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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.
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someone28624
09-02-2010 at 09:00 PM.
09-02-2010 at 09:00 PM.
Quote from .teri. :
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.
You do realize we're talking obgyn surgeries, right? Like, where everything is already wide open and people's hands and surgical instruments are already likely going in there.

Quote from implode :
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.
That's ridiculous.

Quote from perpetualsun :
I hate teaching hospitals.
Honestly, teaching hospitals are where you'll get the best care, and where the latest greatest treatments are available.
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Last edited by someone28624 September 2, 2010 at 09:01 PM.
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.teri.
09-02-2010 at 09:06 PM.
09-02-2010 at 09:06 PM.
Quote from someone28624 :
You do realize we're talking obgyn surgeries, right? Like, where everything is already wide open and people's hands and surgical instruments are already likely going in there.
.
Yes, I realize that. There are many surgeries in the OB/GYN spectrum that are not done vaginally, in fact most are done abdominally. For example, laproscopic surgeries, hysterectomies, c sections, etc etc. Further, if you are going in for surgery then you have most likely gotten a vaginal exam by your surgeon prior, along with xrays, ct scans or whatever you may have needed. by the time you get into surgery a vaginal exam probably isn't necessary anymore.
As I stated, if a vaginal exam is necessary then it's fine, If it's just to give a student a chance to practice, then it is not.

The fact that teaching hospitals offer good medical care has nothing to do with this practice.
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Last edited by .teri. September 2, 2010 at 09:11 PM.
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someone28624
09-02-2010 at 09:18 PM.
09-02-2010 at 09:18 PM.
Quote from .teri. :
Yes, I realize that. There are many surgeries in the OB/GYN spectrum that are not done vaginally, in fact most are done abdominally. For example, laproscopic surgeries, hysterectomies, c sections, etc etc. Further, if you are going in for surgery then you have most likely gotten a vaginal exam by your surgeon prior, along with xrays, ct scans or whatever you may have needed. by the time you get into surgery a vaginal exam probably isn't necessary anymore.
As I stated, if a vaginal exam is necessary then it's fine, If it's just to give a student a chance to practice, then it is not.

The fact that teaching hospitals offer good medical care has nothing to do with this practice.
I agree that if the vagina doesn't need to be assessed anyways it probably shouldn't be just for the sake of the student. However, occasionally it is necessary to go through the vagina even if most of the surgery is done abdominal. Many hysterectomies are done vaginally now.

The comment on teaching hospitals having better care was in response to someone stating they "hate" teaching hospitals, which is an absurd stance to take. Would you rather your doctor have never seen a real patient by the time they graduate? I'll argue that they not only have GOOD care, but BETTER care.
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Last edited by someone28624 September 2, 2010 at 09:34 PM.
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.teri.
09-02-2010 at 09:25 PM.
09-02-2010 at 09:25 PM.
Quote from someone28624 :
I agree that if the vagina doesn't need to be assessed anyways it probably shouldn't be just for the sack of the student. However, occasionally it is necessary to go through the vagina even if most of the surgery is done abdominal. Many hysterectomies are done vaginally now.

The comment on teaching hospitals having better care was in response to someone stating they "hate" teaching hospitals, which is an absurd stance to take. Would you rather your doctor have never seen a real patient by the time they graduate? I'll argue that they not only have GOOD care, but BETTER care.
perhaps I misread OP's link. I understood the issue to be that students were doing 'routine' vaginal exams on women under anesthia for the sake of learning how to do them. With that information, then having a vaginal hysterectomy would still not require a student to practice his vaginal exams on the woman. If he/she assists in the surgery thats one thing, but to practice on someone who hasn't agreed to let that happen is not ok, whether they go in through the vagina or the throat.
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someone28624
09-02-2010 at 09:32 PM.
09-02-2010 at 09:32 PM.
Quote from .teri. :
perhaps I misread OP's link. I understood the issue to be that students were doing 'routine' vaginal exams on women under anesthia for the sake of learning how to do them. With that information, then having a vaginal hysterectomy would still not require a student to practice his vaginal exams on the woman. If he/she assists in the surgery thats one thing, but to practice on someone who hasn't agreed to let that happen is not ok, whether they go in through the vagina or the throat.
The original link was from a website that basically sited no source other than someone who was offered the chance to do a pelvic exam on someone having a D&C, which is totally done vaginally. The whole website has a conspiracy-theory tone to it, which discounts it's entire credibility to me.

My experience with hospitals and health care practitioners is that they genuinely are concerned for patients and want to be ethically and morally correct overall.
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.teri.
09-02-2010 at 09:45 PM.
09-02-2010 at 09:45 PM.
Quote from someone28624 :
The original link was from a website that basically sited no source other than someone who was offered the chance to do a pelvic exam on someone having a D&C, which is totally done vaginally. The whole website has a conspiracy-theory tone to it, which discounts it's entire credibility to me.

