Pelvic exam during general anesthesia ??

[Winged Scapula]

Reminds me of the engineering triad. Fast, cheap, high quality, pick two cuz you can't have all three. ....

LOL…I'll have to remember that. When patients complain about having to wait a few days/weeks for their elective surgery, I sometimes remind them that I'm busy, so they can have someone else fast and always available, or me within a reasonable time frame, and popular (@DermViser - is that arrogant?)

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[Elisabeth Kate]

While it is a right that both parties hold, I'd challenge the idea that refusing to treat patients who will not see trainees as petty. An academic physician working in a teaching hospital has chosen to make his/her career based on the education of future healthcare providers and makes sacrifices to realize that.

I agree with you when it comes to patients refusing trainees involved in their care, period. However, I think the argument in this thread is more subtle. If a patient said they refused to have any trainee involved in care, I'd say the physician has every right to refuse care since it is a teaching hospital. However, if a patient says they're fine with trainees involved in their care, they just don't want med students doing pelvic exams on them, I think that's a reasonable request and no reason for the resident or attending to refuse care.

 

[DermViser]

LOL…I'll have to remember that. When patients complain about having to wait a few days/weeks for their elective surgery, I sometimes remind them that I'm busy, so they can have someone else fast and always available, or me within a reasonable time frame, and popular (@DermViser - is that arrogant?)

No, not at all. I didn't say the "strong/arrogant opinions" comment! I was responding to someone who said that. My threshold for labeling someone as "arrogant" is quite high.

 

[Winged Scapula]

I agree with you when it comes to patients refusing trainees involved in their care, period. However, I think the argument in this thread is more subtle. If a patient said they refused to have any trainee involved in care, I'd say the physician has every right to refuse care since it is a teaching hospital. However, if a patient says they're fine with trainees involved in their care, they just don't want med students doing pelvic exams on them, I think that's a reasonable request and no reason for the resident or attending to refuse care.

And I don't disagree with you. I was "arguing" against the wholesale refusal of such care and the idea that physicians don't have the same autonomy about providing care as patients do to refuse it.

 

[Winged Scapula]

No, not at all. I didn't say the "strong/arrogant opinions" comment! I was responding to someone who said that. My threshold for labeling someone as "arrogant" is quite high.

I know - I didn't do the winky face emoticon next to my comment above.

 

[DermViser]

And I don't disagree with you. I was "arguing" against the wholesale refusal of such care and the idea that physicians don't have the same autonomy about providing care as patients do to refuse it.

Maybe I'm alone in this opinion, but a teaching hospital for me means teaching for both residents AND medical students (w/in reason).

 

[Elisabeth Kate]

My threshold for labeling someone as "arrogant" is quite high.

I should hope so, considering the source . I kid, I kid.

 

[DermViser]

I should hope so, considering the source . I kid, I kid.

I resemble...I mean resent that remark.

 

[SouthernSurgeon]

And I don't disagree with you. I was "arguing" against the wholesale refusal of such care and the idea that physicians don't have the same autonomy about providing care as patients do to refuse it.

When a patient tries to wholesale refuse trainee involvement, one of our surgeons is known for saying - "I'm the one who knows how to do the operation. My residents are the ones who know how to keep you alive afterwards."

 

[VA Hopeful Dr]

When a patient tries to wholesale refuse trainee involvement, one of our surgeons is known for saying - "I'm the one who knows how to do the operation. My residents are the ones who know how to keep you alive afterwards."

We had a dermatologist on staff at the medical school (unheard of without a derm residency, I know), who when a patient would say that they didn't want medical students involved in their care would immediately fire them.

 

[mvenus929]

The other issue that's glossed over is that pelvic exams aren't always benign procedures. If you have certain medical conditions, the poking and prodding can be painful so not wanting extra people poking around exacerbating things is more than just psychological or a case of the patient sexualizing a very non-sexual procedure. Sometimes it just makes you more miserable.

Actually, in the context of this thread, that point is being rightfully glossed over, because we're talking about exams under anesthesia. When the patient won't feel it. Usually when surgery is being done to correct the problem. So the objection is purely psychological in this instance.

