pelvic exam on anesthetized women

[14022]

Let me pose a question. I am on gynecological surgery and several different residents and attendings have told me that prior to surgery it is a great idea to perform a pelvic exam on the anesthetized woman in order to get practice. Many have said it is not traumatic to the patient and you get a more technically adequate exam since the patient is not guarding. Sure enough, before every procedure the attending and resident (and I have worked with 6 attendings and 4 residents, both males and females, at two different hospitals, both community and academic hospital) perform a quick pelvic exam.

Is this wrong? The attending does it for one last chance to feel for any previously undiagnosed masses or other abnormalities, but the resident and student do it primarily for educational purposes. The patient has consented to the surgery, but not for the pelvic exam. Does consent to surgery of the uterus, vagina, vulva, ovaries, etc. also imply consent to manual palpation of these structures during the surgery?

Has anyone else had a similar experience on their ob/gyn clerkship?

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[starayamoskva]

Let me pose a question. I am on gynecological surgery and several different residents and attendings have told me that prior to surgery it is a great idea to perform a pelvic exam on the anesthetized woman in order to get practice. Many have said it is not traumatic to the patient and you get a more technically adequate exam since the patient is not guarding. Sure enough, before every procedure the attending and resident (and I have worked with 6 attendings and 4 residents, both males and females, at two different hospitals, both community and academic hospital) perform a quick pelvic exam.

Is this wrong? The attending does it for one last chance to feel for any previously undiagnosed masses or other abnormalities, but the resident and student do it primarily for educational purposes. The patient has consented to the surgery, but not for the pelvic exam. Does consent to surgery of the uterus, vagina, vulva, ovaries, etc. also imply consent to manual palpation of these structures during the surgery?

Has anyone else had a similar experience on their ob/gyn clerkship?

It is standard procedure. How else do you think the residents and students are going to learn?

 

[14022]

The reason I ask is because in another thread people have said that a rectal exam should not be done on a patient by a student unless it is absolutely indicated. And I suggested that when its utility is questionable and the patient consents to the exam then it should be performed, because in an academic hospital students are expected to do these things in order to learn. I guess I do not understand how this is any different. One student performing a rectal exam of questionable utility on one consenting person versus three people performing a pelvic of established utility on an anesthetized women.

 

[delchrys]

i am a final-year law student who works at a med mal firm (defense) and i have been highly interested in medicine most of my life. the subject of pelvic exams on anesthetized women has actually been brought up a few times in some of the stuff i've read, and if you google in under a few basic permutations, you'll see that it's becoming a subject of conversation in several circles in the legal and medical community. some hospitals have started integrating consent to this procedure into their patient consent forms. i can't say with any degree of certainty (there never is, in law, lol), but it's probably not there YET, but nearing the point where there will be successful lawsuits by patients in the circumstances you describe.

the much more immediate and practical question, though, is whether it's ethical to perform a procedure, even a purely diagnostic procedure that is part of the learning process, on a person who has not consented to it.

and to the person who justified this by stating that "it's standard procedure, how else are students going to learn"...since when does something being standard procedure mean that it's morally or ethically right simply because it is standard procedure? the programs that have changed and now actually ASK their patients if it's okay find that the patients overwhelmingly are permissive, so it's not like asking acts as a bar to students needing practice. are you a physician, or are you still a student? the reason i ask is that if you are still a student and already are viewing patients as teaching tools rather than as individuals with rights, you might want to do a reality check. (no offense meant, honestly.)

 

[ericdamiansean]

Honestly speaking, I feel that it's wrong, and if I'm a female, I would not like to be subjected to anything that I did not consent to under anes.

BUt then, the medical chunk of me which is a really huge portion says that it's the only way we're going to learn

 

[Idiopathic]

Two things:

1) Anyone who does anything on a patient that was not fully disclosed beforehand or is not at least discussed (i.e. there will be several people examining you while you are asleep...) should be removed.

2) Anyone who goes in for a procedure at a teaching institution should probably get a brain pelvic.

 

[mikegoal]

You dont do it to learn how to do a pelvic. You do it to get a feel for the anatomy that you are going to be operating on(ok retracting). obvioisly the attending is going to be helped more by doing this but it does help to know where things are before you start

 

[Gauss]

Two things:

1) Anyone who does anything on a patient that was not fully disclosed beforehand or is not at least discussed (i.e. there will be several people examining you while you are asleep...) should be removed.

2) Anyone who goes in for a procedure at a teaching institution should probably get a brain pelvic.

pelvics on anesthesized women prior to surgery is routine - infomed consent was obtained as part of the surgical consent. Also she is cathed there which is also routine and part of surgical consent. As far as I know the consent nor the patient specifies who does those procedures.
I'm not taking sides here but I'm certain similar things happen in urology.