My experience with hospitals and health care practitioners is that they genuinely are concerned for patients and want to be ethically and morally correct overall.
Dontknow I see no reason to do a pelvic on someone already in the OR though. Anything to be found has already been found by prior pelvic, hence they are in the OR....having a procedure vaginally and getting a pelvic exam are two entirely different things. There is no need for a pelvic exam in the OR. A pelvic exam is a diagnostic procedure, not a surgical procedure. Am I making sense to you? laugh out loud
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someone28624
09-02-2010 at 09:51 PM.
09-02-2010 at 09:51 PM.
Quote from .teri. :
Dontknow I see no reason to do a pelvic on someone already in the OR though. Anything to be found has already been found by prior pelvic, hence they are in the OR....having a procedure vaginally and getting a pelvic exam are two entirely different things. There is no need for a pelvic exam in the OR. A pelvic exam is a diagnostic procedure, not a surgical procedure. Am I making sense to you? laugh out loud
I guess my point is just that if a speculum is already up there, what's wrong with letting the student, who one way or another the patient consented to being there, having a look?

What I don't get, though, is pelvic exams don't exactly take a lot of practice. Doing it two or three times should be sufficient to pretty much know your way around a vagina and a uterus.

"Pelvic exam" kind of is a broad term. Just looking at it is technically an exam.

Many of the procedures are emergent, and thus, exam is necessary.

I don't think just having the patient unconscious is reason to let the student have full access to any body part, but c'mon, if the patient is already there spread eagle with a speculum up there, what's wrong with the student looking in there?

That being said, I highly doubt that it's nearly as common as the article makes it out to be.
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Joined Mar 2007
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.teri.
09-02-2010 at 10:00 PM.
09-02-2010 at 10:00 PM.
Quote from someone28624 :
I don't think just having the patient unconscious is reason to let the student have full access to any body part, but c'mon, if the patient is already there spread eagle with a speculum up there, what's wrong with the student looking in there?
To me theres alot wrong with it. I would have never dreamed my doctor was a sicko, but he was and he was sent to prison for it. So maybe I'm overly cautious, but I believe the patient should be asked if it's ok or at the very least informed that students will be practicing their pelvic exam skills while in surgery. So ends the great vagina debate Roll
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SDRebel
09-02-2010 at 10:53 PM.
09-02-2010 at 10:53 PM.
Quote from narrowcamaro :
I have no issues with student doctors, I had a bunch in the room for my post pardum visit.
I didn't want anyone close to me during my pardum...or after it, or before Nono

Quote from veritableqndry :
I think you're all looking at this the wrong way. You're all slickdealers, right?

Hey, free pelvic! woot
I no need no stinking free prostate exam shake head
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Last edited by SDRebel September 2, 2010 at 10:53 PM.
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SDRebel
09-02-2010 at 11:03 PM.
09-02-2010 at 11:03 PM.
Quote from someone28624 :
Essentially, a non-consensual, unnecessary pelvic exam is not only completely unethical, but chargeable as assault if it were to go to court. Hopefully someone in the OR would have the morality to stop such a thing. When in the hospital, you typically sign a general consent for treatment, and a separate consent for any invasive procedure you're having. I have never heard of a pelvic exam requiring a separate consent, other than the general consent for treatment, but if it's strictly for learning purposes, it would not be covered under the treatment consent as it's not necessary for treatment or standard of care.

That being said, I suspect this does happen, but not as often as this website makes it out to be. The website seems in general to be anti-medical establishment.

Also, that being said, for any procedure that a lithotomy position is used for, doing a pelvic exam is not a far stretch from what's required for the operation itself. It's basically already "all out there."
I would hope so...not sure why the hell they would risk getting sued like that
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someone28624
09-02-2010 at 11:16 PM.
09-02-2010 at 11:16 PM.
I'll also add that during my undergrad ob/gyn rotation I saw more crotches than I'd ever care to see, all on awake patients, none who seemed to have much of an issue with it, thus, I can't imagine med students are having such a hard time finding people that are willing to consent to exams that they've just been forced to find unconscious patients to practice on.
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Forscythe87
09-02-2010 at 11:22 PM.
09-02-2010 at 11:22 PM.
When I had a colonoscopy i had to sign a paper that state that medical students may experiment on me while im under and will more likely view the procedure. Whata you know, I get wheeled into the room and there's a group of 4-8 students waiting anxiously in the hallEEK!.
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someone28624
09-02-2010 at 11:30 PM.
09-02-2010 at 11:30 PM.
Quote from Forscythe87 :
When I had a colonoscopy i had to sign a paper that state that medical students may experiment on me while im under and will more likely view the procedure. Whata you know, I get wheeled into the room and there's a group of 4-8 students waiting anxiously in the hallEEK!.
They're not "experimenting," they're watching and possibly assisting under very close supervision. I wouldn't feel comfortable with 8 students in the room. I can't imagine 8 students, the patient, the doctor, and the nurse would all fit in an endoscopy suite.
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jeepdog
09-03-2010 at 08:43 AM.
09-03-2010 at 08:43 AM.
Quote from fbskiracer :
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.
maybe thats what is wrong with medicine today. Maybe if everybody wasnt garanteed a spot, there would be more competition, and we would have less mistakes made by doctors.
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someone28624
09-03-2010 at 08:55 AM.
09-03-2010 at 08:55 AM.
Quote from jeepdog :
maybe thats what is wrong with medicine today. Maybe if everybody wasnt garanteed a spot, there would be more competition, and we would have less mistakes made by doctors.
There's plenty of competition to GET INTO med school, just less for residency, after you're done with med school. Still, if you want to match to the residency of your choice, you need to be highly competitive. Otherwise, you're left scrambling for whatever residency spots none of the other students really wanted.
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