Pelvic exam during general anesthesia ??

[DermViser]

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Wait, covenant with the public? I have never heard of this and did not enter into such an agreement. It is absolutely disrespect to me and my body to practice any procedure on me without clear consent. That models are needed does not mean that patients should lose the right to refuse participating as a model.

At a Planned Parenthood office, a student nurse came into the exam room with the NP to observe my exam. I refused. The appointment is unpleasant enough without a stranger there looking at my body as if it were an anatomy book. How invasive. She couldn't even bother to ask, but simply showed up planning to breach my privacy for her benefit. It is for her benefit. She is the one who wished to become a nurse.

There seems to be a disconnect here that because medical students need to learn, patients have an obligation to cast aside modesty and autonomy and allow themselves to be used.

When I became a phlebotomist, I told every single patient that I was a student qualifying to become certified, and asked in the form of a question (never a statement of what I would be doing to them) if they would allow me to draw their blood. Some patients refused, as they had every right to do.

You did when you enter a TEACHING hospital. You have the full right to refuse and go to another non-teaching hospital. It's pretty easy to discern which ones are teaching hospitals and which ones aren't. (Hint: the teaching hospitals are the ones with all the Medicaid patients). I must say you're highly entitled. Med school (if u make it there) should be fun for you.

 

[pdxhopeful]

If you consider it invasive and offensive that a student had the audacity to enter the room....

Then yeah, I'd say we have a disconnect here.

Yup, you're not understanding. What she found offensive wasn't the student entering the room, but that neither the student or the physician gave her the opportunity to agree or not to the student's continued presence.

 

[mvenus929]

There seems to be a disconnect here that because medical students need to learn, patients have an obligation to cast aside modesty and autonomy and allow themselves to be used.

In my experience on OB-GYN (as a female student), most older women have absolutely no problem with me preforming an exam or participating in their surgery. A few younger women refused, and I backed up and let the resident/attending do her (or his) thing. When I worked with adolescents at our teen health center, about half requested that I not do the pelvic exam (half of whom allowed me to watch, and the other half did not want me in the room), but allowed me to take a history. I've had a grand total of one (parent) kick me out of the room during my evaluation, and I believe that had more to do with her perception of me doing useless chit-chat while she was in a hurry than the fact that I was a student. I had another patient on psych who was so manic that she really didn't let anyone talk to her, let alone the med student.

Patients have a full right to refuse treatment by a student. Most don't. You seem to be one of those that do. That's fine. We're not going to tie you down while we do a pelvic exam on you.

 

[SouthernSurgeon]

Yup, you're not understanding. What she found offensive wasn't the student entering the room, but that neither the student or the physician gave her the opportunity to agree or not to the student's continued presence.

I understand fully. I just think the attitude of shock and outrage is a WEE bit over the top...when literally the student was standing in the corner observing.

 

[DrCharlemagne]

"No patients" was an exaggeration. But surely you can agree that if you asked every patient explicitly, "do you want a medical student learning by examining you and performing procedures", or any other way you want to word that sentiment, the # who agree would be a fraction of what it is now.

I don't have any data to address your second point. I would not have thought so though. There are a lot of community clinics with sliding scale clinics which don't have students. And teaching hospitals, in my experience, are so inefficient that I can't imagine they can afford to charge a lot less. And yeah, tough **** is my pretty much my attitude towards most things, not just this topic. I get that the genitalia are very, very private for most women. I got kicked out of plenty of patient rooms on OB/GYN by virtue of having a penis, which resulted in a poor learning experience compared to female students. I'm not going into OBGYN so I didn't particularly care, but there are male students who will be and if I'm weighing the pros and cons of having poorly trained womens health physicians versus having written consent and not explicitly addressing the medical student involvement orally, I'm going to lean towards getting students proper training every time.

That said, if a patient explicitly says I want no students then obviously that wish is respected (and eI've never seen anything violating patient wishes).

I'm sorry you feel your education was limited, but might it have had less to do with your genitals and more with *students' sense of entitlement to *their patients'? Someone else mentioned that many Medicaid patients wind up in teaching hospitals, so the question of exploiting vulnerable groups is again raised, and cannot ethically be dismissed by "tough ****" or "I need to learn." If we agree to disagree, fine, but elsewhere residents have indicated that obtaining consent and letting patients explicitly know that students will be involved with their care are priorities, so I don't think I'm just imagining that this is as simple as a mere matter of training.

Edited because my original phrasing was unfair.