And idio, don't look dumbfounded when you're in the OR and the attending looks at you and says put gloves on and do the pelvic/cath. It WILL happen.

there's a gigantic thread on this same topic wayyyy back somewhere which I'm too lazy to find

 

[starayamoskva]

i am a final-year law student who works at a med mal firm (defense) and i have been highly interested in medicine most of my life. the subject of pelvic exams on anesthetized women has actually been brought up a few times in some of the stuff i've read, and if you google in under a few basic permutations, you'll see that it's becoming a subject of conversation in several circles in the legal and medical community. some hospitals have started integrating consent to this procedure into their patient consent forms. i can't say with any degree of certainty (there never is, in law, lol), but it's probably not there YET, but nearing the point where there will be successful lawsuits by patients in the circumstances you describe.

the much more immediate and practical question, though, is whether it's ethical to perform a procedure, even a purely diagnostic procedure that is part of the learning process, on a person who has not consented to it.

and to the person who justified this by stating that "it's standard procedure, how else are students going to learn"...since when does something being standard procedure mean that it's morally or ethically right simply because it is standard procedure? the programs that have changed and now actually ASK their patients if it's okay find that the patients overwhelmingly are permissive, so it's not like asking acts as a bar to students needing practice. are you a physician, or are you still a student? the reason i ask is that if you are still a student and already are viewing patients as teaching tools rather than as individuals with rights, you might want to do a reality check. (no offense meant, honestly.)

The person who justified this feels you are quite presumptive to assume that by my saying it is standard procedure it automatically means that I am so inane that I would not get consent from the patient. It is also standard procedure to discuss this with the patient during their preop visit. Now get off your I'm the law student high horse and realize that there are people in the world who have standards and behave in a morally and ethically respectable manor without it being dictated to them by a bunch of self serving lawyers looking for the next opportunity to suck the life out of the medical profession.

 

[delchrys]

The person who justified this feels you are quite presumptive to assume that by my saying it is standard procedure it automatically means that I am so inane that I would not get consent from the patient.

is that even english? a spelling error or common grammatical mistake is one thing, but it's an entirely different thing to write something so incomprehensible that 5 minutes of re-reading doesn't shed any light on whatever it is you're trying to say. if, by some miracle, i am reading this right, then you are saying that i shouldn't have assumed that your one-line initial reply to the OP was flippant and intended to be taken as your definitive thought on the subject. if so, try actually explaining yourself when you post rather than relying on everyone else to read your mind.

It is also standard procedure to discuss this with the patient during their preop visit. Now get off your I'm the law student high horse and realize that there are people in the world who have standards and behave in a morally and ethically respectable manor without it being dictated to them by a bunch of self serving lawyers looking for the next opportunity to suck the life out of the medical profession.

um, the "i'm a law student" was not meant as a self-aggrandizing statement, but as something to establish some minor shred of credibility, since it has happened a few times that posters here have asked if i am "even a med student" as if my lack of medical education invalidates my observations. it was also intended to ensure that no one made the mistake of thinking i was speaking from direct experience doing ob/gyn or gyn onc. self-serving lawyers? you do understand that i work to DEFEND doctors and hospitals, right? even the ones who blatantly screw up and should lose their licenses? this is not a pissing contest, "Old Moscow," and the fact that you have attempted to shift this discussion from the relevant (and important) topic brought up by the OP to one of personal insults should embarrass you.

 

[Mumpu]

Basically, the question you should be asking is "did the patient consent to a pelvic by a medical student?" When you are admitted to a teaching institution, you do not automatically surrender your freedoms and priveleges. I ask for consent for everything I do -- patient interviews in clinic (and this is the second consent actually -- my preceptor or the nurse asks as they are rooming the patient), assuming care of the patient as part of a hospital team, auscultation, rectal, everything.

Think about the absolute trust the patient places in your skills and professionalism when they go under anesthesia. They are paralyzed and unconscious and it is grossly unprofessional of you to violate that trust by violating their body. There's no "greater good" clause here. To do an un-consensted exam is assault (any firefighter/EMT who ever worked on the streets knows this), to do an un-consented pelvic is sexual assault.

 

[Paul1441]

is that even english? a spelling error or common grammatical mistake is one thing, but it's an entirely different thing to write something so incomprehensible that 5 minutes of re-reading doesn't shed any light on whatever it is you're trying to say. if, by some miracle, i am reading this right, then you are saying that i shouldn't have assumed that your one-line initial reply to the OP was flippant and intended to be taken as your definitive thought on the subject. if so, try actually explaining yourself when you post rather than relying on everyone else to read your mind.

That is saying a lot coming from a Law student. I've seen some of the as*-backward, run-on, completely incomprehensible reading material they are required to read, and they still manage to grind through it day after day. So Delchrys is probably right in saying that sentence was messed up.
(totally off the subject)

 

[delchrys]

LOL! yeah, lawyers love to hear themselves talk, and i suppose i'm no exception. the only reason i took a swing at the guy/girl, though, is that they got all personally offended. bah.

 

[watto]

The person who justified this feels you are quite presumptive to assume that by my saying it is standard procedure it automatically means that I am so inane that I would not get consent from the patient.

What an awesome string of verbiage. I started at the end and worked backward--I think he means the attending would be blind not to know consent would be requested.

Makes Ulysses read like Ziggy in comparison.

 

[starayamoskva]

What an awesome string of verbiage. I started at the end and worked backward--I think he means the attending would be blind not to know consent would be requested.

Makes Ulysses read like Ziggy in comparison.

I will eat crow on this one big time. That was possible the worst excuse for a sentence ever created. That is what you get when you have been awake for 36 consecutive hours working your butt off then come home and get on SDN and try to write comprehensibly.
The first post, was indeed glib and did not explain things well. I will swear off using SDN while I am on call and sleep deprived.
The tone of the second post was hostile (in addition to being incomprehensible) and I apologize for that.

