Kind of messed up.

[LuciusVorenus]

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http://www.theunnecesarean.com/blog...-perform-pelvic-exams-on-anesthetized-pa.html

 

[deleted325463]

:/

 

[eldoctor]

Very interesting read. As usual, there are reasonable arguments from both sides...

 

[leixample]

If you read the reddit comments, many people mention that this isn't the case in most institutions and it's pretty clear from the title of the blog that the writer isn't exactly unbiased 🙂

Then again, it's probably worth reading just in case one of us does have to face that sort of situation in the future..

 

[theWUbear]

Then again, it's probably worth reading just in case one of us does have to face that sort of situation in the future..

👍

 

[nopressure]

nobody in my year was allowed to perform a pelvic examination without a signed consent form from the patient; we had to go early and explain the procedure and our role as students ourselves. a few women say no, but most were fine with it when i asked. as long as you're polite and honest, most patients are happy to be part of the learning process for students.

i disagree with the article saying you will learn nothing. there's a lot you can learn because you are less worried about harming/embarrassing the patient and there is a greater opportunity to ask questions. yes, it's not the same as when the patient is awake, but it's still a good way to practice, get familiar with the equipment and feel more prepared when you actually do it on an awake patient.

edit: should add, i think it is best to get consent from the patient. while i'm sure some people would not mind on this forum, i think a lot of people would like to know what happens with their body even when they are anaesthetised.

 

[gravitywave]

Very interesting read. As usual, there are reasonable arguments from both sides...

it's no longer considered reasonable to practice unnecessary procedures on unconscious patients without informed consent. my understanding is that the prevalence of this practice in American medical education has declined precipitously in recent years. it's plainly unethical by modern standards.

note that the interview with Dr. Greger is from 2003, i think there's been changes a lot of places since then.

i just started, but i'm pretty certain it isn't done here. if i found that it was, i'd go straight to the top about it.

 

[eldoctor]

it's no longer considered reasonable to practice unnecessary procedures on unconscious patients without informed consent. my understanding is that the prevalence of this practice in American medical education has declined precipitously in recent years. it's plainly unethical by modern standards.

note that the interview with Dr. Greger is from 2003, i think there's been changes a lot of places since then.

i just started, but i'm pretty certain it isn't done here. if i found that it was, i'd go straight to the top about it.

I agree, and while I also like to consider myself as somebody that would go straight to the top about something I feel strongly about, it's easier said than done. Especially when 'going to the top' means confronting the very people who are teaching you and telling you to do these exams. I think the reason this practice is being phased out is that the older generation of MDs who supported it is retiring. The younger MDs I think are probably more likely to have different views that align more closely with ours.

But then again, I might just be making **** up.

 

[45408]

Holy melodramatic.

When you say a team, how many people do you mean?

That depends. There's the attending, a few residents, an intern and then as many medical students as they can round up.

However, I'm less concerned about interns and residents. They are doctors that have a role in that patient's care, so doing a pelvic exam might be useful for them. But for medical students, no one even pretends it's about the patient. Patients are strictly tools for our education. There's no thought that there's any benefit to the individual patient when medical students are just lining up in there.

When you were a medical student, did all your classmates perform non-consensual pelvic exams on women?

Yes, particularly the male students practiced pelvic exams on anesthetized women. As of last year, which was the last time I checked, they still do.

What bull****. I've never been in any gyn case with more than one med student and one resident. It's very educational to do one on a sleeping woman, because you can actually push harder to feel for pathology and normal findings. The consent they signed for surgery is pretty all-encompassing in terms of allowing this sort of thing. Nobody ever reads the consent though, even though it clearly says that students and residents will be involved in the surgery.

The "especially male" students line is just fear-mongering. Every gyn case we did had a pre-op bi-manual exam, and the student's gender was irrelevant.

Are there ways for student to learn how to perform pelvic exams other than on non-consenting women?

