Do NOT read "Heart Failure"

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Furrball said:
Have I seen things that should not have happened? Yes. Have I seen communiations between specialties break down and have patients suffer for it? Yes. Have a seen any major, or for that point minor, ethically dubious actions? No. Believe it or not most physicians and surgeons go into medicine with at least some thought of helping other people. It may not be their first reason, but it is probably in the top three.

For the most part, when you read posts by medical students in their clinical years we seem to be enjoying ourselves. Even more realistic books like the House of God are reflective of a past time in medicine. Although I would recommend that book just for the 10 Rules of the Fat Man. But 80 hour work week restrictions and much more ancillary staff have changed the role of both the resident and the medical student. I would go so far to say that any book about medical school written more than ten years ago is proabably out of date and should be ignored. Over the last decade many schools have changed the organizational structure of classes. Courses have been introduced specifically to help teach students to be more humane. At my medical school we started having direct patient contact in our second week in preceptorships in the surrounding community.

Lastly, ignore the book. If you feel that medicine is what you want for a vocation than do it. I can honestly say that I am very happy with medicine. I enjoyed medical school. I liked med shcool much more than my experience in graduate school. And I am looking forward to the Match next week.


Thanks a lot, that is actually really helpful! Cuz the alternative I was debating over was graduate school. But I think I'll stay with my initial plan since med school seems like it would be more interesting and rewarding. Thanks for the advice, and best of luck with the match! 🙂
 
Furrball said:
Insanity is a legal term, not a medical term. In any case I'm amazed that any of you read it all. I followed that inital link and skimmed two paragraphs and knew it for crap. I think he is a stuck-up hypocrite and a git.

I agree with you, but never-the-less I found his book to be compelling reading. Absolutely fascinating from a freak-show perspective.

I am certainly not offended by anything the author says. It is obvious that he is poltically somewhat to the left of Karl Marx but that's fine with me too. I'm sure if we sent a Klansman to medical school he would produce something as equally inflammatory but from a different perspective.

Another medical school "tell-all" I thouroughly enjoyed was "Patch Adams." I like it even better now that I am almost done with medical school and can laugh and hoot at the more ridiculous parts of the movie. You guys should really watch that movie before you go to medical school, then watch it in fourth year and see how your perspective has changed.
 
getunconcsious said:
Well I did read it with an open mind! I started the thread to ask people if what the author described actually happened or not. I have yet to see even one person post something corroborating his tales of egregious misconduct. Have you been to medical school? And if so, did you see anything as bad as he described? I don't really care about the book's entertainment value, I want to know if it's true or not!

Geez, sorry for being confused and reaching out for help with career choices! 🙄

No, I'm starting in August, just like you. Neither of us know what to expect, but that will be half the fun. You haven't seen corroboration of some of his anecdotes? You haven't looked hard enough. Maybe only 10% of your experience will resonate with the sh1t he went through. Even so, you will be better equiped to deal with it, maybe even laugh it off.

There are so many funny anecdotes, interesting quotes, revealing insights, why anyone would plead for people NOT to read this is beyond me. Any reasonably intelligent person can devour this book and stand to benefit immensely. But then again, many pre-meds are in a perverse state of mind and some of the books accounts, however true or untrue, pose a threat to their conception of what medicine should be while invalidating their selfless and idealist motivations.
 
Since people here are commenting on what a flakey liberal this guy seems to be, I just want to say that it's not necessary to be a conservative to see that he's full of crap. Anybody can see that. His problem is not about politics, but maturity. I only got through the pediatric "chapter" (minus some of the gratuitous aphorisms--gag!) before I wanted to throw up. The "I Question Authority" button? Give me a break. This guy needs to grow up.

He is not a credible author--and if he was, he wouldn't be resorting to self-epublishing his little diatribe either. Just look at the cover of the "book." It's way overdone. People who actually observe things well and write well about them don't have to stoop to those kind of antics.

What I don't get (ok I only read that one chapter, but that was too much)--is that Susan figure. Who'd go out with this guy? Would somebody please let me know if she dumps him by the end of the book? Clearly, she should! I mean, how can anyone be serious about a guy who wears an I Question Authority button to work and complains about being asked to remove brown nail polish while at work?
 
pushkin said:
Since people here are commenting on what a flakey liberal this guy seems to be, I just want to say that it's not necessary to be a conservative to see that he's full of crap. ...