Now that I have had a good nights sleep, the point I was trying to make was that it is standard procedure to get consent for the pelvic (including med students mumpu) at our institution. I could not in good conscious subject a patient to exams they had not consented to.

Again, I apologize for the first two posts and deeply regret having trampled on anyone's sensibilities.

Best regards,

S

 

[delchrys]

old moscow:

it's totally cool. i trample on people's feelings a lot here, so your minor bump hit the perfect guy in the sense that i rarely ever hold grudges.



cool?

 

[starayamoskva]

old moscow:

it's totally cool. i trample on people's feelings a lot here, so your minor bump hit the perfect guy in the sense that i rarely ever hold grudges.



cool?

Absolutely cool

Grudges make you old before your time, I do my best to avoid them

 

[Idiopathic]

And idio, don't look dumbfounded when you're in the OR and the attending looks at you and says put gloves on and do the pelvic/cath. It WILL happen.

Why would I look dumbfounded? I have done several caths and more than one pelvic, so that isnt a concern. As far as being in the OR and doing it, it wont be a problem. HOWEVER, the OP described the situation as one of 'practice' and implied that several pelvics would be done on the nameless anesthetized woman (at least more than one). No call for that, IMHO.

 

[souljah1]

We don't do "practice" pelvics on women who are anesthesized here. We practice pelvics on awake women who are comfortable with medical student physical examinations. I think it is ridiculous that people would be practicing pelvic exams on an unconscious patient. Is the patient consenting to "practice pelvic exams" when they sign the consent form to allow catheterization or a pelvic exam to gain appreciation of anatomy when relevant to the surgical procedure. There was one instance here a few years ago where a student refused to perform a pelvic exam on an anesthesized woman b/c he/she had never met this woman and spoken to her about it. The attending got pissed, but could do nothing about it b/c the student felt that doing the exam was in conflict with is ethical standards. Props to the student if you ask me.

Bottom line: If you aren't getting enough practice doing pelvics on your Ob/gyn or Fam med rotation - you are getting poor training.

 

[Doc Ivy]

Honestly speaking, I feel that it's wrong, and if I'm a female, I would not like to be subjected to anything that I did not consent to under anes.

BUt then, the medical chunk of me which is a really huge portion says that it's the only way we're going to learn

As a woman I have to say that I really don't have a problem with this. If I am at a teaching hospital it's what I would expect. Strictly speaking there's a lot going on in surgery that you don't expressly consent to, and I've had major surgery so I can attest to this. So if you want to take a quick look see down there while you put in the Foley, I say no harm no foul, just leave the area as you found it and "do no harm".

 

[starayamoskva]

Bottom line: If you aren't getting enough practice doing pelvics on your Ob/gyn or Fam med rotation - you are getting poor training.

First let me say that my feeling is that if you aren't participating in the surgery you have no business doing the exam.
The pelvic exam on an anesthetized woman can be VERY different from the exam on that same woman while awake. When awake, she may be guarding or tensed up to the point that you cannot evaluate her fully. In my experience the exams have been done prior to either surgery for cancer or for urogyn procedures. For some women with no abnormality the pelvic exam is particularly uncomfortable or downright painful.

I for one think it would be cruel to make the patient undergo mutliple exams on a painful cancer while awake when with proper consent it can be done while she is asleep and pain free.

What is everyone's take on the medical students learning to do cervical checks during their labor and delivery rotations? Is it unnecessary as most will never darken the doors of the OB department again?

 

[4th year]

"If, in the pursuit of excellence in the field of medicine, you neglect to develop yourself as a whole person, to love, to play, and to relax, then you are not doing anyone any favors, not your patients, not your friends, not your family, and most of all, not yourself."
--me

What do you know about it? This qoute is based in ignorance. Have you done the same in the pursuit in the excellence of law?
Are you going to be one of those guys who fills their wallets on other people's misfortunes while trying to put doctors out of work?

 

[14022]

What do you know about it? This qoute is based in ignorance. Have you done the same in the pursuit in the excellence of law?
Are you going to be one of those guys who fills their wallets on other people's misfortunes while trying to put doctors out of work?

How many times does our lawyer friend have to indicate that he DEFENDS doctors for others to understand his position. He has not "flip-flopped" during his comments. Personally, I think his perspective is interesting and should be very valuable to medical students interested in the discussion of ethical issues in medicine. Whether you like it or not, many of us will be sued and will need a lawyer on our side, so instead of pissing him off to the point that he stereotypes all doctors to demonstrate the same sort of ignorance that you have demonstrated and decides to move to the "dark side of law" and become doctor-unfriendly. He hasn't said anything insulting, condescending, or judgmental. Let's get back to the issue of the original post and put our lawyer phobias aside for a bit.

 

[4th year]

How many times does our lawyer friend have to indicate that he DEFENDS doctors for others to understand his position. He has not "flip-flopped" during his comments. Personally, I think his perspective is interesting and should be very valuable to medical students interested in the discussion of ethical issues in medicine. Whether you like it or not, many of us will be sued and will need a lawyer on our side, so instead of pissing him off to the point that he stereotypes all doctors to demonstrate the same sort of ignorance that you have demonstrated and decides to move to the "dark side of law" and become doctor-unfriendly. He hasn't said anything insulting, condescending, or judgmental. Let's get back to the issue of the original post and put our lawyer phobias aside for a bit.

