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Consent for Invasive Exams While Under Anesthesia?

Consent for Invasive Exams While Under Anesthesia?

There was an interesting article in the New York Times called "She Didn't Want a Pelvic Exam. She Received One Anyway." The article was written by Emma Goldberg and published on February 17, 2020. It was about a nurse who checked into a hospital for abdominal surgery. She informed the surgeon and hospital that she did not consent to having medical students directly involved in her care. After she woke up from anesthesia, she was told by a medical resident that she had gotten her period, which was discovered by him, while he was performing a pelvic exam. The surgeon said they saw she was due for a pap smear, so they did that as well. This was very surprising to the patient because she had not consented to have a pelvic exam or a pap smear that day. The pelvic exam was not related to the surgery. The patient had a prior history of sexual assault and abuse, and consequently felt violated by the procedure and by the lack of an informed consent for it.

The article stated that in many US states and medical institutions, physicians are not required to obtain explicit consent for performing pelvic exams on patients under anesthesia, as the exams are sometimes done solely for the educational benefit of medical trainees.

Last year, 11 states passed laws banning medical professionals performing unauthorized pelvic exams. Other states, including Delaware, Maryland, New York, and Utah, passed laws mandating informed consent, joining six states with regulations already on the books. Some medical institutions also have their own policies in place regarding the performance of pelvic exams on patients under anesthesia.

Back in 2003, Dr Silver-Isenstadt coauthored a study titled "Don't Ask, Don't Tell," published in the American Journal of Obstetrics and Gynecology. He surveyed 401 students at five Pennsylvania medical schools and found that 90 percent had performed pelvic exams on anesthetized patients. Completing a gynecological clerkship, he found, was associated with a reduced appreciation of the importance of consent for the procedure. After that article was published, a number of states passed laws banning unauthorized pelvic exams, some citing his paper: California in 2003, Illinois in 2004, Virginia in 2007, Oregon in 2011, Hawaii in 2012, and Iowa in 2017.

All health care providers need practice and experience to learn how to perform different types of exams and procedures. However, this should always be done with fully informed patient consent. Many medical institutions have gynecologic teaching associates who allow students to practice pelvic exams on them as they offer guidance. This should be the standard of care and practice for all students to learn how to do pelvic exams. We should never do something to a patient under anesthesia that they have not consented to. Respecting a patient's rights and fully informed consent should be our highest priority as health care providers.

References
  • Goldberg E. She didn't want a pelvic exam. She received one anyway. www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html. Accessed March 3, 2020.
  • Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: A change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. American Journal of Obstetrics & Gynecology. 2003;188:575-579.

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Filed under: Health Policy and Trends, Miscellaneous

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