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Wow. Um, here's another one of those things guys don't have to worry about.

26,675 2,340 September 1, 2010 at 06:51 AM in Sad (2)
linly [theunnecesarean.com]

Quote :
Are all women who are put under general anesthesia in a hospital practiced on by students while unconscious?

All women in the OB/GYN department at most teaching hospitals and hospitals affiliated with a medical school are. If you're anesthetized and you're in the OB/GYN department, you probably have had students practice pelvic exams on you regardless of what you're in the hospital for - even if the procedure you need doesn't require a pelvic exam!

Additionally, while doctors don't go to other departments — such as general surgery patients, neurosurgery patients or cardiac surgery patients — if your surgeon is an OB/GYN, odds are there's going to be a team of hungry medical students waiting for you to fall asleep.



Can you explain what happens during these non-consensual pelvic exams?

They are usually "bi-digital" exams. This means students insert two fingers as deeply as they can into the vagina with one hand and use the other hand to feel around the outside of the abdomen for the ovaries. What they're trying to do is trap the ovaries between their two fingers and their hand and feel for the internal organs from the inside. Sometimes, speculums are also used in the exams.



What stops students from simply asking the patient for permission?

When I was a student and approached the chairperson of my department and said I was uncomfortable with this, and he said, "I don't see anything wrong with it." My response was, "If there's nothing wrong it, then you won't mind if I ask permission." He said I couldn't do that. He knew that women would be absolutely outraged at the thought, and so, no one would tell them anything.



So, how can a woman prevent non-consensual pelvic exams happening to her?

All you can do is ask and hope that your doctor will honor your request. Once you're asleep, however, you have no power. And what a powerless thing for women to know this goes on and think, "Well, I'm just going to have to trust my doctor."

What if you don't trust your doctor?

Women can write on their bikini line, "I do not give consent for medical students to practice pelvic exams on me" in marker. Then as soon as the clothes come off or the robe is lifted and all the medical students are getting on their latex gloves they can see that message. And that will stop them. I was inspired to think up this tip because of patient advocates like Bernie Siegel, M.D., who recommend that patients use a magic marker to write "Wrong leg" or "Wrong arm" on their healthy body parts to prevent them their doctor from performing surgery on the wrong limb - a common mistake.
Bigeye OMG Cold

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AbbyGabby
09-02-2010 at 11:53 AM.
09-02-2010 at 11:53 AM.
Quote from RefCache :
Some people claim there's a woman to blame.

You're right. nod

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jj.12321
09-02-2010 at 01:31 PM.
09-02-2010 at 01:31 PM.
Quote from jmegirl :
i've got pomegranate rim salt for the margaritas this weekend Evil
Cool, you'll be nice and drunk, and ready for those surpise "examinations" laugh out loud
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Schooby
09-02-2010 at 01:39 PM.
09-02-2010 at 01:39 PM.
Quote from digitalhandle :
Actually that is what I was thinking. No idea if they are really allowed to do this or not, but it would be free. And they might find something. Generally it is good to find something rather than to be unaware of it before there are more problems.
Hmm that might be tricky to explain to the patient.

We have good news, bad news and creepy news...which would you like first?
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You can call me "Al"
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MsGal
09-02-2010 at 02:10 PM.
09-02-2010 at 02:10 PM.
I don't know about all that but I do know that when I had my thyroid removed at the Mayo in Jax, FL 5 years ago, I was NOT told that students would be "assisting" during the procedure. Nor was it noted in the records I received afterwards. I was told about it only after one of the PA's mentioned something on a follow-up appt. 2 months later. Then I requested a meeting with the surgeon who said that, yes, students assisted but "under his supervision".

I was not happy about it but it was too late to do anything about it. Apparently, the Mayo in Jax is a teaching hospital.
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coulditbeSatan
09-02-2010 at 02:17 PM.
09-02-2010 at 02:17 PM.
Quote from homycraz2 :
That only works with the penis.
Found out the "hard" way, didja?
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HoMycraz Not horNycraz!
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homycraz2
09-02-2010 at 02:19 PM.
09-02-2010 at 02:19 PM.
Quote from coulditbeSatan :
Found out the "hard" way, didja?
Sadwalk
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fbskiracer
09-02-2010 at 07:01 PM.
09-02-2010 at 07:01 PM.
I think this is being blown out of context a little bit.

