I’m one of those lawyers - nothing makes us crazier than lack of consent!

Truly informed consent only takes a few minutes.

They need to make sure they thoroughly explain the consents too instead of just rushing thru them. I work in surgery and have had a few surgeries myself, so I know what’s on those forms. But what about the average human that doesn’t and isn’t given the chance to really read the consents and have them explained?

As a physician, a students ability to learn directly impacts lives saved. These aren't highschool students, these are individuals working on their doctorates, they're highly skilled and very professional. In many medical practices they're an essential part of the team. At the end of the day, if you don't want students involved in your care, then don't get treatment at teaching institutions or under physicians that are doing the extremely crucial job of training the next generation that will be responsible for your own care one day and many others.

@@DEFENDERd25 as a survivor of rape in childhood I let females only be in the room for things involving my genitals I have a right to say no everyone dose I have been asked if I minded letting students do blood draws I said go for it during my first delivery I was asked if I minded Med students be present I say if they are females I am ok with it the dame with my 2ed 4 were there during my first and none at my 2 I was asked to let a med student do a papsmear and breast exzam it was a female so I had no problem with it do to having many bad encounters with males in my past I don't like male doctors my peditrion every time I came in even for a steep test made me dress in a gown then parted the lips of my vagina my step dad raped me my bio grandfather told me I turned him on I and every other person has a right to say no at any time if you don't get precision before then you don't have permission to do so during if I pass out at a party and have given joe permission to fuck me that dose not give him permission to let his friends do so too just because I give doctor mike permission to do the exam dose don't mean I gave 1 to 14 students to do so too

DEFENDERd25 With all due respect, the point is that the attending surgeon is required to get consent. It doesn’t matter whether or not it is a teaching hospital. A person under anesthesia has a right to decide ahead of time whether or not they want to allow anyone to stick their fingers inside of them. I understand that the students need this training. Maybe the the most crucial part of the training is teaching them to get informed consent.

@@DEFENDERd25 The problem is there are no private hospitals in our area any longer. They have all been bought up and or closed by one major concern in Pittsburgh. When my wife was in treatment for her cancer we had to battle every step of the way to keep these unauthorized practices in check. I had to threaten them with a lawsuit if our requests were not followed or at least given a passing thought.

@@DEFENDERd25 That's just preposterous. I feel like as a physician you are way to caught up in what you see as logically ethical, and that you aren't thinking about what is ethical to the individual. This isn't a numbers game, this is about violating an individual without their permission. Don't stick you hands inside someone elses' genitals unless they give you consent, period. Many would consider this rape whether you like it or not, and that's just the reality of the situation. There is no way to justify rape for the greater good, that's just not the way things work. If more people knew about this there would be an uproar, I guarantee it. I hope you come to see the errors in your ways.

Oh my god, my heart goes out to you. I have almost a completely identical story, and I still struggle with the emotional pain and violation to this day.

@@elzbthlncstr Thank you, I sometimes think doctors need to understand what it's like for us. It's for lack of a better word, you feel raped. You weren't in the traditional sense but your trust and everything was completely violated by people you're supposed to be able to trust. There needs to be a word for this kind of thing, since saying the rape word isn't technically true, but on the level of emotions and remembering the pain of it all, it's rape adjacent. It's an extreme violation of trust when you're at your most vulnerable and in so much pain. We need doctors to understand this and not create any more victims.

Marie Katherine The pelvic exam is only done immediately before pelvic surgery, never is it done during any other surgery, including arm surgery.

Beau Palmer yes, in some cases it’s shown that they did pelvic exams on patients that were having completely unrelated surgeries like that.

Horrible! How did you find out it was done to you?

You can sue. . . What's stopping you?