Yes, there's a surrogate program that pays volunteers. If you contact a chairperson at an OB/GYN department or medical school they will tell you all about the surrogate program if they have one. What they won't tell you is that in addition to the surrogate program they still carry out this practice. At [omitted], second year students practiced on a surrogate. That's how I learned how to do it. But then in my third year on my OB/GYN rotation I performed pelvic exams on unconscious patients. Women would come in for appendicitis or something. Then, once they're asleep, the crowd gathers, line forms to the left.

That's funny, why would the OB/gyn be doing an appendectomy? 🙄

What if you don't trust your doctor?

Women can write on their bikini line, "I do not give consent for medical students to practice pelvic exams on me" in marker. Then as soon as the clothes come off or the robe is lifted and all the medical students are getting on their latex gloves they can see that message. And that will stop them.

I was inspired to think up this tip because of patient advocates like Bernie Siegel, M.D., who recommend that patients use a magic marker to write "Wrong leg" or "Wrong arm" on their healthy body parts to prevent them their doctor from performing surgery on the wrong limb - a common mistake.

common?

i just started, but i'm pretty certain it isn't done here. if i found that it was, i'd go straight to the top about it.

It probably is done at your school (by ONE student and resident) before a gynecological case, and you probably won't do anything about it.

 

[katiemaude]

I've been introduced to residents and once, a PA student, over the years by various doctors and always allowed them to sit in on the consultation, get a patient history from me, and even repeat the procedure for their education with no benefit to me. However, a pelvic exam is a pretty uncomfortable thing. (Men, you have no idea unless you've visited a proctologist.) You are in a very vulnerable position (even if you're not conscious at the time).

That said, if I was introduced before the exam and asked to allow a repeat pelvic by a resident or even a medical student, I'd probably say yes. I've had at least 20 of them in my lifetime. I can wince through another. I'd also let them know if he/she was hurting me, because that's important information.

Would every woman agree to this? Maybe not a 18-year-old getting her first pelvic. An older woman - say, one who's had 3 babies - would be more used to people looking at her hooha and might agree.

So undoubtedly you will get some no's. But I bet you'd get a lot of sure, why nots.

The idea of my doc doing this without my knowledge is HORRIFYING. Amazingly, this never occurred to me that the times I've been under the knife, this could be going on without my informed consent. I will never, ever have scheduled surgery again without bringing this up. Yes, if a resident wants to participate in the surgery, I'm OK with it. But a pelvic that has nothing to do with my treatment? Wait til I wake up, and then let's talk.

I don't care if some med student, male or female, is so intimidated he or she is more comfortable doing this on an unconscious person the first few times. It's not about the student's comfort.

 

[gravitywave]

Holy melodramatic.

I actually read Dr. Greger's book, he went to Tufts in the 1990's. He IS a bit of a bleeding heart; I seem to recall another anecdote where he fights the power in the peds ward by wearing flippant ties. His attendings dress him down and mark him up, but he doesn't budge!!!! It doesn't seem as though he was cut out for medicine; he doesn't currently practice. By the way that the book ended, I'm not sure that he ever did.

It probably is done at your school (by ONE student and resident) before a gynecological case, and you probably won't do anything about it.

Thanks for your input on my character. I'm not out to change the world but I do know what my ground rules are. I'm confident I'd know what to do if I was in this situation as a student.

 

[vickpick]

how the efff else are we gonna learn? people like love to plant the seed of doubt in others' minds..

 

[RogueUnicorn]

how the efff else are we gonna learn? people like love to plant the seed of doubt in others' minds..

by asking? this is a serious breach of trust.

 

[45408]

Thanks for your input on my character. I'm not out to change the world but I do know what my ground rules are. I'm confident I'd know what to do if I was in this situation as a student.

So if you were scrubbing into a vaginal hysterectomy for fibroids after meeting the patient in pre-op and reading about the case, and the patient has been anesthetized, and your attending said "Why don't you do a pelvic exam to feel these fibroids?" you would say no? Because that's the real-life situation in which these exams happen. There isn't a line of students extending into the hallway waiting to do these (and if there is, I've never heard of it).

 

[45408]

But a pelvic that has nothing to do with my treatment? Wait til I wake up, and then let's talk.

Melodramatic blog entry aside, I've only ever seen pelvic exams done that are completely relevant to the procedure at hand.

by asking? this is a serious breach of trust.

