W A S H I N G T O N, June 10, 2003 -- Some teaching hospitals have failed to end the controversial practice of allowing medical students to perform pelvic exams on unconscious patients without permission, says a new study.
Some 90 percent of medical students performed pelvic exams during their clerkship, yet it's unclear what percent of patients actually consent to such exams, found the research, published in the May issue of American Journal of Obstetrics and Gynecology .
Dr. Ari Silver-Isenstadt, co-author of the study, says for years students have been performing pelvic exams on patients who have not officially given consent.
"I did the study based on my own experiences in medical school when I was asked to participate in some of these educational experiences and I felt very uncomfortable," Silver-Isenstadt told ABCNEWS' Good Morning America."I wanted to use that discomfort and look at it in a little bit more scholarly way to understand what was happening," he said.
While some of the nation's leading medical schools have abandoned the little-known, decades-old practice over time, in part because of years of complaints from medical students, there is still no law against it.
ABCNEWS' Dr. Timothy Johnson says he is familiar with the practice from the time he spent in medical school, but he assumed that it was a practice of the past. "I thought it was no longer being done in the modern age when we are more sensitive," Johnson said.
"I was appalled to find out it was still being done," added Dr. Johnson. "Clearly it is necessary as a learning experience, but it should never be done without the patient's consent and understanding."
The practice is coming under government scrutiny. Today, the Federal Trade Commission will address the issue of informed consent during a hearing in Washington.
Old School Practice Changing at Some Hospitals
Silver-Isenstadt says consent should be made mandatory for pelvic exams. He and Johnson agree many patients are happy to help when asked, and that students' education would not be compromised by seeking mandatory consent in hospitals nation-wide.
"I think the vast majority of patients would give consent if they know that it's being supervised carefully by their doctor," Johnson said.
Under current practice, Silver-Isenstadt says there is often no way for medical students to know for sure whether or not the patient has given the hospital permission for a pelvic exam.
"My problem was that if they found out about it, they might be really upset. The medical examination by the doctor is for the patient's benefit, but when it's done by the student it's only for the student's benefit," he said.
But student complaints have led to some changes in university hospitals without government intervention.
Objections to such exams by students at Harvard Medical School in the mid-1990s led to policy changes at the teaching hospital. Now women having surgery at the hospital are asked whether they agree to having a student performed a pelvic exam for training purposes, before an exam takes place.
Complaints by students at the University of California, San Francisco, School of Medicine, in the late 1990s also led to changes on patient consent forms.
The forms now specifically note that women undergoing gynecological surgery may be given a pelvic exam while they are under anesthesia.
Men Face Unsolicited Prostate Exams
Silver-Isenstadt says the study he co-authored indicates notification and consent are still not the universal practice.
As part of the study, students in Philadelphia-area hospitals were surveyed before and after they completed pelvic exams.
Before they completed their obstetrics and gynecology clerkship, 70 percent of them said it was important to ask women for consent before giving them a pelvic exam under anesthesia.
That number dropped to 51 percent among students who had completed their clerkship. Silver-Isenstadt says the numbers reveal the casual attitude that is sometimes present when it comes to patient privacy in teaching hospitals
Silver-Isenstadt says men undergoing prostate surgery are also in danger of being examined without their knowledge while under anesthesia.
Johnson suggests that patients undergoing gynecological surgeries talk to their doctor about who will be present during the operation before they go under.
Johnson says patients should ask if medical students will be present and if they will perform a pelvic examination. If the patient tells the doctor that they object to a student examination, the doctor will respect the patient's wishes, he said.