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 article by Caldicott et al has raised very important issues. Many
of the responses, so far, seem to have compounded them.
The issues should include one about the appropriateness of
publication and why usual standards were waived in this case. The
accompanying editorial calls it ‘a triumph of academic freedom’. But, in
reality, the issue was based on (quite a good) sample of students’ opinion
in one UK medical school, that itself seems at odds with current practice
(there is no clinical experience in Year 1). Under normal circumstances
the BMJ would not have published such a study, as colleagues who have been
conducting survey research, even on important topics, in medical schools
for 20 years, ruefully confide. Perhaps the fact that it was Bristol and
that it is an obviously important issue, if generalisable to a wider
population of schools, students and staff, swayed the hanging committee.
But some of the responses beggar belief. They confirm that what has
happened to Bristol students almost certainly is happening elsewhere. And
maybe publishing the article was the quickest route to such confirmation.
Certainly quicker than funding a defensible research project. I have been
working with colleagues responsible for ethical and communication issues
in medical schools for many years and I am surprised and disappointed at
how little progress seems to have been made. We were working on these
issues in London in the mid 80’s. We had policies, at least within
Departments, and we tried to implement them. I thought, obviously
mistakenly, that in general the culture now operating recognised the
importance of, at the very least, engaging in egalitarian discussions with
patients about who should examine them and how. I thought that the culture
was also promoting the sensible procedures, or alternative or adjunct
learning strategies outlined by respondents such as written information
and consent forms, simulated and mannequin patients and so forth. I was
too complacent and that is where the problem lies I guess.
The responses
also demonstrate how restrained and polite some contributors can be. It
was really the comments made by the SHO respondent (“I wonder how pleased
this correspondent will be when a young GP misses a rectal cancer because
he/she has never had any experience of feeling one”) that jolted me out of
this complacency. First because it demonstrated exactly what the patient
had said about the need for medical teachers and learners to ‘listen and
learn’. This patient was not saying that such examinations should not be
done, only that consent was needed. I hope the SHO’s boss reads these
responses, and the SHO’s boss’s boss. It seems that trying to change the
culture through broadening minds and educating future generations doesn’t
work, but changing the view at the top might. Or does Sheffield want to
move to Bristol?
Rapid Response:
Faking It
The article by Caldicott et al has raised very important issues. Many
of the responses, so far, seem to have compounded them.
The issues should include one about the appropriateness of
publication and why usual standards were waived in this case. The
accompanying editorial calls it ‘a triumph of academic freedom’. But, in
reality, the issue was based on (quite a good) sample of students’ opinion
in one UK medical school, that itself seems at odds with current practice
(there is no clinical experience in Year 1). Under normal circumstances
the BMJ would not have published such a study, as colleagues who have been
conducting survey research, even on important topics, in medical schools
for 20 years, ruefully confide. Perhaps the fact that it was Bristol and
that it is an obviously important issue, if generalisable to a wider
population of schools, students and staff, swayed the hanging committee.
But some of the responses beggar belief. They confirm that what has
happened to Bristol students almost certainly is happening elsewhere. And
maybe publishing the article was the quickest route to such confirmation.
Certainly quicker than funding a defensible research project. I have been
working with colleagues responsible for ethical and communication issues
in medical schools for many years and I am surprised and disappointed at
how little progress seems to have been made. We were working on these
issues in London in the mid 80’s. We had policies, at least within
Departments, and we tried to implement them. I thought, obviously
mistakenly, that in general the culture now operating recognised the
importance of, at the very least, engaging in egalitarian discussions with
patients about who should examine them and how. I thought that the culture
was also promoting the sensible procedures, or alternative or adjunct
learning strategies outlined by respondents such as written information
and consent forms, simulated and mannequin patients and so forth. I was
too complacent and that is where the problem lies I guess.
The responses
also demonstrate how restrained and polite some contributors can be. It
was really the comments made by the SHO respondent (“I wonder how pleased
this correspondent will be when a young GP misses a rectal cancer because
he/she has never had any experience of feeling one”) that jolted me out of
this complacency. First because it demonstrated exactly what the patient
had said about the need for medical teachers and learners to ‘listen and
learn’. This patient was not saying that such examinations should not be
done, only that consent was needed. I hope the SHO’s boss reads these
responses, and the SHO’s boss’s boss. It seems that trying to change the
culture through broadening minds and educating future generations doesn’t
work, but changing the view at the top might. Or does Sheffield want to
move to Bristol?
Competing interests:
None declared
Competing interests: No competing interests