Medically Sanctioned Rape

I read about this and I'm just so angry!


http://www.theglobeandmail.com/life/...rticle1447337/

Andre Picard's Second Opinion

Time to end pelvic exams done without consent

Andre Picard | Columnist profile | E-mail

From Thursday's Globe and Mail

Published Thursday, Jan. 28, 2010 9:56AM EST <h5 class="articledateline sans sm">Last updated Wednesday, Sep. 15, 2010 6:39PM EDT

Imagine that you are undergoing a fairly routine surgery – say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.

• Doctors add required consent to pelvic exam policy

Do you consider this okay, or an outrageous violation of your rights?
Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.

Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent, at least in Canada.

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.
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.


There is also an assumption that women would never accept pelvic exams by students while conscious so sneaking them in, while not ideal, is acceptable.

When Dr. Wainberg took a position as a resident at Foothills Hospital in Calgary, she decided to study the issue further. She and fellow researchers polled 102 women who were patients at the Calgary Pelvic Floor Disorders Clinic.

The results – reported in The Medical Post and in the Journal of Obstetrics and Gynecology – are as fascinating as they are troubling.

Dr. Wainberg and her team found that fewer than one in five women were aware that a student might do a pelvic exam in the operating room. At the same time, 72 per cent expected to be asked for consent before such an exam was done.

The patients – unlike medical educators – seem to be quite clear on the concept of informed consent.

You don't probe, poke or otherwise invade the orifices of a patient without their permission, regardless of how educational it might be. Period.
The most intriguing part of the survey, though, is that it showed that women are quite willing to undergo these gynecological exams – if they're asked.

Sixty-two per cent of respondents said they would consent to medical students doing pelvic exams, and an additional 5 per cent said “yes” but only if a female student was doing the exam.

This lays to rest the notion that it would be impossible for medical students to get this training unless they were doing it in the current surreptitious, unethical manner.

But let's be clear: Even if all the women surveyed had rejected exams by medical students, the current approach would still be wrong.

There are other ways to do this training, using simulation models, paid volunteers and consenting patients in other settings such as clinics.

Patients have a right to say “No.” They are not merely a collection of body parts to be practised on. Patients are due respect and ethical treatment, whether they are awake or anesthetized, and no matter how potentially embarrassing the procedure may be.

The research done by Dr. Wainberg and her colleagues, in passing, exposed something else important: Patients have very little idea what goes on in the operating room. Most have no idea that, in addition to the surgeon and nurses, medical residents or medical students may be present and may even participate actively.

This 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.”

“It's definitely the patient's business who does what to them,” Dr. Wainberg said. “They have to be informed and they have to give consent.”
In fact, if she was starting over again as a medical student and was asked to perform a pelvic exam, Dr. Wainberg has no doubt she would refuse.

So too should every medical student and every teacher.
A good doctor does not merely possess good technical skills, she or he must behave ethically and treat patients with the utmost respect.

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The Globe and Mail is one of Canada's national newspapers.

They say consent is implied, but the women who commented clearly say they didn't know pelvic exams by med students would be performed while they are under anesthesia.

It just sickens me. I wonder if the same happens to men for prostrate exams? I doubt it.

Ugh, I am hating the medical profession right now. It's just so wrong. They do them under anesthesia so that the women aren't embarrassed, but this is a huge violation! It borders on sexual assault in my mind.

If I ever go to the hospital or need surgery or something, I am definitely making it clear that I don't want medical students poking/prodding, asking me questions or observing me. No offense to the medical students out there. I bet doctors don't let medical students perform medical procedures on them.

They can learn from the people who don't mind.

Argh, I'm just so freaking angry about this!

OMG thanks for posting this Greenleaves - I had no idea this was done. I wonder is this done only when a woman's having a gynegological procedure done or is this done if someones having another surgery like gallbladder etc? Is this explained on the consent form? I appreciate you posting this in the event I ever have surgery - I would never want this to be done. It shouldn't be allowed unless the patient agrees. It's so wrong!!!

