The ethics of pelvic exams performed on anesthetized women without their knowledge

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  • John Pack Lambert of Michigan Ypsilanti, MI
    Jan. 8, 2019 7:57 p.m.

    Those who want to treat this like any other procedure ignroe the fact that some parts of the body are more private than others. In fact, the doctor who tried to argue we should disregard mores and run roughshod over the populace has so little understanding of the human body they should be driven from the profession.

    Should eye exams and pelvic exams be treated the same? Of course not. To even suggest that examing any part of the body has the same social impact as examing any other type of the body is to treat patients as non-persons.

  • John Pack Lambert of Michigan Ypsilanti, MI
    Jan. 8, 2019 7:42 p.m.

    The Larry Nassar case showed us that rules about having a second person present for some procedures are disregarded even when imposed as part of TItle IX adjudication. There is a reason why the Federal government still is running Title IX invesigations against MSU.

    However while Larry Nassar is hopefully an outlier in actions, the fact that other doctors stuck up for him so much shows that in medicine the patient is not the primary focus for too many.

    We need to shift from doing these sorts of things with limited informed consent that is often not given with full knowledge to a situation. We need more medical models and to have them be more key in the process, and to also pay those who are mock patients a living wage.

  • John Pack Lambert of Michigan Ypsilanti, MI
    Jan. 8, 2019 7:31 p.m.

    It is this desire to do end runs around family beliefs that causes so many to dislike doctors.

    It is this sort of condescending attitudes towards patients that allow Larry Nassar to continue to abuse patients for almost 20 years after the first time people reported objections to his procedure. Even more so it allow him to continue two years after a formal inquiry that started with allegations that should have been unquestioned signs of sexual abuse.

  • Nuschler121 Villa Rica, GA
    Jan. 4, 2019 11:56 a.m.

    At the University of Utah, slim women were paid to act as models for pelvic exams. They were usually other med students making extra money.

    We learned on a rubber like manikin. Then a woman would tell us whether we were inserting the speculum correctly without hurting her and if we were doing the bimanual exam correctly reaching the organs of the reproductive system.

    All very professional with instant feedback. We had paid models for taking histories correctly and doing the rest of the physical...so models made sense.

  • 01slcmom Salt Lake City, UT
    Jan. 4, 2019 3:20 a.m.

    Granted my experience is 30 years old. But it did happen, and was absolutely appalling. My daughter was a 12 year old patient at Primary Children's Hospital. The first night she was there I went home to sleep. The next morning she told me that two medical students had awakened her in the middle of the night to practice medical exams including a pelvic exam. There was no medical reason for the exam. I insisted that no medical students be involved at all in her care, but I was shutting the barn doors after the horse escaped.

  • Susan Fritzler Tooele, UT
    Jan. 3, 2019 5:54 p.m.

    This is so hideously wrong. We are still in the Dark Ages in women's medicine.
    It's time for people to be allowed to designate a family member to observe surgeries and procedures where the patient will be anesthetized, to protect patients.

  • Cosmobrutus ,
    Jan. 2, 2019 10:41 p.m.

    I have to say that this report shocks me. I am a gynecologist. It is actually my job to perform pelvic exams on a daily basis. And from medical school through residency I have never even heard of this being done. I did the pelvic exams every student did on a paid live model in medical school then a few times in the schools Gynecology clinic. It really wasn’t until my OB/GYN residency that I really had any training to do this. My questions are where are they teaching like this? And what in the world is the advantage for students to do it? Especially if they have no interest in it? If it at all has anything to do with what you will see in your specialty then you will get it in your residency in the appropriate setting. Maybe that’s just where I trained.

  • Justinstitches American Fork, UT
    Jan. 2, 2019 9:56 p.m.

    Doing a pelvic exam on a dead body is significantly different from doing it on an unconscious patient.

    When I have signed consent forms for surgeries, I read them and they have appeared to be specifically referring to my surgery and needs during surgery. Doing an unnecessary procedure without patient consent is assault. Medical personnel can’t do anything without the expressed consent of a patient. Using the excuse that the patient might say no so they don’t ask is unethical at the very least. It’s certainly very arrogant.

    Frankly, I think many women would be ok with it, if asked. I would, because I believe in education. But don’t you dare do it without my consent. For those who say no, there is usually a very good reason behind it. Performing a pelvic exam on an unconscious patient for no other reason than for practice without consent is violating the integrity of a person’s body.

    These exams need to be done ONLY with the expressed consent of the patient.

