Joined Jul 2005
Scarydevil Monastery
Forum Thread
Wow. Um, here's another one of those things guys don't have to worry about.
September 1, 2010 at
06:51 AM
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linly [theunnecesarean.com]
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Quote
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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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By and large I think a pelvic was done before every OB/gyn surgery I did in the OR, even if it was only to make sure nothing changed. I guess they could do them before rolling back to the OR, but most people would prefer to be asleep, but thats really a formality.
When I was in labor (at a hospital that is NOT a teaching hospital), the doctor asked if the intern (? I don't remember what she was called, but she was not certified) could place the catheter in. The catheter!
Had I found out she did it without asking? I'd probably feel upset. When I gave her permission, I understood that she could mess up. Not giving her permission puts the blame solely on her (I didn't sign anything saying a student could do it. Maybe that's why they asked) and leaves the patient (possibly) feeling victimized.
I see no reason not to ask. Plenty of people are willing to help.
If it's at a teaching hospital, it should be made incredibly clear. It shouldn't just be something in the fine print.
When I was in school/clinic, the students often performed tests and procedures that usually aren't part of the routine comprehensive exam. The school's clinic doesn't charge the patients extra. To me, it's just like getting an extra thorough exam and extra tests for free.
And note, during those extra pelvic exams, the med students could potentially catch something that wasn't seen/observed during the annual gynecological exam.
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When I was in school/clinic, the students often performed tests and procedures that usually aren't part of the routine comprehensive exam. The school's clinic doesn't charge the patients extra. To me, it's just like getting an extra thorough exam and extra tests for free.
And note, during those extra pelvic exams, the med students could potentially catch something that wasn't seen/observed during the annual gynecological exam.
Now, we're not talking about someone going in for Lasik and getting a pelvic exam. We're talking about a pelvic exam when you're in a hospital department that usually performs that type of exam. Also, and many ppl may not be aware of this, but there are many procedures that could be done that may be part of the standard of care for a particular kind of visit but done again to rule out bigger problems.
For example, let's say you come in with a pink eye. Although it may look like your run-of-the-mill viral conjunctivitis, many doctors will go ahead and measure intra-ocular pressures, dilated fundus exams, or even visual fields to rule out more serious problems. If you're in a teaching facility, they may do it either way to cover all the bases and allow their students more practice.
If the woman is in for surgery, chances are they will catch it when they open her up. It is not a matter of needing to do the exam before surgery. These are students, not residents. They probably have only done a handful of exams. Would you, as an Attending, go solely on the findings of a short coater for a pelvic that was necessary before surgery? Not many would. I would think that if a pelvic was needed, the Attending would do it, and then let the student practice to let them learn for ex what an ovarian cyst felt like under pelvic examination. The practice is fine, as long as the woman knows it is happening and as long as the entire class isn't up her hoo haa at one time. How hard is it to understand???
Am I in the club now? Are there perks other than getting all my drinks for free now?
http://digitalcommons.
A 1992 study showed that 37 percent of U.S. and Canadian
medical schools allowed students to use anesthetized women without their consent to
learn how to perform pelvic exams
90 percent of medical students who completed obstetrics and gynecology
(ob-gyn) rotations at four Philadelphia-area medical schools performed pelvic exams on
anesthetized women for educational purposes
in 1997, a Duke University professor published narratives of medical student training
experiences that described as many as five or six students performing pelvic exams in
succession on a single anesthetized patient. As one student said, "[It was like] all these
medical students parading in to each take their turn, y'know, like going to a vending
machine, and walking by. Only it's not a vending machine, it's a woman's vagina. And
you're each taking your turn, walking by and sticking your hand in
http://findarticles.co
The American College of Obstetricians and Gynecologists (ACOG) and other medical organizations for years have been urging that patients be informed and that. doctors obtain patient consent "The problem is the medical community is left to police itself. They're saying that something is wrong, but why hasn't it changed?"
For its part, ACOG's Committee on Ethics, in a statement issued in .April, said that a woman's informed consent is a "prerequisite" to medical treatment and participation in research. If a pelvic exam planned for an anesthetized woman offers her no personal benefit and is performed solely for teaching purposes, "it should be performed only with her specific informed consent, obtained when she has full decision-making capacity," the committee said.
And as far as docs being able to do nursing duties.. well, no offense to any doctors around here.. but there are alot of nursing functions that docs wouldn't be very skilled at.. I am sure they were taught the info, but they don't do it, so therefore don't maintain any skills at it.. I had a patient once tell me that she was tired of being stuck for an IV and wanted her doctor to put it in when he came by.. I just laughed cause I knew she really wouldn't want that if she knew. And most of our doctors would admit that too! I would not want them sticking me for an IV, lab work, inserting a catheter, NG tube, etc. By the same token, I won't dare claim to be as good at drawing blood as our lab techs who do it all day every day.
And as far as the pelvics go.. I would be very upset if it happened to me when I was asleep. I don't work at a teaching hospital so I guess I don't have experience with that.. but in our OR, they get consent for almost everything it seems.
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