What I don't get (ok I only read that one chapter, but that was too much)--is that Susan figure. Who'd go out with this guy? Would somebody please let me know if she dumps him by the end of the book? Clearly, she should! I mean, how can anyone be serious about a guy who wears an I Question Authority button to work and complains about being asked to remove brown nail polish while at work?

lol, I agree with you about the political thing. I would probably be considered very liberal in most ways, and I don't think this guy is screwed up because he's a liberal, he's just plain weird.

As far as the Susan woman, I have to admit I had the same thought (I feel sort of bad about that, I mean even semi-crazy people deserve to be happy 😛 ). In the "about the author" section it says that he and Susan were, at the time of writing, engaged to be married. Maybe she's just as flaky as he is 🙄
 
With apologies to Evo and Pre-allo for thread drift ...

http://www.drgreger.org/

"...kinda like the Michael Moore of nutrition."
-Mary Lawrence, chef and cooking instructor

pepper.jpg


http://www.consumerfreedom.com/news_detail.cfm/headline/1601

"Greger is a long-time animal activist and vegetarian evangelist who typifies the collective move of American animal-rights zealots toward cooperation with other radical movements. In his own “Animal Rights 2002” convention speech, Greger declared: “The future of the animal liberation movement depends on our ability to unite with other social justice movements, and corporate globalization is the key bridging issue we’ve been waiting for all of our lives” [click here to hear the audio].

When he’s not railing against corporations (especially the ones that bring us milk and meat), Greger edits a mad-cow-scare web page for the Organic Consumers Association. He also has ties to a variety of leftist political movements, including the 1999 Seattle anti-globalist riots, last week’s “Anti-Capitalist Convergence” protests in Washington, and last year’s “living wage” actions at Harvard University."
 
pushkin said:
Since people here are commenting on what a flakey liberal this guy seems to be, I just want to say that it's not necessary to be a conservative to see that he's full of crap. Anybody can see that. His problem is not about politics, but maturity. I only got through the pediatric "chapter" (minus some of the gratuitous aphorisms--gag!) before I wanted to throw up. The "I Question Authority" button? Give me a break. This guy needs to grow up.

He is not a credible author--and if he was, he wouldn't be resorting to self-epublishing his little diatribe either. Just look at the cover of the "book." It's way overdone. People who actually observe things well and write well about them don't have to stoop to those kind of antics.

What I don't get (ok I only read that one chapter, but that was too much)--is that Susan figure. Who'd go out with this guy? Would somebody please let me know if she dumps him by the end of the book? Clearly, she should! I mean, how can anyone be serious about a guy who wears an I Question Authority button to work and complains about being asked to remove brown nail polish while at work?

In the end, his presentation of his experiences are probably overly dramatic.
However, do you honestly believe that:
1) Med students aren't belittled / treated poorly?
2) MDs aren't arrogant?
3) There aren't problems with the way patients are treated?
4) There is already enough "care" in our health care system?
5) MDs don't make sexist/racist comments?

Most of your comments (along with many other people) don't address his complaints. (So much for the line "don't judge a book by its cover".)

Detractors here are saying that he's too liberal, he's just a burnout, he needs to get a life, or he's got a holier-than-thou attitude. Is this true? Maybe, maybe, maybe, and probably.

Regardless, is it really so bad to hear what could be going wrong? Is it really so bad to have someone stand up and say that there are problems and they need addressing?

For whatever it's worth, I emailed a few (5) med students here at UCSF who are in their 4th year and asked them what they thought about this. All of them thought he was overly dramatic, but none of them disagreed with the points he brought up.

If these points are valid (regardless of how hyped they are), then some change is needed. Change can only occur when a problem is recognized.

In the end, I don't see what's wrong with that.
 
beastmaster said:
No, I'm starting in August, just like you. Neither of us know what to expect, but that will be half the fun. You haven't seen corroboration of some of his anecdotes? You haven't looked hard enough. Maybe only 10% of your experience will resonate with the sh1t he went through. Even so, you will be better equiped to deal with it, maybe even laugh it off.

There are so many funny anecdotes, interesting quotes, revealing insights, why anyone would plead for people NOT to read this is beyond me. Any reasonably intelligent person can devour this book and stand to benefit immensely. But then again, many pre-meds are in a perverse state of mind and some of the books accounts, however true or untrue, pose a threat to their conception of what medicine should be while invalidating their selfless and idealist motivations.

