Medical students are performing intrusive exams on unconscious patients

Posted by Kendall Harmon

Australian medical students are carrying out intrusive procedures on unconscious and anaesthetised patients without gaining the patient's consent.

The unauthorised examinations include genital, rectal and breast exams, and raise serious questions about the ethics of up-and-coming doctors, Madison reports.

The research, soon to be published in international medical journal, Medical Education, describes - among others - a student with "no qualms" about performing an anal examination on a female patient because she didn't think the woman's consent was relevant.

Read it all.

Filed under: * Culture-WatchHealth & Medicine* International News & CommentaryAustralia / NZ

30 Comments
Posted January 31, 2011 at 11:20 am [Printer Friendly] [Print w/ comments]



1. Ralph wrote:

Not likely going on in Charleston, or the other US medical schools. At least, not in the last several years.

January 31, 5:23 pm | [comment link]
2. Clueless wrote:

Agreed.  Litigation would make such behavior rare in the US.  Certainly I have never heard of students lining up in the OR in this fashion whatever the ethics of the matter. 

On the downside, this is the reason why US medical students are often lacking in certain clinical examination skills compared to physicians in other parts of the world.  Identifying a prostate nodule does require that one have felt a few normal and abnormal prostates previously.  Same with identifying rectal or gynecological cancers.  The alternative is to do a rather more expensive test or to simply accept the fact that stuff will be missed due to lack of experience.

Basically this is another form of NIMBY.  (NIMBside?).  The only reason anybody picks up a prostate nodule is that the physician in question was permitted to feel one in somebody else before he knew what prostate nodules felt like.

A solution might be to offer price breaks for patients who volunteer to be “guinea pigs” or to wave malpractice claims.  Right now that is illegal however, so it is not an option.  And since Australia has governmental insurance (I think) it wouldn’t work there anyway.

January 31, 6:48 pm | [comment link]
3. Sick & Tired of Nuance wrote:

#2

Here is another solution…let medical students practice their art of prostate nodule location on each other in the absence of a patient giving informed consent.  Each medical class has dozens of folks right there that can act as a pool of volunteers.  When people go through training to give shots, administer IVs, and take blood, they practice on their fellow students.  I think that doctors would gain a certain appreciation of the sensibilities of their patients if they all had to experience the same treatment they are going to perform on their patients (within reason and as possible to do safely) at the hands of a fellow medical student.

The following is not directed at previous posters on this thread:

Informed consent is POINT #1 of the Nuremberg Code…that code of medical ethics developed after the Nazis claimed their medical experiments were legal during war crimes trials. 

It is that simple.  There is no gray area here or questions about the ethics of doing this.  It is wrong.  It is a violation of a person’s autonomy to do this!  It is an outrage.  In the US and many other countries, it is a criminal act to do this.

If the “student with “no qualms” about performing an anal examination on a female patient because she didn’t think the woman’s consent was relevant” did this in the United States, she would be facing sexual assault charges…most likely 1st degree Sodomy charges, which are a felony.  Sexual assault isn’t about sex, it’s about power and this is a criminal abuse of power over another human being that is in a helpless state.

OUTRAGEOUS!!!

They might as well work for the TSA!

February 1, 12:08 am | [comment link]
4. Clueless wrote:

I believe in informed consent.

In addition, in my medical school we did as a matter of fact do vaginal and pelvics on each other. We also drew blood, placed IVs, and in fellowship did EMG/NCS on each other.

This does not change the fact that it takes several hundred normal and abnormal palpations to get a feel for pathology.  That is why residency is 3 years.  Most of the experience is obtained in residency.  There is not much that can be done in medical school.

And in the US we do have informed consent.  All medical students are instructed to introduce themselves as “Bill Jones a 3rd year medical student”.  They wear short white coats to differentiate them from the physicians who wear long white coats. 

However getting practice is a problem.  Anybody who does not wish to be “practiced on” is enjoying the fruits of those who were “practised on” while being to selfish to pay it forward.

Those folks, seems to me, should be paying more.

February 1, 10:20 am | [comment link]
5. Clueless wrote:

Palpating 100 twenty year old prostates will not allow you to differentiate a normal somewhat irregular 50 year old prostate from an nodular 50 year old prostate.  Age (and pathology) matters.  Fifty year old breasts are different from 20 year old breasts.  A somewhat atrophic and fibrous breast is different from a breast with fibrocystic disease.  It takes hundreds of examinations to make a physician.  About 10,000 hours.  And those 10,000 hours needs to be spent on sick people of varying ages.  Not healthy 20 year olds.

This is not a new problem.  Competance takes practice and experience, however patients feel that they are entitled to competance without permitting practice or experience.