 

[SouthernSurgeon]

I'm sorry you feel your education was limited, but might it have had less to do with your genitals and more with your sense of entitlement to your patients'? Someone else mentioned that many Medicaid patients wind up in teaching hospitals, so the question of exploiting vulnerable groups is again raised, and cannot ethically be dismissed by "tough ****" or "I need to learn." If we agree to disagree, fine, but elsewhere residents have indicated that obtaining consent and letting patients explicitly know that students will be involved with their care are priorities, so I don't think I'm just imagining that this is as simple as a mere matter of training.

I have to say - as a student I only ever had one female patient refuse an exam - and that patient belonged to an ethnic group that as a whole feel very strongly about not having male providers for gynecologic care.

I have also had the vast majority of my patients consent to having a rectal/gyn/whathaveyou exam by a student.

I do think the attitude and the way you approach the conversation is a big deal.

When a student is going to scrub a case with me, I bring them to preop with me - I explain their role (both in the OR and postop when the student will be following their course) and introduce them. Its exceptionally rare that this is an issue for patients.

 

[PregnantAt51]

Can you explain what you mean by "until it was too late"? Are you waking from anesthesia and seeing a student there? The frustration is understandable. How would you want this addressed? It's on the paper you sign, and patients can see medical students and residents wandering around and probably talking to them. Do you want it to be a mandatory part of the informed consent process (which is already overwhelming for a patient)?

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

 

[Elisabeth Kate]

I'm starting to think that you are one of those anti-medicine hipsters trolling, but I'll answer this question seriously anyway. Remember, this student might someday be repairing cystoceles/rectoceles. How is he supposed to know how to fix it if he doesn't even know what a rectocele is? As medical students aren't we supposed to learn certain things like, oh, I don't know, ANATOMY? Then again you aren't in medicine.

Lose the attitude. You're making us all look bad with your entitled attitude.

Probably because nobody would say yes and students would never learn. I'm going to stick a rigid metal scope, a foley into your vagina but my fingers are off limits. Makes sense I suppose

Ah, so the philosophy is, since I'm sure they'll say no, we just won't ask permission. Just stop talking.

There are teaching hospitals and hospitals without students. If you do not wish to be a teaching tool, it would make sense to seek out hospitals without residents or medical students. If a patient goes to a teaching hospital, it is kind of implied they will be used to teach students, no?

Teaching students is entirely different from letting a student do a pelvic exam without asking permission.

Sorry, but you INHERENTLY agree to that when you're seen in an academic teaching hospital. You agree to have residents and medical students participate in your care, not just an attending. If you just want an attending, then you are free to go to a non-teaching hospital. That's the deal.

No, you do not agree to that. You agree to allow the student to be part of the teaching process. Example -- if the patient was awake, would the student just go in and start doing a pelvic exam without asking permission? Hell, students don't even get the HPI without asking first. To defend them practicing a pelvic without asking is absurd.

This is a member of the new generation of patients. They think they are entitled to the best care, usually subsidized to some extent at the teaching hospital, but want to dictate terms. It's all part of this "customer satisfaction" crap, and the mentality that the patient is a customer who is "always right." It's a terrible paradigm and obstructs care.

Actually, you're the one who sounds entitled. You are NOT entitled to learn medicine by practicing on anyone who walks through the hospital doors. You're just not. If you think you are, then check yourself at the door and quit med school.

Is a pelvic exam under anesthesia any more invasive than me teaching a student how to explore the abdomen at the beginning of a laparotomy? Or having the student palpate the abdomen to "feel the olive" in an anesthetized baby with pyloric stenosis? Or letting a student feel the beating heart before we go on pump for a CABG? Or cradle the transplanted kidney in their hands before we sew it in?

No. The only difference between the pelvic exam and any of these other educational experiences in the OR is that our society has made the genitals culturally taboo.

Actually, it IS different because it's a very personal part of a woman's anatomy and while the procedure isn't sexual in nature, the genitals DO have sexual connotation. A woman who's been raped or molested may not want 3 students exploring down there while she's asleep and she has ever right to make that decision. It's a psychological thing.

Am I the only one that thinks that 1) PregnantAt51 is either trolling or has made up her mind that she is going to be frustrated before considering anything factual, and 2) that it's fairly selfish to be seen by a trained provider who learned on other people while simultaneously refusing to allow students to learn by partaking in your care?

No, what's selfish is med students thinking they have the right to do whatever the hell they want because they're med students and the patients better deal with it or get lost.

