The part you quoted said:
Bolding mine. The article cleary states that these exams are unrelated.
Also, are you in the States? Again, this is happening in Canada.
And if, as Kobal2 says, all that happens is “minor tearing” :rolleyes:, how would that be explained?
The article states they are unrelated, but I don’t necessarily agree - depends on your definition of “related.” Removal uterine fibroids or a hysterectomy are the only examples given in the article, and they are clearly gynecological procedures where you’d already be in stirrups or a position where a pelvic exam could be done and is not completely unrelated to the procedure. Unlike the hypothetical example stated in this thread of doing a pelvic exam during bunion surgery, which would be ridiculous.
I am Canadian. Born and raised in Edmonton, Alberta. Currently in my second year of nursing school in Edmonton.
All of the pre-surgery consent forms I have ever signed when I was a patient included a statement that students may be involved in the procedure. I can’t guarantee that all informed consent forms everywhere have that language, and often “informed consent” may not be adequately explained to the patients or they may not read the form or they may not have enough literacy to understand it. Medical forms can be verbose and complicated, and I know plenty of intelligent people who just skip to the bottom and sign without really reading, and I’ve known other people who didn’t understand what it was saying but didn’t bother to speak up.
Even without a student pelvic exam, “minor tearing” might occur when doing a hysterectomy or fibroid removal which are usually/often done via the vagina (not an abdominal incision). But in your example, I’d assume the doctor would explain what happened to the patient, saying how a student was involved with the procedure as a learning opportunity. I do have to say that I don’t think even “minor tearing” would occur very often from a basic pelvic exam - probably more likely to occur from the surgery itself. Of course if it was the ridiculous pelvic exam during bunionectomy, “minor tearing” of the perineum or vagina would be much more difficult (impossible!) to “explain” in a non-lawsuit-provoking way. However, I haven’t seen any legitimate cites thus far that pelvic exams are done during non-gynecological procedures.
Too late to edit and add: I realize the specific “bunion” example was a joke, but it does appear that some in the thread still think pelvic exams may be done during totally unrelated surgeries, which I have yet to see a cite for.
I don’t remember if I signed any consent forms before my surgery in Calgary 10+ years ago. My husband doesn’t remember if he signed consent forms for his surgery in Calgary two years ago. They obviously aren’t registering very much on us. 
It stated that pelvic exams were performed on unconscious patients, UNRELATED to the surgery they were undergoing. Again, it stated, at NO time did they bother to obtain anyone’s consent, or indeed, inform these women that students were going to be performing examinations on them.
What part of UNRELATED do you not understand? As well as “WITHOUT YOUR KNOWLEDGE?” If it were needed, I’m guessing the doctor would have informed said patient.
So much for “getting patient’s consent.” If a patient does not understand said document, I would expect a doctor to explain what the operation entails. He/She is, after all, the expert.
Bolding mine. THAT is exactly, what people are so disgusted about.
And again, as for Kobal’s argument:
Does NOT fit with medical ethics, as they stand:
Bedside manner and caring for patients as PEOPLE are important. If you can only see them as body parts, you’re in the wrong field. You’re better off going into medical research, or some area of medicine where you don’t have to deal directly with patients.
And, IF this, as Kobal2 said “minor tearing” was a result of a pelvic exam. If you lie and say that’s a result of surgery, is that ethical?
I don’t doubt this, but the issue at hand isn’t a student or students being involved in a given procedure; it’s the students performing an entirely different and wholly unnecessary procedure. If I sign a consent form saying that medical students may be watching and assisting in my hysterectomy, then I’m consenting to have people who are not yet doctors watching and assisting in my hysterectomy. I’m not consenting to having people who are not yet doctors, let alone my doctor, perform an invasive exam.
Both aren’t antithetic. I didn’t mean to say doctors don’t give a damn about their patients - if they didn’t, they would indeed be in the wrong line of work, Dr. House notwithstanding. But they’ve seen enough of the human body not to have conceits about its nature, and most don’t consider the genital apparatus to be anything special or prurient. You can be dispassionate about anatomy, while still caring for whose anatomy it is.
Look, it’s beyond obvious that if they can afford the luxury of asking consent for the exams without the percentage of refusals affecting the quality of their teaching, then yes, of course they should ask for consent. My point is that, if as I suspect the *actual *number of people giving their consent to be touched by students is abysmal, and thus the choice is between quality teaching for doctors and not offending you, then better doctors wins hands down IMO. Needs of the few, needs of the many, all that jazz.
That’s already the case, apparently. There was a GQ thread about it a few months back.
First, the “it” that said this was an opinion column, not a news story. If the Globe & Mail is anything like my local newspapers, opinion columns are considerably less careful about their facts than news stories.
And note that the author doesn’t actually say “at NO time did they bother to obtain anyone’s consent”, he says “without getting specific consent”. He apparently wants the hospital to get “specific consent” for each procedure or exam that is done. Maybe he even wants “specific consent” for each medical student by name?
But I’ll bet that the admitting documents that the patient signed have a generalized consent form, authorizing medical students to do exams under the supervision of a doctor. And IMO, that is all that should be required. It’s all that a US teaching hospital required when I was a patient there.
The newspaper article says “unrelated”, but as someone with a little bit of medical knowledge (but definitely not a doctor and only halfway to being a nurse), IMHO a pelvic exam during a hysterectomy would be “not required” but not “unrelated”. If you’re already up in stirrups and having an invasive surgery through your vagina, I can see how some doctors and med schools might justify doing a pelvic exam. Not that I necessarily agree with them, and if I were one of those students I would have to think about it, but I can see where they’re coming from.