Sue the rapists

HIRE AN ATTORNEY..YOU CAN SUE

@@greensarah2059 When you're getting jaw surgery for an underbite, which should only take about 3-4 hours with no complications, and wake up with pain and an uncomfortable tender feeling "down there", that's how you know. For a 3 hour surgery, most people don't even need a catheter. This happened to me at 18, after I got my braces taken off. I knew about the un-consented anesthetized pelvic exams from doing tons of research online, because I was paranoid about my first real surgery. Which is why I wrote "NO STUDENTS, NO PELVIC" in big, bold letters on my care contract. I was unsure whether it really happened at first, until a male nurse practitioner, whom I never met before, came in my room to "inform" me that I had two cysts on my cervix and I was on my period, after I woke up and pressed the call button. I already knew about the cysts from my previous gynecology appointment. I told him I wrote NO STUDENTS and NO PELVIC on my papers, so why were they even down there?? I also told the surgeons the same thing, no students, no pelvic. He started stuttering a bunch of medical nonsense, stared at me awkwardly, then asked me if I wanted to speak to the head nurse or the head surgeon. I guess he noticed my "You're asking for a lawsuit" expression. I wanted to call him some names, but I decided to keep quiet and just said "No. I'll just look in my summary after I'm released and call my primary. I want to sleep right now". Knowing damn well that nothing about that pelvic exam would be in my after-visit summary. After he left, I shut the door, called my uncle who lived nearby to explain what happened, and asked him to come pick me up at the entrance as soon as possible. He told me to be outside in 15 minutes. Carefully took out my IVs and EKG stickers, wrapped myself in another hospital gown to cover my back, washed up a bit, put on deodorant, and hauled ass outside. I knew I probably looked absolutely insane, running around wrapped in two gowns, with only hospital socks on, with my jaw and face wrapped in gauze. My face was completely numb from the drugs, but I was super wobbly. I sat down in a wheelchair at the pickup area, so I would look a bit more "normal". Left my clothes and purse there, because they didn't have anything important, except maybe my lip gloss. I was also too afraid to ask a nurse for my belongings, because they might've forced me to come back. I recovered from my underbite surgery at home, rather than in the hospital, and refused to go back there when they called asking where the hell I went. My mother was angry at me when I got home, and called me crazy and stupid more than once, but she still sympathized with my reason. She's a feminist and was far more angry with the hospital than with me. Me and her did some research and found out that anesthetized pelvic exams are still legal in my state (Ohio). So we couldn't sue them, unless we attempted to sue the whole state. I've never been that angry before, and I'm still furious about it. I was young, I was a virgin, and I never even used a tampon. No one ever saw my privates except my mother and siblings before then. Much less some random strangers who will most likely end up dropping out of med school before their term is up.

Don’t get rid of them they are very important however not uncommented that is sexual assault in my eyes even if you are a training doctor. Our intimate parts are not revolving doors open to anyone.

Speaking up to authority is often more difficult than people are self aware enough to realize or acknowledge to others. It's easy to say what we think we would do.That being said as a patient I would expect to be ask to give consent prior to any procedure.

You probably DID cause harm. Were you under pressure by your superiors to abuse the patients? Can you name this hospital, and the doctor you were working under ?

@@cse1028 yes, pressure. Absolutely not naming for obvious reasons. Unfortunately the lines of informed consent are often blurred in medical training, with both trainees and patients having difficulty navigating that space. For a nuanced discussion I would suggest the book "Complications: a Surgeon's notes on an imperfect science" by Atul Gawande. He wrestles with the very real problem that in order to train medical practitioners, some patient must be their "first." Surgery, pelvic exam, clinic visit, etc.

Brooke99 - As an RN student, I thank you for allowing us to be a part of your life. It’s very uncomfortable, but it’s the only way we learn. I am childfree by choice and was dreading my OB clinical. Turns out, I loved it more than anything I’ve done before or since. 🧡

OMG! So this actually happens and happened to you except that you had the chance to accept.

@@theuofc Certainly! During labor, the Attending and the RN asked if I would consent to s student exam following theirs. The attending would clarify that the student would be 'talked through'. Thus, a little more discomfort if I was ok with it. The student always introduced themself and the attending would ask what they 'got' and why! My third was precipitous, though. 11 minutes from the ER door, so the whole unit got to participate with her... And she's still a fireball!