Really ashamed of this thread.

 

[PL198]

You know everything that is asked of you. You just don't take the time to read it. No one is playing games here. If something is allowable to happen by law, it's in a piece of paper that you sign. It's your fault for not reading it. Surely you don't want a surgeon to hold your hand through reading 10 pages of some agreement and making sure you understand, when they could actually be doing productive things?

You make it seem like it's all the vague BS so that a surgeon can chop your head off if they want. No, it's clearly outlined and in writing. Yes there are some people that do weird stuff and break protocol. This is the huge huge minority. So in the context of this conversation, anything that can be done to you, you easily should know about, provided you take the time yourself to read what you sign.

 

[VisionaryTics]

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

If that actually happened, that's horrific, certainly not the norm, and absolutely not what we have been defending in this thread.

 

[sobored]

When I became a phlebotomist, I told every single patient that I was a student qualifying to become certified, and asked in the form of a question (never a statement of what I would be doing to them) if they would allow me to draw their blood. Some patients refused, as they had every right to do.

Come on, ever heard of "fake it til you make it"?

 

[SouthernSurgeon]

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

I'm very sorry that you had this traumatic experience. You are right to be horrified by what happened.

However, I think you are very unlikely to get the response or closure you seem to be seeking from this site.

Your experience seems to have very strongly jaded you against the role of learners in medicine, which is understandable but very unfortunate, particularly given your role of influence over others. What was discussed on this thread seven years ago is not what you experienced or what people have been defending.

 

[DermViser]

Lose the attitude. You're making us all look bad with your entitled attitude.



Ah, so the philosophy is, since I'm sure they'll say no, we just won't ask permission. Just stop talking.



Teaching students is entirely different from letting a student do a pelvic exam without asking permission.



No, you do not agree to that. You agree to allow the student to be part of the teaching process. Example -- if the patient was awake, would the student just go in and start doing a pelvic exam without asking permission? Hell, students don't even get the HPI without asking first. To defend them practicing a pelvic without asking is absurd.



Actually, you're the one who sounds entitled. You are NOT entitled to learn medicine by practicing on anyone who walks through the hospital doors. You're just not. If you think you are, then check yourself at the door and quit med school.



Actually, it IS different because it's a very personal part of a woman's anatomy and while the procedure isn't sexual in nature, the genitals DO have sexual connotation. A woman who's been raped or molested may not want 3 students exploring down there while she's asleep and she has ever right to make that decision. It's a psychological thing.



No, what's selfish is med students thinking they have the right to do whatever the hell they want because they're med students and the patients better deal with it or get lost.

Really ashamed of this thread.

No. For a teaching hospital, it's both residents AND students. If you don't want a resident or student to participate in your care at a teaching hospital, you are more than welcome to leave the front door and go to hospital that doesn't have residents or students, where you can see the attending only. That's the deal.

 

[Flamen04]

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

I'm pretty sure you made this up. I'm not saying shady things don't happen in medicine, but this is sensationalism

 

[Elisabeth Kate]

No, it's clearly outlined and in writing

No, it isn't. Perhaps it was at your hospital, but this is not universally true.

No. For a teaching hospital, it's both residents AND students. If you don't want a resident or student to participate in your care at a teaching hospital, you are more than welcome to leave the front door and go to hospital that doesn't have residents or students, where you can see the attending only. That's the deal.

Actually, the deal is that at a teaching hospital, students are not entitled to do whatever the hell they want. That's why they ask permission to obtain an HPI, why they ask permission to take blood, why they ask permission to do a physical exam. If the patient is awake, permission is always obtained for a reason -- because no one besides med students subscribes to this philosophy of entitlement that patients will be guinea pigs in a teaching hospital, even if they object. Many patients don't know the difference between a teaching hospital and a community hospital. Many only have teaching hospitals close by. Many are taken there due to emergencies. It doesn't mean that students should feel they have a right to learn on their bodies, no matter what they say. To endorse such a philosophy reeks of selfish entitlement.

 

[DrCharlemagne]

I'm pretty sure you made this up. I'm not saying shady things don't happen in medicine, but this is sensationalism

Wow. Just no. Don't do that. Think it, but don't do that.

 

[evilbooyaa]

If that actually happened, that's horrific, certainly not the norm, and absolutely not what we have been defending in this thread.

This. If I had an experience like the one you posted about, I would be as jaded as you are about medical students.

