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PDF Editor FAQ

Can pelvic exams under anesthesia have separate informed consent, especially for pelvic exams?

A2A. Thanks.Ideally, informed consent is required for any procedure with moderate invasiveness or higher. For example, informed consent for general anesthesia is universally agreed on. And virtually none requires you of informed consent for giving you an intramuscular injection. So it depends on how invasive pelvic exam is you define. Then how invasive it is? Well, I guess it depends on the medical policy of the country.

What is the creepiest thing that society accepts as a cultural norm?

That just because one wears a stethoscope (i.e. being a doctor, nurse, etc.), that it is OK for that person to to see another person naked and touch their genitals (especially children) without permission or with coercion.…and to do this repeatedly, and see nothing wrong with the practice (because they are the ones wearing the clothes).Also to say that gender doesn’t matter (it does to the naked patient).To require patients allow medical students to learn on their bodies (i.e. treat them as warm cadavers). Many doctors and medical students feel patients are “obligated” to accept (not allow) student participation.The fact that when doctors commit crimes of sexual assault they CANNOT be charged for a crime (very, very, very rarely a very few are charged) if they say THEY FELT it medically necessary.Before you TRY to say that I am wrong, let me offer this proof (and a few examples):Doctors requiring invasive pelvic exams to prescribe hormonal birth control when they are NOT required: pelvic exams on anesthetized women without consent: The ethics of conducting a pelvic exam on an anesthetized woman AND (this was still happening in 2012) Pelvic Exams While Under Anesthesia Sparks DebateDr. Stanley Bo-Shui Chung performed excessive and aggressive genital, breast, and rectal exams, some on children (minors):(...Dr. Chung conducted 18 breast and pelvic exams on her in just over two years...) Toronto doctor’s ‘aggressive’ exams unprofessional, but not sex abuse, committee rules(The now-retired physician is accused of conducting excessive and unneeded pelvic and breast exams on 19 of his former patients, including a developmentally delayed 15-year-old girl.) Dr. Stanley Bo-Shui Chung, testifying at disciplinary hearing, denies performing exams for sexual reasons | Toronto Star(“The entire process has been extraordinarily distressing to Dr. Chung and his family,” [Awwww, poor guy, wonder how his patients felt?] she wrote in an email. “He is relieved that the Committee dismissed the allegations of sexual misconduct.”) Toronto doctor guilty of professional misconduct | Toronto Star2014 - 02 - 27 Discipline Committee Decisions | 2014 | News Releases | What's New | College of Physicians and Surgeons of Ontario(One patient had 19 pelvic exams in the years following 2002. As many as 10 weren’t necessary, she said. The patient also had 22 breast exams, 17 of which weren’t necessary.) Intimate exams were medically unnecessary, expert testifies(And in another case, a young patient received 40 pelvic exams between the end of 2002 and 2010 — 22 of which Wintemute deemed not necessary.) That is a pelvic exam every 3 months for almost 10 years on a teenager!!! Intimate exams were medically unnecessary, expert testifiesPedophiles can molest children legally if they call it “healthcare." About william ayres AND Pediatrician Indicted: 103 Counts of Sex AbusePhysicians can legally sexually assault patients if they call it “healthcare.”Medical community reflects on 'disgusting and scandalous' episodes in the operating room(Unfortunately, the stories are quite credible...) Tales from the OR: Appalling? Criminal? And AnonymousShameful Operating Room Moments: Medical Journal On Calling Out ‘Dirtball’ DoctorsAnonymous essay exposes sexual abuse in the operating roomDoctors Behaving BadlyMedical students feel patients are “obligated to be teaching aids, so much so that they routinely do not ask permission and this had to be published: Medical Students’ and Physicians’ Attitudes toward Patients’ Consent to Participate in Clinical Training AND Ethics versus education: pelvic exams on anesthetized women. AND The ethics of intimate examinations—teaching tomorrow's doctorsMedical students and teachers feel patients are “obligated” to be teaching aids for students: Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clini... - PubMed - NCBIFinally, the fact that physicians, teachers, and students do NOT know that not only is consent legally required, patients expect that they be treated with dignity and asked: Teaching pelvic examinations under anaesthesia: what do women think?I can go on ad nausium, but I have made my point. There are hundreds of thousands more examples that I can point to. What it comes down to is that med school creates sociopathic behaviors. Read how here (this is a long, 5 part article that goes into some intense psychological analysis): How to Create a Sociopath: Part 1Thank you for reading.

Why are doctors performing pelvic exams on unconscious women without prior consent to further their training?

Thirty or so years ago 4 or 5 of my med school friends and I were walking down the hall (different hospital than where I now work) to grab a quick lunch when a urologist spotted us and told us to go to the OR. We put on gowns, surgical caps, masks and gloves. There was a man asleep on at the OR table, in the prone (bent at the waist, butt in the air) position, with everything exposed. The urologist explained that the man had “the most advanced prostate cancer you will ever feel- it’s hard as a rock!” then asked each of us to put a finger in his rectum to examine him. I was intensely uncomfortable because this seemed abusive, so I pretended to do the exam. This man was a war veteran and I had never met him, and I did not know if he gave consent for multiple students to do an exam. Assuming he did not give consent for multiple exams under anesthesia, It is still the worst case of informed consent abuse I have witnessed.I have always obtained verbal consent prior to performing an exam under anesthesia (EUA) regardless of whether I have a student with me. It’s an easy conversation, not unlike the dozens of other informed consent conversations I have with patients about other aspects of their care. Gynecologists perform EUAs for several reasons. When the patient is under anesthesia her muscles are relaxed and it’s easier to do an exam. This is especially true if she is overweight. If a rectal exam would by helpful (for example, if you are worried about rectovaginal endometriosis) it’s a much nicer experience for the patient to do this when she’s asleep. If the uterus is markedly retroverted it may change the angle that you insert uterine instruments. Or, if the uterus is at the umbilicus (belly button) you may need to insert laparoscopic instruments differently than normal. If the patient has cervical and sometimes ovarian cancer the EUA can help determine how far the cancer has spread. A brief EUA, which is done in the presence of the circulating nurse, surgical nurse, and anesthesiologist or CRNA, can be very helpful. In addition, we often have to insert a urinary catheter, or place instruments into the uterus to perform the surgery, which is also an “exam under anesthesia.”Learning how to feel the uterus, and especially the ovaries, which are the size of walnuts, is quite difficult and takes a lot of practice. The EUA is a perfect time to show a student (note that I said 1 student, not a line of them) how to perform an exam, so that she or he can do a gentle and useful exam when the patient is awake. I believe patients *should* understand what is going to happen when they are asleep and have the opportunity to agree or decline. IMO, despite what is written online, patients rarely decline student participation. When asked, patients report that they want to help students learn how to perform a gentle and useful exam. Sure, some patients say no, and they have every right to do so, but many women (and men) understand that student doctors will one day be practicing doctors and they need to learn in order to take care of us and our children (and for the record, I have never declined student participation in my care). There is no conspiracy here: the goal is to teach students and young doctors how to identify normal versus abnormal findings during a physical exam. Patients should have the right to agree or decline to participate.

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