I did not read the whole thread. I appologize.

 

[delchrys]

duke does a lineup of students, 4-6 in a row, for pelvics on anesthetized women.

 

[delchrys]

scholes: wow, that was way cool of you, seriously. i DO get offensive, i am sarcastic, and i often bait people for fun. BUT i never mean it to hurt others, unless they're major dicks. and i NEVER take stuff personally here, seriously . so thanks for the kind words.

4th year: totally cool, bro. if you hadn't said anything to qualify your "mean" post i would have just ripped on you or something, but see above (this same post) to understand the context if i ever do rip on anyone.

i used to want to be a doctor when i was younger, but screwing up undergrad kind of changed that for me (i figured it was like high school--no work necessary). so, i did what every guy does who can't make it in the big leagues, and waited tables, then worked for a major automaker in their finance dept answering phones and later running a department (fun for almost a year, then it got boring when i was getting hounded--LITERALLY--to use less staples and color ink (tells you how efficient things were if that's all they could f*ck with me about, lol)), and finally decided, hey, what does everyone do who can't figure out what they want to be when they grow up? i'll go to law school. and, surprise, it IS just like high school--cliques, "cool kids," etc, and hardly any work necessary to stay ahead of the pack. i've learned more working in my med mal firm than i have in 2 (almost 2.5, holy shizzle) years of law school. it's fun, but i'm sure it will get boring. i'm thinking of either going for a MPH in public policy (do they even offer that specialty?) or med school, or raise kids, depending on what my woman ends up doing (she's going into surgery, starting her residency at some yet-to-be-matched location...nervous = me, since i will have to do the bar exam for the state she matches in). my sister, my best friend, his wife, and my woman are all physicians, or within a year of being official docs...having doc friends doesn't make me one, but i ask a lot of questions and am hyperalert when medical topics arise...so i know a lot about a some of what goes on in med schools (DO and MD), though not even a tenth of a percent of what you guys go/went/will go through.

i guess my goal is public policy, politics or legislative action committee work. and there is no fear that i'll stereotype docs--i already have, and meet those who defy the stereotypes regularly, just as i meet those who reaffirm the stereotypes. i like most docs, i definitely respect them, and i use this forum as a way to relax and let of steam (via lame internet arguments) and to better understand your world/my possible future world.

understand one thing about me, though (aside from the fact that i offer lots of unasked-for information to strangers online, lol): even if i switch over to the plaintiff's side of the med mal scene, i will not work cases i don't believe in. i like defense because i feel like i'm helping the side that society thinks of as "bad," but i see just as many legit cases come through and because i'm "young" in terms of experience, i can't pick and choose. either way, i think this business is just a learning tool for me; it will get old and i will move on to something more fulfilling and real. maybe belly dancing...

 

[stomper627]

Bottom line: If you aren't getting enough practice doing pelvics on your Ob/gyn or Fam med rotation - you are getting poor training.

Unfortunately, being a male, many times we dont get good training on these rotations. I was sent to the hall many a times because a woman did not want me to perform the exam, nor did she even want me in the room.
My question to our lawyer friend is where do we draw the line between getting an education and being sensitive to our patients. The way the laws are now, what once was considered for "medical students" is now for interns to learn, and what once was considered for interns, is now for residents. Where does this leave attendings?
I know my father had over 500 solo deliveries (no attending there) as a med student, and also moonlighted at an ER on the weekends as a MSIV. This is unheard of today.
stomper

 

[delchrys]

i guess the way i feel about it is in large part governed by my unnatural sensitivity to the idea of other men, even docs, seeing my woman unclothed. i guess the best analogy i can come up with is working at a domestic violence/rape crisis center. when i was at umich, i wanted to work at their domestic violence shelter, but they would not allow men to answer the hotlines or do counseling work with women. i felt that it was extreme, overly-PC, and sexist. with OB/GYN, or with any profession dealing with something as scary and personal to the average person as medicine, i think that, aside from the immediate concerns one has for the patient in front of them, the patient's autonomy and right to refuse any procedure/treatment that he/she wants should govern, provided that he/she is adequately informed of the consequences of their actions.

that being said, i don't want a parade of men, for any reason, doing bimanuals or basic pelvics on my wife while she's conscious or unconscious. some people don't care. it would seem that there are enough women out there who are okay with it that it doesn't make learning impossible, just tougher. while that sucks for the aspiring male OB/GYN, the result will possibly be less males in that specialty, and i think the world will keep turning without major incident. i seriously don't mean to sound callous, and i used to think male OB/GYNs were pervs in disguise (i do NOT think this now!), but i can understand why they didn't let men answer rape crisis hotlines, and, while pelvic exams are not even on the same planet, it still speaks to privacy issues. a patient exists to be treated, not to serve as a teaching tool. medical students and residents are able to learn quite a lot from patients who voluntarily submit to being a teaching tool, and i will certainly not object to students doing stuff on me when i inevitably have to go to the hospital, but i think a person's right to refuse this should be held sacred, given that there are other patients who will not refuse.