I’m entitled.  You owe me.  And legislators and courts agree.

Back in the 15th century there were two types of physicians.  The quacks who simply went around with an air of authority making pronouncements, and charging high fees.  Then there were the folks who really wanted to understand the disease and examined patients who were comatose (they weren’t allowed to touch women, or for that matter most men so the only time they could examine patients was essentially in secret).  Doctors dug bodies up from graveyards in order to figure out how the bones were put together so they could figure out how better to set fractures or dislocations.

It was all illegal.  If they were caught they would have been hung.

It was all unethical.  (Obviously).

It was all necessary if you actually wanted medicine rather than opinion. 

We stand on the shoulders of those unethical physicians who brought us anatomy and pathology and physiology against the wills and without the knowledge or consent of their patients.

Again, I would say that the solution should be the free market.  Let those who wish to be NIMBsiders pay more.

February 1, 10:43 am | [comment link]
6. Sick & Tired of Nuance wrote:

I have never said “no” when asked if a medical student, doctor or nurse, be allowed to participate…not once.

If I found out that a medical student (or a doctor for that matter)  did something to me without my knowledge or consent, they had better hope that I calm down enough to call the authorities rather than settle the matter myself.

I’ll say it again…this is a CRIME if done without informed consent.  As for the comments about “standing on the shoulders of those unethical physicians”...we also stand on the shoulders of people that gave Native Americans smallpox infected blankets, enslaved others, etc.  That isn’t anything to be proud of.  In the past, many things were done that were wrong.  Appealing to wrongful acts of the past to justify illegal, immoral, and unethical practices today isn’t particularly compelling. 

I agree that physicians need to practice their art, and that is why I have never refused a medical student access.  But it isn’t a right of medical students (or doctors for that matter) to practice without obtaining informed consent.  The ends do not justify the means.

I would like to share an anecdote about this subject.  About 2 years ago, I had to have a liver biopsy.  I was asked if a nursing student could participate and I agreed.  The doctor came in and began the procedure.  I was a little frightened and there was some pain involved…mostly a dull ache, but punctuated by sharp periods too.  The doctor was terrific and explained things as he went along.  He administered additional anesthetic as he proceded, etc.  There were the doctor, 2 nurses, and the student nurse present.  The student nurse was just observing, but she did something that meant a great deal to me.  Throughout the entire procedure, she held my hand.  That’s it.  In addition to watching what was going on very closely, she simply held my hand.  I cannot explain how much that small kindness provided me with such comfort, but I will never forget it.  I was and am so very grateful for it.  It most likely seems like a mere trifle, a nothing…yet it made all the difference.

I don’t want to come across as an enemy of the healing arts, but I think the hubris of practicing without informed consent is a real danger.  First do no harm.

February 1, 11:13 am | [comment link]
7. Clueless wrote:

“I agree that physicians need to practice their art, and that is why I have never refused a medical student access.  But it isn’t a right of medical students (or doctors for that matter) to practice without obtaining informed consent.  The ends do not justify the means.”

No arguments here.  Informed consent is not just the right thing to do, it is the law.  However most people (while they are willing to have students observe) are not willing to have multiple prostate examinations.  Or have a painful knee palpated by more than one (the senior) physician. 

There is an upper limit to what can be learned by just watching.  A determination of knee stability, crepitance, all this requires palpation and (usually painful) movement of the extremity.  That does not happen in the US (at least not at the medical student or intern level, it does happen at the resident level).

But then you are talking about extending medical education (which is extended in the US.  That’s why US medical students graduate 150,000 in debt, with a great deal of book knowledge, and having “watched a lot”, and listened to a lot of tapes but having fewer physical examination skills than an Australian physician where it is expected that patient’s in the government hospital will be examined multiple times.  They will then do a residency where they will catch up with most countries in physical diagnostic skills, but since they will defer their debt and work 80 hour weeks (used to be 100 hour) they will emerge needing higher salaries to service their debt, after having spent far longer in training than physicians in other parts of the world.

I recall when I was in residency in the US, a particularly promising neurosurgeon was sent to Australia to be a restrar (basically a higher level resident) so he could get the experience he needed to be an attending in neurosurgery at the hospital.  (Litigation meant he couldn’t get really good in the US because of course he wouldn’t be allowed to practice the tricky bits of neurosurgery).

Unfortunately, every neurosurgeon has to practice.  Most get their most practice once they get into practice.

I recall that the really serious US neurologists used to make a pilgrimage to Queen’s Square in London to learn physical diagnostic skills.  This was not just because there were some really able teachers there, but because they were allowed to “line up and practice” which they could not in the entitled states of america.

