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

[SonicVersusGynaephobia]

And it's perfectly legal in most states.

This is in America, not, as far as I know, in the UK. But I'm completely gobsmacked and really upset. I don't understand how this is allowed.

bust.com/feminism/195099-public-exams-anesthesia.html

" Did you know that doctors and med students are allowed to practice pelvic exams on patients who they are under anesthesia for unrelated surgeries? Did you know that they do not need to ask first, or let them know after if it happened?

I first heard about this phenomenon on the Throwing Shade podcast when Erin Gibson, author of the new book Feminasty, brought it up as her women's topic of the week. Erin read a report from the NYU Ethics Division detailing this ongoing practicing and continued to rant about how gross it is. I immediately started asking my friends if they knew about it. The responses to whether or not they knew was mixed, but the responses of disgust were consistent. I started doing further research and found that this practice is shockingly widespread.

It is very common for teaching hospitals around the world to have med students “practice” performing pelvic exams on a surgical patient while they are under anesthesia without their consent, or even knowledge. According to Medscape, oftentimes, multiple med students will practice on the same patient. In the US, non-consensual pelvic exams are legal in every state besides Hawaii, California, Illinois, and Virginia.

Phoebe Friesen, a medical researcher, published an article called "Educational Pelvic Exams On Anesthetized Women: Why Consent Matters" in which she studied the phenomenon. She noted that in 2005, a study at University of Oklahoma “found that a large majority of medical students had given pelvic exams to gynecologic surgery patients who were under anesthesia, and that in nearly three quarters of these cases the women had not consented to the exam.” 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.”

According to Medscape, a 2007 study done in Canada found that 72 percent of med students admitted to having done a pelvic exam on an anesthetized patient. A common argument for these non-consensual pelvis exams made by doctors is that many patients would say no—which is really a further reason for why they should be asking. If patients are not willing to be used as test subjects, medical school should hire people to practice on who are informed and willing.

Lauren Dobson-Hughes, an activist and former president of Planned Parenthood, wrote a thread on Twitter about this epidemic. She said that after there was media coverage about this happening, many people came forward about unexplained internal bruising and vaginal pain after undergoing an unrelated surgery. She heard anecdotally from many others saying their demands for their own medical records had been blocked or redacted as hospitals attempt to cover up their rape-y practices.

In 2013, writer Tasneem published a personal essay on XOJane about how she suspected this had happened to her but she has no way of knowing. She double checked the fine print in what she signed before her surgery to make sure she had not unknowingly agreed to it but there was nothing. She writes, “Why wouldn’t they just ask me if they could try it out while I was conscious, I wondered? I am a sexual health activist, and I’d love to help people get better at giving pelvic exams!” She called her doctor to ask him directly and, “he responded brusquely that he does so many surgeries that he could not say for sure whether or not it had happened.” She then asked if it is something he’s done in the past with medical students and he said yes. She filed for an investigation with the patient advocacy center of the hospital, but she never heard back.

This widespread use of patients' bodies is intwined in the sexual assault epidemic we are seeing rise to the surface with the #MeToo movement. It is a further assumption that any body that is not cis and male is open for invasive practice without question. If you live in a state where this is legal, which is very likely since that includes 46, pressure your legislatures to change that."

Livid.

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

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

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.

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.

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’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

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

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

examinations: report of a working party. London: RCOG Press, 1997.

Competing interests:

None declared"

How's YOUR googling going washedwithrain or is it up to everyone else to disprove what is a guess and an assumption on your part?

In fact that whole thread is interesting. The respondents have cited their roles so it's not like reddit or something.

Extract from one further down (remember this is all in response to a question asked in 2003):

"But some of the responses beggar belief. They confirm that what has
happened to Bristol students almost certainly is happening elsewhere. And
maybe publishing the article was the quickest route to such confirmation.
Certainly quicker than funding a defensible research project. I have been
working with colleagues responsible for ethical and communication issues
in medical schools for many years and I am surprised and disappointed at
how little progress seems to have been made. We were working on these
issues in London in the mid 80’s. We had policies, at least within
Departments, and we tried to implement them. I thought, obviously
mistakenly, that in general the culture now operating recognised the
importance of, at the very least, engaging in egalitarian discussions with
patients about who should examine them and how. I thought that the culture
was also promoting the sensible procedures, or alternative or adjunct
learning strategies outlined by respondents such as written information
and consent forms, simulated and mannequin patients and so forth. I was
too complacent and that is where the problem lies I guess."

@washedwithrain

BBC article linked to the srudy which also is the item being discussed in the BMJ link previously provided

news.bbc.co.uk/1/hi/health/2642861.stm

"Patients anaesthetised for operations are being used to train medical students in "intimate examinations" - without their consent.
A survey of students in one medical school suggested a quarter felt examinations they carried out on sedated or anaesthetised patients may not have involved "adequate consent".

Guidelines from the General Medical Council state that the permission of patients must be sought prior to any check or treatment.

However, the survey, carried out at the University of Bristol Medical School, suggests that this good practice is not always adhered to.

Students said they were asked to carry out rectal and vaginal examinations "inappropriately".

" I was told in the second year that the best way to learn to do rectal examinations was when the patient was under anaesthetic"

Fourth-year medical student"

Oh hold on

"To be clear I am talking about unrelated surgery, not gynae - where I absolutely did see women examined under anaesthetic by medical students."

