Feb 2, 2010

Patient consent and the surprise pelvic exam

I read this article in the Globe and Mail (one of Canada's two large national news papers) and was aghast. Medical students doing pelvic exams on unconscious women without consent?!

After contacting some friends who would know more than I do about this, I am feeling somewhat assured that Mr. Picard may have overstated the problem. Still, there is a problem.

This really shouldn't be happening at all. While some might argue that the consent implicit, I would certainly like to be explicitly informed if there is going to be a student prodding around in my parts. If it were explicitly stated, I would give consent - I suspect many women would.

There is one way to clear all of this up: just ask.


  1. Oh, you might be interested in this post:


    This is where I first heard about this issue the other day. There is a really great, informative comment by Canadian Nurse that I found very interesting.

  2. I wrote about this a while ago. I completely understand the ethical dilemma when you're having non-gyn surgery (apparently they used to have med students do pelvic exams on all kinds of patients). But for gyn surgery, I have to disagree.

    The fact is, when you have a gyn surgery, the residents, fellow, and then the attending, who are all participating in the surgery, all do their own pelvic exam on you while you are asleep. This is part of doing a good job. I don't think it would be unethical at all for the med student to perform a pelvic exam as well at this time given that this is what you're supposed to do before pelvic surgery. The same thing happens with the rectal exam during male pelvic surgery, FYI. And sometimes, the gyn exam includes a rectal exam as well.

    I think a lot of the shock and horror comes from the fact that patients don't realize that when they have gyn surgery, a bunch of pelvic exams under anesthesia already come with the territory. And of course there is the historical precedent which justifiably upsets people. To my knowledge, THAT type of pelvic exam does not occur anymore.

  3. Or dear God -- just took a look at the article. I hope you realize I meant that only the medical surgery actually working with that team should be allowed to do the pelvic exam -- not a whole army of them.


  4. I agree OMDG, I think there are various situations where one might reasonably expect a pelvic exam (or two) from students - certainly any kind of gyn surgery would seem fairly obvious.

    The image the article brought to my mind was a team of med students gloving up with their speculums during my tonsillectomy :-)

  5. This is why women should only go to female doctors or an all female facility for this type of thing.

  6. Why not just have a sexual orgy before the surgery so everyone, patient and students, can get to know each other?

  7. Umm, no I should NOT automatically get a pelvic exam while unconscious by a student, resident, AND attending. That is not for the patient's benefit - that is for the student and resident, who are training.

    It is the patient's choice whether or not to allow students and/or residents to be involved in their care - the patient should give permission.

    Some patients, and even medical staff, assume that the patient's body is for students and residents to practice upon. It is not - it is a choice.

    Hopefully, most patients will give permission, as the future doctors do need to train. But it is a choice.

  8. Oh, and I just read the whole article - note to self, do NOT have surgery in Canada. Wow.