Pelvic exams performed on unsuspecting WUSM patients
A recent barrage of public scrutiny has caused the Washington University School of Medicine to re-evaluate the standard practice of allowing medical students to conduct pelvic examinations on anesthetized female patients without obtaining explicit consent.
The change was prompted by a wave of concerned medical students at a number of institutions who have refused to conduct such exams, citing an awareness of the rights of anesthetized patients. Effective the week of March 10, WUSM has now abandoned the practice of not obtaining explicit consent from its female patients.
Normally, a surgeon conducts a pelvic exam prior to gynecological operations. The controversy concerns students who practice their examination skills on the patient after the physician has completed the initial examination. This procedure is no longer for the benefit of the patient, but intended only to enhance the clinical skills of the medical student.
Vera Sharav, president of the Alliance for Human Research Protection, said that this is a practice about which patients should be informed.
“Evidently U.S. medical curricula do not include the admonition: thou shalt [sic] not touch a woman’s genitals without her consent,” said Sharav.
A pelvic examination involves placing two fingers inside a patient’s vagina to locate and examine her ovaries. Learning how to properly administer such an examination is a essential part of a medical student’s training.
Joni Westerhouse, executive director for medical communications at WUSM, has dealt with informing the public about this controversy.
“Women undergoing gynecologic surgery at WU Medical Center, and at all hospitals in the U.S.A., receive a pre-operative pelvic exam by the physician/surgeons,” said Westerhouse. “This exam is important for patient safety. For the women’s comfort, this exam is done after anesthesia.”
Both Rebecca P. McAlister, MD, the OB/GYN residency program director for WUSM, and James R Schrieber, MD, the OB/GYN department head for WUSM, declined to comment on the issue and directed all inquiries to the Medical Public Affairs Department.
“If a medical student has been assigned to assist with the case, they may perform a pelvic exam under the direction of the surgeon in charge,” said Westerhouse. “Previously, the consent form advised patients that students are part of the medical team and may be providing medical care, tests and procedures as assigned by the surgeon in charge. Effective one week ago, women are specifically asked if they consent to a pelvic exam by a medical student [if a student is part of the team].”
In the wake of this change, the public is questioning whether students are receiving adequate education about patients’ rights.
Jerry Chang, a fourth year medical student at WUSM, maintains that WU stresses those rights.
“We’re always very sensitive to the patient’s rights and their privacies, and we’re always very appreciative of their cooperation,” said Chang. “But, it’s always patients first. They are there for our learning, but their needs come before ours.”
Dr. Michael Gregory, a graduate of Tufts University School of Medicine, has conducted studies that suggest most women are not opposed to being a part of the medical students’ training process, as long as consent is obtained beforehand.
“It’s this paternalistic, patronizing view that the doctors know best,” said Gregory in a recent New York Times article. “We underestimate people’s incredible charity and their willingness to let us train. But I think that at a gut level, doctors understand that if they actually told patients that this was happening without their consent, people would be outraged.”
Today most medical students initially practice their clinical techniques on paid volunteers before examining actual patients. However, eventually examining real patients with real disorders is crucial to their training. The medical school hopes new consent policies will allow for this.
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