February 1, 11:37 am | [comment link]
8. Clueless wrote:

This is all part of the old “patient empowerment” movement.  It is sort of like the “student empowerment” movement that took place in the late 60s-80s.  First there were strict, old fashioned schools in the inner city where there were 60 kids in a class, no such thing as ADD, and everybody could read and write, with a paddle to keep order.  Then there was no paddle and only 40 kids, and some general mouthyness. Then there was no paddle, only 30 kids, a school psychologist to help students understand their feelings and ADD was beginning.  And now there are only 25 students in a class, the ADD kids now are Bipolar and have conduct disorder, and their IEPs make clear that they cannot possibly learn, and it is unfair to expect them to do so, and it all costs 100 times what it did before, and nobody can read and right.

But the students are “empowered” and their “rights are respected” so it’s all good, isn’t it? 

In the late 60’s, medical school cost 2 thousand a year, residents worked 100 hours a week, and there was essentially no litigation.  Doctors respected their patients, and patients respected their physicians. Most physicians volunteers their services, and health care was cheap.  Now patients are “empowered”.  That means that everything needs to be documented (taking about 30% of time and money), only the most senior physicians on a case do anything painful, or sensitive.  Medical school costs 40,000/year, and most kids graduate 150-300,000 in debt with worse skills.  In private practice, most physicians work 80-100 hours a week and have little time to volunteer. 

Last week, a little boy died at one of our local elementary schools.  The soccar goal fell on him and he had a subdural hematoma.  He was taken to the nearest hospital but they had no neurosurgeon.  There is a huge neurosurgery shortage, and the 15 odd neurosurgeons who used to practice in this area have dwindled to 2, none of whom do pediatrics or brain cases (just necks and backs).  By the time they aerovaced him to a larger city, he was dead. 

There used to be 20 neurologists including 4 pediatric neurologists in this area.  There are now only 8, and nobody sees kids.  In the meantime the price of health insurance has put health care out of the reach of a large segment of the population. 

But at least the population is “empowered”.  So it’s all good.

February 1, 12:08 pm | [comment link]
9. Country Doc wrote:

Well, in my day we saw and did so much in med school ane really learned.  Now that has all been telescoped out to four more years.  I am so grateful for all the patients we learned on.  They were “charity” patients and paid little or nothing.  We always had informed consent and approval, but they knew they were in a teaching hospital.  Now everyone like that has medicare/medicaid and are ‘entitled’  Just wait with Obamacare when all your medical records are mandated to be entered on the internet and sent to multible federal agencies.  Of course they will be secure.  Just look at wikileaks—-they can’t even keep top secret documents off the internet!  Of course ehtics is now a dead issue.  Everything is detemined by the corrupt legal/judical group.  How you like that change?

February 2, 12:36 am | [comment link]
10. Sick & Tired of Nuance wrote:

If you want to be angry, be angry at the doctors that conducted syphilis “studies” on the Tuskegee airmen…or sterilized poor people in Appalachia, etc.  Being angry at people because people are frightened that doctors might do them harm without telling them what is going on, and because that fear spills over into legitimate situations where the doctor (or student) is merely wanting to practice his art isn’t very productive.

I think it would serve your purposes far better to be just as angry at the doctors that have done unethical things…in short, taking the side of the “empowered” population and thus earning their trust.  It is much easier to educate people that aren’t frightened of you or what you might do to them.  I have a very good relationship with my doctor.  He is the best doctor I have ever had (that I am aware of).  I’m not afraid that he is “experimenting” on me.  He has earned my trust and confidence.  If he told me at my next visit that he wanted to “try something”, I would feel very confident that he wouldn’t deliberately do anything that would harm me. 

Recently, he had a new PA in the office.  They had to do some blood work on me and she wanted to take the blood.  Many pokes later, she got my vein.  I didn’t complain or get mad or anything like that, because I knew that she was doing her best and she was really trying to do it right.  I even complimented her when she finally got my vein.  I had a massive bruise at the sight for days because she had poked right through to the other side of the vein.  But that’s ok.  I don’t expect perfection.

February 2, 1:13 am | [comment link]
11. Clueless wrote:

Those abuses were over 50 years ago.  In the days when we had Jim Crow, before Civil Rights.  What was the rest of the United States like, back then?

The people to be angry at are the Boomers (and the Silver Fox generation, just ahead of them).  They inherited a GREAT and fairly inexpensive school system, but their narcicissm meant that they felt “entitled” to be stroked and pampered while in school.  So the system they left in their wake for the generations that followed them was trashed.

