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A pelvic exam without my consent?

As you know, I am now bopping around in Twitter checking it all out and making new friends, er, followers.

Today I started to notice some tweets about women having pelvic exams done to them while they are unconscious in the hospital. Like many bits of way too information that I let into my day, I let it go into my line of sight and then right back out — I easily dismissed it as something pulled from a trashy magazine or something. But the tweets on this kept coming, and then I saw Ann Douglas, a highly respected parenting author and social activist make a tweet on it. What the? Could it really be a real story?

I checked out one of these tweet links, which led me to The Bad Moms Club blog. And it turns out that this story is not only for real, but it’s from Canada. I was utterly stunned. Here is the article from today’s Globe & Mail for you to read for yourself. It begins like this:

Imagine that you are undergoing a fairly routine surgery – say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.

Do you consider this okay, or an outrageous violation of your rights?

Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.

I want to read the full source article that the Globe’s Andre Picard refers to. To date though, I’ve only found an abstract, which you can read here and which states in part:

Medical students need to undertake supervised pelvic examinations to achieve competence. This experience is freqently obtained by conducting pelvic examinations on anaesthetized patients who are undergoing gynaecological surgery.

I think you’ll agree that the very fact that the study was published in the Journal of Obstetrics and Gynecology, published by the Society of Obstetricians and Gynecologist of Canada (SOGC) is really ruining my trashy magazine theory.

So, to get down to the nitty gritty on this … if I go in to the hospital to get my tonsils taken out, I’m not going to have a pelvic exam unknowingly done on me while I’m unconscious. But, if I go into the hospital to have a gynecological surgery of some sort, well, yeah, there’s a good chance that this could happen.

The actual SOGC Clinical Practice Guidelines on “Pelvic Examinations by Medical Trainees” is available in full here. It states:

For most pelvic surgeries, it is important for the members of the surgical team to examine the patient under anaesthesia to confirm the suspected patholody and the initial steps of the surgical approach. As part of the description of the surgical procedure, the surgeon should inform the patient that she may be examined by a trainee at the beginning of the surgery.

Okay, it’s getting a bit more clear for me now … If I go in for a gynecological surgery, chances are that I will require a pelvic exam as part of the surgical process. If the surgery is taking place in a teaching hospital, a medical trainee may be the one to actually do the pelvic exam. If a medical trainee is involved in my surgery, I will be informed in advance and my consent secured. I can refuse consent. Okay, I’m all good with that.

The pelvic examination is a component of the surgical procedure. Consent for a pelvic examination by medical trainees who are a part of the surgical team is therefore implicit [emphasis mine] when consent for participation in the surgical proceudre by medical trainees is obtained.

But here’s where it gets a bit gray: Do all gynecological surgeries require a pelvic exam? It seems not because later in these same clinical guidelines it states:

As pelvic examination under anaesthesia is a component of most [emphasis mine] pelvic surgeries, consent for pelvic examination by medical trainees is contained within content for a surgical procedure.

So from reading the above, it seems that a medical trainee may undertake a pelvic exam on a unconscious patient for “education purposes” — purposes that have nothing to do with the surgery. Yet, as the patient, I am completely unware that this is being done because consent is considered “implicit.”

Huh. Please tell me how consent — by its very definition — can ever be implicit? One cannot consent to something if one doesn’t know it’s happening!

I’d like to see these clinical guidelines changed to ensure that there is explicit consent, wouldn’t you?

An extra note: Not surprisingly, women are up in arms about this practice. Since last night, tons of new posts have gone up on this issue. You can add a comment to this post “Dear Nether-probers, we the undersigned, say STOP IT” in support of ending this practice.

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Comments

  1. If I roll into the ER and I’m bleeding to death and am unconscious and they need to do XYZ so that I don’t die, I’m totally ok with that. To me, that consent is implicit.

    If this is an elective, I have a right to know who is doing what to me, and to determine whether or not it is appropriate for “trainees to do it”… anything else is assault.

  2. I think when you sign that consent form before your surgery the thing says something like you’re consenting to your doctor doing anything he/she thinks is required. It’s a very wide open statement anyway that could be interpreted to include any sort of training. We should bring lawyers to all our medical procedures from now on…. and vice versa.

  3. Nat & XUP – isn’t it a sickening feeling to think that unknowingly, your body could be used as a guinea pig of sorts?? It makes me feel sick. Good point on the “explicit consent” Nat.

  4. Just read a great comment attached to the original Globe & Mail article: “Why can’t hte medical trainees practice on each other?” It makes sense, doesn’t it?

    Tons of twitter action on this issue at #noconsent

  5. Nicely written, and I’m very glad to see that this topic is “going viral”.

  6. Thanks for commenting on my take on this as well. I find it appalling that anyone would do a pelvic exam for the sake of practice if it has nothing to do with my surgery. On the other hand, I’d very likely willingly sign a consent form to have it done if I was ASKED first. It’s the not asking that upsets me.

    I mean, really, if they were doing surgery in an area near but not ON the heart would they let a med student go ahead and play around in my heart for practice just because, heck, it’s there? No. Or at least I would freakin’ hope not.

    So then why should it be okay to poke around in my vagina just because I’m lying there anyway?

  7. Yeah, I read this as well, and it concerns me A LOT. As if we women don’t have enough to deal with….

  8. WHAT THE F#$%???/ This is unbelievable and THANK YOU so much for bringing it up!!! You CAN be sure if I ever end up in hospital I will be absolutely INFORMED on what I am CONSENTING too!!!

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