Brooke99 it doesn't sound like you were under anesthesia

Brooke99 the thing is though, you was given the chance to give consent to this exam. However, there are many women out there who would balk at this, by undergoing an intimate exam twice for the sake of allowing a student bit of practice, and that is myself included. Yes they have to learn, and yes I have the right to tell them to piss off, in a respectful manner I hasten to add. Bad enough a doctor, but dealing with students, nope not for me. I need at least 3 surgeries, and after watching a few of these videos, I can honestly say, I will NOT be having one, what little trust I had for doctors (this lack of trust for the medical profession started at 8years of age, when my GP told my parents that I was faking my illness, 36hrs later, I underwent emergency surgery, 6hrs away from death’s door) has been completely shattered! My dignity means the world to me, because when everything has been taken from you, the only thing we have left is our dignity, and if doctors don’t understand that, then they need to find another profession.

Great point! They are endangering patients for their own benefit. NOT ETHICAL.

If it's my body, yeah, you should get consent for those possibilities while I'm awake, before you put me under. It's my right to decide if I want to let a student (or anyone else) try something with my body. When I was a student, I told people I was a student and asked if it was OK for me to treat them. Some of them said no and that's the way it goes. Patients are allowed to say no, regardless of how it affects the learning experiences of students. The student's experience isn't the patient's responsibility.

@@cleverkimscurios3783 Students need to be trained, and patients shouldn't forget that the doctors and nurses treating them had to learn at some point. Patients avail of a health service and some seem to expect that the skills of future clinicians will appear out of thin air. If a patient is conscious the student should obviously be gaining consent for procedures as would any healthcare professional. We as clinicians should be supporting patients and reassuring them of the value of being part of this learning process. As far as procedures under anaesthesia go - if the procedure is going to be done anyway, I see no reason to specifically get consent for a particular member of the team to perform it, and students are part of that team. If the patient needs another IV cannula after they're asleep, it simply needs to be done or supervised by a competent team member. However, specifically doing something (be it an IV line or a bimanual/rectal exam) that would not have been done in the routine course of the patient's care solely for learning clearly requires explicit consent prior to anaesthesia.

MajorXaero - An excellent summation. Thank you. Signed: RN student.

@@majorxaero4964 OK. Explain all that while the patient's awake. Say "the team, which includes an X student." If the Pt doesn't want a student working on them, it's their right. Most will say yes, but you still need to respect the rights of those who say no.

Clever Kim's Curios ~ I’m 110% with you on this. Complete informed consent is needed if going under a planned surgery. Emergency surgery won’t permit informed consent so minimal intimate (genitalia) contact should be mandatory.

Can't film. It would be distributed to people the patient would NOT want to see it. We need ADVOCATES that work for US in the OR keeping an eye on them.

Absolutely correct. I have read stories that as many as 10 students doing this. If each exam takes 10 mins. you have kept the pt. under anesthesia for approximately. 100 extra mins. There are such things as standardized individuals who are paid to let students examine them. Don't practice on me. An anesthtised pt. can offer no feedback while they are under. So what are they learning.

Sounds weird...you think so? Sounds like a case of sexual abue to me. Di he even have a nurse or someone with him?

Sounds like a malpractice lawsuit. Public bathrooms in hospitals are not sterile; there is no kind of exam that should be conducted in a bathroom that everyone uses.

that is not normal.

Usually this is an add on exam before surgery or other procedures, but if a pelvic exam is very uncomfortable for the woman, they can be anesthetized only for this exam. However, the latter is much less common.

Thank you

L Francis Just for pelvic surgeries where the surgeon is already going to do a pelvic exam as part of the surgical prep (a hysterectomy, for example). The students just repeat the same exam the surgeon did, but that’s only allowed if the patient consented for student participation.

Sociological studies have shown that patients view their sexual organs as much more sensitive than their other body parts. People are much more comfortable with doctors examining their arms, for example, than their vagina. And he wasn’t merely talking about pelvic exams as a whole, but *non consensual* ones. When I go to my gynecologist for a check up and they perform a pelvic exam, it’s uncomfortable and awkward, but not psychologically distressing because that’s what I’m there to do and my sexual health is important. When I went to the ER and was violated without my consent, it was not empowering at all, because again, they did it without my consent. That’s the important part here.