Now, things were brought up about medical students doing pelvic exams without permission on an awake patient, but the general consensus after those issues were raised was 'that's wrong'.

Maybe I'm alone in this opinion, but a teaching hospital for me means teaching for both residents AND medical students (w/in reason).

I'm going into pediatrics. I may end up working in academics (not sure at this point). If I were to have a baby in a teaching hospital, I might request that medical students not be involved in the delivery, solely because I might be an attending to those students on their pediatric clerkship, which might make things awkward. The OB residents, on the other hand, I would have relatively little interaction with (maybe occasionally in the nursery setting), and the pediatric residents would care more about my baby than the fact that I was delivering. Then again, I'm a long way from either scenario, so maybe it wouldn't matter at all.

 

[calvnandhobbs68]

I really don't understand any objection to students doing pelvic exams under anesthesia for a gyn case. I don't agree with doing it for non-gyn cases (mostly bc there's no reason, the vast majority are normal exams and you don't really learn anything except how to do a normal pelvic exam on an anesthetized patient which isn't very useful in real life). During gyn procedures, they're usually trying to show you some pathology, i.e. can you feel that mass, how large is this uterus, etc.

I mean, if I had some prostate surgery and students did a rectal exam under anesthesia to feel my enlarged prostate or nodules, its more comfortable for me than doing it awake and essentially benign. What's to object to?

 

[wholeheartedly]

Actually, in the context of this thread, that point is being rightfully glossed over, because we're talking about exams under anesthesia. When the patient won't feel it. Usually when surgery is being done to correct the problem. So the objection is purely psychological in this instance

Not really. Just because you can't feel it during the exam under anesthesia doesn't mean you can't feel it after.

But why is the psychological objection not important as well? I don't sexualize the exam or think doctors are perverts or anything, but I'm a very shy, private person and if that type of exam needs to be done I'd rather only have one person do it and I'd like a heads up it's going to happen. If it was a gyn surgery thing and there was something abnormal for students to learn from, I'd probably ok it even though it would make me a bit uncomfortable.

I just don't see the problem with giving people a heads up. Like I said, it works really well here and no one is lacking for the learning experiences they need.

 

[mvenus929]

Not really. Just because you can't feel it during the exam under anesthesia doesn't mean you can feel it after.

But why is the psychological objection not important as well? I don't sexualize the exam or think doctors are perverts or anything, but I'm a very shy, private person and if that type of exam needs to be done I'd rather only have one person do it and I'd like a heads up it's going to happen. If it was a gyn surgery thing and there was something abnormal for students to learn from, I'd probably ok it even though it would make me a bit uncomfortable.

I'm assuming you meant 'can't' for the second one (so you may be able to feel it later). The reason the pain aspect is being glossed over is because this should ONLY be done for a GYN surgery, where there is going to be a lot going on that will result in far more discomfort later than a pelvic exam. Hopefully after the initial surgical incisions are healed, it'll all feel better than it did before. That is the point of most of these surgeries.

And I'm all for consent. I just think in the grand scheme of things, the pelvic exam under anesthesia is probably the least traumatizing thing that'll happen to the patient in the course of their treatment.

 

[wholeheartedly]

I'm assuming you meant 'can't' for the second one (so you may be able to feel it later). The reason the pain aspect is being glossed over is because this should ONLY be done for a GYN surgery, where there is going to be a lot going on that will result in far more discomfort later than a pelvic exam. Hopefully after the initial surgical incisions are healed, it'll all feel better than it did before. That is the point of most of these surgeries.

And I'm all for consent. I just think in the grand scheme of things, the pelvic exam under anesthesia is probably the least traumatizing thing that'll happen to the patient in the course of their treatment.

True. Honestly, most of what rubbed me wrong in this thread is the idea that not getting consent was no big deal by some posters or that just a general consent without specifics is enough. I just thought it was worth mentioning there is potential to increase physical discomfort as well and you're very right that depending on what else is going on that's probably going to be the least of the patients problems. It just adds to the overall being misery, lol.

That said I think this thread probably needs to die or drift back into obscurity again. It's always really weird when a patient who has obviously felt traumatized comes in and stirs things up.