 

[delchrys]

oh, and about the law--much of the regulations about who can do what in the hospital (student vs. resident vs. chief vs. attending) are regulation promulgated by the hospital or by organizations, rather than congress.

i haven't dealt much with this aspect of the law yet (such a typical answer, lol). though it does interest me, i feel as though my time is best spent now just trying to pass my classes (took a LOT this term) and do okay at my jobs and not get fired, etc. any extracurricular law learning i'm doing is generally directed at med mal, simply to get a solid basic understanding of the REAL story of how many claims are truly frivolous that get awarded money and how many are legit (as opposed to the TONS of rhetoric and policitcally-charged 'reports' out there coming from all sides of the debate).

 

[Ice-1]

As a woman and a med student I will be filing criminal battery charges against the physicians, students and hospital if I am anesthetized and any procedure is performed on me that:
A) I did not expressly consent to or
B) If not expressly consented to was NOT done in an emergency situation

Idiopathic I agree with your earlier sentiments. Practice exams of any type by physicians or students should be done only with the patient's consent and consent is not implied by virtue of being in a teaching hospital.

 

[ericdamiansean]

As a woman I have to say that I really don't have a problem with this. If I am at a teaching hospital it's what I would expect. Strictly speaking there's a lot going on in surgery that you don't expressly consent to, and I've had major surgery so I can attest to this. So if you want to take a quick look see down there while you put in the Foley, I say no harm no foul, just leave the area as you found it and "do no harm".

a) Define 'do no harm'
b) In bimanuals, technically, we are not even supposed to 'accidentally' touch the clitoris. So, if you have a student who's pretty perverted and he's looking down on you while you are under anes and fondles you, he knows, no one else knows, what are you going to do?

 

[souljah1]

Lining up 4-6 medical studens to do pelvics on anesthesized women is totally ****ed up in my opinion. Not giving clear information regarding students lining up to examine their genitalia and reproductive organs is incredibly unethical in my opinion. I doubt that the consent form states that medical students may line up and take turns examining you and do bimanuals when they are of no benefit to you clinically at the time. That does not happen here in any way to my knowledge. And if it did, I am incredibly confident that the majority of my classmates would refuse. This question was actually raised to our faculty when we had preparation coursed for clerkships and we were assured that we would not be put in that position, and were given the impression that this sort of thing is looked upon unfavorably.

 

[phoenixsupra]

At my school, the rule is that it's ok to do on wellfare patients but not on private patients. Go figure.

 

[tupac_don]

Let me pose a question. I am on gynecological surgery and several different residents and attendings have told me that prior to surgery it is a great idea to perform a pelvic exam on the anesthetized woman in order to get practice. Many have said it is not traumatic to the patient and you get a more technically adequate exam since the patient is not guarding. Sure enough, before every procedure the attending and resident (and I have worked with 6 attendings and 4 residents, both males and females, at two different hospitals, both community and academic hospital) perform a quick pelvic exam.

Is this wrong? The attending does it for one last chance to feel for any previously undiagnosed masses or other abnormalities, but the resident and student do it primarily for educational purposes. The patient has consented to the surgery, but not for the pelvic exam. Does consent to surgery of the uterus, vagina, vulva, ovaries, etc. also imply consent to manual palpation of these structures during the surgery?

Has anyone else had a similar experience on their ob/gyn clerkship?

Been there done that, it's A okay.

 

[Mumpu]

Rule of Life #1: Just because you can do something, doesn't mean you should. Use your brain, if ya got one, and have some balls for once in your life.

 

[Trisomy13]

and if i could get my hands on some vecuronium i'd do it at the supermarket too.


booya.




or something.

 

[apgar7]

Interesting question by the OP. I assumed the pelvic exam under anaesthesia was part of the surgical procedural itself. It's the physicians last attempt to double check there are no masses or abnormalities he/she might have missed prior. So someone honestly tell me, is the pelvic exam a distinct procedure from the surgery itself? If it is not, then they are both one procedure that the patient consents to. If it is a teaching hospital, there is usually a clause that students and residents will be assisting and participating in the medical or surgical care. Of course, if the pelvic exam is distinct from the surgery itself, then perhaps not even the surgeon should be doing it if consent is not given, let alone a medical student.

 

[starayamoskva]

Interesting question by the OP. I assumed the pelvic exam under anaesthesia was part of the surgical procedural itself. It's the physicians last attempt to double check there are no masses or abnormalities he/she might have missed prior. So someone honestly tell me, is the pelvic exam a distinct procedure from the surgery itself? If it is not, then they are both one procedure that the patient consents to. If it is a teaching hospital, there is usually a clause that students and residents will be assisting and participating in the medical or surgical care. Of course, if the pelvic exam is distinct from the surgery itself, then perhaps not even the surgeon should be doing it if consent is not given, let alone a medical student.

Once the patient is under anesthesia (either general or spinal) and before being prepped and draped for the surgery a pelvic exam is performed. The exam gives you information on the location of lesions, amount of pelvic relaxation and uterine descent. It can be helpful in making the decision to do a vaginal versus abdominal hysterectomy. The pelvic exam is imperative when doing any oncologic procedure because it allows you to evaluate for vaginal, parametrial or rectal invasion.

 

[TX OMFS]

I started to read this thread but I can't finish it; I'm going to hurl. Look, I'm on my Ob/Gyn rotation right now too and I've seen this practice as well. Our consent does not mention anything about pelvics under anes., nor does it mention that you may get a foley for that matter. So what? Doing a pelvic is part of the procedure. This thread is getting asinine.

