Balancing appropriate consent and adequate experience
Rapid response to:
Education And Debate
The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first
Balancing appropriate consent and adequate experience
Coldicott’s study1 and the accompanying
debate highlight an important inconsistency between what we know to be right and
what happens in practice. It was interesting that both commentaries were written
by gynaecologists, particularly considering it was rectal examinations on which
only one responding medical school had a formal policy. Unfortunately, the study
did not differentiate between consent obtained for gynaecological and surgical
examinations. One is left wondering what the surgeons make of all this.
The challenge of obtaining consent for students undertaking pelvic examinations
both in clinic and under anaesthesia is acknowledged and here may lie the reason
for the failure to obtain appropriate, informed consent. A recent study confirms
our perception that this is more often a problem for male students.2
Older and parous patients are identified as those more likely to agree, and the
authors suggest these women be specifically targeted for involvement in medical
education.
Other research, 3 reports that the main reason
women agree to medical student involvement is a desire to contribute to the training
of future doctors. Rapport with the student was cited in one third of cases to
be important and an anxiety about privacy was the most common concern in those
who declined. In this study, 84% of patients overall were happy for students to
be involved in the consultation and 68% for this to include intimate examination.
It is understandable that if we give the student’s presence no context then
it may be seen only as an uncomfortable addition to an already embarrassing event.
Student rapport is crucial and in the outpatient setting this is usefully achieved
by allowing the student to clerk the patient beforehand; a skill they obviously
need to develop in any case.
Finally, when obtaining consent, doctors should perhaps take an early opportunity
to reassure about issues of confidentiality, given that this may be a pivotal
issue for some patients.
1. Coldicott Y, Pope C & Roberts C. The ethics of intimate examinations -
teaching tomorrow's doctors. BMJ 2003;326:97-101 [Medline].
2. Rymer J & O’Flynn N. Women’s attitudes to the sex of medical
students in a gynaecology clinic: cross sectional survey. BMJ 2002; 325:
683-4 [Medline].
3. Ching SL, Gates EA, Robertson PA. Factors influencing obstetric and gynecologic
patients’ decisions toward medical student involvement in the outpatient
setting. Am J Obstet Gynecol. 2000; 182: 1429-32.
Rapid Response:
Balancing appropriate consent and adequate experience
Coldicott’s study1 and the accompanying
debate highlight an important inconsistency between what we know to be right and
what happens in practice. It was interesting that both commentaries were written
by gynaecologists, particularly considering it was rectal examinations on which
only one responding medical school had a formal policy. Unfortunately, the study
did not differentiate between consent obtained for gynaecological and surgical
examinations. One is left wondering what the surgeons make of all this.
The challenge of obtaining consent for students undertaking pelvic examinations
both in clinic and under anaesthesia is acknowledged and here may lie the reason
for the failure to obtain appropriate, informed consent. A recent study confirms
our perception that this is more often a problem for male students.2
Older and parous patients are identified as those more likely to agree, and the
authors suggest these women be specifically targeted for involvement in medical
education.
Other research, 3 reports that the main reason
women agree to medical student involvement is a desire to contribute to the training
of future doctors. Rapport with the student was cited in one third of cases to
be important and an anxiety about privacy was the most common concern in those
who declined. In this study, 84% of patients overall were happy for students to
be involved in the consultation and 68% for this to include intimate examination.
It is understandable that if we give the student’s presence no context then
it may be seen only as an uncomfortable addition to an already embarrassing event.
Student rapport is crucial and in the outpatient setting this is usefully achieved
by allowing the student to clerk the patient beforehand; a skill they obviously
need to develop in any case.
Finally, when obtaining consent, doctors should perhaps take an early opportunity
to reassure about issues of confidentiality, given that this may be a pivotal
issue for some patients.
1. Coldicott Y, Pope C & Roberts C. The ethics of intimate examinations -
teaching tomorrow's doctors. BMJ 2003;326:97-101 [Medline].
2. Rymer J & O’Flynn N. Women’s attitudes to the sex of medical
students in a gynaecology clinic: cross sectional survey. BMJ 2002; 325:
683-4 [Medline].
3. Ching SL, Gates EA, Robertson PA. Factors influencing obstetric and gynecologic
patients’ decisions toward medical student involvement in the outpatient
setting. Am J Obstet Gynecol. 2000; 182: 1429-32.
Competing interests:
None declared
Competing interests: No competing interests