Same with Medicine.  The Boomers and Silver Foxes inherited a great and fairly inexpensive Health Care system.  Thanks to their sense of entitlement it has not only soared in price, but thanks to their unwillingness to put up with the discomforts that their predecessors EXPECTED, the knowledge base is not/will not be there for the generations that follow.  When the current generation of physicians who are now over the age of 50 (myself included) retire the remaining neurosurgeons will do only necks and backs (all heads go to seniors only), while family physicians will be unable to pick up prostate nodues or other simple tasks.  The knowledge base will be lost.  It will begin with the poor and the young (medicaid) but it will extend to the rest.

That kid who died last week, died because of the Boomer sense of entitlement.  Neurosurgeons used to be common in small cities. 

And BTW, EVERYBODY puts up with a few sticks now and then.  That’s not what we are talking about.  We are talking about actual, SERIOUS discomfort, and painful, DANGEROUS, procedures like our parents had to deal with that we are too soft, flabby and self important to think we should have to put up with.  The fact that you think that your doing your part by letting yourself get stuck a couple of times and allowing folks to watch a liver biopsy just makes CLEAR your sense of entitlement.  I did my first liver biopsy in medical school (and yes I got informed consent.  The patient knew I was a student.  He also knew he was in a teaching hospital and that the attending would be holding my hand).  Now, not only do medical students not do liver biopsies, but neither do interns, residents or “regular physicians”.  They are the province of not just gastroenterology specialists but subspecialists in hepatology.  And how many do you think there are of those?  Not too many, and all of them are over 40.

However yours is a generational sense of entitlement.  I do not blame you.  You are no better than your generation, whose narcicism has ruined the United States for her children.

February 2, 10:23 am | [comment link]
12. Clueless wrote:

When I was a medical student we did everything (under supervision and with the knowledge of the patients).  In a 3 month internal medicine rotation I did 4 lumbar punctures, 2-3 thoracenteses and paracenteses, a bone marrow, multiple IV sticks, foleys, blood draws.  In the three month surgery rotation we were 1st or 2nd assistant on every case, sewing up afterwards.  That was multiple biopsies, chest tubes, appendectomies etc.

Then in residency and fellowship one does more and more of the case, so that by one’s last year in a surgical residency one is doing it all and very, very competantly.

That is how one used to make physicians and surgeons.

You want to know what medical students do now?  They WATCH.  Oh and sometimes the patients even let them HOLD THEIR HANDS!  Most student don’t do ANY procedures any more.

And guess how much the interns do.  Not much more.  There are iv teams and blood gas teams and foley teams to make sure that no patient ever gets stuck by a beginner.  CANT HAVE THAT.  Residents get to do a little more but even residents don’t do surgeries from start to finish any more, litigation and regulation does not permit this.  They mostly practice when they get out of residency (where there is no supervision).  And because there is no supervision, they usually confine themselves to the easier procedures.

Ergo, no kids, no head cases, and no neurosurgeon for the fourth grader who got hit on the head by the soccar goal tipping over on him.

But think how “empowered” he was.

February 2, 10:38 am | [comment link]
13. Sick & Tired of Nuance wrote:

#11

You know what?  You don’t know what you are talking about. 

First, YOU are the one that has a “sense of entitlement”.  You think that doctors are some sort of elite super demi-gods that should have the power to inflict pain and suffering on other people to satisfy their career ambitions and curiosity.

Second, I am not a “boomer”.  To give you an idea of my age, I’ll tell you that I joined the military in 1984 and went to basic training in 1985.  You, on the other hand, at age 50 ARE a boomer, so your indictment is against yourself.

Third, I was serving in the US military in 1990 when the FDA granted the DoD a FREAKING WAVER of the Nuremburg Code and let the US Army use unapproved drugs on us…experimenting on us.  Have you ever heard of Gulf War Syndrome?  Oh, I know, don’t bother…“it’s all in your head soldier”. Yeah, right.  That Anthrax vaccine, approved by the FDA without any large scale clinical trials and that was demonstrably highly reactogenic, and that they FORCED on us didn’t mean anything!  And the pyridostigmine bromide(PB) pills didn’t do anything to us either. Yeah, keep talking “doctor”...your lips are moving but the words ain’t gettin’ through!

I almost forgot…they also took DNA samples from us.  They said it was so they could identify us if our bodies were beyond recognition.  I asked how long they were going to keep the samples.  They said they would keep them until we turned 60…regardless of whether we stayed in the military or not.  Hmmmm…I wonder why they would need to identify my body if I’ve been out of the military for 10 or 20 years?  I wonder what they are doing with our DNA all that time.  I’ve been out of the military for 9 years now and they still have my DNA.  Ten years from now, they will still have my DNA.  I wonder, why they are keeping all those tens of thousands of DNA samples of people that no longer work for them…are no longer in danger of having to have their bodies DNA identified.