 

[Rendar5]

I was awake and vigorously refusing while three students took turns jamming their fingers up my vagina to feel my cervix. One actually stood with her fingers in my vagina while I was saying "get your hand out! Get out, this is my body." and proudly said "Nine! She's nine!", then stepped aside and her colleague inserted his fingers to verify the nine. The colleague turned and said to the attending "I'm going to get a rectal..." and stuck a finger into my rectum. I don't care what they were learning. I don't care what they needed. I was being violated, and they were doing me great harm. I finally gave up protesting and just cried until my child was born.

That is illegal not to mention makes no sense from a medical point of view. Exam under anesthesia is not done by students if pt refuses, but if pt does not explicitly states it, may be done if medically necessary and may be done by any staff specified on the consent form. Normally it might be written as "dr. so-and-so and colleagues". It is also been established with legal precedent that going to a place for a procedure where common sense dictates certain things might happen, it is legal for them to do so, as there is no basis for the person receiving the procedure to expect they will be treated differently than everybody else.

 

[calvnandhobbs68]

True. Honestly, most of what rubbed me wrong in this thread is the idea that not getting consent was no big deal by some posters or that just a general consent without specifics is enough. I just thought it was worth mentioning there is potential to increase physical discomfort as well and you're very right that depending on what else is going on that's probably going to be the least of the patients problems. It just adds to the overall being misery, lol.

That said I think this thread probably needs to die or drift back into obscurity again. It's always really weird when a patient who has obviously felt traumatized comes in and stirs things up.

I think the difference is that many of us believe this falls under the general "students and residents will be involved in your care" part of the consent, while some seem to think they need a specific heads up on pelvic exams for some reason. If you've spent any amount of time in an operating room, I think you'd realize why we think this is unnecessary. There are a hundred things that are done during a surgery that don't require your specific consent (some of them much more "humiliating" than a pelvic exam...there's not really much left to be shy about during a gyn/rectal/prostate surgery, let me put it that way). Having an extra person do an indicated pelvic exam before the start of a procedure which is going to address the very thing we are examining is a very benign thing in the grand scheme of the surgery. If you want the surgeon to put that in/discuss that separately, they might as well let you know that they'll be using 4-0 vicryl to close your skin incision, as that'll have much more of an effect on you than a pre-op pelvic exam.

 

[IrisSong]

Doctors have their opinions and patients have theirs. Doctors should be including patients in decisions about their care. Doctors and patients can differ however in how they view care. Some doctors say the pelvic exam is no big deal, some patients may not agree. The issue should be about making the patient aware, not assuming it's "no big deal". This shouldn't be the scenario of "what the patient doesn't know, won't hurt them". This is a mistake.

Personally, it's the idea that I wouldn't be included in the knowledge of what was happening that bothers me. A doctor's idea of "that's not important for you to know" is, at the very least, not comforting. I'm sure there will be some patients who care and some who don't.......but the point is the medical profession shouldn't speak for every patient.

 

[Brain Bucket]

wow.

 

[DermViser]

....ok......how about just this:

does society place different expectations on doctors than non-doctors?

What do you think?

 

[fab4fan]

Speaking from my own experience, after going through the shock and awe of being told you have cancer, and one that doesn't have a good track record regarding treatment, the last thing I was interested in was being "Exhibit A" for a student. It was overwhelming, and to top it off, my family was away, so I was by myself when the bomb was dropped on me. (Although, to be honest, I was pretty sure I had cancer a few months before I went to the doctor. I was just in denial at the time. Stupid, stupid, stupid.)

The hospital where I had my surgery doesn't have students, just residents in FP and surgery. Since my doctor was a gyn/onc, it wasn't an issue. I'm just trying to give you the perspective as a patient.

 

[fab4fan]

LOL…I'll have to remember that. When patients complain about having to wait a few days/weeks for their elective surgery, I sometimes remind them that I'm busy, so they can have someone else fast and always available, or me within a reasonable time frame, and popular (@DermViser - is that arrogant?)

Kind of like choosing between a McDonald's cheeseburger, or filet mignon.