All those words on the informed consent are there for a reason. If you just go "tl;dr" and sign it, then you still consented.

If you made a blog entry about the average surgery, a lot of people would be mortified about what happens. You're stripped naked and propped into embarrassing positions in an operating room with glass windows into the hallway as people walk in and out with supplies and such. I've got a friend who had her gall bladder out, and she was shocked to hear that standard procedure is to prep the patient from nipples to pubis. She pretty much envisioned that her only her belly had been exposed.

 

[nopressure]

All those words on the informed consent are there for a reason. If you just go "tl;dr" and sign it, then you still consented.

that's not the policy at my medical school. there are specific forms which the students must ask the patients to sign. otherwise, we must document it in the notes in some fashion with the patient's signature. the official line is we are not to perform such examinations without consent. nobody in my year had a problem with this rule; it just seemed like common sense.

of course, i'm sure the situation you describe still happens at some placements and students will do as they're told.


i agree that the original article is *****ic on several different levels, but i don't think it is too much to expect students to gain consent. it's more ethical, most patients will say yes and the only real excuse is laziness.

 

[gravitywave]

So if you were scrubbing into a vaginal hysterectomy for fibroids after meeting the patient in pre-op and reading about the case, and the patient has been anesthetized, and your attending said "Why don't you do a pelvic exam to feel these fibroids?" you would say no? Because that's the real-life situation in which these exams happen. There isn't a line of students extending into the hallway waiting to do these (and if there is, I've never heard of it).

i've made my position clear. i've stated that i was opposed to "unnecessary procedures on unconscious patients without informed consent." This thread concerns such a procedure, as outlined in the blog post mentioned in the OP. I honestly don't know whether or not the situation you describe qualifies as such. Is the exam considered a routine part of the procedure you describe?

Melodramatic blog entry aside, I've only ever seen pelvic exams done that are completely relevant to the procedure at hand.

All right, then. The discussion I was responding to, as i understood it, was regarding the practice of asking medical students to perform pelvic exams on anesthetized patients in the course of treatment where such an exam isn't warranted. Is it really difficult to believe that this was once a more accepted practice than it is now, even on women who were having surgery for reasons completely unrelated to OB/GYN? It sounds to me like it was seen as a great way for students to practice their exam skills, with a sort of "It's there, have at it!" attitude. Patients were once treated far more as physicians' property than they are now.... perhaps you are familiar with the story behind HeLa cells?

So maybe we are talking about different situations. I for one wouldn't be so quick to dismiss Dr. Greger's story, given the history of the medical profession. Sure he's melodramatic, but just because you haven't ever witnessed this practice personally doesn't mean that he didn't, even just ten years earlier than when you were a student.

 

[Geekchick921]

I was just getting into with some of my mom friends about this exact post yesterday. I do sometimes like the posts on that site (personal experience :/ ) but I agree that this is very melodramatic. There was another post about it where the word "rape" was dropped so many times my eyes nearly rolled out of my head. I wish I was kidding.

The reality is that things like this are typically encompassed in a surgical informed consent form. If you didn't read all of it or didn't ask questions when given the opportunity, and signed that you understood it all and gave the doctor your informed consent, well...

That said, while I personally don't think it's a big deal, especially since, like Prowler said, you receive a pelvic anyway before a procedure where it's relevant, I do think they should obtain more explicit consent. Surveys have shown that the majority of women would expressly agree to being examined by residents and medical students while under anesthesia. They are just squicked out by the thought of it happening without it being specifically mentioned beforehand.

 

[45408]

i've made my position clear. i've stated that i was opposed to "unnecessary procedures on unconscious patients without informed consent." This thread concerns such a procedure, as outlined in the blog post mentioned in the OP. I honestly don't know whether or not the situation you describe qualifies as such. Is the exam considered a routine part of the procedure you describe?

Is feeling the uterus a routine part of removing the uterus? Yeah, I'd say so.

All right, then. The discussion I was responding to, as i understood it, was regarding the practice of asking medical students to perform pelvic exams on anesthetized patients in the course of treatment where such an exam isn't warranted.