Pelvic exams are not an "indignity". It's a medical procedure.

Have you had one? It may be necessary, but it's an indignity.

Actually, patients more often go to teaching hospitals because they're the closest ones. I really don't see how anything else would be the factor. The only hospital in my city is a teaching hospital. Obviously, I am ok with students learning when my consent is given. But certainly not if I have not consented to it. The doctors always ask if it's ok that a student is present, let alone if they do something.

Ann Genaske They will never refuse to do the surgery if you refuse to let a student do this exam. If you refuse to let the surgeon herself do the exam, that might be a problem.

I had a hysterectomy last year. On the consent form, there was an “opt-out” to refuse to allow students in the OR, and refuse to allow students to examine me, or do any part of the surgery. But I’m a healthcare attorney, so I also know to ask.

They do inform the patient before hand. At least all the multitudes of OBGYNs that I've worked with have done so.

That makes sense. I've been wondering what good it does to perform a pelvic exam on an anesthetized woman as a way of practicing for pelvic exams on unanesthetized women. The explanations seems to be that you can feel the anatomy much more clearly, but if you didn't perform an unanesthetized pelvic exam on the woman first, then how are you going to compare how the two exams feel so that you can then make some generalization to all the women you'll be performing pelvic exams on when they aren't anesthetized, which, one assumes, will be the majority of the people you'll be doing pelvic exams on. As for the woman laying there on the table, anesthetized, ready for surgery, she isn't going to benefit from a pelvic exam, for her surgeon's sake or hers. She's already likely been through ultrasound and CT scans that have given the surgeon a clear understanding of her anatomy and the finer points are about to be revealed in complete detail when surgery commences. The woman herself doesn't seem as if she's going to receive any benefit. Her reproductive organs are going to be removed. Why perform a manual exam on organs that are headed to the pathologist? And the extra time taken for not only a surgeon but medical students to go through several pelvic exams on her, and we all know that it's going to take each of the students longer than an experienced doctor to perform those exams plus the time to instruct them, is more time that the woman has to spend under general anesthesia. So it's not even a neutral experience for the woman. It's increasing the risk of her procedure. Thank you for taking a stand on this issue, explaining the lack of teaching benefit that performing this procedure provides to the the medical students and for making it evident that the patients are being asked to consent to a procedure that appears to be unnecessary and puts them at greater risk.

Laus Deo for the thanks and for my not having to take a stand many years ago against OB/Gyn attending(s) as a medical student. My commenting here really isn't taking a stand but rather sharing the simple fact that we, who are doctors, really do learn more from the physical exam of a conscious/alert patient than from examining an unconscious/sedated patient. In the interim, I am wonderfully hungry, and hope you, Carol, also have a healthy appetite too. So how are you ?

Link to commenting on the MedPage Today article --> www.medpagetoday.com/blogs/zdoggmd/76191?comment=true

@@carolheaton1584 not all gynaecology surgery is removal of pelvic organs. For instance just today, I had a hysteroscopy (scope into the uterus), D&C (dilitation and curettage -being dilation of cervix and scraping out uterine lining) and insertion of Mirena IUD. I would expect that a manual pelvic exam is done prior to them inserting the speculum. I had no ultrasound or unnecessary radiation exposure for a CT scan prior to this routine and fairly simple surgery, not would I expect either test. I was informed and asked if a student could perform my procedure and I consented. I hope the student learnt something from me. I can see perfectly well how a student can learn valuable palpation skills from an anaesthetised patient, and I can also see how and why they also need to learn on awake patients, both are important. However I certainly gained from having a pelvic exam prior to surgery, as if my vagina was deformed or there was any growths, the speculum could have seriously damaged me.

