Thursday, July 05, 2007

Learning Pelvic Exams

A commenter on Kevin MD asked:

Is it still true today that anesthesized female patients in the OR provide the opportunity for med students to practice pelvic/rectal exams in secret? Secret from the patient who has no idea this is happening to her? Supposedly the vague consent form the patient signs before the operation is the legal cover teaching hospitals and doctors hide behind to justify this clandestine procedure.I wonder if the surgeon would resent the patient should he or she be asked that the practice not be done. Or might the request not even be honored. The idea of medical students lining up to probe and examine the vagina of an unsuspecting unconscious patient for their own benefit, in my opinion, is nothing short of medical rape.

Medical students are no longer allowed to practice pelvic exams on anesthesized female patients.

Most medical students learn the basics of a pelvic exam from "standardized patients."
Below is a link about standardized patients:

However medical students still need to practice to get good, and many leave medical school without the ability to do an adequate pelvic exam. Some learn how to do it during OB/GYN rotations, but in many cases the patients on OB/GYN services don't want students to examine them. Therefore many doctors don't become proficient at pelvic exams until residency, if it all.


Anonymous said...

I've been in practice for 30 years,and teach medical students.I went to med school in Vt and FP residency in Mn. I never heard of practicing pelvic exams in woman under anesthesia. Was this the standard practice in any medical school or an urban myth?

Michael Rack, MD said...

Not sure. When I was a med student from '93-97, we learned pelvic exams from standardized patients.

kathy g said...

I highly suspect that I was used as a prop for pelvic exams during my breast surgery a few years ago. After obtaining the operating reports from my medical records, I noticed under "patient position" written "modified lithotomy" (for breast surgery?) Also it noted that 10 minutes prior to patient prep was devoted to "teaching". Hmmm...

I googled 'unauthorized pelvic exams' and a ton of stuff came up. It's definitely in practice in a lot of teaching hospitals. Here are a few interesting links:

(and men are victims too)

kathy g said...

sorry, this link didn't print out in my post. Here it is again:

Bongi said...

if this really happens i am dumbfounded. what a total violation of someone. yes maybe in nazi camps but in modern medicine???

how is it any different to rape?

Jonathan said...

I just left a comment on the other post regarding pelvic exams under anesthesia. Let me clarify. These were done after induction of anesthesia for surgeries relating to the uterus or the ovaries. I agree that it's absurd to "practice" a pelvic exam on a patient with normal findings undergoing an unrelated surgery. I have never seen nor heard of this.

The problem I have with the question posed and some of the comments are that they assume medical students are superfluous to the working of the hospital. The teaching/county hospital where I did most of my training depended on residents to function, who in turn depended on medical students to gather vital signs, document lab work, etc. In short, the difference between an intern and a medical student is just a milestone in education. They are all "doctors in training." A woman has a choice whether to go to a private hospital with no residents or medical students, or to a teaching institution where the care may be top of the line but there are some inconveniences (like having a medical student round before the resident who rounds before the attending).

I find bongi's comments troubling. It is entirely appropriate for a resident and a medical student to examine a patient with fibroids or an ovarian mass prior to the surgery. This is not "medical rape" or a violation. It's patient care. And it's a form of "practice"--learning to identify something abnormal so that the next time, when you're doing it on your own, you might actually help someone.

MCKean said...

You may find this news story interesting
Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits

Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

Did you know that:

Large teaching hospitals are pulling bait and switches, and unauthorized pelvic, breast, and rectal exams as described in the story at link above. Even if a woman going under anesthesia requests no men were involved in her care at this time, she will be ignored. As soon as she is out, they will bring in students to probe and prod all over her body.

Large V.A.s have a history as teaching hospitals, but as large state hospitals play less and less of a role in poor folks medical care, the V.A. patients have born a larger share of the burden.

As states have passed laws regarding informed consent and unauthorized exams and bait and switches, as baby boomer physicians retire, the need for more patients rises. In response, ALL VA Facilities are about to become teaching facilities. No vet will be safe, and women will be battered on a regular base. Teaching Hospitals like OHSU in Oregon are trying to gain greater access to other facilities, but as their practices tend to result in a greater number of law suites (OHSU is sued on avg. twice a month and they earn more than they get), they cannot get all the access they want.

Therefore, now all these women vets, harassed and raped at a much higher rate than the public will have the privilege of being raped for the rest of her life in the name of teaching Doctors. Not only will she be raped in the sense of unauthorized unwanted pelvic and anal (men also subject to this) exams, but after male CNAs and techs watch this abuse and disregard of women's rights over their bodies, then the women while still under anesthesia are left in their care.

Anonymous said...

Having surgery? You may very well be subjected to practice exams. You also may have students performing the surgery without your knowledge. If you request all women staff, they will simply lie. They will even go so far as to perform a little mini play right before surgery about how it is an all female team and how rare it is, just us girls, oh boy. then as soon as you are out, in come all the men. you are left with men after surgery, men come and go in dark rooms after surgery while you are still drugged.
It is violent, abusive, and happens every day to women who do not want men involved in care such as mastectomies, GYN surgeries, or colonoscopies.

Anonymous said...

I'm a female non-doctor and the practices you mention here sound like gross violation of my culture.

I would have committed suicide if I found out something like this was done to me.

At to that person here who commented that it's ok, and that women have a choice of going to another hospital (private)--even if they have no money, right? -- HOPE YOU DIE, AND ALL YOUR FEMALE RELATIVES AND YOU GET VIOLENTLY RAPED.

Anonymous said...

This happened to my wife , age 26. Conventional gall bladder removal (open incision, abdomen) .
After the sugery we were informed that she had an ovarion cyst . I was curious as to how this was discovered while working on the gall bladder . The doctor was a bit evasive and claimed he had a Gyne "assisting" with the operation . Still curious as to why they were plugging the genitals for a gall bladder surgery . She was also in recovery for a longer than normal time . Turns out the gyne brought a rather large group on board to show them just what the cyst "felt like" There was no permission given for this unwelcome, unrelated plundering by blundering students . The arrogance of the medical communtity is disgusting at best .
Doctors who claim thes is OK should be raped daily and relgated to sewer cleaning as a profession .

Anonymous said...

Proverbs Ch. 6;29 specifically states, anyone who goes into or touches HIS neighbors wife, shall NOT go unpunished. Men should understand that examining another mans wife, is SIN!

Anonymous said...

i had goll bladder surgery and im wondering why my uniary track hurts hope nobody went in my vagina