  • SallyS86 , 00
    Jan. 2, 2019 8:33 p.m.

    I have actually seen multiple articles on this topic. Zdogg MD on facebook has brought this to light quite a few times. The problem is that it IS happening. Yes it sounds HORRIBLE and unethical. Many doctors want to say, oh no it isn't happening, look at the research and many coming forward, it is! There was even a documentary on it!
    It's time to make this illegal across the board... Ask the patient for consent, if you don't have consent then don't be doing it! Until then I guess we have to educate all of our families/friends/daughters etc on what to say when they go into a hospital and under anesthesia on what to allow and not allow.

  • a_voice_of_reason Woods Cross, UT
    Jan. 2, 2019 5:19 p.m.

    I can't believe this is happening. I completely agree and understand that learning has to happen. Of course it does! This is completely logical. But, to perform unnecessary exams without consent is unreal! I wouldn't want a student touching me without my consent. I wouldn't want any doctor performing an exam of my feet while I was unconscious for a knee surgery without consent. If they asked me, I'd be fine to offer consent in nearly all cases. I want the students to learn; however, my body is not an open laboratory for use whenever I go in for care. My consent to be treated, is not consent to be used. Unbelievable!

  • Susan Quinton Draper, UT
    Jan. 2, 2019 4:39 p.m.

    To those who are saying no harm done- not true. Women are more susceptible to infections the more pelvic exams performed, and our midwives for all of our homebirths limited these intrusive exams. If a woman can’t consent, that’s a no.

  • MarkpMD ,
    Jan. 2, 2019 4:10 p.m.

    In 10 years of medical training at 3 different universities in 3 different areas of the country (including Utah) and 20 years of practice and involvement in physician training in 6 different hospitals in Utah, I have never even heard of a rumor of such despicable practices. I am not saying it doesn’t occur, but it also can’t be widespread. And informed consent really means informed in my experience. Each section of the form is reviewed and explained until the patient is satisfied. I have never seen one that would make such exams allowable. Again, I am not saying it doesn’t occur, but more of us would know about it if it were widespread.

  • Clip the man SALT LAKE CITY, UT
    Jan. 2, 2019 2:56 p.m.

    If those supervising and performing such procedures really feel that there is no ethical concern with doing so then they should have no problem explaining that to the patient or their family prior to the exam/procedure happening. The mere fact that they hide it shows that they know many people would not agree to it.

  • idablu Idaho Falls, ID
    Jan. 2, 2019 2:54 p.m.

    My experience is the same as Dr.GTR81. In 8 yrs of training, (Univ of Wash and Univ of Ariz) I never witnessed or even heard of the practice of practice pelvic exams in unconsented, anesthetized patients. My training came through live, awake, consenting patients or consenting, paid models. In this day and age, consent is paramount, and doing a pelvic exam on an anesthetized patient for say, a knee arthroscopy, without specific consent would amount to assault and should be prosecuted.
    I just can’t believe this would happen as often as the author implies. It certainly didn’t happen at my medical school or residency.

  • search diligently Lehi, UT
    Jan. 2, 2019 1:36 p.m.

    This may be true, but my guess is that it is not true in general in most hospitals or clinics. Each state should pass laws to prohibit such an offensive things and if known these have happened without consent, I feel the individuals involved and especially those supervising should be prosecuted to the fullest extent of the law.

  • yankees27 Heber, Utah
    Jan. 2, 2019 1:05 p.m.

    Is it out of the question to offer compensation for women to have a pelvic exam as a teaching tool? Seems a few hundred bucks is cheaper than potential lawsuits. Turn this around and would men feel violated finding out they had a student give them a prostate exam while under anesthesia? I know i'd feel pretty weird about it.

  • Dr.GTR81 ,
    Jan. 2, 2019 1:02 p.m.

    I was taught in OR’s in 3 states as a medical student and then as a resident, including intermountain healthcare facilities along the wasatch front. Not once was it ever suggested that I should do an unnecessary pelvic (or any other type of) exam under anesthesia without consent.

    The only times I did pelvic examinations under anesthesia were for gynecological surgeries where the exam was indicated, and when the patient had been informed I would be present and agreed to my participation in their procedures.

    There were myriad opportunities to learn the female pelvic exam with conscious and consented patients in the office setting. I must’ve done 100 of them in the OBGyn clinic alone. There is no reason for a student or resident to do what’s described in the article. And I think the article is a bit hyped up most likely. In my 8 years of medical training, I never once saw this happen anywhere, nor did I hear of it happening.