Once my son had fifths disease and presented with the full rash, evidently very uncommon. At the hospital here, they stripped him down and brought in all the student docotrs to look at him. Hen one of the femal doctors actually lifted his whizzer to take a look at how far the rash had spread, he whacked her hand and snapped, "Ask first, lady. Have you no shame!?" He was seven at the time.

I had nothing against them letting folks look at the rash with his underwear on, but before i knew it, full liberties were being taken "in the name of science". At the time, My swedish was not good, and i felt they took advantage of that to run over me as a parent. I was so proud of him that he felt he could stand up to a room of adults and draw the line, and I handed him his underwear and said, "I think that's enough."

They acted as if we were being hysterical, above all the women, who acted as if because they were women, it shouln't have been a problem. But my son didn't want to be touched by strangers, even though he was able to understand that they wanted to see what the rashes looked like. In general, the lack of empathy that gets trained into the medical profession is frightening.! HUggs all.

Greetings,

How intriguing.

Have a good one.

I'm really angry and distressed again. I can't get over this. I wonder if I've been abused and just don't remember it?

I'm just so upset right now!

Greenleaves, is there some way you canCopy your posting and take it to your T? If it makes you so upset to read about this, then there is something there that it seems you need to bring up with him or her. It's a really offensive thing that all too much gets justified in the name of science. It's also very, very likely that you have NOT been vicimizd in this way. Your T can help you sort this out and findsome balance.
HUggs dear. Don't blame you for being T.o.'d. That's a lot of nerve to bring in the students.

that's frankly quite shocking and makes me want to never go in to hospital again even though i'm in the uk

I heard this kind of news story yrs ago, even over here in the uk, apparenly a load of students were filmed laughing when a woman was under sedation and having some routine internal stuff being done, at first I was angry and shocked, and would be still I guess if someone provided me with proof this too had happened to me during an proceedure and I had been unaware, but I dont know have proof and doctors and surgeons have been caught on youtube during heart surgeries playing around whilst the patient was "out", I think my rational mind knows its their sick attempt at dealing with what they have to do, not right I know, my other thought is, if they find gold whilst doing an internal and dont tell me then I would be real angry LOL! sorry, my way of dealing with stuff is to dissociate from it and find humour. sometimes what we dont know don't hurt us, unless we want it too? I dont consider it rape, perhaps some would I can understand that and yes it would be nice to think someone will put a stop to this sort of thing, but knowing humanbeings I dont think they can completely prevent it happening.

The thing is, my T is a pdoc and when I asked her if she did pelvic exams on anaesthetized women without consent, she just said she got consent. In Canada the consent does not need to be explicit, it is only implicit, so now I think pdoc did pelvic exams on women without their consent.

I don't know if she would understand my point of view because she is a doctor and she did this to women.

I will bring it up with her. I just hope she can make me feel better about this!

I think it is good that you do bring this up with her, because that way you don't have to sit and wonder about it. I think that makes it worse. Here in Sweden, it's not unusual that you get an extra docotr getting dragged in and get introduced to them as "Here is dr. Said and he is going to follow along because he is getting his licence to practice here" or something like that. They don't tell you you can kick him out, but i always assume I could probably do that if I wanted. Again, that is also an implicite consent/from both sides. Problem is both understand that the patient is usually well socialized not to talk back to a dr. and is not a snippy doctor's daughter like me.
By all means, get her to define what implicit means in those circumstances. I think it is fair to point out that for a lot of people who don't live in the medical world, these terms arenot understood the same way as they are in the world that the medical student lives in.
Huggs dear, and I hope that you guys can work this out to your satisfaction.

When I got my first pap smear there was a training doctor at the school clinic. I was told that the person would like to observe, but it was up to me. I was told this without the student in the room. I said that I didn't feel comfortable and the NP was totally cool with that. The second (at a hospital) time I was offered by the NP to have someone else in the room if I wanted because I was so scared. I didn't take her up on the offer but it was nice that they wanted to make me comfortable.