So you did see women having internal examinations by students while under anaesthetic and without their consent?

I must have missed this bit.

I'm not sure you are understanding what I'm saying. There are three different scenarios and the RCOG link relates to the first one below, which everyone agrees did happen.

Women were examined under anaesthetic by medical students when undergoing gynae procedures in the past. I have witnessed that and know it happened. I know when it stopped where I worked because 'Mary' reported it, and despite the enormous pressure she was put under, she stuck to her guns and the practise ceased. I dont know when it stopped elsewhere but you have googled that and found what the RCOG said.

I have never heard of nor witnessed (and other people on this thread have said similarly) women undergoing gynae examinations when having entirely unrelated surgery. If you had worked in theatres, you would understand how unlikely a scenario that would have been. I've tried to explain why upthread. I dont think anyone on this thread has suggested that it did routinely happen have they?

I never witnessed a sexual assault on a patient, but couldn't of course say that it never happened. However, there are possible explanations for what might appear to be a sexual assault, which if you had worked in theatres, you would be aware of, and again, several of us have tried to explain those scenarios. So for example, why patients (male and female) didnt wear pants to theatre, or if they did, why they were removed.

So you did see women having internal examinations by students while under anaesthetic and without their consent? I must have missed this bit.

I think you have missed or misunderstood what I said, yes. I dont know whether the women consented to the examination under anaesthetic, that would have been done prior to coming to theatre. Whether they did or didnt, the one consultant (who if you re-read what I wrote earlier was a vile man) was stopped from allowing 'his' students to do it. This was in the 80s.

Washed

I am sorry but I don't think you understand what assault is.

If a woman went into theatre for gynae surgery and was examined by student or students whilst under anaesthetic that is assault unless that student had specifically obtained consent from her whilst she was awake and not under pressure.

So unless your 80s medical students each separately consented those women, then yes you witnessed assaults.

Sticking your fingers into a woman without asking her first is assault. Doesn't matter whether she's having gynae surgery or tea with the Queen.

Unconsented gynae exams are assault. End of.

Xpost!

So basically you have no idea whether what you were witnessing was assault.

But given PP have shown that guidelines about consent only came in in the 90s, and given that MW was moved to speak up to stop it all, and given many reports elsewhere of women having unconsented exams under GA in the UK in the 70s and 80s, I think it is not safe to assume they had consented.

I do not know whether they consented. How could I? It appears possible that they did not consent with the benefit of hindsight and investigation.

They weren't 'my' medical students, the responsibility for what they did lies entirely with them.

I think it's safe to say it was still going on in the UK in at least 2003,

And googling didn't bring up any blanket bans. It seems to be up to the individual trusts / teaching hosps etc

So while I HOPE it doesn't happen any more,

I dont' think anyone can state with confidence that it doesn't, here in the UK. Fucking hell.

"They weren't 'my' medical students, the responsibility for what they did lies entirely with them."

No. That's not right. They are young and doing what they are told by their teachers, by people with positional power, presumably power to affect their futures etc.

The consultants and other qualified medics instructing this / watching it happen and not asking questions are also culpable. The hospitals for letting it happen. The NHS for not issuing a ban across the board and etc and so on.

Lots of parties standing by / party to this.

You can't lay it all on the students and ignore the poeple who told them to do it, the people who wacthed, who knew, the hospitals for allowign it etc and so on.

This is an example of an INSTUTIONAL falining, not individuals.

All I can say is that it stopped in the 80s at the large teaching hospital I was at. You are right about it being the Consultant's responsibility too, I do agree on that actually. The medical students and junior doctors ARE responsible though. I whistle blew on someone very senior, and it was a really difficult thing to do. They could, and should, have done the same.

Well done Beingginger!

I really don't see why, if this had only happened when a woman was in for gynae surgery, that would make it less bad. That's going right back to the same rapey logic that led to the "well we don't do it to virgins" policy. The fact that a woman has consented to sex with one person/a specific procedure does not in any way make it OK for people to decide that they can therefore have a bit of a general poke around because that would benefit them, even though it's in no way necessary for her.

Washed I never said they were your students

Sorry if I have you wrong but you really seem to be minimising this. First it was all, oh it doesn't happen now, then oh it may have happened somewhere but I never saw it , then oh it was only gynae but they may have consented, then well I have no idea if they consented but I wasn't responsible.

No one is blaming you obviously I find the hcps on this thread worryingly not condemning it outright straight off. More distracting and blameshifting. "It was bad but...."

No. It was just bad.

So unless YOUR 80s medical students each separately consented those women, then yes you witnessed assaults

There you go Johnny.

Who isnt condemning assault? I praised the person in charge who raised the activity and even named her. The truth is patients may have consented, they may not. I didnt know at the time. If the person actually undertaking the procedure (or assault if consent hadnt been given) can be absolved of blame with a wave of the hand for not speaking up in case it spoilt their career , then its fascinating how junior theatre staff can be accused of blameshifting.

Okay, sorry, I meant "your" in the sense of "the ones you were discussing". I didn't think they were your students but you are right that the wording is unclear.

I am not aware anyone has been absolved and I think it is blameshifting to repeatedly say oh it didn't happen much, oh it was ages ago etc. Obviously no one is blaming you for it happening. Obviously. However as a victim I don't see your posts to date as robustly condemning.