@@wormwoodbush3537 I hadn't considered that, so you make a good point for your situation. And you were fully informed and still willing to have that take place. That's your choice. But a document containing a blanket statement to the effect that "medical students may be present during or assisting with any medical procedures performed", with that statement buried in a sheet of paragraphs addressing a wide range of surgical issues pushed in front of you to sign after you've already been administered oral medications related to anesthesia in the 30-60 minutes immediately prior to surgery - that's not fully-informed consent. And meeting the anesthesiologist and the CRNA and circulating nurse immediately prior to surgery doesn't constitute being introduced to the surgical team, who you'll never remember anyway because you've already been drugged. So if either or god forbid both of those were to be the case, I hope you can see that that isn't fully-informed consent, and to find afterwards that something like this had happened would leave someone feeling very violated and as if their trust had been betrayed. And to think that something like that might have happened but have no idea how find out if it had is extremely upsetting. If there were medical students present in the operating room, would they be noted in the record of the surgery alongside the other personnel who are noted? Would have it have been recorded in surgical notes available to patients that a pelvic exam under anesthesia was performed at all, much less how many were performed and by whom? If they're going to do it to you, they should have to provide you with a record of everything that had been done.

A form doesn't mean informed.

Legally, if you sign it, you are.

franz kindel well we, unlike most do now, actually went through and read it word for word to the patient and then explained what it meant. Ours really was informed consent.

@@SallyWooten That is great to hear. I've had this conversation with a few of our medical students and their preceptors. The more information you can give your patients, the better.

@@hz3917 I hope you haven't done this

This is not true. Look at this article, Do Chaperones Really Protect Patients? at sexualmisconductbydoctors.com/chaperones.aspx

I'm a physician. I don't think a male student could (or should) get through training without doing a pelvic exam. Getting to know female and male anatomy and physiology is critical to practicing medicine.

@@jopa948 fucking sick,

The point is...get consent first

@@jopa948 Get consent first

@@mcthuggin9803 zero points for reading comprehension.

😅😂😁

FenderTelecast Don’t make a joke about this. Grow up.

@@michelleeaton6602 He literally said it in the video, please grow some common sense.

It is on us, as medical professionals, to educate our patients/clients, and gain their trust. You might be surprised how many people are willing to contribute to your education, if you will only ask.

please give me the name of your institution

@@geriroush8004 thank you for being a decent, real human, unlike-

There have also been studies that have shown that a considerable amount of women would gladly consent to a pelvic exam under anesthesia for teaching purposes, as long as they gave consent first. So the argument that having to get consent makes it harder to teach med students is a little ridiculous. Plus, don’t you think it’s worth the trouble of taking a few extra steps to teach students, than violating patients?

Nope. The ampulla of a rectum in a dead person is the same in a living person

Nope. The ampulla of a rectum in a dead person is the same in a living person. One is just more full of shit

Yes, in a cadaver the structures are hardened from the preservatives such that they no longer feel as they do in an alive patient. It takes a long time to feel what is normal for this exam because of patient discomfort, different body types, and often your own discomfort with performing the exam. All of the patients on the ob gyn service where I rotated were consented for exam under anesthesia before any pelvic surgery to confirm the exam was consistent and hadn’t changed from the original visits. Never did a rectovaginal exam on anyone. Where I am, same day surgery patients sign their consent in holding but all of the patients had discussed the details of what they were having done in a pre op appointment with the surgeon.

@@kmfioretti They were specifically told every step?

carol Heaton unfortunately we don’t get to work with each attending to see how they do pre op appointments, but the one I got to work with explained that in the OR the patient would have a speculum and bimanual exam performed just like the ones she would get at an annual visit followed by whatever procedure we were doing. It was never specifically noted that more than one person would perform the exam, but she was always very clear that students and residents are active participants in their surgical care. These two things are in different sections of the form when going through it with a patient, and I never ran into a situation where someone put it together. I’m torn on this issue because I felt that our patients were well informed as to what would happen to them while under anesthesia and Zdogg acts like it is a spectacle with everyone lining up to examine the patient for no reason. I can definitely see it going that route and obviously if it’s not been consented for its unquestionably wrong, but I truly saw it as professional part of the procedure where we discussed as a team the expected anatomy confirmed by the exam before a procedure was started.

If someone can stick their fingers in me in more ways than one,without my consent,while I'm put under its assault. Period

You should report those rapists. Like a good man would do, Scott.

Sorry you've felt used and now doesnt give af about your body. I haven't and still treat my body with respect. So you do you. But dont speak on behalf of other women~

@@azula08 I only spoke for myself, sweetie.

