US teaching hospitals are allowing medical students to perform pelvic exams on unconscious, unconsenting women? [Edited by MNHQ]

In fact the rest of that response is interesting - this part follows directly from my first copy paste:

"We are now looking to improve this specific consent form along with
our other consent forms, which have been developed in line with the
recommendations from the Department of Health (DOH) guidelines.
Why not introduce a consent form, based on this tried and tested model,
for consenting to intimate procedures under anaesthetic, for women and men
patients, in all teaching hospitals or indeed in all hospitals?

Who should obtain the consent? Verbal feedback has revealed that
students think they should. They learn the skills of creating a good
rapport, sensitivity and understanding of the patients as well as the
components of
taking a valid consent. Such a task could be tested in an OSCE – it is a
prime example of the need for good communication skills.

How far should we take this? Medical students doing rectal
examinations of the prostate, canulating a vein, palpating a breast lump
while the patient is under anaesthetic?
The DOH does not specify what should or should not have written consent,
other than implying that if risk is involved written consent is needed. It
leaves it to the Trust concerned to decide what to include. It does say
that ‘before you examine, treat or care for competent adult patients you
must obtain their consent’. So consent must always be sought by the health
professional, but the tricky question of training students with sensitive
procedures/examinations such as the above is not addressed by the DOH.
This is something that needs to be reviewed regularly within each Trust by
medical, legal and patient groups to get consensus.

Yours sincerely,

Heulwen Morgan FRCOG, Consultant/Senior Lecturer, Women’s Health,
Whittington Hospital and Sub Dean, Archway Campus, Royal Free and
University College Medical School, London.

[email protected]

Jane Wilson RGN, MBE, Patient Information Co-ordinator, The
Whittington Hospital, London.

[email protected]

1. Royal College of Obstetricians and Gynaecologists, Intimate

Competing interests:

None declared"

washedwithrain

someone upthread said it stopped in 80s in uk

i am trying to get something more definitive for you although why I am having to google to answer your questions when you're a medical person and presumably know better where to look than me is anyone's guess

anyway I found this BMJ thing with some responses www.bmj.com/content/326/7380/97/rapid-responses one of them says this

"Example of good practice - at the Whittington Hospital we have been
using a student consent form for intimate examinations of women under
anaesthetic since 1997, when the Royal College of Gynaecologist’s
publication was produced (1). It is part of the student training pack.
The woman is clerked by the student, who personally obtains her written
consent to vaginal examination; only that student performs the
examination, under supervision, in theatre. Verbal consent is obtained
for examination in clinic. Examinations on mannequins, in clinics and in
theatre provide different learning experiences, all of which are
complimentary."

question was asked in 2003

It’s revolting that this is allowed.
When I was having DD the dr who delivered her asked if I wanted some diclofenac for pain relief and I said yes, he gave me a suppository which I didn’t consent to or realise until he put his finger in my rectum, so I kicked him

Just one other thing. I am not saying that a sexual assault didnt happen, I am saying it wasnt routine practice for these examinations to happen. There is a really important difference in those two scenarios.

It seems to me they wouldn't speak up about it anyway - something I would understand by the way

I do hope that isnt aimed at me. I bloody well would speak up about it and in fact did whistle blow on something entirely unrelated to this subject.

Certianly it WAS common practice here until relatively recently and is still common practice in many countries all over the world.

When you say 'here' where do you mean, because it wasnt common practice in large teaching hospitals in the 80s and 90s? Of course, desperately sadly, someone may have been assaulted, but what those of us who worked in that environment are saying is that it wasnt common practice to examine women in this way, and we are struggling to see a scenario where it might have happened. Certainly in English teaching hospitals anyway. To be clear I am talking about unrelated surgery, not gynae - where I absolutely did see women examined under anaesthetic by medical students.

To be honest I take with a pinch of salt someone who dismisses outright what a person has said because they have never witnessed it. It seems to me they wouldn't speak up about it anyway - something I would understand by the way.

Thank you Mary

Thank you Dora Opuku

A few of them, like myself, also lived in London.

Just because you never witnessed it doesn't mean it didn't happen.

I've never been raped by a stranger but that doesn't mean it doesn't happen.

I've never witnessed a Tsunami, but that doesn't mean it doesn't happen.

I have seen someone throw themselves on a train line and commit suicide. There were at least a hundred people on the platform - overground. However when I tell people this all of them are thankful they have never seen anything like that happen despite every one of them having visited London.

Does anyone know if there was a minimum age on this practice, or is in countries where it is still allowed?

Washedwithrain

With all due respect, you dont't know when this posters friend had this happen (could be decades ago) nor do you know which country (although I assume UK as well).

Certianly it WAS common practice here until relatively recently and is still common practice in many countries all over the world.

If a woman says she has unexplained bruising, soreness and lubrication INSIDE her vagina when she has gone in fro a tonsil op then it's a massive benefit of the doubt to say it is DEFINITELY something else that has happened.

