The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first
The practice of clinical examination is integral to student learning,
however, its marginal benefit for patients is small if not absent. It is
our experience that, in the majority, patients do not object to being
examined by students, but a sensitive approach is essential.
The article by Coldicott et al raises the alarming prospect that
consent may not have been sought for intimate examinations by medical
students at Bristol. The authors contend that it seems unlikely that
Bristol is atypical, but such generalisations must be challenged. Our
students are required to document obtaining consent before examining
patients under anaesthesia, whilst verbal consent is required for clinical
examination of un-anaesthetised patients. Even at Bristol, the article
itself does not provide evidence beyond student recollection through a
survey, and does not explain the wide discrepancy between the experience
of 2nd and 3rd year students on the one hand and that of 4th year
students. For example, for 2nd and 3rd year students the number of
examinations under general anaesthesia which were presumably done without
consent was 100% and 91% respectively for the more junior students, but
this dropped sharply to 7% when students reached the 4th year. It would
have been more informative if the authors explored whether the discrepancy
could be explained through progressive student maturation, which sharpened
their awareness of patient-doctor communication and of the consent
process.
It is not clear whether the authors themselves obtained consent from
their research subjects, particularly given the way non-responders were
tracked, or why the authors did not attempt a structured approach to the
analysis of student free text entries.
The authors' attempt to explain their findings in terms of changing
ethical standards is unfortunate. Patient's acceptance of examination by
students should be viewed within the framework of altruism towards future
patients or towards the students themselves, rather than through an appeal
to utilitarianism, which is unlikely to condone such practice because of
its serious implications on trust as a foundation of patient-doctor
interaction.
Coldicott Y, Pope C, Roberts C. The ethics of intimate examinations -
teaching tomorrow's doctors. BMJ 2003;326:97-101.
Marwan A Habiba
Senior Lecturer in Obstetrics and Gynaecology, Leicester Warwick Medical
School
Clinical Sciences Building,
Leicester Royal Infirmary,
Leicester LE2 7LX, UK
Rapid Response:
The ethics of intimate examinations
The practice of clinical examination is integral to student learning,
however, its marginal benefit for patients is small if not absent. It is
our experience that, in the majority, patients do not object to being
examined by students, but a sensitive approach is essential.
The article by Coldicott et al raises the alarming prospect that
consent may not have been sought for intimate examinations by medical
students at Bristol. The authors contend that it seems unlikely that
Bristol is atypical, but such generalisations must be challenged. Our
students are required to document obtaining consent before examining
patients under anaesthesia, whilst verbal consent is required for clinical
examination of un-anaesthetised patients. Even at Bristol, the article
itself does not provide evidence beyond student recollection through a
survey, and does not explain the wide discrepancy between the experience
of 2nd and 3rd year students on the one hand and that of 4th year
students. For example, for 2nd and 3rd year students the number of
examinations under general anaesthesia which were presumably done without
consent was 100% and 91% respectively for the more junior students, but
this dropped sharply to 7% when students reached the 4th year. It would
have been more informative if the authors explored whether the discrepancy
could be explained through progressive student maturation, which sharpened
their awareness of patient-doctor communication and of the consent
process.
It is not clear whether the authors themselves obtained consent from
their research subjects, particularly given the way non-responders were
tracked, or why the authors did not attempt a structured approach to the
analysis of student free text entries.
The authors' attempt to explain their findings in terms of changing
ethical standards is unfortunate. Patient's acceptance of examination by
students should be viewed within the framework of altruism towards future
patients or towards the students themselves, rather than through an appeal
to utilitarianism, which is unlikely to condone such practice because of
its serious implications on trust as a foundation of patient-doctor
interaction.
Coldicott Y, Pope C, Roberts C. The ethics of intimate examinations -
teaching tomorrow's doctors. BMJ 2003;326:97-101.
Marwan A Habiba
Senior Lecturer in Obstetrics and Gynaecology, Leicester Warwick Medical
School
Clinical Sciences Building,
Leicester Royal Infirmary,
Leicester LE2 7LX, UK
mah6@le.ac.uk
Justin C Konje
Senior Lecturer in Obstetrics and Gynaecology, Leicester Warwick Medical
School
Clinical Sciences Building,
Leicester Royal Infirmary,
Leicester LE2 7LX, UK
jck4@le.ac.uk
David J Taylor
Professor of Obstetrics and Gynaecology, Vice Dean, Leicester Warwick
Medical School
Department of Obstetrics and Gynaecology,
Clinical Sciences Building,
Leicester Royal Infirmary,
Leicester LE2 7LX, UK
sal8@le.ac.uk
Competing interests:
None declared
Competing interests: No competing interests