Dr. Dramatic even said that it happened only in OB/gyn, in which pretty much everything is relevant to a pelvic exam.

Is it really difficult to believe that this was once a more accepted practice than it is now, even on women who were having surgery for reasons completely unrelated to OB/GYN?

Unless you know it happened in the past, I don't see why you would think it was safe to assume that's what happened. Either way, no, I don't think a line of students examining a patient is acceptable, but it doesn't happen anywhere I've ever been.

 

[RogueUnicorn]

All those words on the informed consent are there for a reason. If you just go "tl;dr" and sign it, then you still consented.

If you made a blog entry about the average surgery, a lot of people would be mortified about what happens. You're stripped naked and propped into embarrassing positions in an operating room with glass windows into the hallway as people walk in and out with supplies and such. I've got a friend who had her gall bladder out, and she was shocked to hear that standard procedure is to prep the patient from nipples to pubis. She pretty much envisioned that her only her belly had been exposed.

i've read all the consent forms and the ones i've seen have always mentioned students/residents in the context of care. It's one thing if a pelvic is related to the procedure, but if it's completely unnecessary/irrelevant to whatever procedure is supposed to be performed, then i think that's a problem.

 

[45408]

i've read all the consent forms and the ones i've seen have always mentioned students/residents in the context of care. It's one thing if a pelvic is related to the procedure, but if it's completely unnecessary/irrelevant to whatever procedure is supposed to be performed, then i think that's a problem.

Even the blog article was about a student doing a pelvic on a patient getting a D&C.

The quoted interview from Dr. Greger said:

If you're anesthetized and you're in the OB/GYN department, you probably have had students practice pelvic exams on you regardless of what you're in the hospital for - even if the procedure you need doesn't require a pelvic exam!

What OB/gyn surgical procedure doesn't involve a pelvic exam? I can't think of any.

He then contradicts himself anyways:

Additionally, while doctors don't go to other departments — such as general surgery patients, neurosurgery patients or cardiac surgery patients — if your surgeon is an OB/GYN, odds are there's going to be a team of hungry medical students waiting for you to fall asleep.
.....
But then in my third year on my OB/GYN rotation I performed pelvic exams on unconscious patients. Women would come in for appendicitis or something. Then, once they're asleep, the crowd gathers, line forms to the left.

Where are the OB/gyns doing appendectomies on an M3 OB/gyn rotation? I'm not buying it (a gyn-onc doing an incidental/indicated appy during another abdominal procedure doesn't count, because it's not the primary/only procedure).


None of the examples have indicated anyone doing any exam not related to the procedure.

 

[LuciusVorenus]

If I was a woman and I was going in for surgery after reading this, I'd just leave a little vial up there with a note in it that said "Consent or GTFO".

It's not really about doing the exam while the person is asleep, related or not. It's because they don't ask consent. Honestly, I wouldn't mind if I was stripped naked on an operating table, but I would mind if someone was giving me a prostate exam while I was asleep without my consent. I'd say yes if they asked me, so why not just ask?

 

[Robot Unicorn]

Wow, some of you guys just have no perspective about how the patient would feel about this. Sure, doing a pelvic exam in this fashion might be a good learning experience in some people's opinion, but I just don't see how this would make you better at giving pelvic exams. Either way you are getting to feel the anatomy, but one of the main concerns a doctor should have when giving these exams is how the patient feels. Obviously, it's going to be uncomfortable no matter what, but some doctors definitely have more finesse when doing it than others. Wouldn't you want to learn on someone who was awake and could tell you if you were hurting them or not?

Also, I am astounded at some of the comments on here about how you can be rougher or harder on an anesthetized patient. I am always sore after pelvic exams (as I am sure many women are) so I am sure it would cause more pain than necessary for them to be examined while asleep as apposed to awake. I guess it might be hard for some of you men on here to understand, but think about it this way; would you want to be poked and prodded during a prostate exam rougher than necessary? Mind you, that pelvic exams don't always just stop at the vagina as doctors sometimes have to go through the "back door" to feel for the ovaries and such. I would be totally fine with an exam being done on me when I am awake, but it just seems like it being done while asleep doesn't really provide much benefit and would just end up causing more pain.