 

[TooMuchResearch]

Quote from glorytaker<<When I was doing OB/GYN as a med student, the attending would have me do a pelvic right after the patient was under and before we started surgery. Of course, we were doing GYN-related surgery and he wanted me to note the difference before and after a cystocele or rectocele repair. We didn't exactly get permission but it was for teaching purposes.>>

It says here that the attending wanted the student to note the different before and after the surgical procedure. That states that the med student was doing the pelvic exam to familiarize him/herself with the particular anatomy and how it felt before and after the procedure. That is of no benefit to the patient if the attending also does a pelvic as part of the surgical procedure.

It also says in the above snip that "We didn't exactly get permission, but it was for teaching purposes."

As a patient, I do not have an obligation to be a live dummy for any person to hone their skill of feeling organs. It seems that medical professionals become desensitized to the fact that a patient deserves respect. Inserting an object or a part of your body into another individual's body for purposes beneficial only to the first party without express consent is a violation. That it's the least invasive procedure to happen to the patient that day does not make it any less of a violation.

"This is the medical student that will be with me today."

Having students participate in care means exams get repeated for the purpose of education. Pelvic exam of some sort tends to happen during OB/Gyn procedures. Medical student involvement means parts of it may happen more than once.

If you declined the involvement of a student, and the student was still present and examining you, there would be an issue.

 

[Anastomoses]

I've considered the idea of handing my body over to medicine for study purposes one day, but the non-consentual pelvic exam by a student still seems an obvious no-go.

I also agree with the poster who finds it petty that an attending would not perform on someone who might say they do not want students involved in physical exploration/procedures. I don't think a patient gets to say who fills out paperwork or answers call, but anything hands-on seems completely reasonable. If someone wishes to be generous and allow a student for learning purposes, that's laudable and should be given the opportunity to sign something saying so. I don't like the suggestion that it's poor behavior on the patient's part not to offer this benefit to a student. Go practice pelvic exams on your family if its so dire.

We had a dermatologist on staff at the medical school (unheard of without a derm residency, I know), who when a patient would say that they didn't want medical students involved in their care would immediately fire them.

Sorry, would fire who? the patient?

 

[DermViser]

I've considered the idea of handing my body over to medicine for study purposes one day, but the non-consentual pelvic exam by a student still seems an obvious no-go.

I also agree with the poster who finds it petty that an attending would not perform on someone who might say they do not want students involved in physical exploration/procedures. I don't think a patient gets to say who fills out paperwork or answers call, but anything hands-on seems completely reasonable. If someone wishes to be generous and allow a student for learning purposes, that's laudable and should be given the opportunity to sign something saying so. I don't like the suggestion that it's poor behavior on the patient's part not to offer this benefit to a student. Go practice pelvic exams on your family if its so dire.

Sorry, would fire who? the patient?

Unless your family has the ability to demonstrate every conceivable pelvic pathology along with before and after surgery, then this is a no-go. That same student who wishes to do OB-Gyn will then be the intern who has never done it, making them and their patients worse off. And yes, he's referring to firing the patient, which any doctor can do.

 

[NickNaylor]

From the perspective of the layman, I get the concern with "non-consensual" pelvic exams. It's invasive, seems unnecessary, and "immodest" (though, as calvn points out, I think being concerned about these issues in the context of having your vaginal cavity shown on 46" LCDs x 4 in the OR is pretty silly). Hell, I remember reading these stories as a pre-med and being mortified and squarely on the side of the patients.

That said, these opportunities may very well be the only time students get to see this pathology. The only opportunities I really had to do a quality pelvic exam where I felt I had the time necessary to think about what I was doing were during gyn cases after the patient was anesthetized. Given that the resident will definitely be doing the pelvic exam (to tell the attending the findings) and that the attending will also be doing the pelvic exams (can't trust those residents), it seems somewhat silly to now all of a sudden have an issue with medical students doing a third exam. The problem with the OB/GYN stuff specifically is that it can be difficult to get any sort of meaningful exposure to it exactly because it's "sensitive." As a man, I was probably refused to be allowed in the room ~50% of the time on the out-patient portion of my OB/GYN rotation. In the other 50%, I was so worried about not being a goofball on an awake patient that my exams were brisk and superficial at best. Sure, I knew I wasn't going to be an OB/GYN while doing the rotation, but I still want to learn this stuff and at least have some kind of exposure to it.