I am also an oral surgery resident. I don't get consent to stick my fingers in people's mouths, down their throat, and in their oropharynx. However, we still do these things commonly as diagnostic procedures while the pt is asleep. We might even have several people do it for teaching purposes. It's an invasive diagnostic procedure in the same way that a pelvic is except that it doesn't involve the hoo-ha.

I'm about sick of the damn lawyers mucking in my profession. I don't tell a lawyer how to practice. Besides, wtf do the women think happens when they get surgery done on their vagina? Do they think we send everyone out of the room except one women and that woman does the surgery all be herself in the dark to protect the pt's privacy?

If you come to a teaching hospital things like this happen. It's part of the bargain for reduced fees. If you happen to be at the teaching hospital b/c you need specialized care/procedures not available in the private world tough noogie. Just treat your patients like people (even if some of them are barely human), explain thing to them, and have integrity--let the students do the exam, but make sure the door and windows to the OR are shut, etc.

On a personal note, while I've been Ob/Gyn I've tried my best to avoid doing procedures or being in the room, unless I know what I'm doing won't have to be repeated. I'm not going to be an ob/gyn so I'm content with just knowing about procedures without actually "joining the party" and being the sixth person in the room during a colpo.

 

[TX OMFS]

"Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less in human beings of whom they know nothing." -- Voltaire

"The art of medicine consists of amusing the patient while nature cures the disease." -- Voltaire


Mumpu, these quotes are stupid.

 

[delchrys]

I started to read this thread but I can't finish it; I'm going to hurl. Look, I'm on my Ob/Gyn rotation right now too and I've seen this practice as well. Our consent does not mention anything about pelvics under anes., nor does it mention that you may get a foley for that matter. So what? Doing a pelvic is part of the procedure. This thread is getting asinine.

I am also an oral surgery resident. I don't get consent to stick my fingers in people's mouths, down their throat, and in their oropharynx. However, we still do these things commonly as diagnostic procedures while the pt is asleep. We might even have several people do it for teaching purposes. It's an invasive diagnostic procedure in the same way that a pelvic is except that it doesn't involve the hoo-ha.

I'm about sick of the damn lawyers mucking in my profession. I don't tell a lawyer how to practice. Besides, wtf do the women think happens when they get surgery done on their vagina? Do they think we send everyone out of the room except one women and that woman does the surgery all be herself in the dark to protect the pt's privacy?

If you come to a teaching hospital things like this happen. It's part of the bargain for reduced fees. If you happen to be at the teaching hospital b/c you need specialized care/procedures not available in the private world tough noogie. Just treat your patients like people (even if some of them are barely human), explain thing to them, and have integrity--let the students do the exam, but make sure the door and windows to the OR are shut, etc.

On a personal note, while I've been Ob/Gyn I've tried my best to avoid doing procedures or being in the room, unless I know what I'm doing won't have to be repeated. I'm not going to be an ob/gyn so I'm content with just knowing about procedures without actually "joining the party" and being the sixth person in the room during a colpo.

when you place a foley cath, do you then remove it and let the next idiot try it, and then the next, and then the next, until all the little medtards have had their shot? no--one person places it, and it's done. so, why would a line of med students get a crack at doing a pelvic on a woman when the need for the pelvic by the attending himself/herself is questionable to begin with?

yeah, crack on my profession; if you haven't noticed my sig, i do the same thing. but you can get on your knees and blow me if you think that i am somehow ignorant or incapable of expressing a cogent view on patients' rights, you sanctimonious f*ckwad.

people like you make me sick--you know best, you're the doc, and all mere mortals aught to shut their mouths, avert their eyes, and beg for mercy. sorry, the 19th century is over, bro, and even the little people like patients have rights, and you will be aware of this when the first lawsuit hits you. of course, they will just be greedy bloodsuckers, manipulated into suing you frivolously by the evil vulture attorneys, no doubt. the average person doesn't know the difference between a teaching hospital and one that's not, but somehow they are supposed to know that they've signed their rights away at the door? you should post the name of your hospital, so people can avoid going there. thank god you don't speak for all the members of your otherwise highly respected profession.

 

[Doc Ivy]

I started to read this thread but I can't finish it; I'm going to hurl. Look, I'm on my Ob/Gyn rotation right now too and I've seen this practice as well. Our consent does not mention anything about pelvics under anes., nor does it mention that you may get a foley for that matter. So what? Doing a pelvic is part of the procedure. This thread is getting asinine.

Finally, someone with some freaking common sense!!!
I don't see the need to unload a whole busload of students to do pelvics on unsuspecting women, but if the student scrubbed in on the case does a pelvic for purely edification purposes with the guidance of the attending then that isn't a problem. My goodness

 

[TX OMFS]

delchrys:

Sweet, my chance to debate a mental giant. I too enjoy a good sparring match, though I don't usually fight unarmed men. I wasn't making lawyer comments aimed at you. I was just saying that case law shouldn't affect my practice. Since you bit, though, let me say that in as much as I am the "doc, and all mere mortals aught to shut their mouths, avert their eyes, and beg for mercy" you lawyers think you are the holy defenders of the unclean masses b/c they're too stupid to take care of themselves.