 

[nopressure]

I would be totally fine with an exam being done on me when I am awake, but it just seems like it being done while asleep doesn't really provide much benefit and would just end up causing more pain.

how would you know what is or is not useful to a medical student? you aren't one. with your logic people may as well never practice a single procedure on models either. the pelvic examination is only done if appropriate; doctors don't care so much about their students' education that they'll ask students to do unnecessary examinations in a surgical theatre. the whole article is rubbish, don't listen to it.

these patients are having a surgery in that area; larger and nastier instruments are entering anything you feel or use for examination. the pain they feel is not going to be from an examination, it's going to be from their surgery.

 

[katiemaude]

I'm not going to venture a guess on what is real and what's exaggerated in the article, because I'm just a premed and this is the first time I've heard of this.

The point is, if a pelvic before surgery is part of the procedure, and the patient consents to having residents and/or medical students involved in the procedure, that is one thing. If the pelvic is gratuitous (as in, the surgeon wouldn't have done one at that point), and/or the patient hasn't been told, I find that offensive as a woman and a human being. Having a resident/student repeat a pelvic after the surgeon for their education, with the patient's consent? OK.

Btw, I'm someone who has had major surgery and I was OK with being naked and flopped all over that OR table. If I had later found out that my body had been used as an anatomical dummy and parts accessed that had nothing to do with the surgery, I'd be pretty pissed off.

It's about respect.

 

[LuciusVorenus]

how would you know what is or is not useful to a medical student? you aren't one. with your logic people may as well never practice a single procedure on models either. the pelvic examination is only done if appropriate; doctors don't care so much about their students' education that they'll ask students to do unnecessary examinations in a surgical theatre. the whole article is rubbish, don't listen to it.

these patients are having a surgery in that area; larger and nastier instruments are entering anything you feel or use for examination. the pain they feel is not going to be from an examination, it's going to be from their surgery.

You obviously didn't read all of what she said. Practicing on a woman who is awake has the advantage of teaching you how to make the exam as comfortable as possible. If for some reason that doesn't seem important to you then nevermind...

No matter how biased, this article isn't the only one that mentions this happening, so whether it happens at your school or not, it's obviously common enough for the AMA to make a statement.

An instrument being used during surgery is completely different from having a group of medical students use you as a test dummy without getting your consent. I don't understand why you think it's such a terrible idea to just ask the person explicitly?

 

[nopressure]

luciusvorenus, i've adressed your concerns in my previous posts. read them.

You obviously didn't read all of what she said. Practicing on a woman who is awake has the advantage of teaching you how to make the exam as comfortable as possible. If for some reason that doesn't seem important to you then nevermind...

stupid strawman. do students who practice taking blood on a model not care about keeping their patients comfortable? oh that's right, they also practice on real patients!

No matter how biased, this article isn't the only one that mentions this happening, so whether it happens at your school or not, it's obviously common enough for the AMA to make a statement.

An instrument being used during surgery is completely different from having a group of medical students use you as a test dummy without getting your consent. I don't understand why you think it's such a terrible idea to just ask the person explicitly?

i've made my position clear. i don't believe there is an excuse not to gain consent for this examination. it's in my first post; i agree it is ethically bad. my medical school does not allow its students to do any such thing.

you do not get groups of medical students lining up in a surgical theatre to do examinations 🙄


as i already said the article makes one valid point: students should get consent. that message is unfortunately lost in its sensationalist drivel.

 

[sustentacular]

None of the examples have indicated anyone doing any exam not related to the procedure.

The issue for me would not be is the exam related to what I'm being treated for but rather, are 2 or 3 of said exams performed without my knowledge by people who are just practicing really necessary?

But I also think the article is incredibly sensationalized because of the anatomical area it involves.. If this were about having med students palpate something in a far more innocuous area while patients anesthetized it probably wouldn't even warrant an article.