I doubt that anybody in my class dislikes third year as much as I do, and I still think the author is either a compulsive liar or a complete halfwit or probably both. Any reasonably intelligent person could indeed devour this book and have the impression that they benefitted immensely, since they have no framework upon which to hang this man's ridiculous rantings. The anecdotes, quotes and insights which you describe as, respectively, funny, interesting and revealing are in fact nauseatingly self-righteous nuggets of crap all carefully chosen to paint the author in a holy glow. He's a complete tool and his book is garbage.
 
Sigma said:
However, do you honestly believe that:
1) Med students aren't belittled / treated poorly?

I, of course, can only speak from my own experiences, but the only times I personally was ever treated poorly was occasionally on my surgery rotation, and it was hardly anything to write home about. In general we're treated with respect by just about everybody but the nurses.

2) MDs aren't arrogant?

Some people in every profession are arrogant. Do I think that--generally speaking, as a group--MDs are so arrogant that it constitutes a major instititional problem? Not really.

3) There aren't problems with the way patients are treated?

Again, sometimes that are problems with the way patients are treated. Hospitals are busy places with busy people and a lot of sh1t going on, sometimes things happen that shouldn't. Sometimes things don't happen that should. Can it sometimes be a problem? Absolutely. It is as if patients are routinely being murdered in their sleep and nobody gives a sh1t? Of course not.

4) There is already enough "care" in our health care system?

There is always room for improvement in any field, any profession.

5) MDs don't make sexist/racist comments?

There are racist and sexist people everywhere. Is it a particular issue among MDs? No, I don't think so.

Hey, if your question is "Are there problems with health care and hospitals and physician training in America?" then of course the answer is going to be "yes." There are problems with everything, everywhere, always in life. Is "Heart Failure" a reasoned, intelligent, accurate depiction of realistic problems? Not in any way, shape or form. It's a hysterical rant.
 
sacrament said:
I, of course, can only speak from my own experiences, but the only times I personally was ever treated poorly was occasionally on my surgery rotation, and it was hardly anything to write home about. In general we're treated with respect by just about everybody but the nurses.



Some people in every profession are arrogant. Do I think that--generally speaking, as a group--MDs are so arrogant that it constitutes a major instititional problem? Not really.



Again, sometimes that are problems with the way patients are treated. Hospitals are busy places with busy people and a lot of sh1t going on, sometimes things happen that shouldn't. Sometimes things don't happen that should. Can it sometimes be a problem? Absolutely. It is as if patients are routinely being murdered in their sleep and nobody gives a sh1t? Of course not.



There is always room for improvement in any field, any profession.



There are racist and sexist people everywhere. Is it a particular issue among MDs? No, I don't think so.

Hey, if your question is "Are there problems with health care and hospitals and physician training in America?" then of course the answer is going to be "yes." There are problems with everything, everywhere, always in life. Is "Heart Failure" a reasoned, intelligent, accurate depiction of realistic problems? Not in any way, shape or form. It's a hysterical rant.


Well, I think it's short-sighted to dismiss content because of form.

Yes, there are problems, and what are the "problems"? This guy believes those problems include MD arrogance, improper care of patients, etc. It sounds like you believe that these problems either don't exist, or exist at acceptable levels. (Correct me if I'm wrong.) I'm basing this assumption on your responses to MD arrogance and patient care issues. And, if you believe that, that's fine.

However, I would argue that these factors contribute to the dehumanization of both patients and students. And, as we've had drilled into our heads (right or wrong), a patient's biggest issue with seeing an MD is the fact that they don't feel like they are being treated as a person. Based on that alone, I believe this means the problem of dehumaning patients is beyond acceptable levels.

The argument that "hey, there's problems everywhere, what can you do?" just doesn't wash. What can you? Demand that your peers and other MDs treat patients more as people. Find some other creative outlet. (I don't have the answer myself.) The fact that the world is ripe with problems doesn't give licence to be complacent in your corner of it. Especially, especially, when you are responsible for the lives of others.

To be clear, I'm not defending this guy's rhetoric, I'm trying to indicate that there may be valid points contained in the text.

Again, it's unreasonable to dismiss content because of form.
 
Sigma said:
Well, I think it's short-sighted to dismiss content because of form.

Yes, there are problems, and what are the "problems"? This guy believes those problems include MD arrogance, improper care of patients, etc. It sounds like you believe that these problems either don't exist, or exist at acceptable levels. (Correct me if I'm wrong.) I'm basing this assumption on your responses to MD arrogance and patient care issues. And, if you believe that, that's fine.