The fact that patients are at a teaching institution is also worth emphasizing. If you don't want this kind of "attention," then avoid going to a teaching institution. Plain and simple. I try to avoid being completely insensitive to the issue, but in the context of everything else that goes on in the OR and in the context of being at an institution that has a major goal of education clinicians, I think the argument is pretty weak.

I think it goes without saying that doing pelvic exams when otherwise not indicated is definitely crossing a line.

 

[DermViser]

From the perspective of the layman, I get the concern with "non-consensual" pelvic exams. It's invasive, seems unnecessary, and "immodest" (though, as calvn points out, I think being concerned about these issues in the context of having your vaginal cavity shown on 46" LCDs x 4 in the OR is pretty silly). Hell, I remember reading these stories as a pre-med and being mortified and squarely on the side of the patients.

That said, these opportunities may very well be the only time students get to see this pathology. The only opportunities I really had to do a quality pelvic exam where I felt I had the time necessary to think about what I was doing were during gyn cases after the patient was anesthetized. Given that the resident will definitely be doing the pelvic exam (to tell the attending the findings) and that the attending will also be doing the pelvic exams (can't trust those residents), it seems somewhat silly to now all of a sudden have an issue with medical students doing a third exam. The problem with the OB/GYN stuff specifically is that it can be difficult to get any sort of meaningful exposure to it exactly because it's "sensitive." As a man, I was probably refused to be allowed in the room ~50% of the time on the out-patient portion of my OB/GYN rotation. In the other 50%, I was so worried about not being a goofball on an awake patient that my exams were brisk and superficial at best. Sure, I knew I wasn't going to be an OB/GYN while doing the rotation, but I still want to learn this stuff and at least have some kind of exposure to it.

The fact that patients are at a teaching institution is also worth emphasizing. If you don't want this kind of "attention," then avoid going to a teaching institution. Plain and simple. I try to avoid being completely insensitive to the issue, but in the context of everything else that goes on in the OR and in the context of being at an institution that has a major goal of education clinicians, I think the argument is pretty weak.

I think it goes without saying that doing pelvic exams when otherwise not indicated is definitely crossing a line.

The LAST thing medical students need is (who pay a LOT of money for that year) to do even less than they are doing now. It is perfectly acceptable now for medical students to be passed through rotations by doing nothing. Then there is utter shock as to why problems of lack of clinical knowledge, lack of physical exam skills, etc. "suddenly" appear during internship.

 

[Elisabeth Kate]

From the perspective of the layman, I get the concern with "non-consensual" pelvic exams. It's invasive, seems unnecessary, and "immodest" (though, as calvn points out, I think being concerned about these issues in the context of having your vaginal cavity shown on 46" LCDs x 4 in the OR is pretty silly). Hell, I remember reading these stories as a pre-med and being mortified and squarely on the side of the patients

That said, these opportunities may very well be the only time students get to see this pathology

That doesn't negate the fact that you were not given permission to do it (since we're talking about "non-consensual" exams). Your "right" to see pathology as a student does not trump the right of the patient to be informed of this.

The only opportunities I really had to do a quality pelvic exam where I felt I had the time necessary to think about what I was doing were during gyn cases after the patient was anesthetized. Given that the resident will definitely be doing the pelvic exam (to tell the attending the findings) and that the attending will also be doing the pelvic exams (can't trust those residents), it seems somewhat silly to now all of a sudden have an issue with medical students doing a third exam

That isn't really how it works, at least not in my experience. What usually happens in these situations is that the patient is under, the student is asked to "practice" their exam skills. Sure, in some cases, it's to feel a specific pathology and learn from it, but everyone knows that the predominant reason for students to do a pelvic in these cases is simply to practice doing a pelvic.

The fact that patients are at a teaching institution is also worth emphasizing

This has been emphasized and it's been shot down by an attending, among others.

The LAST thing medical students need is (who pay a LOT of money for that year) to do even less than they are doing now. It is perfectly acceptable now for medical students to be passed through rotations by doing nothing. Then there is utter shock as to why problems of lack of clinical knowledge, lack of physical exam skills, etc. "suddenly" appear during internship.