 

[LuciusVorenus]

luciusvorenus, i've adressed your concerns in my previous posts. read them.



stupid strawman. do students who practice taking blood on a model not care about keeping their patients comfortable? oh that's right, they also practice on real patients!



i've made my position clear. i don't believe there is an excuse not to gain consent for this examination. it's in my first post; i agree it is ethically bad. my medical school does not allow its students to do any such thing.

you do not get groups of medical students lining up in a surgical theatre to do examinations 🙄


as i already said the article makes one valid point: students should get consent. that message is unfortunately lost in its sensationalist drivel.

That's what we were all saying?

 

[nopressure]

That's what we were all saying?

then why did you quote me, claim i am against gaining consent and then proceed to strawman me and throw in some ad hominems?!

it's pretty obvious my posts advocated gaining consent

 

[LuciusVorenus]

then why did you quote me, claim i am against gaining consent and then proceed to strawman me and throw in some ad hominems?!

it's pretty obvious my posts advocated gaining consent

Because you were disagreeing with what she was saying (that they should get consent so they can do it while you're awake and maybe even have a better learning opportunity) so I assumed you were against it.

 

[nopressure]

i disagreed with the other aspects of robot unicorn's posts, which are unfortunately based on the terrible article: performing these examinations is useful for students, they are not performed in unnecessary cases and you do not get lines of medical students waiting.

you could have just read my other posts in the thread 🙂

 

[Bacchus]

I don't know if this was brought up, but is there any evidence of this occuring to men with regards to DREs?

 

[LuciusVorenus]

i disagreed with the other aspects of robot unicorn's posts, which are unfortunately based on the terrible article: performing these examinations is useful for students, they are not performed in unnecessary cases and you do not get lines of medical students waiting.

you could have just read my other posts in the thread 🙂

Never 😛

I don't know if this was brought up, but is there any evidence of this occuring to men with regards to DREs?

That's what I'm wondering.

 

[pianola]

hmm...they told us last week in 'orientation to pelvic exam' not to do an exam on an un-consented anesthetized patient.

that's all I really have to share right now; i'm still a 2nd year.

 

[45408]

but I would mind if someone was giving me a prostate exam while I was asleep without my consent. I'd say yes if they asked me, so why not just ask?

If you were getting surgery on your prostate/rectum, and a resident and medical student came in and introduced themselves and said they would be helping/working with the Dr. Butt, it doesn't seem quite reasonable to you that they would examine/palpate the tissue at hand?

We are NOT talking about getting a pelvic/prostate exam when you have a lipoma on your arm.

I am always sore after pelvic exams (as I am sure many women are) so I am sure it would cause more pain than necessary for them to be examined while asleep as apposed to awake. I guess it might be hard for some of you men on here to understand, but think about it this way; would you want to be poked and prodded during a prostate exam rougher than necessary?

Why are you sure?

You're about to get surgery on those parts. That's what's going to cause you pain. It hurts more to get your prostate cut out than it does to have it pushed on with a finger.

The issue for me would not be is the exam related to what I'm being treated for but rather, are 2 or 3 of said exams performed without my knowledge by people who are just practicing really necessary?

If you go to a teaching hospital, you should do so with the full expectation that you will be used as a teaching case. Is it necessary? Yes, because residents need to work on real people hundreds and thousands of times with supervision before they are out on their own. The mission statement of the hospital I work at says it will provide patient care, education and research. I don't hear anyone complaining about nursing students placing foleys in the OR on anesthetized patients, but that's just as intimate.

I don't know if this was brought up, but is there any evidence of this occuring to men with regards to DREs?

That's what I'm wondering.

I've never done a urology rotation, so I can't speak towards the prostate, but every time I've been involved in any kind of anal/rectal surgery, yes, we do a rectal exam (male or female).

It's as simple as this: if you are getting a body part operated on, and you know there are students/residents there, they will be examining it. The vagina or prostate aren't special. They're just sensational to the lay person.

 

[gravitywave]

We are NOT talking about getting a pelvic/prostate exam when you have a lipoma on your arm.

I'm not questioning your authority as a resident to know what is and is not an appropriate OB/GYN exam to be performed on unconscious OB/GYN surgery patients. I question your authority to make blanket statements saying that inappropriate exams such as could occur in the case of said lipoma patient have never occurred, anywhere, ever. Or for that matter, that they don't still occur in places that you've never been to. That's what I'm talking about, that's what Dr. Greger is talking about.