The operative word here is "USED." You better believe it. Without your consent having some male students stick their fingers in your vagina and rectum and penetrate you is called RAPE.

@@ValidityJ Obviously, true informed consent is essential. However, to say "it's called cadavers" is unrelated to the topic and inaccurate. Cadaver dissection is extremely helpful when learning anatomy, but of little to no benefit when learning how to complete a proper physical examination. The preserved tissue (cadaver) is in no way similar and palpation/tactile sensation is basically unrelated to what would be expected from an alive patient.

I completely agree that it is vital for physicians-in-training to correctly learn how to perform medical exams at the feet of trained physicians. Without this ability, medical students will never learn how to translate ideas and concepts learned from their preceptors into procedural knowledge that can benefit their future patients, which you specifically pointed out. However, Dr. Damania (ZDoggMD) brought up an important ethical code that must guide physicians as they work with patients: respect for autonomy. Autonomy is the principle that patients have the freedom to choose for themselves what is best for their body after a physician has explained the risks and benefits of a procedure and requested consent. While medical professionals are trained to work in ways that benefit their patients, sometimes the physician’s values do not align with their patient’s values. This could be due to the patient’s personal preferences or dislike of particular procedural risks, family values, or religious beliefs. In situations where a physician’s values do not align with patient values, patients must have the final say in the matter because it is the patient who will ultimately have to live with the consequences of medical intervention, whether these consequences are good or bad. In addition to patient autonomy being vital due to a patient’s ownership of self, physician respect for patient autonomy is also integral to trust within the patient-physician relationship. If a patient ever believes that a physician might force a procedure upon them that doesn’t align with their values, they might choose not to receive any type of medical care in certain situations, which can put them at risk. In the case of unconsented pelvic exams performed under anesthesia by physicians-in-training, lack of consent breaks the principle of self-autonomy and puts the physician-patient relationship in jeopardy. Lastly, I’d like to mention that ensuring that consent is received from patients does not mean that future physicians will be undertrained. While it is likely that a small subset of patients would reject student involvement in their care, a study performed in 2005 showed that 90% of patients were willing to give consent for medical student involvement in their care (bit.ly/2QkLxxq). There are certainly enough learning opportunities for physicians-in-training during residency that, along with the appropriate checks and balances in medical education, will ensure that our future physicians are well-trained.

Your sick in the head

The thing is that most people would be ok with it as long as they were asked for consent. There wouldn't be large losses to training opportunities. I've never said no to any training done on me and neither has my mother or my grandmother. To be fair, it has not involved these kinds of examinations, but it has involved nurses in training being there for my grandmother's colposcopy, looking at the screen where my grandmother's cervix was filmed. She was fully awake and consented to them being there. Because most people value learning and understand that they need to experience these things. But not behind our backs!

I'd never give consent for that and if they did it anyways I'd sue the fuck out of them

Joy Wolfenbarger you didn’t read my whole comment did you? I specifically said that ANY non consented student performed procedure is a violation. Thanks for indicating you’re not here for a good discussion though.

Joy Wolfenbarger and actually, I probably would consent to student examination. Only one or two of them though.

It's invasive. Examing a knee or whatever is not the same. The pelvic area of any patient should be off limits without either consent or cause.

kk70x7 AND ANOTHER PERSON WHO DIDN’T READ MY COMMENT CLOSELY ENOUGH. I clearly said unconsented pelvic examinations are unacceptable.

@@nathanward4899 Actually, I read every word and I don't agree that any exam without consent holds the same gravity. We've always held that pelvic exams are a bit of a special situation in healthcare. I wonder if you are actually in this profession.

"They" do a lot of things to women in developing countries like cutting off their clitoris. And the excuse re: students learning is invalid without a patient's consent and thorough understanding BEFOREHAND.

HEL-LO, Jake. So anything goes when it comes to medical students? Give. Me. A. Break. How about consulting the patients before hand and getting their consent...in writing? That allows for student learning and more important for ethical treatment and respect of the patient.

but you have to ask for consent dumbass