  • OlderGreg USA, CA
    Jan. 2, 2019 12:02 p.m.

    Quite frequently, that "consent" is buried under a bunch of bureaucratic stack of fine print verbose legalize "sign here"s at the last minute.

  • RiDal Sandy, UT
    Jan. 2, 2019 11:54 a.m.

    "But you gave consent in the pre-treatment forms."

    That would easily be destroyed in a court of law. Anyone requiring treatment serious enough to require a hospital stay, and being presented with a form that *must* be signed before the treatment could take place, would obviously be signing "under duress".

  • Oh Really? Salt Lake City, UT
    Jan. 2, 2019 11:52 a.m.

    Any time anything is done without a person's reasonable knowledge and consent it is wrong. Period. It doesn't have to be a pelvic exam, though that seem egregious.

    Personally, though different, it still comes too close to Dr. Larry Nassar of USA Gymnastics who performed unnecessary pelvic exams on young girls. It opens the door for potential for abuse.

  • Oh Really? Salt Lake City, UT
    Jan. 2, 2019 11:49 a.m.

    @Sirbobg

    Dear Mr. Scientist. Apparently you do not know what "anecdotally" means. Otherwise, you would understand that "in your experience" is anecdotal evidence, and doesn't preclude the possibility or fact that this does, indeed, happen in other places, or outside of "your experience."

    If, however, you are correct, then there would be no harm in enacting a law against the practice of unauthorized pelvic exams.

    .

  • bikeboy Boise, ID
    Jan. 2, 2019 10:36 a.m.

    Gotta admit - on the few occasions when I've been asked to sign a consent form, I've pretty much signed it without reading it. I can certainly see both sides of the argument, but would hope such practices would be clarified to the subject-patients a little better.

    I'm also curious - one of the people in the story mentioned that they saw "something on her cervix." Suppose an undisclosed exam resulted in a health-threatening condition that was still treatable... would the subject of the exam still be offended that it had taken place?

  • Doug10 Roosevelt, UT
    Jan. 2, 2019 9:46 a.m.

    For $50 cash the hospital can have a line of willing women to volunteer then this practice that makes students and victims out of women could end immediately

  • EscherEnigma Ridgecrest, CA
    Jan. 2, 2019 9:35 a.m.

    How is this controversial?

    Patients should be informed as to what is going to be done as reasonably possible (sometimes things don't go according to plan), and should be informed after-the-fact as to how things went and what was done different from the plan. And yes, this should include any medically unnecessary "teaching" moments such as pelvic exams. This should be obvious.

    And to the degree possible, consent should be acquired *before* any non-emergency procedure. Again, this should include any medicially unnecessary "teaching" moments such as pelvic exams. And again, this should be obvious.

    And if your teaching hospital can't find enough women willing to be pelvically-examined for free, that's a solvable problem: offer them money.

    Same with the cadaver-emergency room thing. If not enough people and/or their families won't consent for the body to be used by students to test procedures on for free, then offer them money.

    This isn't complicated and shouldn't be controversial. That it is says very bad things about our system.

  • JaneB Wilsonville, OR
    Jan. 2, 2019 8:28 a.m.

    Oh my goodness. This is insane.

  • Christmas Carole Hurricane, UT
    Jan. 2, 2019 8:23 a.m.

    I am very supportive of the opportunity for these students to learn...WITH permission. I am surmising that the physicians who are so positive about this practice would be unequivocally positive about said practice being unknowingly performed on them??

  • RiDal Sandy, UT
    Jan. 2, 2019 7:32 a.m.

    This story is the classic example of how those who think they have a "good reason" and are given any power will abuse that power and make it a "standard practice."
    Simply exposing this practice, every rational person is appalled. It is not the worst thing in the world, but definitely a violation of privacy and ethics. Remember that no test, procedure, or examination is without some risks: accidental damage, infection, etc.

  • Sirbobg Salt Lake City, UT
    Jan. 2, 2019 1:08 a.m.

    Here at the University of Utah and a other academic medical centers around the country, there is an option clearly indicated on treatment forms for physician trainees such as residents and medical students to assist in the treatment given. I have never seen any questionable practices that are anecdotally referenced in this article here or at other training hospitals. Consent is an ethical pillar to medical practice, and I t sounds as though the people in this somewhat hyped-up article may have simply signed without reading/listening and been surprised afterward. People certainly have a right to decide what happens with their bodies, so please pay attention to what your doctors and treatment team are discussing with you and be forthcoming with the questions on your mind. No one is keeping any secrets from you.