 

[Wordead]

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

If true, that was a serious violation of patient rights. I doubt anyone here would defend those actions. I've never seen anyone continue an exam after patient refusal. That's pretty horrible.

I'd hope you would go in-depth into what their concerns are and why/what is done. It would be a shame if the story turned into students molesting them under anesthesia and they all forgo regular medical care.

 

[ECkayak]

Actually, the deal is that at a teaching hospital, students are not entitled to do whatever the hell they want. That's why they ask permission to obtain an HPI, why they ask permission to take blood, why they ask permission to do a physical exam. If the patient is awake, permission is always obtained for a reason -- because no one besides med students subscribes to this philosophy of entitlement that patients will be guinea pigs in a teaching hospital, even if they object. Many patients don't know the difference between a teaching hospital and a community hospital. Many only have teaching hospitals close by. Many are taken there due to emergencies. It doesn't mean that students should feel they have a right to learn on their bodies, no matter what they say. To endorse such a philosophy reeks of selfish entitlement.

And I'M going to argue that taking advantage of the resources that a teaching hospital has, while refusing any interaction with students and residents (emphasizing that it IS your right to do this) is selfish, entitled and basically theft from the system.

 

[Elisabeth Kate]

And I'M going to argue that taking advantage of the resources that a teaching hospital has, while refusing any interaction with students and residents (emphasizing that it IS your right to do this) is selfish, entitled and basically theft from the system.

Theft? Really? When they're PAYING for the care? Could you possibly sound more naive and entitled?

 

[DermViser]

If true, that was a serious violation of patient rights. I doubt anyone here would defend those actions. I've never seen anyone continue an exam after patient refusal. That's pretty horrible.

I'd hope you would go in-depth into what their concerns are and why/what is done. It would be a shame if the story turned into students molesting them under anesthesia and they all forgo regular medical care.

In an OB-Gyn residency program in an urban inner city? Sadly, I wouldn't be shocked. Have you seen how OB-Gyn residents treat patients?

 

[DermViser]

Theft? Really? When they're PAYING for the care? Could you possibly sound more naive and entitled?

Most teaching hospitals serve the Medicaid population. They didn't pay for jack squat.

 

[PregnantAt51]

Am I the only one that thinks that 1) PregnantAt51 is either trolling or has made up her mind that she is going to be frustrated before considering anything factual, and 2) that it's fairly selfish to be seen by a trained provider who learned on other people while simultaneously refusing to allow students to learn by partaking in your care?

Actually, I came her to get factual information about being able to trust providers. Having a different opinion is not trolling.

I'm disturbed by much of what I've learned here. I did not realize at any time that medical professionals think that patients owe them the right to use their bodies to teach students. Students must learn on real people I understand, but I was under the impression that the medical world respected their patients enough to get full consent rather than assuming that every patient does not mind having strangers view and touch their naked body.

What I would like to see is recognition from providers that what they do every day is not what patients are comfortable having done. It's daunting to find out that physicians and future physicians feel entitled to use patients as they see fit, and justify this by adopting a belief that patients are obligated to defer, and those who don't are selfish.

If you want to bring in students to look at the surgical incision on my knee or the cyst on my eyelid, fine. All I ask is that you ask me for the use of my body. There are certain areas that I prefer not to share. I am saddened to realize that medical training has taught many of you that I am somehow depriving you of something to which you are entitled by wanting to retain right to decide what parts of my body and medical history I wish to share.

 

[Elisabeth Kate]

Most teaching hospitals serve the Medicaid population. They didn't pay for jack squat.

Just because they serve the Medicaid population doesn't mean every patient is on Medicaid. And regardless, so what? Unless you're proposing that it's okay to perform pelvics without consent on Medicaid patients but not on the regular patient population, your point is irrelevant.

 

[DrCharlemagne]

Now, I know medical education is not research, but I was under the impression that as students we were supposed to be guided by ethics, and I feel this citation may be relevant:

"One special instance of injustice results from the involvement of vulnerable subjects. Certain groups, such as racial minorities, the economically disadvantaged, the very sick, and the institutionalized may continually be sought as research subjects, owing to their ready availability in settings where research is conducted. Given their dependent status and their frequently compromised capacity for free consent, they should be protected against the danger of being involved in research solely for administrative convenience, or because they are easy to manipulate as a result of their illness or socioeconomic condition."
http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html

Point being, because they're poor and uneducated, we're supposed to be trying even harder to make sure Medicaid/charity patients are protected.