However, I would argue that these factors contribute to the dehumanization of both patients and students. And, as we've had drilled into our heads (right or wrong), a patient's biggest issue with seeing an MD is the fact that they don't feel like they are being treated as a person. Based on that alone, I believe this means the problem of dehumaning patients is beyond acceptable levels.

The argument that "hey, there's problems everywhere, what can you do?" just doesn't wash. What can you? Demand that your peers and other MDs treat patients more as people. Find some other creative outlet. (I don't have the answer myself.) The fact that the world is ripe with problems doesn't give licence to be complacent in your corner of it. Especially, especially, when you are responsible for the lives of others.

To be clear, I'm not defending this guy's rhetoric, I'm trying to indicate that there may be valid points contained in the text.

Again, it's unreasonable to dismiss content because of form.

I'm dismissing his content because I think he's got the wrong content. That is, not only do I think he's a whiny bitch, but I think he's whining about the wrong things entirely.
 
Sigma said:
In the end, his presentation of his experiences are probably overly dramatic.
However, do you honestly believe that:
1) Med students aren't belittled / treated poorly?
2) MDs aren't arrogant?
3) There aren't problems with the way patients are treated?
4) There is already enough "care" in our health care system?
5) MDs don't make sexist/racist comments?

Most of your comments (along with many other people) don't address his complaints. (So much for the line "don't judge a book by its cover".)

Detractors here are saying that he's too liberal, he's just a burnout, he needs to get a life, or he's got a holier-than-thou attitude. Is this true? Maybe, maybe, maybe, and probably.

Regardless, is it really so bad to hear what could be going wrong? Is it really so bad to have someone stand up and say that there are problems and they need addressing?

For whatever it's worth, I emailed a few (5) med students here at UCSF who are in their 4th year and asked them what they thought about this. All of them thought he was overly dramatic, but none of them disagreed with the points he brought up.

If these points are valid (regardless of how hyped they are), then some change is needed. Change can only occur when a problem is recognized.

In the end, I don't see what's wrong with that.

I certainly believe that there are problems in medicine and that it is worthwhile to address them. However I do not think that our "author" here has written about them in an evenhanded or reliable way. His abilities as a journalist leave a lot to be desired. He's not only biased, he's downright deluded in some ways and just plain annoying in others. I agree with you that problems need to be recognized, but there has to be a standard for what constitutes quality reporting and worthwhile debate. In my opinion, it's just not worth it to read more of what this guy has to say. But if you're into it, by all means go ahead.
 
Wait until some of you meet some of the real winners we have as patients. If doctors occasionally speak disrespectfully about patients among themselves it is because they are frustrated at the apparent unconcern many people have for their own health. This unconcern ranges from not feeling it necessary to take 10 bucks out of their beer and cigarette money to buy their HCTZ to engaging in all kinds of high-risk and frankly stupid behaviors.

Today I had a patient who had a BKA ten years ago. Silly me, I asked him how he lost his leg and he said he didn't know. "Gangrene? Vascular Problem? Trauma?" He didn't remember.

Folks this guy was completely lucid, reasonably intelligent, and AAOx3. If I so much as lost a finger I'd remember every detail about it until I died. This guy lost a leg and couldn't even be troubled to remember why.

So don't get all "Patch Adamsy" on us.
 
Panda Bear said:
I agree with you, but never-the-less I found his book to be compelling reading. Absolutely fascinating from a freak-show perspective.

I am certainly not offended by anything the author says. It is obvious that he is poltically somewhat to the left of Karl Marx but that's fine with me too. I'm sure if we sent a Klansman to medical school he would produce something as equally inflammatory but from a different perspective.

Another medical school "tell-all" I thouroughly enjoyed was "Patch Adams." I like it even better now that I am almost done with medical school and can laugh and hoot at the more ridiculous parts of the movie. You guys should really watch that movie before you go to medical school, then watch it in fourth year and see how your perspective has changed.

As a gun-toating liberal -- yes we do exist -- I would prefer that just because somebody is a mentally challenged nim-wit who wraps himself in self-righteous indignation that they not be used as excuse to slander the rest of us liberals. To be clear calling this @ss a liberal, slanders the rest of us liberals, I'm not saying that anyone is purposefully trying to slander us. Did that make any sense? It just irritates me to lumped in with this crank.