As for the foley, perhaps you should pick-up an SAT practice book and study analigies. A foley is more invasive than and can cause much more damage than a bimanual and yet not specifically consented too. And yes, you ignorant ambulance chaser, sometimes students do attempt the foley and if they can't get it done it does get passed around the damn room until someone does it right.

The need for a preop pelvic by the attending is not questionable. Man, are you ever ignorant. Things can change and this exam may even avert a surgery. That's like saying I shouldn't look in someones mouth before I start cutting their neck to access their mandible. I'd say it's malpractice not to examine every patient before you cut. Any other opinion shows glaring ignorance.

Despite your invitation, I will not blow you, though I do think you are incapable of expressing a cogent view on patients' rights. In fact, your opinions prove the need for malpractice juries made of at least a simple majority of physicians. Your thoughts may seem great in an ecceteric world of tree-hugging and happiness, but reality has to step in somewhere. Letting students and residents do a simple PHYSICAL EXAM is no big deal. Okay, I'll agree it would be nice to tell the women it will happen, but if that doens't happend so what? Everyone in that room was going to see her damn vulva and have their hands either in the vagina or the abdomen anyways so she hasn't lost any privacy.

Patients do have rights? This phrase is thrown around by every damn idiot, like yourself, but where does it come from? Hey Mr. Lawyer, does the Bill of Rights say "Medical students shall not examine a patients vagina prior to vaginal surgery?" This patient's have rights bull**** camefrom lawyers who coinded the phrase and then conveniently used it where ever they could make a buck. Healthcare isn't even a right. Sure medicine needs checks and balances to prevent unethical behavior, but lawyers make it absurd. Funny that lawyers are the only profession that truly self-police. State medical boards bow to lawyers, yet who polices the lawyers? Other lawyers?

Yes, I agree gynecology is a sensitive discipline and a woman's privacy and dignity must be respected. Pull out your hooked on phonics and reread my last paragraph, slowly. Get an adult to help you if you can't understand what I said. However, having medical students do a legitimate exam, even if the value is purely educational, is far from a violation of privacy and dignity. Again, if you come to a teaching hospital you have to pay for your benefit of reduced cost or advanced care somehow. That payment may just be in the fact that a student or resident is going to do a redundant exam on you. This same situation arises in our clinics and no one cries about it. The intern does the pelvic, if they have a question the upper level and the attending redo the exam. The pt probably wasn't told on arrival of this possibility but no one screams about it. I find that lawyers like yourself make a stink when they smell money. Good lawyers do their job without championing nonexistant causes and trying to legislate from the bench.

Finally, the average person does know the difference in private and teaching hospitals. The may not know what the phrase teaching hospital means, but in this town they know that unisured/poor people go to my hospital and other people go to the private hosptial, and they know that my hospital has students and residents. Sorry, that's reality.

 

[captbadass]

way to put him in his place, tx omfs. couldn't have said it better myself.

capt

 

[ridirkulous]

you do understand that i work to DEFEND doctors and hospitals, right? even the ones who blatantly screw up and should lose their licenses?

So someone who blatantly screws up (aka. makes a mistake) should lose their medical liscense? That is ridiculous. When a lawyer makes a mistake and someone's life is screwed up because of it, do they loose their liscense? People make mistakes. Physicians will be wrong sometimes. Only if they've done something clearly unethical should their liscense be revoked. On the other hand, lawyers like you will make them pay in other ways. That is probably okay too--as long as we aren't making physicians "pay" for things they've done right.

 

[delchrys]

So someone who blatantly screws up (aka. makes a mistake) should lose their medical liscense? That is ridiculous. When a lawyer makes a mistake and someone's life is screwed up because of it, do they loose their liscense? People make mistakes. Physicians will be wrong sometimes. Only if they've done something clearly unethical should their liscense be revoked. On the other hand, lawyers like you will make them pay in other ways. That is probably okay too--as long as we aren't making physicians "pay" for things they've done right.

hmmm, did i say "someone who blatantly screws up and THEREFORE should lose their license"? oh, no, that's right, i was talking about two separate factors. like the hospital nearby where the nurses put tape on patients' decubitis and the physicians see it and do a "those crazy nurses" eyeroll and leave it at that. and that's a super-minor issue. but yeah, i think when a physician makes a mistake borne in negligence (that is, violating the standard of care, the lower limit of acceptable treatment) more than a few times in one year, then he or she should lose his or her license rather than be allowed to continue to screw up others' lives. do you disagree? should you get a 5th, 6th, 7th chance to kill more people, or is there a limit? or, because you're a doctor, is any policy that recognizes the shortfalls of bad doctors something that you will oppose?

And yes, you ignorant ambulance chaser, sometimes students do attempt the foley and if they can't get it done it does get passed around the damn room until someone does it right.

sure they do, but they do it in order to reach the end goal, which is a necessary one for patient care: to get the damned thing set up right. after the attending does the pelvic, there is no need for a bunch of students on an ob/gyn rotation to come in and do the rotation in the sense that it does not serve the patient in any way. i love how you continue to insist that patients sign away their rights at the door, and i also love how you treat invasion of the vagina like invasion of the throat, as if they are even comparable.

you don't represent "physicians" when you speak; you represent yourself. i found out about this practice from friends who are physicians, many of whom are female, and they are disgusted by it. they are the ones who have indicated that in some of the cases it is indeed questionable whether the exam is necessary, and one of them is an OB/GYN, though i'm sure your little rotation there is a wealth of solid knowledge.

do the world a favor, and print out a big sign of this little gem of your brilliance, and put it all around your office, when you get one:

This patient's have rights bull****"

classic.

and, last but not least:

I'm about sick of the damn lawyers mucking in my profession. I don't tell a lawyer how to practice.