 

[DrCharlemagne]

If true, that was a serious violation of patient rights. I doubt anyone here would defend those actions. I've never seen anyone continue an exam after patient refusal. That's pretty horrible.

I'd hope you would go in-depth into what their concerns are and why/what is done. It would be a shame if the story turned into students molesting them under anesthesia and they all forgo regular medical care.

Sadly, as a legal nurse my mother has been involved with cases when residents and attendings blew past a patient's wishes and did whatever they wanted. If the patient is a sick illegal immigrant, who is really going to defend her?

 

[Elisabeth Kate]

Actually, I came her to get factual information about being able to trust providers. Having a different opinion is not trolling.

I'm disturbed by much of what I've learned here. I did not realize at any time that medical professionals think that patients owe them the right to use their bodies to teach students. Students must learn on real people I understand, but I was under the impression that the medical world respected their patients enough to get full consent rather than assuming that every patient does not mind having strangers view and touch their naked body.

What I would like to see is recognition from providers that what they do every day is not what patients are comfortable having done. It's daunting to find out that physicians and future physicians feel entitled to use patients as they see fit, and justify this by adopting a belief that patients are obligated to defer, and those who don't are selfish.

If you want to bring in students to look at the surgical incision on my knee or the cyst on my eyelid, fine. All I ask is that you ask me for the use of my body. There are certain areas that I prefer not to share. I am saddened to realize that medical training has taught many of you that I am somehow depriving you of something to which you are entitled by wanting to retain right to decide what parts of my body and medical history I wish to share.

Don't assume this thread represents the views of the majority of physicians. These are medical students, some of them not even in their clinical years yet. They're at the stage in their education (and life) where they're extremely entitled and feel like the world owes them every opportunity to learn their craft and anyone who impedes their learning is an adversary. This is not the predominant philosophy in medicine.

 

[sinombre]

Don't assume this thread represents the views of the majority of physicians. These are medical students, some of them not even in their clinical years yet. They're at the stage in their education (and life) where they're extremely entitled and feel like the world owes them every opportunity to learn their craft and anyone who impedes their learning is an adversary. This is not the predominant philosophy in medicine.

Where are you getting this from? Who has expressed this entitlement you speak of? I'm honestly not seeing it.

 

[DermViser]

Just because they serve the Medicaid population doesn't mean every patient is on Medicaid. And regardless, so what? Unless you're proposing that it's okay to perform pelvics without consent on Medicaid patients but not on the regular patient population, your point is irrelevant.

If you go to a teaching hospital (which serves Medicaid patients) and/or are a Medicaid patient yourself going to a teaching hospital, you give up the right to dictate your care and say that you only want to see the attending for your care. If you don't like it then you are free to go to another hospital.

Want to only see an attending, and have no desire to have a resident or medical student be involved in your care? Simple solution: Get private health insurance and go to a private hospital. Problem solved.

 

[DermViser]

Don't assume this thread represents the views of the majority of physicians. These are medical students, some of them not even in their clinical years yet. They're at the stage in their education (and life) where they're extremely entitled and feel like the world owes them every opportunity to learn their craft and anyone who impedes their learning is an adversary. This is not the predominant philosophy in medicine.

I'm not a medical student and neither is SouthernIM.

 

[Elisabeth Kate]

I'm not a medical student and neither is SouthernIM.

Until you start your residency, I consider you a medical student, just like me. We may have just graduated, but we're not yet residents.

 

[DermViser]

Until you start your residency, I consider you a medical student, just like me. We may have just graduated, but we're not yet residents.

I'm already in it, as is SouthernIM, genius.

 

[Elisabeth Kate]

Where are you getting this from? Who has expressed this entitlement you speak of? I'm honestly not seeing it.

Probably because you have a different definition of entitlement (not surprised). I consider posts that say a patient has submit to whatever a med student wants to do at a teaching hospital to be entitled.

If you go to a teaching hospital (which serves Medicaid patients) and/or are a Medicaid patient yourself going to a teaching hospital, you give up the right to dictate your care

Wait, what???? This isn't just a matter of opinion. You are flat-out wrong on this and frankly, you should ashamed for even uttering those words. The law still dictates that a patient has the right to consent to procedures. Obviously, that means they do NOT give up the right to dictate care.

Want to only see an attending, and have no desire to have a resident or medical student be involved in your care? Simple solution: Get private health insurance and go to a private hospital. Problem solved.