I’d say more, but I am pretty angry right now with your sense of entitlement and if I continue, I will say something profane and regret it later.  One last thing…I pity your patients if you demonstrate that sort of contempt against them in your practice.  You need a serious attitude check.

February 2, 11:13 am | [comment link]
14. Clueless wrote:

I’m a boomer.  No question. My generation fk’d up.  However I was the last neurologist seeing kids in my area and got to explain why the kid needed to go 300 miles away for care instead of getting it in town.  I worked over 100 hours a week trying to take care of sick kids, for more than 20 years until I couldn’t do it any more.  Now I have moved to a setting where I can’t see kids and my hours are less than 60/week.  I do see kids in the free clinic where I volunteer weekly but I’m not a pediatric neurologist, let alone “the only pediatric neurologist” any more.

But it still bothers me when kids die.  That child would not have died 30 years ago, when every ER doc, hospitalist, neurologist or for that matter medical resident could put in burr holes.  Now only neurosurgeons can, and their ranks have thinned dramatically.

As to Gulf War syndrome, time will tell, as it did with Agent Orange. Some parts of the syndrome are likely real, others less so.  The waiver, if you remember was to keep soldiers from dying of chemical warfare.  In war, as in medicine, there are trade offs.  There are no Magic “approved” drugs that prevent death from chemical warfare.  As you noted, it is considered “unethical’ to test drugs on human subjects for chemical warfare.  Nor is it something that you can get volunteers for.  The drug in question (pyridostigmine) was effective in animal studies in chemical warfare, and since pyridostigmine has been used in the treatment of myasthenia gravis in both children and adults since World War II, we are talking about a drug whose safety profile is well understood, that is simply being used for a different purpose than what it was originally designed for.  It is not uncommon to use drugs for purposes that they were not originally designed for “off label”.  Propranolol is a blood pressure medication that is used for migraines. 

A command decision was made that the risk of chemical warfare was greater than the risk of the drug.  (By the way the fact that Saddam Hussain did not/?could not use chemical warfare did not change the fact that he had done so in the past against the kurds, and it was felt that he would do so in the present).  However the Pentagon does not have any better a crystal ball than does the medical profession.  One does the best one can.  That was understood by the patients of 20 years ago.  However it has never been good enough for the patient’s of today.

Again, your sense of entitlement just shines through.

February 2, 12:22 pm | [comment link]
15. Sick & Tired of Nuance wrote:

Again, your sense of entitlement just shines through.

So, you interpret a demand for informed consent as a “sense of entitlement”?  Really?  You interpret a sense of outrage at violations of the Nuremburg Code as a “sense of entitlement”?

Fascinating and a little scary…

February 2, 12:41 pm | [comment link]
16. Clueless wrote:

Read my posts.  We ALWAYS got informed consent when doing our various procedures as a student.  Back 30 years ago, patient understood that students would do the procedures.  Now the patient expects the attending to do the procedure and will not permit the student to do the procedure (and often won’t let the resident do the procedure either).  This is why the rising generation can’t do procedures any more and why that child died.

If you are talking about informed consent in the Military, well, in TIMES OF WAR, informed consent bows to military needs.  That has been true of EVERY war.  Every war has produced an enormous new panolpy of medical advances (amputations, anesthesia, penicillin) for precisely the reason that when you are dealing with large numbers of wounded soldiers you CANT GET INFORMED CONSENT. That is why IN TIMES OF WAR, military physicians operate under different rules.  It has always been thus.  Once the situation has been stabilized, informed consent is required again and even in military/va hospitals INFORMED consent when IT IS NOT AN EMERGENCY, rules.

I can’t believe they didn’t explain this too you in boot camp.  The military has different rules.  I was in the military during the Gulf war also.  They sure explained it to me.

February 2, 12:50 pm | [comment link]
17. Clueless wrote:

” violations of the Nuremburg Code “

Oh. And giving pyridostigmine, a drug that is in common clinical use in all ages, in order to prevent death from chemical warfare is not a violation of the Nuremburg Code.  It DOES require a waiver from the FDA, and during times of peace it would require informed consent.  In TIMES OF WAR, the military can make her soldiers do MUCH MORE DANGEROUS things than simply take a medicine that is in common clinical use for a different disease.

February 2, 12:56 pm | [comment link]
18. Sick & Tired of Nuance wrote:

BTW, I guess the irony of your denigrating my examples of violations of informed consent from 50 years ago, while you appealed to the relevance of 15th century medical practices, is lost on you.

Also, you do realize that everybody dies eventually, right?  The power of life and death is in the hands of God.  I’m sorry that the little boy died…very sorry for his family…but you do understand that a neurologist would only have postponed his death, right?  Or are you further gone than I thought?  I had always thought that a physicians role was to do no harm, ease suffering, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

February 2, 12:57 pm | [comment link]
19. Clueless wrote:

Again, one notices the hysterical air.  Granted one should have informed consent, and in the US one does.