I rotated through close to a teaching centers in Medical School and NEVER have I seen it suggested that a pelvic/rectal be done just because someone is asleep. However, almost every surgical consent for an OB Gyn procedure includes a consent with "exam under anesthesia". If you're coming in for an Ortho case, noone's going near your happy trail at all.

Most hospitals are very forward about being teaching centers. Most don't allow you to refuse student/resident participation. While you may not be told specifically a medical student or resident is there for the whatever you are there for it is always somewhere in your hospital admission paperwork that you probably didn't read but signed anyway. I always introduced myself to patients before cases (as I was the one they saw the most for exams and stuff afterwards too).

If you want more doctors, they need to have training at some point. If you refuse to help in a doctors training don't be surprised when you have trouble finding a doctor later, you become part of the problem when the funneling slows down training. There is a huge funnel right now with residency that is only projected to get worse and when that happens in the next 3-5 years it will seriously counteract the decision of students to enter medical school. There by 2015/2016 it is projected that there will be more US MD graduates than residency training spots. The moment a job is no longer secure/guaranteed in medicine how will that domino back to the choice of a kid going to medical school for $200K in loans and Obamacare or a funded PhD and an industry job thats 9-5.
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Last edited by fbskiracer September 2, 2010 at 07:10 PM.

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fbskiracer
09-02-2010 at 07:05 PM.
09-02-2010 at 07:05 PM.
Quote from Schly :
I'd just wear a huge, bloody pad that day. No one's going to want to peek behind it.
Trauma Protocol 101: Lowest Level Trauma Team member does a rectal exam and checks to remove a tampon (if female) on EVERY patient who comes in the door. They should also place a foley catheter.

It doesn't affect us on bit. Its going to get removed because of the risk of Toxic Shock Syndrome.

The rule of the road is a finger or tube in every orifice.
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Jex
09-02-2010 at 07:06 PM.
09-02-2010 at 07:06 PM.
Quote from fbskiracer :
I think this is being blown out of context a little bit.

I rotated through close to a teaching centers in Medical School and NEVER have I seen it suggested that a pelvic/rectal be done just because someone is asleep. However, almost every surgical consent for an OB Gyn procedure includes a consent with "exam under anesthesia". If you're coming in for an Ortho case, noone's going near your happy trail at all.

Most hospitals are very forward about being teaching centers. Most don't allow you to refuse student/resident participation. I always introduced myself to patients before cases (as I was the one they saw the most for exams and stuff afterwards too).

If you want doctors, they need to have training at some point. If you refuse to help in a doctors training don't be surprised when you have trouble finding a doctor later, you become part of the problem when the funneling slows down training.
If it is so important to their medical training I would not think it would be to difficult for them to ask for permission before proceeding.
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perpetualsun
09-02-2010 at 07:08 PM.
09-02-2010 at 07:08 PM.
I hate teaching hospitals.
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fbskiracer
09-02-2010 at 07:17 PM.
09-02-2010 at 07:17 PM.
Quote from Jex :
If it is so important to their medical training I would not think it would be to difficult for them to ask for permission before proceeding.
Like I said you grant consent the moment you agree to be treated, technically.

The surgical consents specify who's service you will be placed on and who is the attending physician for the procedure. By proxy you are granting consent for everyone working for that attending to take care of you. Additionally most hospital admission paperwork states somewhere that it is a teaching institution and XYZ (med/PA/nursing students ect) may participate in your care. If you don't read all the paperwork you sign, who's fault is that?

Can you imagine how hard it would be to manage/plan consents if you needed one for each medical student/resident/NP/PA/mid level provider to give you care? What about the call teams when the attending goes home for the night.

IDK I always thought it was a reasonable assumption that if you see a medical student/resident in clinic they might be taking care of you later in the OR. Granted you might not be treated by them in clinic but if you didn't know/realize Mayo was a major research/teaching center by walking through the hospital/clinic its kind of hard to fathom honestly.

One of the reasons it is encouraged to participate in an exam under anesthesia as a student is you can learn the procedure of doing the exam without being flustered/nervous/pressured. No one is doing pelvics in the OR just to do a pelvic. Its always on a patient having a procedure done requiring the exam anyway. There is never a train of medical students in the OR EVER. It violates sterile technique and common sense. You might see a gaggle of students rounding with a team, but in the OR it is rare for there to be 2 students in the room and usually only one will scrub. We were always assigned so only one student was in an OR unless the procedure required another set of hands. In the current medicolegal climate no one is in an OR who doesn't belong there be them an attending physician, resident, nurse, product vendor, or patient.
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Last edited by fbskiracer September 2, 2010 at 07:24 PM.
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.teri.
09-02-2010 at 08:01 PM.
09-02-2010 at 08:01 PM.
Quote from fbskiracer :
I think this is being blown out of context a little bit.