I in no way think that consent for surgery means consent for pelvic exams. As a sexual assault survivor, I find this practice repugnant. If they are going to do training at this time, they need to have explicit consent. I talked to someone once who volunteered as a "practice patient" for pelvic exams. There are respectful ways for the students to get the education they need. This is not one of them.

I'm traveling to Canada soon. This makes me hope even more that nothing goes medically wrong.

this is sick. really.
i have to have a gynaelogical operation in 2 weeks and i have read abit about this before, i really hope nothing like this happens!

While I do not view this practice as rape (there's a major difference between having sex and getting a pelvic exam), I am absolutely appalled at the fact that they did not get consent. To me this seems like a clear violation of patient rights and autonomy. There is nothing 'implicit' about the procedure and even if there was, it is important to inform patients of what will happen to them so they can make clear choices, if at all possible. This seems like a covert attempt to get around the issue of consent in order to train medical students. There is no other reason not to ask permission.

Sorry, I don't usually post but I find this practice to be truly disgusting.

This is pretty disturbing, but in all honesty its a very, very common thing. It disturbs me about as much as any of it does. There are countless procedures that take place in the medical field where students in that profession are invited in to come 'take a look' or get 'hands on'.

While I don't agree with anything going on without consent, personally, I find the random pelvic exam taking place on someone who just underwent a hysterectomy a little less daunting then a pack of cardio-thoracic students coming in to prod at my mitral valve during a replacement. The only reason it seems worse is because it deals with something that can be taken on a sexual level.

It should stop, period. Because no matter what the procedure, I'd personally want only that going down and not to be a tool for others to learn from... That's just me.

(((((Addipaddi ))))) please do not worry. Just speak with your surgon about it. Tell your surgon that you read about this and want to know if this is a possibility. Listen to the answer. And then Explicity forbid it, if needed. Then your concent will not be implicit. So you will not have anything to worry about. okay?

Many years ago I forbid something with my surgery. My request had to be honored. Its really a legal matter that they have to honor a reasonable request. Otherwise they could get sued if the patient forbids something and it is done.

I'm really shocked at that! Here in the U.S. they use paid models. I think the models get $50 an hour for pelvics. Ditto male models for the the male specific anatomy. Seems like it wouldn't be that hard to find paid models in Canada.

This just makes me sick to my stomach. It may not technically be considered "rape", but it is a violation if you have not consented. I call that assault at the very least!

Wow. That made me sick to my stomach. Does everyone know about the forced sterilization of people in the Appalachians? This was decades ago but that's what it reminded me of. People would come in during non-related medical procedures and sterilize them while they were under to prevent them from having more kids in that environment. They said that this was 'helping' them because they were in such 'terrible' conditions and that they were preventing more children from growing up in this environment. At least something is being done to bring attention to this and maybe it will stop. They had to ask me when students wanted to sit in on my hysterosonogram and I allowed them to but if I were laying there and looked up to see a dozen people staring at me while I'm having this procedure...I would be FURIOUS!!!!

Involving students in care is mentioned in the treatment consents at teaching hospitals here in the USA. The student would only be performing an exam as part of a procedure that was necessary for care. Any student to be involved in a case is introduced to the patient. Marching in multiple students to examine someone under anesthesia like that is disgusting. How could someone ever think this was okay? And somehow everyone gets the training they need.

Nobody needs a zillion pelvic exams at one time. If anyone tried that garbage with a patient of mine they would be tossed out of the room. I have tossed an entire team of pediatricians out of my NICU patient's room because they wanted the parents tossed out so they could see the rare birth defect. I actually said "you can do anything you need with the parents present" and "I AM NOT RUNNING A FREAK SHOW HERE" after I found out these docs were not assigned to the case. I was backed up by my head NICU doc. Guess I am glad I am a nurse in the US.

Blech! Puke! Just rotten stinking system, I feared this was happening...what about parts of us that are not under, blech, puke...

((((Greensleeves))))

Sorry couldn't bring myself to read this post due to the heading at first but today I felt more brave.