But look at the way it is presented:

A rectal examination is “sexual penetration” and “rape”  !!!!

Use of a medication commonly used for another disease and effective in animal studies to prevent death from chemical exposure is a “violation of the Nurenburg code”  !!!.

Lets all run around screeching in horror like a bunch of 11 year old girls, looking at vomit.

Well, that is why nobody learns procedures now, and why informed consent is required (and frankly has always been required since about WWII).

It is also why that little boy died last week, and why many more will die in the future, especially once the over 50 physicians retire.

Fascinating indeed.

February 2, 1:02 pm | [comment link]
20. Sick & Tired of Nuance wrote:

A rectal examination, WITHOUT INFORMED CONSENT is “sexual penetration” and “rape”.

February 2, 1:09 pm | [comment link]
21. Clueless wrote:

Also, you do realize that everybody dies eventually, right?  The power of life and death is in the hands of God.  I’m sorry that the little boy died…very sorry for his family…but you do understand that a neurologist would only have postponed his death, right?  “

Yes.  That is our job BTW.  To “postpone death” for as long as is reasonably possible. 

Do you really believe it is better that little kids die of entirely preventable injuries so that their elders can feel valued “I’m not letting anybody practice on ME”. 

Or is self esteem more important than lives.  (In my prior example of Education, self esteem appears to be more important than an education. 

Me thinks the boy’s family would have a different opinion on the subject.

February 2, 1:09 pm | [comment link]
22. Clueless wrote:

“A rectal examination, WITHOUT INFORMED CONSENT is “sexual penetration” and “rape”.

Indeed.  And we therefore get informed consent, however since this generation does not believe in being “practiced on” by beginners, your attitude is the reason why your children will die early of prostate cancer (assuming they don’t die early of hitting their heads).  Maybe you can explain to your children that they will be dying rather sooner than you will in order to keep you from being “raped”.  I’m sure that that will make them feel a whole lot better about it all.

February 2, 1:12 pm | [comment link]
23. Sick & Tired of Nuance wrote:

Do you really believe it is better that little kids die of entirely preventable injuries so that their elders can feel valued “I’m not letting anybody practice on ME”. 


No, I do not.  As I stated, I have never denied a medical student access…ever.  You seem to be missing the point.  The folks in Australia ARE doing these things without informed consent and THAT is what I am opposing.

February 2, 1:14 pm | [comment link]
24. Sick & Tired of Nuance wrote:

The article isn’t about U.S. practices, it is about Australians and their NOT GETTING INFORMED CONSENT…which is a violation of the Nuremburg Code and is unethical!

They are violating ethics that you say you believe in…yet you seem to be defending them.  You say you believe in the concept of informed consent, yet when someone is outraged by those not getting informed consent, you attack them as being impediments to the legitimate practice of medicine.

Do you or don’t you believe in the sanctity of human beings?  Do you believe that getting informed consent is a crucial ethical requirement or don’t you?  If your answer is yes, then you should be angry at medical students and doctors in Australia violating that ethic and bringing disgrace upon your profession.  You should be more outraged than I am.  Again, I am talking about what the article is talking about and that is Australians violating the ethic (and the Nuremburg Code) of informed consent.

February 2, 1:20 pm | [comment link]
25. Clueless wrote:

“Do you or don’t you believe in the sanctity of human beings? “

I do.  (Beginning with the sanctity of LIFE - especially young life).

” Do you believe that getting informed consent is a crucial ethical requirement or don’t you?  “

Yes, but not in times of war.

“If your answer is yes, then you should be angry at medical students and doctors in Australia violating that ethic and bringing disgrace upon your profession.  “

I am more angry that the situation has deteriorated to a point where the next generation cannot be trained in critical skills without physicians resorting to unethical practices, and that the situation cannot be discussed without hysterical outbursts about “rape” from adults who should know better.

It is not Australian medical students who are “raping” their patients, but our generation who is RAPING our children.  Previous generations understood that they benefited from having physicians who practiced on their forbears and expected to “PAY IT FORWARD”.  The current generation has taken the knowledge of previous generations and REFUSES to pay it forward.  The solution would be to insist that anybody who wishes to be excused from having procedures performed on them by trainees, under the supervision of a competant physician PAY EXTRA for the privilege.

February 2, 1:36 pm | [comment link]
26. Sick & Tired of Nuance wrote:

“A rectal examination, WITHOUT INFORMED CONSENT is “sexual penetration” and “rape”.

Indeed.  And we therefore get informed consent…

So now you are back tracking on your own agreement that performing a rectal exam without informed consent is rape?

