Thursday, July 05, 2007

Practicing Pelvic exams

A commenter asks:

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?

Practicing pelvic exams in women under general anesthesia was not done when I was a medical student (93-97) or resident. Can any older docs confirm if this was ever done??

22 comments:

Bongi said...

i heard this story. i assume it must be urban legend because it is such an utter violation it surely can't be true.

emily said...

bongi, it's not urban legend. Check the links on the next thread for verification. In 2003, a tv show here exposed the practice and there was such a public uproar that politicians were tripping all over themselves vowing to introduce legislation outlawing the practice.

But the AMA and hospital association lobbies in Washington squelched any debate. All that was left was a "recommendation" that hospitals study the problem.

Here is a link for a bill introduced by a California assemblywoman demanding that women must give explicit consent before these exams. However it died before even being debated. So, the practice continues to this day.

http://democrats.assembly.ca.gov/members/a22/Press/p222003019.htm

btw, Bongi, I enjoy your comments on Dr. Schwab's Surgeonsblog. It's interesting to get views from doctors outside the USA.

Anonymous said...

It happened during my years as a student in AL [86-88 clinical yrs]. Mostly before TAH's or Vag Hys's, once the pt was induced the resident and whatever student was to scrub in would do a bimanual and give the attending their findings. With so any 0f the patients pushing 300lbs I was happy just to figure out where the fingers were supposed to go.

Jonathan said...

I went to medical school in Texas from 2001-2005. My experience is that as a medical student member of the gynecology team, I was allowed to "practice" the pelvic exam, or follow the resident's exam, after the patient was induced for surgery. If there were another medical student on the team, he or she would also do an exam. However, the ONLY people to do an exam under anesthesia were those directly involved in the care of the patient.

If one considers all parts of the body equal, this is philosophically no different than a resident hearing a heart murmur, and then telling the medical student to listen for it. However, because the vagina is considered private and because the exam is mildly invasive, the controversy arose. I suppose the outroar was over the idea that they were pulling in people from the hall--with no participation in the patient's care--to come do an exam with interesting findings.

I fully defend the practice I describe (uh, my experience as a medical student, that is). I believe it's appropriate. If medical students and residents are never permitted to "practice" (or to do a redundant exam), then they will never benefit from the knowledge of others.

Anonymous said...

Graduated 1986... Yes, but the practice had virtually ceased by then. A couple of older guys (with one foot in a retirement property) mentioned that it would be a good way to "practice." That's how they learned...

There are valid reasons for surgeons to examine a woman under anesthesia prior to GYN surgery and one cannot ask for explicit approval for every potential learner. I think the offensive idea is that a redundant genital examination could be done on a woman under anesthesia for an unrelated surgery. It used to happen.

Useful reminder how occasional abuse has undermined trust... One cannot legislate trust, nor should one judge the values of another age.

By the way, for gender-centric, other parts of the physical exam were once "practiced" under anesthesia... including rectal examination.

Gosh, I feel like the old guy I promised i never would be...

scalpel said...

As a medical student in the late 80s, I performed a few pelvic exams under anesthesia, but only in cases for which I was involved and already scrubbed in. It isn't like they opened the doors and lined up the whole class in the hall to take advantage of some poor unsuspecting woman.

You get a really good exam under anesthesia, btw.

Teresa said...

None of you have commented on a key question--it's not whether you or anyone else related or not related to the case did it. The key question is, did the woman know in advance that she would be examined under anesthesia by anyone, just for practice?

I would greatly prefer to be given the option to give permission to for that without anesthesia, for a variety of reasons.

This is a very bad practice from the patients' point of view. I understand the need for practice, but this is not the way to get it. The practice you are getting benefits you and your future patients; you are leaving a person under anesthesia longer than necessary, which does NOT BENEFIT THAT PATIENT. She and her health ought to be your first priority.

There are a lot of things male doctors need to understand about female patients. I could go on, but I suspect it would be lost in the din of the Internet, and probably no one really cares, anyway......

jackiewd said...

Teresa, as a female medical student I must say you are an idiot. If we never did anything that didn't directly benefit the patient at hand, there would be no medical education. A pelvic exam under anesthesia is a much higher-quality exam than with the patient awake (I wish I could get my yearly under anesthesia, actually). And it isn't like there are 15 students coming in to do this, it's the one student who has been following the case and writing notes and examining the patient everyday of their hospitalization. Your comment is illogical and shows absolutely no forethought. The vagina is no different from any other body part - if you don't practice examining it with a resident, you will never learn how to examine it. Furthermore, showing up at a teaching hospital ought to be consent enough. If you don't want care from students/residents then GO TO A PRIVATE DOC IN A PRIVATE HOSPITAL and pay the premium price. We work our asses off for pts and yet we aren't supposed to learn anything? That's what is unreasonable.

Anonymous said...

As a patient, and a woman I am deeply upset by this. Without consent is unbelievable! Just becaue YOU would want to have YOUR exam this way doesn't mean we all would. At least it is YOUR choice.
I had a situation where a resident popped in when I was already undressed. Never announced himself as such, I was never asked if I was okay with him asking questions and helping out. I had an appointment with a FEMALE gyn because I am a rape victim. Stop violating women.