As for “without your knowledge”, we haven’t seen the consent forms and we weren’t present when the patient was given the informed consent. The newspaper article paints it as if none of these patients had any clue what was going on and that practically every med school and med student does this. However, from my experience and from reading the comments of physicians and med students at the bottom of the linked article, failing to get informed consent is not standard practice in Canada. Maybe it happens at a few places, and maybe the informed consent needs to be more thorough.
To follow up on the “specific consent” idea - many consent forms are vague and try to cover the broad brushstrokes of what will occur. They don’t detail every person who may or may not be present in the OR and what each person will or will not do. “Informed consent” versus “specific consent” for every detail is somewhat different. I feel very strongly that getting informed consent is important and making sure that patient’s fully understand the procedure is important, but everyone will draw a different line on how detailed it needs to be. It’s hard to judge after the fact from a newspaper opinion piece that’s scant on details and verifiable facts.
If there is tearing, you’re doing SOMETHING wrong. I would hate it if this was done to me, and i would prefer that you ask before someone practices on me, and there is a possibilty women are going to say no.
I’d be pissed if someone did it to me, and i had a good experience at my last examination.
It should say so on the consent form, in plain english, or other languages because somebody is probably going to be upset.
Many doctors attempt to get blanket consent for all procedures, but under US law, generally speaking, this doesn’t hold up in court. Absent some express and specific consent, the question would be whether there is some kind of implied consent.
If the patient would normally need this exam after a procedure as part of the standard care, consent to having a doctor (and therefore med students) perform it is probably wrapped up in the initial consent to the procedure. If the exam is unrelated to the procedure, then there isn’t really an argument for implied consent, which if not related to some other consent is limited to cases in which a procedure is medically necessary (for the patient) and the patient cannot give consent. I would be surprised if Canadian law is so different.
For the patient to be able to sue, though, she would have to show injury. That might be difficult to prove if there’s no physical injury and she cannot demonstrate emotional damage. The doctors/students could probably be prosecuted by the state even if the patient cannot prove an injury, but that wouldn’t be very politically popular, I’m guessing.
Broadsheet brought up some good points about why, aside from ethics, it’s a terrible idea to do them on non consenting unconscious patients.
I mean, I hope that they’d be also doing them on awake patients to learn all this other important stuff, but if they’re stupid enough to basically commit sexual assault on semi conscious patients, who knows.
I suspect the key to the problem is the lack of specific consent.
The issue is really one of the informed consent process. I have no doubt that admitted patients sign a form stating that they consent to medical procedures - and that, at a teaching hospital, they also consent to the presense of, and examination by, students.
The problem with the drafting of such forms is two-fold:
You want sufficient detail to clearly inform the patient of what they are agreeing to; and yet
The more detail you add, the less likely it is to be read and understood. The problem here is that if the form covers every possibility it would be quite lengthy and thus less likely to be read by a patent.
Ideally, this problem should be solved by having the physician or some other health care professional sit down with the patient, form in hand, and clearly explain every step of the process they, specifically, will undergo, including the examination by students. Indeed, the ethics of truly “informed consent” require that the patient actually be informed, not merely sign a form as (so to speak) a formality.
The difficulty lies in the time and resource pressures involved. The temptation for a time and resource strapped hospital is to use blanket consents phrased generally, which I suspect is the practice being disapproved of here.
As others have noted, these are not “unrelated” procedures.
Me too. Which is why I would, and have, consented to having students perform pelvic exams.
Consent is the issue here, not whether students should practice pelvic exams.
You seem awfully “pwecious” yourself about something that I gather no one has ever wanted to touch. :rolleyes:
Yup, wanting a say in who gets to touch your private areas = being precious. And only people with hundreds of others begging to touch their vaginas are allowed to be choosy.
Wow, you are some gigantic asshole. Probably the sort that needs examining by a medical student.
That’s actually a good, rational, non hysterical point.
However, consider that while they will learn how to do a clean, non painful, comfortable pelvic by practising on each other or voluntary routine patients (not to mention their own patients when they get their diploma), a woman who has to go under the knife might present with some unusual or interesting conditions that they’ve yet to see or feel - whether it’s pregnancy, or menopause, or cancer, or fibrosis, or a somethingcomplicatedoma, or whatever it is they’re really looking for when they stick their fingers up your cookie jar.
I mean, there’s a point to the invasiveness of pelvics, and having examined a thousand healthy vags will not help them one bit when they’re confronted with an unhealthy one - they’ll reckon “hmm, that’s weird”, look it up in their books and find 900 conditions the description of which could apply (seriously, have you ever perused a medical encyclopaedia and not found yourself suffering of at least ten rare and deadly diseases ? ;)).
Just as you can’t accurately describe a color or the taste of a pear, you can’t describe a feeling (in the sense of touch meaning of the word, not the achey brakey heart one. Although I suppose it’s also true for the latter…). So having first hand (sorry) experience with an identified condition does make a difference.
Note that this is neither here nor there when it comes to questions of ethics and consent - I’m just coming up with a reason why examining an unconscious surgery patient makes medical sense.
That doesn’t make a bit of sense.
Yes, medical students should be examining women with various sorts of “female troubles.”
But you have failed to explain why unconscious and unconsenting patients are required to do so.
They’re not. I’m just saying, just because the patients are unconscious, doesn’t make the pelvic training useless from a medical point of view.