From what little I know of Patch Adams, the man, the movie probably did capture his perspective of medicine -- just not the reality of medicine. In a way it was like an op-ed piece. I think a more realistic perspective would be Scrubbs crossed with an internal monologue tone of House.
 
getunconcsious said:
Thanks a lot, that is actually really helpful! Cuz the alternative I was debating over was graduate school. But I think I'll stay with my initial plan since med school seems like it would be more interesting and rewarding. Thanks for the advice, and best of luck with the match! 🙂

Or you could try the MD/PhD thing too. Personally I found graduate school to soul-numbing, but that had a lot to do with who my PI was. Many people find this a really good combination. But if you think you want to be involved in research later on then, IMHO, some graduate school would be helpful. Medical school does not do a great job of teaching people how to be researchers -- that isn't its purpose. Any case, it was just a thought. Good luck.
 
Sigma said:
The argument that "hey, there's problems everywhere, what can you do?" just doesn't wash. What can you? Demand that your peers and other MDs treat patients more as people. Find some other creative outlet. (I don't have the answer myself.) The fact that the world is ripe with problems doesn't give licence to be complacent in your corner of it. Especially, especially, when you are responsible for the lives of others.

To be clear, I'm not defending this guy's rhetoric, I'm trying to indicate that there may be valid points contained in the text.

Again, it's unreasonable to dismiss content because of form.

Have you read the book Complications? It is from a surgery perspective but I think it is a much more realistic perspective. And if you want to read about dehumanization in medicine than try House of God. As I have said above, a lot of things have changed, but I've gone to be bed in a call room with the jack hammers of the wing of zock vibrating my oscicles :laugh: I guess there is enough wrong, and enough right with our healthcare system that hysterics just doesn't help any one.
 
One important note to bear in mind. Some of you are saying "but I'm a 3rd year and this isn't happening now."

This book wasn't written last year. Things have changed. F*cking duh.
 
As a 4th year med student, I can say alot of what was written in "Heart Failure" is true. But the tone and sentiment is exaggerated. For instance, it is true that students often practice gyn exams on anesthecized patients without getting permission beforehand. But frankly, I personally dont think thats morally wrong, hey we're students we gotta learn somewhere and these are teaching hospitals. But that is a whole 'nother debate.

I found the account to be very entertaining. Dont discount the content, alot of it is true and its very well written. However, the author is super sensitive and took things way too personally. And as Panda said, he didnt present the other side of the story; the side that shows how pathetic many patients are.
 
scootad. said:
As a 4th year med student, I can say alot of what was written in "Heart Failure" is true. But the tone and sentiment is exaggerated. For instance, it is true that students often practice gyn exams on anesthecized patients without getting permission beforehand. But frankly, I personally dont think thats morally wrong, hey we're students we gotta learn somewhere and these are teaching hospitals. But that is a whole 'nother debate.

Then your med school is just waiting to get its butt sued. Gyn exams on unconcious patients is a politcal football right now. At my institution the only people who do exams on unconcious patients are medical staff who are scrubbed in and listed as taking part in the proceedure, e.g. attending, resident, med student. If there is a second student observing, he/she does not perform an exam. Of course this is only in the case of Gyn surg patients. If the proceedure is not a gyn proceedure than nobody has any business being in the neighborhood.
 
Furrball said:
Have you read the book Complications? It is from a surgery perspective but I think it is a much more realistic perspective. And if you want to read about dehumanization in medicine than try House of God. As I have said above, a lot of things have changed, but I've gone to be bed in a call room with the jack hammers of the wing of zock vibrating my oscicles :laugh: I guess there is enough wrong, and enough right with our healthcare system that hysterics just doesn't help any one.

Thanks for the references. I'm actually interested in reading some perspectives that may be more balanced.

I agree that hysterics doesn't help. And, when pointing out what's wrong, I certainly wouldn't point to the perspective found in Heart Failure. However, I still contend that his points about the degree of callousness (sp?) and ambivalence found in health care is a problem.
 
Yeah but do you or your resident verbally ask the patient if its ok for the student to practice their gyn exam on them before the procedure, even if they are "listed"? I doubt it. Even if you personally did, do you really believe all students in your class much less across the country do the same? No way jose.

And do you think the patients are aware beforehand that students will be practicing their gyn exam on them during the procedure even if their name is listed to them on some form they probably dont read? Hell no.