That's the really outrageous part, and the part that i think most people respond to.

Again: Dr. Greger attended medical school twelve years ago. Does your experience range this far back, to the teaching hospitals at which he received his education?

 

[nopressure]

well you learn to a pelvic examination during your gynaecology/obstetric rotation. the only time you are in a theatre will be with a gynaecologist and their gynaecology patient. to me, it seems bizarre to ever be asked to perform such examinations in another setting. equipment like a speculum may not even be present and the patient won't, err, be in the correct position.

it's also rather unusual to get large groups of students attached to one doctor and all present in one surgical theatre at the same time. why would this ever happen?

i think the simpler explanation is that the author exaggerated.

 

[LuciusVorenus]

If you were getting surgery on your prostate/rectum, and a resident and medical student came in and introduced themselves and said they would be helping/working with the Dr. Butt, it doesn't seem quite reasonable to you that they would examine/palpate the tissue at hand?

We are NOT talking about getting a pelvic/prostate exam when you have a lipoma on your arm.

Haha sure. If they said they'd be helping/working on the case, they could go crazy for all I care, I'd be out and as far as I'm concerned I just gave consent. I don't think anyone here has a problem with residents/med students doing tests on them (if you do, don't go to a teaching hospital), I think the part everyone freaked out about was the random med students who come in and "don't ask consent and start taking turns performing tests that aren't even necessary" part.

 

[bannie22]

"Additionally, while doctors don't go to other departments — such as general surgery patients, neurosurgery patients or cardiac surgery patients — if your surgeon is an OB/GYN, odds are there's going to be a team of hungry medical students waiting for you to fall asleep."


*drools*

-.-

 

[RogueUnicorn]

the hero returns

 

[Robot Unicorn]

Why are you sure?

You're about to get surgery on those parts. That's what's going to cause you pain. It hurts more to get your prostate cut out than it does to have it pushed on with a finger.

I am not saying it is going to hurt more than the surgery. First of all if it is necessary to do it while I am out, then by all means get consent, put me out, and do it.

I am saying that from personal experience (in the cases where you do not have to be out for the exam and the only reason they are only doing it while you are out is so you don't find out), if I had not been awake during my pelvic exams, there would have been no way for the doctor to know when to stop and it would have been ridiculously more painful than it already was. Also, chances are he would have had a harder time figuring out what was wrong with me.

My point is that if you are learning how to do a simple pelvic exam, then it would probably be a better learning experience to do it while the person is awake because chances are most pelvic exams you are going to do in the future are going to be on women who are awake, no? So why not just ask: "Hello, I'm Dr. Whozits and these are my students, since this is a teaching hospital they will be assisting me with the procedure/preparations and I just wanted to let you know." Problem solved. Now you can do it while I'm awake. Or even better, give me the option of having it done while I'm asleep or awake.

 

[45408]

My point is that if you are learning how to do a simple pelvic exam, then it would probably be a better learning experience to do it while the person is awake because chances are most pelvic exams you are going to do in the future are going to be on women who are awake, no? So why not just ask: "Hello, I'm Dr. Whozits and these are my students, since this is a teaching hospital they will be assisting me with the procedure/preparations and I just wanted to let you know." Problem solved. Now you can do it while I'm awake. Or even better, give me the option of having it done while I'm asleep or awake.

I've done more of them on awake patients than sleeping patients, and I had done at least a dozen on awake patients before I ever did one on a sleeping patient. They're certainly not mutually exclusive.

I question your authority to make blanket statements saying that inappropriate exams such as could occur in the case of said lipoma patient have never occurred, anywhere, ever.

I didn't say that (I said we weren't talking about that), nor am I defending that practice. I'm just telling you guys what it's like on the other side. This conversation started based on a premise that is dubious at best, bullsh*t at worst.

 

[vickpick]

I used training wheels on my bicycle before I was actually able to ride it properly.

 

[LuciusVorenus]

the hero returns