I agree with you, but if the sum of a student's clinical skills depend on whether or not they do pelvics on unconscious women without permission, we're all in trouble.

 

[NickNaylor]

That doesn't negate the fact that you were not given permission to do it (since we're talking about "non-consensual" exams). Your "right" to see pathology as a student does not trump the right of the patient to be informed of this.

They are informed of it on their consent form - you know, the one that no one actually reads.

That isn't really how it works, at least not in my experience. What usually happens in these situations is that the patient is under, the student is asked to "practice" their exam skills. Sure, in some cases, it's to feel a specific pathology and learn from it, but everyone knows that the predominant reason for students to do a pelvic in these cases is simply to practice doing a pelvic.

This hasn't been my experience. I have never been asked to do a pelvic exam "just to practice." Only when there are interesting findings or when it's critical to the case (e.g., estimating uterine size, cervical dilation, etc.).

This has been emphasized and it's been shot down by an attending, among others.

Just because an attending says it doesn't mean it's true. This is certainly an opinionated issue to which there is no right answer.

I agree with you, but if the sum of a student's clinical skills depend on whether or not they do pelvics on unconscious women without permission, we're all in trouble.

Not the sum total and obviously hyperbole, but in this case my experience was not being fulfilled because half of patients refused to let me examine them. What am I to do? Practice on mannequins?

See above.

 

[DermViser]

I agree with you, but if the sum of a student's clinical skills depend on whether or not they do pelvics on unconscious women without permission, we're all in trouble.

I agree with you fully - women who are giving birth and are being taken care of by a fresh faced intern who has never gotten to do a pelvic exam are in a lot of trouble. I'm sure those sim introituses (introiti?) feel exactly like the real thing.
http://en.honglian8.com/p/271/gdf20g-labor-delivery-simulator

 

[Elisabeth Kate]

They are informed of it on their consent form - you know, the one that no one actually reads

Again, this has already been addressed in the thread. Most of the time, it is not said in the consent form beyond the standard "this is a teaching hospital and involved in your care will be..."

This hasn't been my experience. I have never been asked to do a pelvic exam "just to practice." Only when there are interesting findings or when it's critical to the case (e.g., estimating uterine size, cervical dilation, etc.)

While this hasn't been your experience, it has been the experience of others as noted in this thread and the article I posted earlier that appeared in the Journal of the OB/GYN. I believe that's where the controversy stems.

Just because an attending says it doesn't mean it's true. This is certainly an opinionated issue to which there is no right answer

I didn't say it makes it true. However, given that this attending has years of experience dealing with these patients and teaching hospitals, her opinion is worth noting, especially when she gives reasons for why the public is at a teaching hospital, none of which include because they chose to be.

Not the sum total and obviously hyperbole, but in this case my experience was not being fulfilled because half of patients refused to let me examine them. What am I to do? Practice on mannequins?

It's a shame that women aren't more open to male students on the OB/GYN service. I felt the same during my third year clerkship. However, that still isn't an excuse to do it without permission.

I agree with you fully - women who are giving birth and are being taken care of by a fresh faced intern who has never gotten to do a pelvic exam are in a lot of trouble. I'm sure those sim introituses (introiti?) feel exactly like the real thing.
http://en.honglian8.com/p/271/gdf20g-labor-delivery-simulator]

Let's not muddy the facts with this type of hyperbole. I seriously doubt there are interns running around who never did a pelvic exam. Just because some women don't want to be practiced on by a student doesn't mean none of them do. It works the other way too. During third-year, I did only a couple of prostate exams while my male counterparts did many more. I still can't say I would know what prostate pathology feels like, but I don't think it's an excuse to do it when the patient is obviously uncomfortable and/or hasn't been properly informed that I will be doing it.

 

[Evil_Abed]

Your "right" to see pathology as a student does not trump the right of the patient to be informed of this.

The patient has been informed of this when she has been told that medical students and residents will be involved in the care of the patient.

That isn't really how it works, at least not in my experience. What usually happens in these situations is that the patient is under, the student is asked to "practice" their exam skills. Sure, in some cases, it's to feel a specific pathology and learn from it, but everyone knows that the predominant reason for students to do a pelvic in these cases is simply to practice doing a pelvic.