Do I personally think this is wrong? Hell no. This is medical school. We have to learn this stuff.
 
pushkin said:
I certainly believe that there are problems in medicine and that it is worthwhile to address them. However I do not think that our "author" here has written about them in an evenhanded or reliable way. His abilities as a journalist leave a lot to be desired. He's not only biased, he's downright deluded in some ways and just plain annoying in others. I agree with you that problems need to be recognized, but there has to be a standard for what constitutes quality reporting and worthwhile debate. In my opinion, it's just not worth it to read more of what this guy has to say. But if you're into it, by all means go ahead.


I like the way you said this. If your complaint is that his take is too biased to be any more of your time, that's completely legit. (And I don't disagree with you.)

My concern is that many people who've given input are denying these problems exist and pointing to his bias as evidence that the problems don't exist.
 
scootad. said:
As a 4th year med student, I can say alot of what was written in "Heart Failure" is true. But the tone and sentiment is exaggerated. For instance, it is true that students often practice gyn exams on anesthecized patients without getting permission beforehand. But frankly, I personally dont think thats morally wrong, hey we're students we gotta learn somewhere and these are teaching hospitals. But that is a whole 'nother debate.

Oh my God. You must be male, right? As a woman, that thought makes me uncomfortable to the point of never having surgery in a teaching hospital. That is such a huge invasion of privacy.

[Also, med students generally learn to do gyn exams on 1) people hired for that purpose, as 1st/2nd years, and 2) during their gyn rotations. ]

EDIT: post edited to save the writer from much embarrassment
 
beastmaster said:
One important note to bear in mind. Some of you are saying "but I'm a 3rd year and this isn't happening now."

This book wasn't written last year. Things have changed. F*cking duh.


And some things haven't changed.

Like I said earlier, I sent the Heart Failure link to 5 4th years here at UCSF. They all said the problems are still rampant. This is at SF General, and Moffitt. Moffitt, with their big "One of the Top 10 Hospitals in the Nation" banner after the USNWR rankings came out.
 
If you think that is bad, during rectal clinic we had the resident prep the patient (with patient in a face down/prone position) and then the attending and a group of 5 of us medical students come in (I believe without the patient knowing we were there) and one by one each of us would practice the rectal on that patient. As soon as we finished, we walked out of the room and the resident finished counseling the patient.

Those patients were not even under anesthesia!
 
scootad. said:
If you think that is bad, during rectal clinic we had the resident prep the patient (with patient in a face down/prone position) and then the attending and a group of 5 of us medical students come in (I believe without the patient knowing we were there) and one by one each of us would practice the rectal on that patient. As soon as we finished, we walked out of the room and the resident finished counseling the patient.

Those patients were not even under anesthesia!

I don't see that as quite as bad, because the person is there for a rectal exam to begin with. It's not so great for the patient, and it would be better a different way, but again, the patient has consented to a rectal exam. In this case, it is understandable from the point of teaching students. So, when I go to by ob/gyn, and I have an exam from a student, or even two, and then the doctor, I'm okay with that, because it's a teaching hospital, and I've consented to the exam. This is quite different than being examined under anesthesia, with no consent, by people the patient can't even see or know about.
 
http://www.charlotte.com/mld/observer/living/health/5467501.htm

N.C. schools: Pelvic exams not gratuitous

KAREN GARLOCH

Some women expressed disgust over recent news reports about the little-known practice of medical students performing pelvic exams on women, without their consent, while they're under anesthesia.

The discussion started with a February article in the American Journal of Obstetrics and Gynecology that reported on student views about the practice at five medical schools in Philadelphia.

The article's authors included a former University of Pennsylvania medical student who had objected to doing the exams without getting consent from patients.

Some readers came away believing that multiple students perform pelvic exams, solely for practice, on women anesthetized for surgery of any kind. They were bothered by the potential for abuse.

After talking with doctors at North Carolina's four medical schools, I'm more comfortable the practice isn't done gratuitously by students honing their beginners' skills on unsuspecting, unconscious females in the operating room.

Medical school faculty at Duke University, UNC Chapel Hill, Wake Forest University and East Carolina University said students do perform pelvic exams, but they aren't done on anesthetized women undergoing just any surgery, only gynecological surgery.

Doctors emphasized such exams are always done under anesthesia before gynecological surgery; they aren't simply added to give students experience. Also, they said, pelvic exams aren't done by multiple students, only the one -- or sometimes two -- on an ob/gyn patient's care team.

