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01 September 2010 @ 11:02 am
Unnecessary pelvic exams  

I have posted this to Twitter and Facebook, and here I'm posting it again.

Because this particular problem has a particular set of traits that make it ideal for being spread via the internet:
  • It is outrageous
  • It is ubiquitous
  • It is largely unknown
  • It can actually be solved via public opinion and subsequent public outrage

That last is the clincher.  TELL.  EVERYONE.  RIGHT.  NOW.

Here is the article detailing the practice of performing pelvic exams, without consent, upon anesthetized female patients.  Warning, the article may be triggery.

The basics, all of which can be found in the article:
  • If you are put under for any reason in the OB/GYN wing of a teaching hospital, you WILL have students practicing pelvic exams on you
  • These exams are performed without diagnostic benefit to the patient
  • These exams are performed with barely any educational benefit to the student (this is explained in the article)
  • This is happening almost everywhere, all the time, it's been going on for years
  • Medical ethics committees have criticized the practice, with no resulting change
  • Your doctor will lie to you about it, and the best way suggested in the article to deny consent to this procedure is to write on your body in marker that you do not consent to have students perform a pelvic exam on you
  • The only way to change this is to make it common knowledge

This was one of those articles that I started reading with a slow dawning of horror... I started out thinking, "Well, it's natural that all sorts of indignities would be visited on your body when you're anesthetized," and for the record, I'm someone who would willingly let students practice on my body with my consent.

But the more I read, the clearer the situation became.  This is a useless, out of control, repugnant, insulting practice.  I think the uselessness of it offends me more than anything else.  I could almost justify a morally repugnant medical practice that saves lives (it's probably fortunate that I'm not in charge).  But this is simply and plainly ridiculous, it's stupidity and insularity on a massive, ingrown scale.

And guess what?  We can STOP it.

So help stop it.  Repost, retweet, do whatever-the-fuck you do, but do it.
Current Mood: coldcold
soonest_mendedsoonest_mended on September 1st, 2010 04:54 pm (UTC)
Okay, let me throw in here that yesterday morning in Maternity I had a nursing prof (who holds anon-entry sex-ed for all campus residents, passes out condoms, urges women not to have their sons circumcised, and volunteers eight hours a week at a program for teenage mothers) tell us that we would start out our pelvic exams, especially the guys, on women who were unconscious.

I think I just assumed that there'd be a consent form somewhere in the pile of papers. Our clinical instructors are really good about informing patients and getting them involved in the teaching process, usually. We learn about colostomy care, not from instructors, but from people who have dealt with their own colostomies for years, for instance. We are constantly told to listen to the damn patient because a) the patient is smarter than we are, b) the patient is becoming an expert on their own condition even from the moment of diagnosis, and c) "the doctors will ignore them completely, and somebody has to listen."

I've been considering doing a post on the unethical behaviors I've seen in widespread use while doing clinicals at JPS, and kind of held back because I don't want to get sued. Let me tell you: I will be stomping down doors demanding consent for this crap. If they can't show me a nurse-witnessed consent form signed by the patient, there will be a shitshow rivaling any pancreatitis incident on med-surg to date.

I cannot thank you enough for posting this. Crossposting now.
Радаdigitalemur on September 1st, 2010 07:59 pm (UTC)
A friend of mine saw my post about this and said, "Wait, so they're leaving patients under anesthesia longer in order to do this? THAT ISN'T OKAY EITHER."

Here are the citations to articles I've found on the topic:

Wainberg S, Wrigley H, Fair J, Ross S. Teaching pelvic examinations under anaesthesia: what do women think? J Obstet Gynaecol Can. 2010 Jan;32(1):49-53. PubMed PMID: 20370981.

Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63. PubMed PMID: 16471023.

Schniederjan S, Donovan GK. Ethics versus education: pelvic exams on anesthetized women. J Okla State Med Assoc. 2005 Aug;98(8):386-8. PubMed PMID: 16206868.

Wilson RF. Unauthorized practice: teaching pelvic examination on women under anesthesia. J Am Med Womens Assoc. 2003 Fall;58(4):217-20; discussion 221-2. Review. PubMed PMID: 14640251.