Talking with you is like trying to put a nail in jello.  The article is about Australian doctors and medical students violating the ethic of getting informed consent.

Previous generations understood that they benefited from having physicians who practiced on their forbears and expected to “PAY IT FORWARD”.  The current generation has taken the knowledge of previous generations and REFUSES to pay it forward.  The solution would be to insist that anybody who wishes to be excused from having procedures performed on them by trainees, under the supervision of a competant physician PAY EXTRA for the privilege.

Hey, we agree!  That’s amazing.  Now, if we can just get together and jointly condemn the unethical violations by doctors and medical students in Australia performing intrusive medical examinations on helpless patients without first getting informed consent…we could walk together in harmony.

February 2, 1:49 pm | [comment link]
27. Clueless wrote:

“So now you are back tracking on your own agreement that performing a rectal exam without informed consent is rape?”

Did I agree it was “rape”.  I don’t think it is “rape”.  I acknowledged many people DO think it is “rape” though I am not one of them.  I call it a medical procedure that should not have been performed in that fashion.  It should have been performed with the patient awake and alert.  The solution (which worked for generations before this one) is to simply have the hospital general consent INCLUDE all usual procedures including rectal examinations by students and other trainees.  Those who refuse can PAY EXTRA.  That is the way it was done before, and it meant that the student, (like myself) would see the patient after the resident, and intern and would do his/her own physical examination and say “and now Sir, I need to do a rectal examination”.  The difference is that since patients now automatically refuse all exams other than that done by the senior physicians, the Australian teaching hospitals have apparently started doing student procedures without consent, rather than confronting the problem of inappropriate patient expectations.  And yes, that was wrong.  The solution HOWEVER, is not to get a special “informed consent” , nor to do procedures in secret that one knows patients would refuse, but to simply insist that patients LIVE UP TO THE RESPONSIBILITIES OF PREVIOUS GENERATIONS by NOT refusing consent.  Those who don’t like it, should PAY MORE.

February 2, 2:56 pm | [comment link]
28. Sick & Tired of Nuance wrote:

Overview of Sexual Assault(Emphasis added.)

In most jurisdictions, the term sexual assault has replaced the term rape in the state statutes. This was done to be more gender-neutral and to cover more specific types of sexual victimization and various levels of coercion. For example, some state codes define Sexual Assault in the First Degree or Aggravated Sexual Assault as physically or psychologically forced vaginal, anal or oral penetration - which has typically been thought of as rape.

Sexual Abuse, Sexual Misconduct, Sodomy, Lascivious Acts, Indecent Contact, and Indecent Exposure are all examples of possible sexual assault charges. Basically, almost any sexual behavior a person has not consented to that causes that person to feel uncomfortable, frightened or intimidated is included in the sexual assault category.

The law generally assumes that a person does not consent to sexual conduct if he or she is forced, threatened or is unconscious, drugged, a minor, developmentally disabled, chronically mentally ill, or believe they are undergoing a medical procedure. Some examples of sexual assault include:

Someone putting their finger, tongue, mouth, penis or an object in or on your vagina, penis or anus when you don’t want them to;
Someone touching, fondling, kissing or making any unwanted contact with your body;
Someone forcing you to perform oral sex or forcing you to receive oral sex;
Someone forcing you to masturbate, forcing you to masturbate them, or fondling and touching you;
Someone forcing you to look at sexually explicit material or forcing you to pose for sexually explicit pictures; and
A doctor, nurse, or other health care professional giving you an unnecessary internal examination or touching your sexual organs in an unprofessional, unwarranted and inappropriate manner.(Like not getting INFORMED CONSENT!!!)

Source: http://www.ncvc.org/ncvc/main.aspx?dbName=DocumentViewer&DocumentID=32369#1

Ok, I used the word “rape” and I should have used the words “sexual assault”.

...a student with “no qualms” about performing an anal examination on a female patient because she didn’t think the woman’s consent was relevant.

I don’t think it is “hysterical” to alledge sexual assault occurred under the circumstances described.

Definition of a Sexual Assault (Emphasis added.)

————————————————————————————————————————
Sexual assault and rape are crimes of violence and control, using sex acts as a weapon. Rape and sexual assault are not sexually motivated acts; rather, they stem from aggression, rage, sexism, and the determination to exercise power over someone else. Rape is also a legal term that is defined in Massachusetts by three elements: penetration of any orifice by any object; force or threat of force; against the will of the victim. Sexual assault is often more broadly defined as any sexual activity that is forced or coerced or unwanted.