Completely not my experience either, just like NickNaylor.

This has been emphasized and it's been shot down by an attending, among others.

And that point has also been emphasized and advocated for by many other attendings in real life.

 

[DermViser]

Let's not muddy the facts with this type of hyperbole. I seriously doubt there are interns running around who never did a pelvic exam. Just because some women don't want to be practiced on by a student doesn't mean none of them do. It works the other way too. During third-year, I did only a couple of prostate exams while my male counterparts did many more. I still can't say I would know what prostate pathology feels like, but I don't think it's an excuse to do it when the patient is obviously uncomfortable and/or hasn't been properly informed that I will be doing it.

Yeah, except men don't actively give birth to babies through their rectum. OB-Gyn is a field in which giving birth is under a time crunch.

 

[Elisabeth Kate]

The patient has been informed of this when she has been told that medical students and residents will be involved in the care of the patient

Being involved is not the same as being informed that the medical student will be practicing pelvic exam skills on the patient.

 

[DermViser]

That isn't really how it works, at least not in my experience. What usually happens in these situations is that the patient is under, the student is asked to "practice" their exam skills. Sure, in some cases, it's to feel a specific pathology and learn from it, but everyone knows that the predominant reason for students to do a pelvic in these cases is simply to practice doing a pelvic.

Uh, no. Just..no.

 

[Elisabeth Kate]

Yeah, except men don't actively give birth to babies through their rectum. OB-Gyn is a field in which giving birth is under a time crunch.

Again, I have never heard of a student who hasn't done a pelvic exam or helped in a birth throughout med school. You may not do every one, but most patients are fine with it, when they're asked.

 

[DermViser]

Being involved is not the same as being informed that the medical student will be practicing pelvic exam skills on the patient.

So for you, being involved is shadowing? Wonderful.

 

[Evil_Abed]

Being involved is not the same as being informed that the medical student will be practicing pelvic exam skills on the patient.

Being involved is not the same as being informed the the residents/attending will be performing a pelvic exam on the patient either, in that case.

And I already pointed out that, in my experience, we never "practiced" pelvic exam skills on the patient. It was to note interesting findings and pathology.

 

[Elisabeth Kate]

Uh, no. Just..no.

Yes. Just...yes.

So for you, being involved is shadowing? Wonderful.

When did I say that? Don't put words in my mouth. There are tons of ways that a med student can be actively involved without digitally penetrating a vagina without permission.

 

[DermViser]

Yes. Just...yes.



When did I say that? Don't put words in my mouth. There are tons of ways that a med student can be actively involved without digitally penetrating a vagina without permission.

Right. Actively involved = scut work. Why do a physical exam when you can push paper?

 

[Elisabeth Kate]

Right. Actively involved = scut work. Why do a physical exam when you can push paper?

When did getting an HPI and doing a physical exam (minus the digital pelvic exam without consent) become scut work?

 

[alpinism]

Yes. Just...yes.



When did I say that? Don't put words in my mouth. There are tons of ways that a med student can be actively involved without digitally penetrating a vagina without permission.

This is ridiculous. No one is advocating what you're describing (rape). We're talking about a medical professional (med student/resident) performing a medically indicated procedure (pelvic exam) for the purposes of learning in a patient that has already signed a consent form.

 

[NickNaylor]

When did getting an HPI and doing a physical exam (minus the digital pelvic exam without consent) become scut work?

But do you not see the issue? This would be like going into a pediatrics rotation and never examining a kid or going into an internal medicine rotation and never examining adult. The point of the clerkship should not be to do what any monkey could be trained to do with enough time. I would be pissed and frankly concerned if my school found it acceptable to only do HPIs and histories for medical students on clerkships. What if I'm a man and did want to go into OB/GYN?


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[Psai]

But do you not see the issue? This would be like going into a pediatrics rotation and never examining a kid or going into an internal medicine rotation and never examining adult. The point of the clerkship should not be to do what any monkey could be trained to do with enough time. I would be pissed and frankly concerned if my school found it acceptable to only do HPIs and histories for medical students on clerkships. What if I'm a man and did want to go into OB/GYN?


