UK teaching hospitals allowing students to carry out pelvic examinations on women having surgery without consent?

[stealthsquirrelnutkin]

I just read an article about how New York and Utah are voting to make it illegal for teaching hospitals to get students to carry out non-consensual pelvic exams on anaesthetized women.

Someone on the GenderCritical reddit forum posted "This is routinely done in some teaching hospitals while a woman is receiving surgery NOT related to anything vaginal. In other words, you go in for a shoulder repair surgery, and because you have med students, the surgeon decides all the students, be sure you read that, ALL the students can do a vaginal exam of the patient.(Examples including 4-6 students lining up to shove their fingers into an unconscious, unconsenting womans vagina and rectum) No specific consent has been asked for, much less given for that examination, and the patients are never told it even occurred. "

I thought it must just be something insane that only happens in the third world and USA, but then someone posted a link to this article www.forbes.com/sites/paulhsieh/2018/05/14/pelvic-exams-on-anesthetized-women-without-consent-a-troubling-and-outdated-practice/#79db45b47846 that mentions a paper by Phoebe Friesen in the journal Bioethics, she notes that “that the practice is alive and well” in many US and UK medical schools. It’s difficult to know exactly how often this is happening. Most medical school faculty and students don’t talk about it publicly, and affected patients are (by definition) unaware this is happening.

The article goes on to say that a UK survey “reported that at least 24% of intimate examinations they performed on anaesthetized patients occurred without any consent and that ‘on many occasions, more than one student examined the same patient’.”

A common argument for these non-consensual pelvis exams 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.

So that's one more thing to worry about if you are going for surgery in a teaching hospital. Find out in advance what their policy is, so you can make it clear if you don't consent to having your private parts used as a teaching aid while you are unconscious.

I know a fab female GP who was responsible for writing most of her med school review while she was there.

The content was absolutely vile.

Honestly don't go to a medics review if you aren't a medic (and a fair number of medics still don't go) and people aren't the same at 35 as they are at 19. I knew some utter twats and bizarrely they turned out to be great doctors and well rounded human beings once they had grown up.

As a medical student 10 years ago we needed written consent to perform a pelvic examination in theatre and we would be there when the Consultant was completing consent forms during the ward round before the theatre list started, so we met every patient who we were asking to consent.

I'm reassured that so many people are saying this no longer happens in the UK. What troubled me most was the thought that a UK survey “reported that at least 24% of intimate examinations they performed on anaesthetized patients occurred without any consent and that ‘on many occasions, more than one student examined the same patient’.”

I can't see the information on the survey and when it was carried out because I can't download Phoebe Friesen's paper but it was published last year so I'm assuming the information can't be all that dated. Perhaps someone with access to the online repository can download it and check? www.researchgate.net/publication/324721606_Educational_pelvic_exams_on_anesthetized_women_Why_consent_matters (2018) Educational pelvic exams on anesthetized women: why consent matters, Bioethics. 32(5), 298-307.

Very pleasing to see so many medics confirming that this is no longer the case. At a time when women's ability to consent to being undressed, washing, sharing hospital wards, refuges etc with men has been withdrawn from us, it is positive to know that there are still a few areas e.g.intimate touching, where our right to consent is still respected.

I've worked in hospitals for 15 years and on,y ever seen it done on unconscious women with prior consent.

This came up on here about a year ago, I think. I remember reading the article and being horrified.

"As a medical student 10 years ago we needed written consent to perform a pelvic examination in theatre and we would be there when the Consultant was completing consent forms during the ward round before the theatre list started, so we met every patient who we were asking to consent."

The question is why were unconscious patients used at all? Surely, patients could have been conscious and given consent?

The question is why were unconscious patients used at all? Surely, patients could have been conscious and given consent?

Isn't it obvious from point of view of patient comfort. I have had 2 procedures conducted under a general anaesthetic. One was endometrial ablation which I understand on the NHS is not done under general anaesthetic but mine was done privately. The second involved a rectal examination, also done privately.

If I had been in a teaching hospital and under a general anaesthetic if I had been asked to consent to students being involved I'd have been happy to give consent. Had I only been under a local anaesthetic, I'm not sure I would have consented.

Isn't unconscious examination missing out all the key essential steps of making sure the patient feels comfortable, appropriate/inappropriate speech, sympathetic examination, checking for response to pain/signs of discomfort, reassurance, professionalism, dignity? You're doing it on an unconscious person who cannot provide feedback and whom the student does not have to interact with as a human being, they are a couple of holes to be probed, that's it.

So I would NOT be happy to given consent as it teaches virtually nothing that's important - because IRL these examinations are carried out on conscious, living, breathing women!

I note the paper she cites from the UK was published in 2003.

The NHS of today, in particular teaching on consent is unrecognisable from then. So really can't see it happening today.

The figure of 24% includes both rectal and vaginal exams - the author is v clear they are both intimate examinations and there are no figures to separate out whether consent was more likely for vaginal or rectal. Given attitudes at the time, I suspect it was more likely you would get consent for vaginal and not for rectal.