Source: http://www.mass.gov/?pageID=eopsterminal&L=5&L0=Home&L1=Crime+Prevention+&+Personal+Safety&L2=Personal+Safety&L3=Sexual+and+Domestic+Violence&L4=Overview+of+Sexual+&+Domestic+Violence&sid=Eeops&b=terminalcontent&f=programs_fjj_SexualtAssaultDefinition&csid=Eeops

Then again, depending on the jurisdiction, “rape” might well be the right word to use.

February 2, 4:30 pm | [comment link]
29. Clueless wrote:

Again, this is the United States who both, does not engage in rectal examinations on unconcious patients, and has the above legal definitions on rape.  Those legal definitions are rather different in other nations.

Because of those legal definitions, the United States has managed to lose clinical skills in a generation of physicians. 

Because of those legal definitions, a child died last week, and the folks who came up with those definitions and those, such as yourself, who wave them about hysterically, do not even realize that they are DIRECTLY CULPABLE FOR HIS DEATH.  For it is exactly this sort of hysterical sea-lawyering that has led to the loss of clinical skills in a generation of US physicians.  Similarly it was the trash talking about paddling being “child abuse” and drills being “drill and kill” etc. that have made the inner city schools the drug filled warehouses of the ignorant that they now are.  They used to be havens, not hellholes.  I was there. I remember what the city schools of Washington DC used to be like before ADHD was invented. 

For you this is simply an argument to be won.  A cheap debate where we all score points.  But for me, talk is NOT cheap.  It is extremely expensive.  Your sort of trash talking about “rape” and “nurenberg” is the reason that medicine is so expensive, takes so long, and produces so little at the end.  This sort of self centered, “it’s all about me and how I feel”, “it was unwelcome, therefore it was abusive”.  “I feel bad and so it must have been evil” ...I…I…I…I… This sort of talk, (which has gone on since the late 60’s) has cost untold numbers of lives.  Just as the talk in education circles that have destroyed our schools have ruined untold numbers of lives. 

In emergencies, physicians perform far more intrusive examinations on unconcious patients.  I recall performing such an examination in a patient who was comatose and found that the reason for her unexplained fever was toxic shock from an infected tampon.  That was not rape, even though no informed consent was obtained.  We did make some effort to locate family to get consent for treatment, but were not able to do so immediately, so we appropriately, and legally went ahead with all examinations and treatments anyway.

Intention is key in determining if something is rape or not.  When I examined that patient my intension was to find out what was wrong with her, before she died of it.  In a similar fashion, intent is the reason your being forced to take pyridostigmine in the hopes that it would save your life, is the reason that that coercion was NOT a violation of the Nurenberg code.  The fact that you did not like taking medications, and felt frightened, does not change the fact that the intent of the command was to save lives.

If the intent is to save life or to be of direct benefit to an unconcious patient unable to give consent, it is not rape.  I can assure you that I have never met anybody in the medical profession who takes sexual gratification from prostate examinations. 

Now in Australia the intent is somewhat different.  The intent of learning to identify abnormal rectal pathology was not to be of assistance to the comatose patient in question, but to save the life of other patients not yet known.  The intent of medical students in doing this procedure is to learn how to find disease before someone dies of it.  That is a societal good, however it was inappropriately obtained.  It is not rape, or sexual assault because the intent is not control or dominence but to save life though not the life of the person in question. 

This is similar to the “unwanted” body searches performed by TSA. They are not done for the immediate benefit of the passenger, but to save the lives of others.  Folks who don’t like it may walk, take a car, or hire a private plane.  They are welcome to “opt out”.  I personally have been searched twice and while I don’t enjoy it, I don’t consider it rape.  (Neither does the law).

The solution to this problem is to, (as with the TSA) bring it into the open.  Those who wish to enjoy the fruits of medicine without making sure it is available to their children may either refrain from going to the hospital and treat themselves at home, or should be permitted to “opt out” for a higher fee.  The rest of us, who would prefer that there be physicians available to save the lives of our children should try to comply as gracefully as we can, as I complied with the TSA officials examining me.

This will be my last post on this subject.  You are most welcome to “win” this debate.  Far too many people in Australia will be losing this debate, and they will all of them be patients 10 years from now.


Rape would not be used to describe a rectal examination in an unconcious person in a Lat

February 3, 12:56 am | [comment link]
30. Sick & Tired of Nuance wrote:

In a similar fashion, intent is the reason your being forced to take pyridostigmine in the hopes that it would save your life, is the reason that that coercion was NOT a violation of the Nurenberg code.

If it wasn’t a violation of the Nuremburg code…why did they have to get a waiver?

If the Nuremburg code does not apply to war time, why was it developed at the War Crimes trials in Nuremburg after Nazi doctors were claiming that their experiments were legitimate medicine when in fact they were crimes against humanity?

February 3, 1:20 am | [comment link]
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