"We have never endorsed a patient being asleep and just multiple people doing pelvic exams," said Dr. Wesley Fowler, director of gynecologic surgery at UNC Chapel Hill. "Students do do pelvic exams under anesthesia because that is their patient, and it is related to that patient's care."

Dr. Alison Weidner, chief of the division of gynecology at Duke, said students perform exams only if they're part of a patient's care team.

"I don't think it's a common practice or even considered acceptable to gratuitously bring in other (students) who aren't integrally involved in the patients' care," she said. "That just doesn't occur."

Relief from pain

Weidner and others said it is important to get pelvic exams while patients are anesthetized, to make sure findings match those of exams done when patients were awake."The pelvic exam is very different in the unanesthetized person than it is in somebody who's anesthetized and pain-free," said Dr. Edward Newton, chairman of ob/gyn at ECU.

"Somebody with an ectopic pregnancy, it's sore and hurts. They tighten up and you don't get as good an exam. When they have complete relief of their pain, you can really feel what's going on there. There are times, actually frequently, that the surgery may actually be changed on the basis of the exam (under anesthesia)."

In teaching hospitals, a patient's care team includes med students and residents. Patients often will have met each team member, but not always.

Like other doctors, Weidner said she talks with patients, before surgery, about the need to do an exam under anesthesia, but she doesn't get specific written consent for a medical student to perform it.

Because Duke is a teaching hospital, she said, "patients who come to see me understand that ... in many cases medical students are going to be part of their care team."

Fowler said he doesn't ask a patient specifically to allow a medical student to perform a pelvic exam, just as he doesn't get consent every time someone draws blood.

"That's part of your care," he said. "When all else fails, use a little bit of common sense. That's what we try to do. Respect the patients."

Privacy and dignity

Dr. Joseph Ernest, acting chairman of ob/gyn at Wake Forest, said pelvic exams under anesthesia played a larger role in diagnosis before the advent of accurate imaging techniques, such as ultrasound and CT scans.

Today, he said, students learn gynecological exams primarily by working in school-affiliated clinics or by working with paid volunteers. All four N.C. med schools pay volunteers to allow students to perform pelvic exams while they're awake.

What bothered Newton about the recent publicity was that it suggested doctors were physically abusing patients.

"When they go to the operating room, I'm a real stickler. All the windows are covered. We face the operating table away from the door. There is always a woman in the room.

"I think there's a cultural sensitivity to these things, especially in ob/gyn," he said. "You need to protect privacy and dignity. We try to do that."

One female doctor in Charlotte, who asked not to be named, said she never thought of the exams, even without specific consent, as harmful.

She suggested patients have "much more important things to worry about in medical care," including whether they are getting correctly diagnosed or whether their doctors and nurses are communicating with each other.
 
Okay, now see that's not so bad. I don't have a problem with that. The original poster on the issue made it sound as if they were doing these exams on people anesthetized for surgery completely unrelated to gyn. If you're going in for gynecological surgery anyway, having a student do an exam seems basically the same as having it done in a regular gyn checkup, like I said before.

scootad, were you talking about only ob/gyn procedures, or others as well? Because if the former is true, I sound like an idiot for getting so upset. If the latter, I would still be upset.
 
I was referring to gynecological procedures. I agree that it would be very sketchy for unrelated procedures, I've never heard of that happening.
 
tigress said:
The original poster on the issue made it sound as if they were doing these exams on people anesthetized for surgery completely unrelated to gyn.

:idea: Maybe he is trying to sensationalize things, or perhaps is overly sensitive.
 
Um, okay, so now I'm somewhat ashamed of my earlier posts. I'm considering deleting them but then parts of this thread would make no sense. But yeah, sorry about that...I'm just overly emotional today I guess.
 
no problem. I guess we werent exactly clear in what we were discussing. But there are people out there who think its even wrong for students to practice gyn exam on a pt undergoing gyn surgery (like presumably the author of "heart failure")
 
scootad. said:
no problem. I guess we werent exactly clear in what we were discussing. But there are people out there who think its even wrong for students to practice gyn exam on a pt undergoing gyn surgery (like presumably the author of "heart failure")

And this nurse association ...

http://www.awhonn.org/awhonn/?pg=872-2100-15710-10520

March 13, 2003
Wall Street Journal

March 13, 2003

To the Editor:

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) would like to respond to a recent Wall Street Journal article regarding the practice of performing pelvic exams without consent on women who are under anesthesia. It was with great surprise and dismay that we read the article, "Using the Unconscious to Train Medical Students Faces Scrutiny" (March 12, 2003) - surprise that this procedure was ever considered an acceptable practice, and dismay at the lack of unilateral and forceful condemnation of the practice by all OB/GYNs, hospital administrators, and representatives of institutes of higher learning who train medical doctors.