Good lawyers do their job without championing nonexistant causes and trying to legislate from the bench.

beautiful. not only arrogant and full of ****, but stupid and hypocritical, too.

 

[Idiopathic]

delchrys:

Sweet, my chance to debate a mental giant. I too enjoy a good sparring match, though I don't usually fight unarmed men. I wasn't making lawyer comments aimed at you. I was just saying that case law shouldn't affect my practice. Since you bit, though, let me say that in as much as I am the "doc, and all mere mortals aught to shut their mouths, avert their eyes, and beg for mercy" you lawyers think you are the holy defenders of the unclean masses b/c they're too stupid to take care of themselves.

As for the foley, perhaps you should pick-up an SAT practice book and study analigies. A foley is more invasive than and can cause much more damage than a bimanual and yet not specifically consented too. And yes, you ignorant ambulance chaser, sometimes students do attempt the foley and if they can't get it done it does get passed around the damn room until someone does it right.

The need for a preop pelvic by the attending is not questionable. Man, are you ever ignorant. Things can change and this exam may even avert a surgery. That's like saying I shouldn't look in someones mouth before I start cutting their neck to access their mandible. I'd say it's malpractice not to examine every patient before you cut. Any other opinion shows glaring ignorance.

Despite your invitation, I will not blow you, though I do think you are incapable of expressing a cogent view on patients' rights. In fact, your opinions prove the need for malpractice juries made of at least a simple majority of physicians. Your thoughts may seem great in an ecceteric world of tree-hugging and happiness, but reality has to step in somewhere. Letting students and residents do a simple PHYSICAL EXAM is no big deal. Okay, I'll agree it would be nice to tell the women it will happen, but if that doens't happend so what? Everyone in that room was going to see her damn vulva and have their hands either in the vagina or the abdomen anyways so she hasn't lost any privacy.

Patients do have rights? This phrase is thrown around by every damn idiot, like yourself, but where does it come from? Hey Mr. Lawyer, does the Bill of Rights say "Medical students shall not examine a patients vagina prior to vaginal surgery?" This patient's have rights bull**** camefrom lawyers who coinded the phrase and then conveniently used it where ever they could make a buck. Healthcare isn't even a right. Sure medicine needs checks and balances to prevent unethical behavior, but lawyers make it absurd. Funny that lawyers are the only profession that truly self-police. State medical boards bow to lawyers, yet who polices the lawyers? Other lawyers?

Yes, I agree gynecology is a sensitive discipline and a woman's privacy and dignity must be respected. Pull out your hooked on phonics and reread my last paragraph, slowly. Get an adult to help you if you can't understand what I said. However, having medical students do a legitimate exam, even if the value is purely educational, is far from a violation of privacy and dignity. Again, if you come to a teaching hospital you have to pay for your benefit of reduced cost or advanced care somehow. That payment may just be in the fact that a student or resident is going to do a redundant exam on you. This same situation arises in our clinics and no one cries about it. The intern does the pelvic, if they have a question the upper level and the attending redo the exam. The pt probably wasn't told on arrival of this possibility but no one screams about it. I find that lawyers like yourself make a stink when they smell money. Good lawyers do their job without championing nonexistant causes and trying to legislate from the bench.

Finally, the average person does know the difference in private and teaching hospitals. The may not know what the phrase teaching hospital means, but in this town they know that unisured/poor people go to my hospital and other people go to the private hosptial, and they know that my hospital has students and residents. Sorry, that's reality.

You are actually being kind of a little bitch. The debate is over this: after the attending and resident have done said physical exam, should the student do one also, and at what point should the student(s) not do them. If you take debate and criticism this well in real life (and with such snappy comebacks!) you should go far.

Remember, the discussion is about "a parade of male students doing bimanuls/pelvics on anesthetizes women". Dont make it into "so I cant look in someone's mouth before I cut?"

I hope you display this sort of arrogant, sarcastic attitude with your patients...you might need to call mr. delchrys soon...for representation.

 

[EMDrMoe]

Has anyone thought about the benefits of having a procedure repeated, even if it is by a "medtard"? Just recently, I caught a breast lump the resident missed. As a student, I'm supposed to be learning, so I can and do take longer and am sometimes more thorough. So, once in a while, a student may find something while they're learning that really enhances patient care. The patient and student are better off for it. Just a look at the flip side...

 

[Doc Ivy]

Has anyone thought about the benefits of having a procedure repeated, even if it is by a "medtard"? Just recently, I caught a breast lump the resident missed. As a student, I'm supposed to be learning, so I can and do take longer and am sometimes more thorough. So, once in a while, a student may find something while they're learning that really enhances patient care. The patient and student are better off for it. Just a look at the flip side...

Excellent point.

 

[carrigallen]

My understanding is that the pelvic exam during surgical anesthesia is legal in all states except for California, which has a law specifically forbidding this procedure without express informed consent.

I hold with the moderate and rational approach - if it is beneficial and educational for a procedure to be repeated once or twice, then do it. A parade of students is not beneficial for the patient.