I rotated through close to a teaching centers in Medical School and NEVER have I seen it suggested that a pelvic/rectal be done just because someone is asleep. However, almost every surgical consent for an OB Gyn procedure includes a consent with "exam under anesthesia". If you're coming in for an Ortho case, noone's going near your happy trail at all.

Most hospitals are very forward about being teaching centers. Most don't allow you to refuse student/resident participation. While you may not be told specifically a medical student or resident is there for the whatever you are there for it is always somewhere in your hospital admission paperwork that you probably didn't read but signed anyway. I always introduced myself to patients before cases (as I was the one they saw the most for exams and stuff afterwards too).

If you want more doctors, they need to have training at some point. If you refuse to help in a doctors training don't be surprised when you have trouble finding a doctor later, you become part of the problem when the funneling slows down training. There is a huge funnel right now with residency that is only projected to get worse and when that happens in the next 3-5 years it will seriously counteract the decision of students to enter medical school. There by 2015/2016 it is projected that there will be more US MD graduates than residency training spots. The moment a job is no longer secure/guaranteed in medicine how will that domino back to the choice of a kid going to medical school for $200K in loans and Obamacare or a funded PhD and an industry job thats 9-5.
None of the above justifies doing a vaginal exam on a woman when she is under anesthia. If it can't be done while she's awake with full knowledge that it's being done, it shouldn't be done at all. My EX OB/GYN is in prison for pulling snit like this and worse. There is NO justification. If you want a test subject that doesn't know they are being examined, and doesn't care, go examine a cadaver.

If you want a willing participant, try asking.
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Last edited by .teri. September 2, 2010 at 08:04 PM.
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DBC
09-02-2010 at 08:18 PM.
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.teri.
09-02-2010 at 08:20 PM.
09-02-2010 at 08:20 PM.
Quote from fbskiracer :
Like I said you grant consent the moment you agree to be treated, technically.

The surgical consents specify who's service you will be placed on and who is the attending physician for the procedure. By proxy you are granting consent for everyone working for that attending to take care of you. Additionally most hospital admission paperwork states somewhere that it is a teaching institution and XYZ (med/PA/nursing students ect) may participate in your care. If you don't read all the paperwork you sign, who's fault is that?

Can you imagine how hard it would be to manage/plan consents if you needed one for each medical student/resident/NP/PA/mid level provider to give you care? What about the call teams when the attending goes home for the night.

IDK I always thought it was a reasonable assumption that if you see a medical student/resident in clinic they might be taking care of you later in the OR. Granted you might not be treated by them in clinic but if you didn't know/realize Mayo was a major research/teaching center by walking through the hospital/clinic its kind of hard to fathom honestly.

One of the reasons it is encouraged to participate in an exam under anesthesia as a student is you can learn the procedure of doing the exam without being flustered/nervous/pressured. No one is doing pelvics in the OR just to do a pelvic. Its always on a patient having a procedure done requiring the exam anyway. There is never a train of medical students in the OR EVER. It violates sterile technique and common sense. You might see a gaggle of students rounding with a team, but in the OR it is rare for there to be 2 students in the room and usually only one will scrub. We were always assigned so only one student was in an OR unless the procedure required another set of hands. In the current medicolegal climate no one is in an OR who doesn't belong there be them an attending physician, resident, nurse, product vendor, or patient.
If a vaginal exam is part of the procedure in the OR and would be done by the surgeon anyway, then yes it's acceptable. If it isn't and its just an opportunity for a student to practice then it's not acceptable. Do they get to do breast exams while the patient is under as well?
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implode
09-02-2010 at 08:42 PM.
09-02-2010 at 08:42 PM.
I want to tell a story about something VERY awkward in my life in relation to medical teaching. I was diagnosed with appendicitis. My mom is told to go to other room. The doctor in charge gave me a rectal exam. Then proceed to unnecessarily have his group of students take their turn. I was in an awful amount of pain already to be putting up with that shit. As a grade schooler, I didn't know to say no. I'm furious about that breach of trust to this day.
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