Friday, January 29, 2010

What Happened to Informed Consent?

I guess for some people this is old news, but this morning I read this article about medical students doing pelvic and rectal exams on patients who are under general anesthesia for surgery. These patients, in many cases, did not consent to such exams, and may not ever even know it was done to them. Apparently this issue has come up a few times over the years (see the references section of this article) without ever really being resolved. And men, this includes you too... Imagine going in for a routine knee surgery and having 4 or 5 med students practice rectal exams on you while you're out cold.

If a woman goes out to a bar and a man spikes her drink with roofies and then has sex with her while she's unconscious, is it not rape if she can't remember it? Of course it is. How is this significantly different?

Any procedure performed on a patient requires informed consent. It is a legal right and an ethical obligation. The fact that this continues to go on is abhorrent. Of course med students need to learn somehow, but this is not the way.

Studies and surveys have shown that people will, when asked, consent to med students performing such exams. There are also some programs in place that pay volunteers for undergoing examinations in order to teach med students. Both are better alternatives than simply probing people's orifices without their knowledge or consent. More importantly, performing pelvic and rectal exams with a conscious patient have the advantage of allowing the patient to give feedback (as in, "Hey that HURTS!"). The student can better learn to conduct such exams so as not to hurt the patient.

If you are having surgery or any other treatment at a university or teaching hospital, ASK if they have med students learning pelvic and rectal exams on anesthetized patients. If you are ok with simply knowing in advance, you can feel free to consent at that time. Or you can tell your attending physician you do not consent, as well as write it on your consent form that you specifically do not consent to such exams.

If you are a student doctor or nurse, please refuse to check your ethics at the hospital door. Just because "this is the way it's always been done" doesn't mean it has to continue to be done that way. Tell your resident, your attending, your supervisor, or your preceptor that you won't participate in exams of anyone who hasn't given explicit consent.

Hat tip to The Unnecesarean for the topic of this post.
Further reading here

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