March 12, 2003
PHILADELPHIA -- Some of the nation's leading medical schools have abandoned a little-known, decades-old practice of letting students perform pelvic exams on women without their consent while they are under anesthesia.
The schools are asking permission first.
Previously, these institutions had routinely brought in students -- sometimes as many as three or four -- to conduct pelvic exams on unconscious women just before their gynecological surgeries and often without their consent.
Changes in that practice have taken place over the past five years after complaints from students who felt the exams without consent were unethical.
"My problem was that if they found out about it, they might be really upset, and it was really only being done for my benefit," said Dr. Ari Silver-Isenstadt, who refused to examine anesthetized women as a student at the University of Pennsylvania.
"I felt like I would be violating their trust," he said.
Typically, the surgeon performing the operation conducts an exam to confirm the problem to be corrected by surgery.
Most medical students today learn the basics of the pelvic exam by practicing on paid volunteers but eventually need to move on to real patients.
Anesthetized women are the perfect subjects, doctors said, because they are relaxed and unable to feel the sometimes painful mistakes of novice examiners.
Consent is still far from a universal practice.
At the Washington University School of Medicine in St. Louis, patients are told that students will be part of their care team, but aren't specifically told the treatment could include a pelvic exam for educational purposes.
At the University of South Florida in Tampa, only medical students who are involved in the care of a specific patient perform exams for a medical reason.
"It's part of the care," USF spokesman Michael Hoad said. "We wouldn't go and randomly do exams on people. . . . We don't use patients to teach basic pelvic exams."
Patients at Tampa General Hospital sign consent forms indicating that USF students may examine them and students meet with patients when possible, he said.
"We absolutely understand the issue," Hoad said. "We feel the practices at USF fall within the guidelines."
Hoad also said the reason USF doesn't need to use patients as much as other schools is because it uses volunteers to teach basic pelvic exams.
Dr. Michael Gregory, a Boston public health physician who objected to the exams when he was a student at Tufts University School of Medicine, said that while studies show most women will give their consent, doctors are afraid to ask.
"It's this paternalistic, patronizing view that the doctors know best. . . . We underestimate people's incredible charity," he said. "But I think that at a gut level, doctors understand that if they actually told patients that this was happening without their consent, people would be outraged."
-- Staff writer Anita Kumar contributed to this report.