I know a doctor who was forced to do this in Ireland. She objected (being the sixth person to have a go) but was told in no uncertain terms that it wasn't optional.

Fwend said she was 16 and in to have her tonsils removed. She woke up sore and bruised and sticky. This is serious assault.

I think what those of us who worked in theatres are saying is that there may be reasons other than a sexual assault for what happened. The stickiness is most likely due to the diathermy pad. Without knowing details about the bruising, and I'm certainly not going to ask, it isnt possible to say whether there was a reason for this. Patients who have their tonsils out are at risk of bleeding into their airway post op. Sometimes we had to turn patients onto their sides very quickly to keep them safe after a tonsillectomy. Maybe that is what happened. It wouldnt excuse any bruising, but it would explain it.

I think those of us who worked in theatres are really struggling to understand a scenario whereby patients undergoing surgery for something unrelated would be vaginally examined. Putting it bluntly, there wouldnt be time, the patient wouldnt be in the correct position, it wouldn't enter the head of medical staff in other specialties to suggest it, and students wouldnt be doing gynae at the time so they wouldn't ask. Patients in theatre arent left alone for a single second, and it would be rare for there to be fewer than 2 or 3 staff members to be present at all times caring for the patient. I worked in theatres for many years and underwent several procedures myself. I am certain my dignity was maintained and no-one even uncovered part of me unnecessarily. I really hope that Fwend was treated the same way and that there is an explanation other than assault.

Fwend said she was 16 and in to have her tonsils removed. She woke up sore and bruised and sticky. This is serious assault.

Even if you were in for a gynae procedure does that mean it’s ok to perform other intimate examinations on you. A PP said about paramedics practising intubating patients who were unconscious, sometimes brutally and several times. Who authorises this. After my emergency crash cesearean I had a sore throat and a slightly chipped front tooth but they were fighting to save my babies life and mine. It’s not acceptable to do this to the same patient over and over.

One consultant used to get his students to examine gynae patients, none of the others did when I was in theatres. The sister in charge in the Obs and Gynae theatres I worked in challenged it. And the consultant (who was a a vile man) reported her to the Chief Executive. She stood her ground despite him making her life very difficult, and it was stopped. I'm not going to name her fully, because she wouldn't like that and I know she is still around. Mary, you were a brave woman for doing what you did.

@fwend a sticky gel-like substance on your thigh, and potentially soreness, may be due to the diathermy pad which is often placed on the thigh and can be sore when removed.

When I was a student doing my obs and gynae attachment about 17 yrs ago we did examine women under anaesthetic but only those having gynae procedures, only those procedures where this type of examination would be done as part of the procedure anyway and only with consent. It was only a particular examination, as it’s one that can be quite uncomfortable whilst it’s being done - speculum examinations and how to do smear tests and so on we were expected to do as part of our gp rotation, the same with prostate/testicular examination.

Thank you Dora Opoku.

When I was a midwifery student in 1988, our senior tutor told us she had challenged this practice in our hospital a few years earlier. Successfully and bravely, because midwives only got grudging acknowledgement from doctors and management.

She was a star. I will name her because she was a star who is no longer with us.
Professor Dora Opoku.

"She also states that “the vast majority (72–100%) of women say they expect to be specifically consented for an educational pelvic exam performed while they are under anesthesia” and that many women “said they would feel ‘physically assaulted’ if not consented.”"

Let's be clear this is rape in many countries and assault by penetration in the UK (same severity crime as rape).

A person or people putting fingers and / or objects into a woman's vagina when she is unconscious is a sex offence.
As it's a hosp I suppose they can get consent in advance.
However without it, this is a sex offence. Obviously.

Is / was there a minimum age on this?

I was in and out of childrens hosp with multiple GAs between age of 12 and 16 in the 80s.

Sorry, I meant not widespread within the UK/NHS

I don’t know about women not allowing examinations to happen. Presumably if it is being done by medics in an operating theatre or recovery setting you may think it’s part of the procedure. Would anyone really have gone up against the teaching staff and consultants and risked their jobs. It was a practice for years and yet no one came forward.

No I'm not omnipresent Placemats and I'm not in a position to comment on practices abroad.

However I feel confident it hasn't been widespread outside of the UK and outside of gynae theatres for the practical reasons I listed.
I worked in theatres in the late 80's and never saw it happen. However I did see an anaesthetist pop a particularly juicy spot on a woman's back as she was being rolled onto the trolley, proudly announcing what a favour he had done for her. The theatre sister tore him to shreds and he narrowly missed a formal complaint. Lots of women work in theatres and would never allow this to happen.

So not so long ago even from the perspective of people who think the 80s was practically the dark ages.

AAK - upthread I posted a link to an item from 2003 that said 1/4 students at Bristol Medical School reported that they were unhappy that consent had been obtained appropriately.