Kincaide GG. AWHONN responds regarding pelvic exams without consent. AWHONN Lifelines. 2003 Jun-Jul;7(3):197-8. PubMed PMID: 12858676.

Edited at 2010-09-01 08:00 pm (UTC)
J.D.arasirsul on September 2nd, 2010 01:22 am (UTC)
Maybe I'm missing something, but isn't this kind of the point of a _teaching_ hospital? That there may well be things that happen that are of didactic benefit to the students that may not be of any practical benefit to the patient?

Now, I don't like the idea of folks lying about it, sure, but otherwise I think I'm missing something important, because I don't get what all the fuss is about. Best I can tell, that's why they call 'em teaching hospitals...
Tigresstigress666 on September 2nd, 2010 02:46 pm (UTC)
You know, if they asked me I'd say it was ok (and tell me if you find anything ;) ). But, I don't think it's ok for them to do it without asking first.

I agree, they do have to learn some how. But there is also the idea the patient should also have to consent. I realize there is the issue of worrying about too many people not consenting (particularly in the case of asking if a newbie can do their patient care) but maybe what htey should do is go on a campaign to educate people why it is a good thing.

And maybe even offer incentives like a discount on the price of care (I realize this will probably tend to only work towards a certain demographic but hey, people who really can't afford care get a discount, person gets to learn).
Wiseacreewin on September 2nd, 2010 03:14 pm (UTC)
The issue, in which I DO suspect you may be missing something fairly important, is a line of medical students forming to shove their fingers up my vagina while I'm knocked out and unable to tell them to stop.

That's not tantamount to sexual assault, btw, it IS sexual assault (in the state of Ga at least).

Without my prior consent. Without any need. Without any educational benefit, as giving this kind of exam to an anesthetized patient is nothing like giving an exam to a wakeful one. I've had many pelvics in my time, and doctors can get plenty offensive with my underparts even when I'm there to supervise them. I've had to tell doctors to not shove their fingers up my rectum without warning me first; sure is nice to be awake for that. When I was a virgin, I did not once manage a successful pelvic because the smallest size speculum was too painful, and because I was awake to tell the doctor, the doctor was able to stop. After those instances I was sore for a day or so afterward. Even these days I can always tell I've had someone digging around in there.

The issue is waking up with a sore vaginal cavity with no fucking idea of what may have been done to you. And when you ask your doctor, they tell you nothing has happened. So you wonder... was I raped? What else would they lie about? Do I need to be tested for VD now? Because WHERE WOULD I GO FOR THE TEST, if not the hospital?

The issue is this happening in a culture where rape is as prevalent as it is in ours. In some states, it would cross the line from sexual assault to rape, legally speaking. This is the stuff of nightmares. I'd like to think I can avoid someone giving me a date rape drug, even though I know if someone were determined enough, it could happen on just about any date. But I'm not supposed to be frightened of having an ovarian cyst removed.

The issue is that it's something I would offer, if asked, but would so fucking not ever offer in a million fucking years to anybody who did not ask me. I don't want someone touching my BREASTS without my permission. The idea of someone digging around in my vagina makes me start to shake and hyperventilate. If you don't automatically understand why this is terrifying, it may very well never make sense. Would it be okay if it were being done to girl children? Does that up the ante enough?

I was as horrified by the story the medical student told about the prostate exam, by the way. That is not teaching. It's not helpful to students, and it endangers patients. For exams of this particular nature, it teaches medical students exactly the wrong lesson: that the patient is meat, and their rights are to be violated with impunity. But honestly, I'd prefer that lesson were left out of teaching hospitals altogether, not just where sexual violations are concerned.
Avaro Naethavaro_naeth on September 3rd, 2010 05:33 am (UTC)
I will officially never set foot in a teaching hospital now that I've read this, and I'm kind of wary about -any- hospitals now. This is one of the scariest things I've seen in a while. Someone thinking they have the right to even look down there without me giving consent is NOT OKAY WITH ME.