AWHONN, a membership organization of 22,000 nurses, is dedicated to promoting the health of women and newborns. AWHONN members are registered nurses, nurse practitioners, certified nurse midwives, and clinical nurse specialists who work in hospitals, physicians' offices, universities, and community clinics across North America as well as in the Armed Forces around the world. As a nursing association committed to advancing the health of women and newborns, we recognize that women have a right to expect that they will be informed of any planned procedures while they are under sedation, that they will know who will be performing such procedures, and that they will have the option to decline a pelvic exam by a medical student that is unrelated to their primary reason for being there.

It is an abuse of patient rights, as well as patient-physician trust, to perform any procedure or exam without consent, especially an exam that many women consider personally invasive. Make no mistake: an "overall consent form" filled out with other routine forms at the time of admission is no substitute for explicit, informed consent for a pelvic exam by a medical student while under sedation - teaching hospital or not. Modern medicine cannot allow a practice that allows physicians-in-training to perform unapproved procedures on unconscious women, even towards the positive end of increasing medical skill. In fact, we can thank the medical students who felt uncomfortable performing these exams when consent was questionable, both at Harvard Medical School and the University of Toronto, for bringing this troubling practice to light.

The fact that some doctors defend [the practice] as harmless and say asking for consent would make it more likely that patients would say no only emphasizes the need for a patient's considered response. The fact that physicians know that some women may be uncomfortable with the practice does not defend its use; rather, it articulates the necessity of informed choice. Besides, fears that asking for consent would reduce the number of women who would agree to have the procedures performed may be unfounded. The study's author indicated that research shows many women wouldn't object to being examined by students anyway. Medical colleges, hospitals, and OB/GYN instructors should immediately implement procedures to ensure that all women have the opportunity to give or refuse consent before medical students perform a pelvic exam while they are unconscious. The students themselves have recognized this; those charged with their instruction should do the same.

Sincerely,

Gail G. Kincaide

Executive Director
 
I didn't mean to attack the author of the book, I think he's actually a very good, empathetic person. I don't see him as randomly whining, and I don't take issue with his politics. I was just wondering whether or not medicine really is that atrocious. I didn't have some happy sunshine-and-rainbows view of it, but I think it's fair to say that the book posits that nearly ALL doctors are completely unempathetic and only in it for the money, and that they treat patients like crap and then lie about deliberately just to get ahead.

I suppose that the book just caught me at a bad time, since I was already deliberating about research vs. medicine, and it just added to my own personal confusion. Perception is not necessarily rooted in reality--neither mine nor the author's.
 
Let me get this straight: For a vaginal hysterectomy, the surgeon mobilizes the cervix and basically pulls the uterus out through the vagina, essentially turning the woman inside out. And yet you guys get all worked up at the idea that the patient is being violated because a medical student sticks his fingers in beforehand to appreciate some anatomy?

Dudes, girls, folks. DREs, pelvics, and other invasive examinations are not "violations" in any sense of the word. They are necessary parts of the physical exam. I appreciate that these procedures make patients uncomfortable. Heck, I have had several DRE in the past four years and I can't say I enjoyed it.

On the other hand I was pretty sure that my urologist was not getting her jollies sticking her finger up my rectum.

In other words, its just business, not "the business." I sense a little immaturity here. You are not being "naughty" examining a patient. In fact, let me confess that in two years I have only seen one OB-Gyn patient who I would say was even remotely attractive and for whom anybody would have had impure thoughts. For our patients to insist that they not be "violated" is one thing. We need to respect their wishes. It is another thing for you, as future physicians, to buy into the premise that they are being violated.
 
Skimmed it. Here's one part that caught my eye (from the Internal Medicine section):

more interest in social change than in clinical practice
What the heck is that supposed to mean? Last I heard, doctors were supposed to cure sick people, not bring down The Man. The guy (it is a guy, right? He sometimes sounds more like a whiny feminist) sounds like he'd be better off quitting med school, growing long hair and a beard, ceasing regular bathing, and protesting with PETA.
 
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