Oh boo hoo, someone says they'd like to be informed before a med student performs a pelvic exam and suddenly that means they have no desire to have a resident or medical student involved in their care? The indisputable sign of a weak argument is hyperbole.

 

[Wordead]

Sadly, as a legal nurse my mother has been involved with cases when residents and attendings blew past a patient's wishes and did whatever they wanted. If the patient is a sick illegal immigrant, who is really going to defend her?

I would defend those patients as a resident/attending, and I would say that the vast majority of my classmates would not let OP's situation happen. I would absolutely do everything I could to discipline the students/residents/attendings in that situation.

That said, your wording of "blew past a patient's wishes and did whatever they wanted" is somewhat vague and sensational. Are we talking about the OP's post of forced vaginal exams, or "students felt the uterus"? I see a wide, wide gulf between those two situations.

 

[sinombre]

Probably because you have a different definition of entitlement (not surprised). I consider posts that say a patient has submit to whatever a med student wants to do at a teaching hospital to be entitled.

I agree with you on the definition of "entitlement," so I don't think this is a semantics issue.

But where exactly has this occurred in this thread?

 

[DermViser]

Probably because you have a different definition of entitlement (not surprised). I consider posts that say a patient has submit to whatever a med student wants to do at a teaching hospital to be entitled.



Wait, what???? This isn't just a matter of opinion. You are flat-out wrong on this and frankly, you should ashamed for even uttering those words. The law still dictates that a patient has the right to consent to procedures. Obviously, that means they do NOT give up the right to dictate care.



Oh boo hoo, someone says they'd like to be informed before a med student performs a pelvic exam and suddenly that means they have no desire to have a resident or medical student involved in their care? The indisputable sign of a weak argument is hyperbole.

Sorry, but that's how it works. As a Medicaid patient you give up the right to fully dictate your care, by saying that you will only see the attending and no one else. Any attending with cojones will tell the patient nicely that while they understand, this place is a teaching hospital and thus residents and medical students will participate actively in the patient's care, along with the attending.

If the patient doesn't like being seen by residents and medical students at a teaching hospital - the solution is simple - buy private health insurance and go to a community, private hospital.

 

[DrCharlemagne]

I would defend those patients as a resident/attending, and I would say that the vast majority of my classmates would not let OP's situation happen. I would absolutely do everything I could to discipline the students/residents/attendings in that situation.

That said, your wording of "blew past a patient's wishes and did whatever they wanted" is somewhat vague and sensational. Are we talking about the OP's post of forced vaginal exams, or "students felt the uterus"? I see a wide, wide gulf between those two situations.

The first case that comes to my mind was a resident entering the room, inserted his fingers in the patient's vagina without introducing himself (he was wearing gloves), ignoring the patient's pleas for help (she had apparently spit up or drooled excessively and wanted some one to help her clean up) and began running through the chart with the nurse without bothering to address the patient since she only spoke Spanish. There were other stories, but my memories from high school are admittedly foggy.

To be fair, I cannot recall any stories about medical students from this venue, but then again I cannot imagine many students get sued.

 

[Elisabeth Kate]

I agree with you on the definition of "entitlement," so I don't think this is a semantics issue.

But where exactly has this occurred in this thread?

You can't be serious. LOL

Sorry, but that's how it works

If that's how it worked, then there would be no such thing as consent forms.

As a Medicaid patient you give up the right to fully dictate your care, by saying that you will only see the attending and no one else

Once again, the sign of a weak argument is hyperbole. Not a single person said that. Not a single one. The argument in this thread is whether or not patients should be asked if a student can perform a pelvic exam on them, not whether or not they only want an attending caring for them. Don't argue things that were never up for debate.

If the patient doesn't like being seen by residents and medical students at a teaching hospital - the solution is simple - buy private health insurance and go to a community, private hospital.

If a person can't debate based on the facts of the thread, the solution is simple. They should forego this thread and find another one to argue on.

 

[PregnantAt51]

If that actually happened, that's horrific, certainly not the norm, and absolutely not what we have been defending in this thread.

A lot more than that happened. For instance, no one said a word about the episiotomy until I saw a long needle for the saddle block. The students or residents or whatever they were gathered around staring into my crotch while the attending pierced my perineum. I screamed, arched my back and tried to scoot away, saying "No! No episiotomy! I'd rather tear! Don't!". One of the boys between my legs patted my thigh and said 'We're just making the opening a little bigger." I said "No, you can't do that without cutting me!". Somebody shoved their finger down into my the muscles just inside my vagina (sorry, don't know the name) to stretch the tissue. The pressure caused intense pain and I arched again and said "Ow, oh stop that hurts..." The student/residen/boy said "One minute..." then I felt a burning pain and heard flesh being cut with scissor. I wasn't numb yet. My husband said I screamed "what are you doing?", my eyes rolled back, blood fell onto the floor and I began sobbing. The boy looked up and said "See? All over." like he was putting a band-aid on a toddler. I tore another inch as my child's head was born.

