling culturally intimidated, as many people are.

There are doctors who get all these problems. They are fastidious about informed consent. We need them as allies too, although I don't know how we do that. Obviously the woman who started this study is one of them, as her brother was before her. My doctor friend who will protest unnecessary procedures is a guy, and he taught me a lot of what I believe about medical ethics. So the world has changed a lot from the dark ages pre- Our Bodies Our Selves. But we have to keep it changing.

Sun, 2010-02-07 11:27

#26

Refuge

Personally I put this up so that when women are going in they are aware and can specifically request this not be done if they don't want it done until things change. or even if they are of the position that it is fine they can say to the doctor I know this is the practice so if you were doing the right thing and telling me specifically about it I would say that it is fine - that kinda exposes the doctors actions in a way they may not wish to be exposed. That was the "action" that I was thinking about because as Michelle says it looks like the college is looking into it on their side but there have been no changes as of yet so it is something each women can do personally.

Thu, 2010-03-18 18:01

#27

ephemeral

Michelle wrote:
I highly doubt they highlight that a line up of med students will be trooping through and shoving things up your vagina while you're out like a light.

One of the doctors who authored the paper commented on the online G&M article said that Picard exaggerated on that point. Although the authors are grateful to Picard for drawing attention to the issue, they clarified that it is usually one intern with a fully-licensed surgeon.

Fri, 2010-03-19 08:26

#28

Stargazer

MollyMcevil wrote:

OK.. so we are all disgusted and angry.. so what are we going to do about it? blogging is nice.. but action is better. Who do we write to? what can we do to spread the word? Wonder if the do the same thing with rectal exams on men?

Exactly what I was thinking! Welcome to babble.

Hi eph!!! So nice to see you!

Fri, 2010-03-19 09:31

#29

Michelle

That's good to know, ephemeral. And I'm happy to see you, too!

Sat, 2010-03-20 21:33

#30

ephemeral

Hey, it's nice to see you guys too!

I am working on a paper related to this issue and I have not been able to find information on men's rectal exams. However, I did learn that the other groups of people who were not required to give consent in the views of medical professionals were cadavers and mentally-challenged boys. This was in Kingston circa 1980's, 1990's.

This same issue was huge in the States in 2003, and because of the outcry (newspaper articles, complaints, etc.), at least 126 hospitals changed their policy to require informed consent from women. If we want history to repeat herself here in Canada, we need to keep talking about it. Write to papers, politicians, blog, etc.

Sat, 2010-03-20 22:32

#31

Bacchus

Eph!! great to see you too!!! *super tight hugs designed to make Thwap jealous*

Thu, 2010-04-22 12:23

#32

Yiwah

I want to be completely clear on who is going to be doing what to my vag, and when it's going to happen. This is quite disturbing.

Thu, 2010-07-22 12:12

#33

Robert s

The facts are that med students are routinely marched into sugery and practice pelvics on women who are put under. It is NOT just one intern either. Many have been in at one time. Anyone who says differently is lying! There was a recent article about women med students in Israel who are now refusing to do it to unconscious women.

The consent forms are short, vague and give cart blanche to the hospital and doctors. You should CROSS OUT anything that may even remotely give them permission to do pelvic exams and write on them yourself -"I DO NOT GIVE CONSENT TO HAVE STUDENTS PRACTICE PELVICS ON ME". You will NEVER be asked before. Its YOUR job to make sure it doesn't happen. Many different drugs and procedures are used without your prior consent. MAKE THEM tell you before!!!!

Fri, 2010-10-22 16:48

#34

Robert r.

Quote: SSC - "it notes in the article that other countries, the US included, are not allowed to do these pelvic exams without explicit consent. We need a similar change here. I had absolutely no idea about this until the Globe covered it, and it seems the majority of women are the same."

"It just sickens me."

I hate to burst your bubble there but the USA DOES allow it WITHOUT CONSENT and in fact, it is VERY common in almost ALL teaching hospitals in the USA.

Here In NC it happens at Duke, and at Wake Forest Baptist hospital which is part of Bowman Gray med school. It seems medical students and nurses and doctors feel it is their God given right do what ever they want to patients and YOU should have NO say over it! Stay away from teaching hospitals period! Lawyers need to push this issue until it stops.