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I hope those children were fully informed before you used cotton to penetrate their oral mucosa without permission.

 

[Elisabeth Kate]

This is ridiculous. No one is advocating what you're describing (rape). We're talking about a medical professional (med student/resident) performing a medically indicated procedure (pelvic exam) for the purposes of learning in a patient that has already signed a consent form.

According to YOU, that's what we're talking about. According to the dozens of journal articles, studies, and blog posts on the issue, we're talking about doing a pelvic exam on someone who wasn't informed that this would be happening. It's not like I'm on here making crap up. Everything I'm saying is well documented in respected medical journals and articles.

But do you not see the issue? This would be like going into a pediatrics rotation and never examining a kid or going into an internal medicine rotation and never examining adult

That would only be similar if someone went through their entire OB/GYN rotation and never did a pelvic. Show me one med student who got through an entire rotation and never did a pelvic and I'll show you a med student who didn't go to med school in the U.S. No U.S. med school is going to graduate someone who never did a pelvic exam. This is an excuse, not a real argument because what you're saying is that you have to do the pelvics while they're asleep and without informed consent because otherwise, you'll never have the experience.

The point of the clerkship should not be to do what any monkey could be trained to do with enough time. I would be pissed and frankly concerned if my school found it acceptable to only do HPIs and histories for medical students on clerkships. What if I'm a man and did want to go into OB/GYN?

Look, I honestly I feel bad for guys who want to do OB because it sucks that by the nature of the specialty, many of the patients prefer women. However, I still don't think that's a good excuse to do pelvics without informed consent. And by the way, no one is saying ALL you should ever do is HPIs and histories. What I added that you left off was PHYSICAL EXAMS -- you know, the majority of what a physician does. This "if we don't do pelvics when they're asleep, then all we're doing is scut" or "we're doing what any monkey can do" attitude is, once again, an excuse. I'm not saying you should do pelvics. I'm saying don't do pelvics on women who are not aware that you're going to do a pelvic until she is informed.

 

[calvnandhobbs68]

The above poster has the same attitude as anti-vaccine advocates. "Everyone else will get vaccinated, so why should my kid?" "Other women will let students do pelvic exams so why should I?"

Basically a tragedy of the commons type of attitude. We can all see the road this ends up heading down...

 

[Elisabeth Kate]

The above poster has the same attitude as anti-vaccine advocates. "Everyone else will get vaccinated, so why should my kid?" "Other women will let students do pelvic exams so why should I?"

Basically a tragedy of the commons type of attitude. We can all see the road this ends up heading down...

Orrr, I have a conscious and a sense of decency and right and wrong and I acknowledge that I am not entitled to put my hands anywhere I want just by virtue of being a medical student. I respect a patient's right to privacy and I don't get my feelings hurt when someone says they'd prefer to be asked before I probe around their genitals when they're asleep. Guess I respect my patients. Try it sometime. You might like it.

 

[VisionaryTics]

Question, Elizabeth Kate:

Do you think patients should be consented if the med student is putting in lines, intubating, doing small procedures, or suturing while under anesthesia?

How about putting in Foleys?

 

[calvnandhobbs68]

Orrr, I have a conscious and a sense of decency and right and wrong and I acknowledge that I am not entitled to put my hands anywhere I want just by virtue of being a medical student. I respect a patient's right to privacy and I don't get my feelings hurt when someone says they'd prefer to be asked before I probe around their genitals when they're asleep. Guess I respect my patients. Try it sometime. You might like it.

Watch out everyone, the rest of us "don't have a sense of conscious and a sense of decency and right and wrong".

I don't use this much but talk about an ad hominem...

 

[Elisabeth Kate]

Question, Elizabeth Kate:

Do you think patients should be consented if the med student is putting in lines, intubating, doing small procedures, or suturing while under anesthesia?

How about putting in Foleys?

If the patient is awake when you know you're going to be doing it, absolutely. Sometimes, emergencies come up and we need to do something else while the patient is unconscious and, obviously, in those cases, you do what you need to do to save the patient, but in that case, 99% of the time, it's not the med student doing it.

As has been discussed before, intubating and suturing are not the same as pelvics.