Any protests I gave were either ignored or I was placated with platitudes like "You're almost done". They never addressed anything that I said or asked them to do or not do.

There was one moment when the three were between my legs touching and staring at my vulva, which felt so humiliating. I remember feeling that getting pregnant was a terrible mistake and I was paying for it. A woman should not feel guilty for giving birth!

One of them said "Look, I see hair!" as though this would cheer me up. I snapped "Well I guess you do. Haven't you ever seen one of those before? They have hair."

I was not a welfare patient, btw. I had full insurance and was paying for the services of a private physician. One of the residents/students even poked fun at my husband, saying " well, if you want the pros, don't have a baby at 6pm on a Friday. They've all gone home."

My point here is that it seems doctors have forgotten that pelvic exams, gynecological procedure, breast exams, giving birth, those processes can feel terrible, and in a lasting way. To you, it's routine. To some of your patients, it's like being stripped and penetrated against our will, in the middle of Wal-Mart. Our feelings are valid.

I am trying to find a way to give the youth group girls a balanced view.

 

[DermViser]

You can't be serious. LOL



If that's how it worked, then there would be no such thing as consent forms.



Once again, the sign of a weak argument is hyperbole. Not a single person said that. Not a single one. The argument in this thread is whether or not patients should be asked if a student can perform a pelvic exam on them, not whether or not they only want an attending caring for them. Don't argue things that were never up for debate.



If a person can't debate based on the facts of the thread, the solution is simple. They should forego this thread and find another one to argue on.

That includes physical exam maneuvers. You sign a consent form at the point of care at the beginning of the visit/inpatient stay.

 

[Elisabeth Kate]

That includes physical exam maneuvers. You sign a consent form at the point of care at the beginning of the visit/inpatient stay.

Yes, and then you ask permission for every single thing you do. The fact that you think it's okay to not ask permission for doing a pelvic speaks volumes.

 

[Wordead]

The first case that comes to my mind was a resident entering the room, inserted his fingers in the patient's vagina without introducing himself (he was wearing gloves), ignoring the patient's pleas for help (she had apparently spit up or drooled excessively and wanted some one to help her clean up) and began running through the chart with the nurse without bothering to address the patient since she only spoke Spanish. There were other stories, but my memories from high school are admittedly foggy.

To be fair, I cannot recall any stories about medical students from this venue, but then again I cannot imagine many students get sued.

So....did the patient object to the vaginal exam? Otherwise, bad bedside manner but no rights violated as I read that situation. No introduction and he didn't understand her concern/problem with drool does not constitute "doing whatever he wanted to her" to me.

 

[DermViser]

A lot more than that happened. For instance, no one said a word about the episiotomy until I saw a long needle for the saddle block. The students or residents or whatever they were gathered around staring into my crotch while the attending pierced my perineum. I screamed, arched my back and tried to scoot away, saying "No! No episiotomy! I'd rather tear! Don't!". One of the boys between my legs patted my thigh and said 'We're just making the opening a little bigger." I said "No, you can't do that without cutting me!". Somebody shoved their finger down into my the muscles just inside my vagina (sorry, don't know the name) to stretch the tissue. The pressure caused intense pain and I arched again and said "Ow, oh stop that hurts..." The student/residen/boy said "One minute..." then I felt a burning pain and heard flesh being cut with scissor. I wasn't numb yet. My husband said I screamed "what are you doing?", my eyes rolled back, blood fell onto the floor and I began sobbing. The boy looked up and said "See? All over." like he was putting a band-aid on a toddler. I tore another inch as my child's head was born.

Any protests I gave were either ignored or I was placated with platitudes like "You're almost done". They never addressed anything that I said or asked them to do or not do.

There was one moment when the three were between my legs touching and staring at my vulva, which felt so humiliating. I remember feeling that getting pregnant was a terrible mistake and I was paying for it. A woman should not feel guilty for giving birth!

One of them said "Look, I see hair!" as though this would cheer me up. I snapped "Well I guess you do. Haven't you ever seen one of those before? They have hair."

