Interesting article in the Globe and Mail - re pelvic exams

[Andie]

http://www.theglobeandmail.com/life/health/time-to-end-pelvic-exams-done-without-consent/article1447337/

[terryann]

EHH...but I think this has been going on for years, if you go back and look into old articles......ehhh

[A-Stark]

I've intubated, placed venous lines, bagged ventilated, given lots of drugs, taken ABG samples, sutured on closure, cut suture wires, reflected tissue, retracted, inserted oral temperature probes, among other things, all in the OR, all while the patients were unconscious. I'm also pretty sure that patients never specifically consent to foley insertions in the OR by particular people.

 

Now, whether completely unnecessary learning exams should be done in the OR is certainly debatable. I'm not sure myself. But the tone of the article is inflammatory and it conflates such exams with the normal legitimate practice of "learners" being present during procedures.

[rogerroger]

Most of my shadowing has been in the OR and I never witnessed what is being described. The pelvic exam stuff done at my stage of training has always been in a clinic setting with informed consent and a nurse and attending also getting this consent to back you up.

 

The article raises a good discussion point about trainees within teaching hospitals. But for me the unbalanced finger pointing is distracting... Typical Globe hysteria...

[Lactic Folly]

It's more likely to happen in a gynecology OR than in any other setting, as pelvic exams aren't part of the objectives for clerks on other rotations.

[Satsuma]

I think this article kind of exagerates the truth...well maybe not even kind of, but alot.

 

First he uses the example of 1 medical student refusing to do a pelvic exam. This 1 student later gets turned into a whole group a students parading into the OR to perform an unecessary pelvic exam. Seriously...what surgeon is going to have time to round up a whole group of medical students and wait for them each to take their turn with a pelvic exam.

 

And he gives examples of gynecological surgeries....which do require a pelvic exam. I have done a pelvic exam on every pt we did a hysterectomy on...not for the fun of it, but because you can assess certain things required to know for the surgery.

 

The article gives the impression that some unkowing person would be getting a pelvic thrown in with their tonsillectomy. Which is not the case anywhere.

 

It also makes assumptions stating that the medical profession makes the assumption that women wouldn`t consent to learners performing a pelvic exam. Which is just not true. Clerks rotate through OBGYN and do pelvic exams on plenty of consenting women. So it isn`t like they would NEED to sneak into the OR an assault patients!

 

Now...in the past I have heard this was common practice. However, this is no longer the case. And specifically this topic was even discussed with our class pre-clerkship to be clear on the issue.

[Madz25]

ummm done that. the docs encourage you to do pelvic exams in gyne ORs...and also DREs on male patients in urology. Honestly, models and all that are great - but it's not the same. It's an important skill and the only way to develop it is by doing as many as you can. I agree with where the patients view as well but how do we learn if we cant do it?

[Laika]

I've never liked Andre Picard, but this article is something else... Did he go to the Fox school of fair and balanced reporting?

[A-Stark]

I normally enjoy his columns - this seems like a real misfire, though, and I'll be interested to see what kind of letters it generates.

[Ollie]

Yeah, this article is quite misleading. I've done bimanuals on patients during gyne surgery, but they are usually consented for an "exam under anesthesia" as part of their surgery. I've never seen them done unnecessarily, and they are almost always indicated prior to any gyne surgery. It's never a "parade of medical students" it's only those who are scrubbing to assist (so usually a resident and a med student. I do agree though that there should be more explicit consent, and women should be told that an exam will be done after they are anesthetized by the surgeon and assistants.

[scrub]

Wow.

 

Is the "poll" found anywhere? Seriously I can just email a couple buddies and it can count as a poll?

 

The relative ease with which the public can be sent into an outrage is depressing. Sigh.

[KennethToronto]

Feel free to send some choice words back to Mr.Picard on his "reporting" skills.

apicard@globeandmail.com

[scrub]

So, in the context of pre-operative and intra-operative evaulation, a vaginal exam is invasive, yet OPEN SURGERY isn't?

 

This guy is an a55hole.

 

Not just the exam but the accompanying parade. I understand where he's coming from though. Those parades get pretty elaborate. I was late for work this morning because I almost hit a float that was on its way to some woman's ligation.

[ploughboy]

Not just the exam but the accompanying parade. I understand where he's coming from though. Those parades get pretty elaborate. I was late for work this morning because I almost hit a float that was on its way to some woman's ligation.

 

One time I tripped over one of those Shriners in their clown cars and almost contaminated the sterile field.

[FacetheMusic]

Sigh. I got sent this article too. Now all my non-medical friends think "schools across the country" encourage medical students to do this to every female patient in the OR.

 

http://www.thespec.com/News/Local/article/714924

 

This article is a little bit less sensational.

[national]

as a few people have mentioned, the issue is not with the pelvic exam itself, but with the lack of consent.

 

i don;t know how many of you have been present when a woman is consenting for gyne surgery, but honestly, how often have you heard the surgeon mention that a pelvic exam is done while she's under anaesthetic? I've never heard anyone explicitly say this (let alone mention the fact that the exam will be done by the surgeon, 2 residents, and one or two medical students). Usually it's like "risk of bleeding, infection, perforation, converting to open, etc etc"

 

i've felt uncomfortable doing these in the past (though never declined to do one). i'm not going to be an obs/gyne, so knowing whether the uterus is ante or retroverted is not useful knowledge really. besides, we get to do pelvic exams on AWAKE, CONSENTING patients as part of our rotation anyway.

 

i agree the article promotes some fear-mongering, but it's not without it's merits. if it was my mother or girlfriend going in for surgery, i wouldn't want my classmates doing unnecessary pelvic exams.

[NLengr]

If you are gonna have your hands in the field for the surgery, then you had better god damned know what is happening with the field. Part of knowing what is happening with the field is doing a peri-operative physical before you start to cut (it also includes reviewing pt. hx, prior exams, imaging etc.).

 

If you are scrubbing to operate/assist a gyne surgery, you need to do the exam under anesthesia IMO. For patients to expect otherwise would be foolish.

 

I know at most centers this is included in the fine print of consent. It also commonly says that the surgeon has final decision over who will be in the OR/assisting, and the Anes has final call over anesthetic choices.

 

This article is pure sensationalism to stir up easily provoked people and get readers to buy papers.