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(3,186 posts)
Sat May 5, 2012, 09:31 PM May 2012

Wanted. Medical ethics opinions please...Re: Medical trainees/interns [View all]

performing pelvic exams without the consent of the patient.

Yup, this actually happened to my 18 year old niece on her first ever gynecological appointment. My sister is livid. I can't say that I blame her, but would love to know what you guys think.

Ok here is what happened:

First let me begin by saying that my niece is what I'd call "a young 18". She's very bright, does well in school, but is a bit shy and on the naive side. Which is why it's a very good thing that she and my sister are so close. My niece tells my sister everything, including the fact that she feels 'ready' to go a little farther in her relationship with a young man (same age) that she's been dating for over 6 months.

They of course, had a long talk about it, the pros and the cons, ect. but in the end, my sister agreed to take her to a gynecologist for contraception as well as a routine type exam. My niece of course, was a bit nervous and resisted seeing my sister's regular OB/GYN. She insisted upon a female doctor whose practice is some distance away.

My sister didn't go in for the actual exam because my niece wanted it that way. On the way home, prescription for 'the pill' in hand, my niece seemed unusually quiet. Finally my niece tearfully opened up to my sister about how 'a man' had examined her in addition to the female doctor. Apparently this guy was some sort of medical student or trainee.

Ok, I realize that medical students need to learn, but what makes this incident egregious imo, is that 1) Not only was my niece not asked if it'd be ok, 2) The female doctor didn't even bother to introduce this guy to my niece as a trainee (or whatever). We still don't know exactly who this guy was to be honest. My niece said that he had no nametag on anything to indicate who he was and what level of training he had had. Plus she had specifically wanted only a woman to examine her.

Apparently during the pelvic exam, the female doctor had him sitting right next to her on a stool, explaining the steps, and then handed the speculum to him so that he could "try". My niece said it hurt when he collected the pap sample. The doctor also allowed this random guy to do an internal exam by hand.

You may be wondering why my niece didn't speak up in protest. But please keep in mind that this was her first time, she has a tendency to defer to adults in authority, was very nervous, and just plain didn't know how to handle the situation. All of this happened yesterday, and the office was closed for the weekend by the time my sister learned of what had happened. But she is seriously considering calling the doctor's office on Monday to complain.

I've been doing some googling about this. Most of the cases cited where about trainees who were asked to give pelvic exams to anesthetized patients in teaching hospitals. Patients who had not consented. Apparently this sort of thing happens shockingly often. Oh, and surprise, surprise-- It's much more common a practice for poor women and minorities.Some of these teaching hospitals have tried to justify this practice by saying a woman "implies consent" by the very fact that she agreed to medical care in a teaching hospital.

In the case of my niece however, this was *not* a teaching hospital but a private practice. I did find some useful info in one PDF file. From what I can tell, nothing illegal had occurred. However, in that file, the info went into great detail about the ethics of this practice- (or lack thereof) including cases like my niece's when the patient is conscious. I'd post the link- but I'm having trouble with it.

Sorry this is so long, but if you've read this far, is my sister and niece right to be upset? What do you think? My poor niece says she felt 'violated'.

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