The paper notes that at the time 17 deans responding had a policy for vaginal exams and only one for rectal. It just wasn't seen as the same.

The UK paper is also highly cited and I suspect v influential in finally eradicating the practice in the UK.It helpfully concludes by telling us how they changed teaching and policy in their own med school.

So going back to the original article in Forbes - I'd suggest this is lazy journalism to say the practice is alive and well in UK medical schools by quoting a paper from 2003.

Hopefully you can read the article here:
www.researchgate.net/publication/10956025_The_ethics_of_intimate_examinations_-_Teaching_tomorrow's_doctors

To answer prev questions about examining unconscious women:

Yes totally you need to be alert to the fact you are examining a real live women and where it might hurt, what her feelings and emotions are and so on.

But when you are starting to learn, you are just really rubbish and take ages. And some women (thank-you so much to those who consent) are happy to agree to consent under anaesthesia when you can have a teaching experience of 'can you feel this over there? - No? Oh you are looking in the wrong place, up a bit' without having to not look like a nitwit.

Some women will also agree to a student exam under anaesthesia when they wouldn't have awake. And again, grateful to those women as we need future doctors who are going to know what they are doing and be competent when they qualify.

This happened i the 1970s, it is not legal to do this any more. It should never have been.

This is why you read consent forms and cross out anything you do not agree with.

The last op I had the anesthetist was being shadowed by a med student, I asked the student if you wanted to do the intubation, the anesthetist said to the student, 'you have consent for that, anything else is assault'.

Plus, extending the time that someone is under anaesthesia so students can have a prod. Wow.

This came up a few months ago with much the same response. No UK doctors or theatre staff were aware of this having been practised for at least the last few decades.

The 24% of U.K. medical students came from:
Coldicott, Y., Pope, C., & Roberts, C. (2003). The ethics of intimate exami- nations–teaching tomorrow’s doctors.
It seems the results from a survey in 2000 and, to me, indicate a slowly changing culture. Doesn’t mean it’s never done anymore, but it does seem like a stepping stone from the 1980s situation where it was fairly routine and not really thought about towards what medical people on this thread are saying is the current situation where it would be unacceptable to most staff who witnessed it.

The question is why were unconscious patients used at all? Surely, patients could have been conscious and given consent?

The patients are consenting when they are conscious! If you mean why are examined at all when unconscious, fair question. As a previous poster has said, vaginal examinations can take some time and even with years of practice, including in gynaecology, there will be things that I still miss from examinations.

Yes also to the poster who asked about acknowledging feelings, patients feeling comfortable etc. Trainees (qualified doctors) will examine patients in GP or clinics, and this is where the skills learnt in the med student days about knowing what, for example, a normal sized uterus feels like compared to a larger uterus, will fit in with the communication aspect.

Hope that makes sense. And having worked in different med schools training students, and working as a doctor in different trusts, I can safely say I have never ever seen a patient examined without consent, whether conscious or unconscious.

I'm a nurse and as a professional have never witnessed this. However, as a patient I have had multiple gynaecology surgeries and for two of those I was approached by students asking permission (which I gave) to do an internal exam. I don't know any healthcare professionals who would Stand by and allow this to happen without consent!

The reason for using unconscious patients is to improve technique and get good at knowing what normal and abnormal feel like.

You can take a little longer to get it right without making the patient uncomfortable, then when you’re doing it on someone awake you can hopefully be slicker and gentler.

You can see what the surgical findings are like in comparison with what you can feel on examination.

If you were examining an awake person as a new student the patient would need a repeat examination by someone experienced so you’re not putting them through 2 examinations they can feel, one by someone inexperienced.

It’s obviously also very important to competently be able to examine awake patients. I think we did 10 or so on anaesthetised patients and then went on to awake patients.

You are absolutely not required to consent to this either awake or asleep but it does make a huge difference to learning and I’m very grateful to the kind women who generously did let me.

you might have your surgery filmed for subsequent review/learning for trainee surgeons. Takes place with no consent or knowledge of the person on the operating table

I am very sceptical at this being the practice in the UK.

This is from one of the largest NHS Trusts in the UK, from under 10 years ago... I'm not making it up I promise. If it's been eradicated since then great, I can't speak to that, I can only recount what was said to me from a very senior director of that hospital trust.

Thankfully I have never been taught by anyone who has allowed this at my teaching hospital.

I think what is being referred to is this sort of thing:

Where anonymised pre-existing images from procedures are used to teach junior doctors what a bleeding stomach ulcer looks like. In the same way that we use anonymised xrays, biopsy specimens, etc. And as long as the patient is not identifiable in any way (and if it is footage of your internal organs, then you are not identifiable), and it is for internal teaching purposes only (ie no YouTube, not for publication) then I can’t see the problem personally.

These are procedures which are all done via camera and the images retained anyway, they are just showing the anonymised images to other people. It’s not like they have a film crew in the operating theatre.