Anonymous said...

And by the way, this implies that women are nothing more than objects. How many prostate exams do you do on unsuspecting men when they are under? Yeah. That's what I thought.

Anonymous said...

Hey JackieWD and Johnathan, I'm sure you won't mind then when your daughter gets drunk at a party gets "examined" or raped, hell, she'll be "under"--going to the party and getting drunk is consent enough isn't it, dumb asses!

Suzy said...

Sometimes they don't bother to wait until the patient is under anesthesia. They just wait until she is helpless. When I was in labor, I was examined repeatedly against my wishes by 3 students or interns or whatever they were. They were not my doctor and I didn't want them touching me, but my repeated refusal was met with 'just relax'. Naturally, in advanced labor, I couldn't get up and leave. One female jumped in between my legs and shoved her fingers up my vagina so hard I shrieked. She pulled out her hand and proudly announced "nine cenemeters" to the attending.

Of course, I was told I couldn't sue because it was 'routine'. I'm not a charity patient, I was paying full price, and they treated me like something between a blow up doll and a whore.

I don't care what they needed to learn. Those people had no right to traumatize and assault me in order to further their learning. How they get their education is none of my concern! My birth was ruined, and the severe depression I suffered for years after was definitely related to the assault. I have not seen a gynecologist since...I will never again be in that helpless of a position.

Suzy said...

Another thought...I've seen posts complaining that 'if we can't practice on patients, we can't learn". Exactly what makes live, autonomous human beings obligated to be your teaching tool? Let's see, you get to learn, you get to graduate, you get to make the big dollars. The patient gets nothing but violated.

Anonymous said...

Jonathan looks like a little faggot anyway--he surely examining young boys.

Anonymous said...

Pelvic examinations are given under anesthesia to patients with mental disabilities or suffer from psychological trauma.

Anonymous said...

jackiewd - I find it unfortunate that a medical student would speak in such a way and be so closed minded. Calling someone an idiot because they have a different opinion? I seriously hope that you are truly not a med student. Personally, I am disgusted by the whole thing. Perhaps to you the vagina is just another part of the body, but to others it is sacred and private. It is MY freaking body, I should have the choice!
Also, perhaps a teaching hospital is the only viable option for someone-I know for my sister this was the case. I will avoid surgery at all costs now.

Anonymous said...

I just think it's terrible that they STILL do this practice and defend it! It is a violation of privacy and the patient's medical rights! I will make sure that from this point on, I have a family member in the operating room anytime I am going to get surgery and if they see something suspicious, they can stop it ASAP! I have always hated doctors, and this makes me hate them even more! I am a sexual assault victim and I have been victim of a poor ob gyn exam. It left me in tears and scarred me for life!
You're telling me there is nothing wrong with giving un-knowing women pelvic exams?! You're sick!!! If I had the option to tell doctors I didn't want this performed I would definitely tell them not to perform it! I have sever anxiety and panic disorder and if this happened to me, I would suffer for years to come! Thank God the last surgery I had was when I was 13, I wouldn't think they'd do the surgery THAT early at least, I hope not! @_@
This is just an outrage!!! Hell, I may never go get surgery, even if I really really need it!!!

Suzy said...

Jackiewd, you are amazingly arrogant. "If we never did anything that didn't directly benefit the patient at hand, there would be no medical education."
Since when does any patient owe you use of their body to further medical education?

Anonymous said...

Patients must be treated with sensitivity and respect and as much as possible every procedure explained beforehand. However, if there is to be a competent medical profession in future (like when you're old and really need such care or for your daughters) invasive and unsavory "redundant" examinations must sometimes be tolerated. But only in an atmosphere of trust based on knowledge. The doctor after all wants what is best for the patient (generally speaking).

Anonymous said...

It makes me cry to think that people treat other people this way. That a woman with uterine cancer goes into a hospital with a doctor she trusts, and she can be violated, raped, while she's unconscious, and people not only think it's ok, but they argue their sick reasons why they should be able to do that. I have tears in my eyes now because I had that surgery at Tufts Medical Center in Boston. Three students introduced themselves in the room you're in before you go to the OR. I had no problem with the fact that they would observe the operation.

At my next checkup I'm going to ask my oncologist if he let them do that to me. He knows I have sexual abuse issues. If he says no, which I'm hoping, then I will continue to love him, he has helped me so much. If he says yes, that one or more of the students practiced on me, I'm going to stand up and condemn him and put a curse on him that the same will happen to his mother, his wife, his daughter and his granddaughters. And I will use a lot of force in my words. And it will come true.

He better say no.

Anonymous said...

AND you can bet that he won't be expecting the question AND that I'll be watching his face very closely. I will know if he lies.

Till then I'll try to not think about this.

Anonymous said...

med students why not let your buddies examine each others wives or girlfriends,or sisters or moms,i mean its all professional and a body is just a body right?rapists is what you are,legalized rapists.