I was not a welfare patient, btw. I had full insurance and was paying for the services of a private physician. One of the residents/students even poked fun at my husband, saying " well, if you want the pros, don't have a baby at 6pm on a Friday. They've all gone home."
Ok, if you're going to troll, try to be more subtle so at least it isn't so obvious.

My point here is that it seems doctors have forgotten that pelvic exams, gynecological procedure, breast exams, giving birth, those processes can feel terrible, and in a lasting way. To you, it's routine. To some of your patients, it's like being stripped and penetrated against our will, in the middle of Wal-Mart. Our feelings are valid.

I am trying to find a way to give the youth group girls a balanced view.

Ok, at least if you're going to troll, try not to make it so obvious.

 

[Priapism4tooLong]

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.

The questions that the adolescent girls in my group posed included wanting to know if doctors can/will violate them in the name of medicine. I hoped to find more to reassure them.

you realize what you are explaining right now is rape.

 

[DrCharlemagne]

So....did the patient object to the vaginal exam? Otherwise, bad bedside manner but no rights violated as I read that situation. No introduction and he didn't understand her concern/problem with drool does not constitute "doing whatever he wanted to her" to me.

Yes, the patient objected, since consent to the exam was not obtained and there was no extenuating emergent circumstance.

 

[PregnantAt51]

I understand fully. I just think the attitude of shock and outrage is a WEE bit over the top...when literally the student was standing in the corner observing.

The student was NOT standing in the corner observing. The student walked in with the NP, and said to me "Hello, Mrs. H. I'm going to be observing your [pap test, bi-manual, rectal and breast] exam today as part of my training." She decided that she could invade and contaminate my paid visit. Yes, contaminate. I did not feel comfortable having anyone staring at my breasts while a practitioner palpated, then staring into and inside of my genitals, and I would not have discussed all of my health concerns with this stranger there. There is such a thing as a desire for privacy, and to be naked in front of no more strangers than absolutely necessary.

 

[DermViser]

A lot more than that happened. For instance, no one said a word about the episiotomy until I saw a long needle for the saddle block. The students or residents or whatever they were gathered around staring into my crotch while the attending pierced my perineum. I screamed, arched my back and tried to scoot away, saying "No! No episiotomy! I'd rather tear! Don't!". One of the boys between my legs patted my thigh and said 'We're just making the opening a little bigger." I said "No, you can't do that without cutting me!". Somebody shoved their finger down into my the muscles just inside my vagina (sorry, don't know the name) to stretch the tissue. The pressure caused intense pain and I arched again and said "Ow, oh stop that hurts..." The student/residen/boy said "One minute..." then I felt a burning pain and heard flesh being cut with scissor. I wasn't numb yet. My husband said I screamed "what are you doing?", my eyes rolled back, blood fell onto the floor and I began sobbing. The boy looked up and said "See? All over." like he was putting a band-aid on a toddler. I tore another inch as my child's head was born.

Any protests I gave were either ignored or I was placated with platitudes like "You're almost done". They never addressed anything that I said or asked them to do or not do.

There was one moment when the three were between my legs touching and staring at my vulva, which felt so humiliating. I remember feeling that getting pregnant was a terrible mistake and I was paying for it. A woman should not feel guilty for giving birth!

One of them said "Look, I see hair!" as though this would cheer me up. I snapped "Well I guess you do. Haven't you ever seen one of those before? They have hair."

I was not a welfare patient, btw. I had full insurance and was paying for the services of a private physician. One of the residents/students even poked fun at my husband, saying " well, if you want the pros, don't have a baby at 6pm on a Friday. They've all gone home."

My point here is that it seems doctors have forgotten that pelvic exams, gynecological procedure, breast exams, giving birth, those processes can feel terrible, and in a lasting way. To you, it's routine. To some of your patients, it's like being stripped and penetrated against our will, in the middle of Wal-Mart. Our feelings are valid.

I am trying to find a way to give the youth group girls a balanced view.

One can be on Medicaid and not be on welfare, necessarily. If you had private health insurance, then why did you go to an academic teaching hospital where residents do deliveries?

 

[DrCharlemagne]

you realize what you are explaining right now is rape.

Pretty sure she's aware of that.

 

[Priapism4tooLong]

Pretty sure she's aware of that.

she's a troll no way this **** happens in real life.

 

[DrCharlemagne]

she's a troll no way this **** happens in real life.

Sad to say it does, and sad to say your reaction is not uncommon.