The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first
I read the paper (1) and accompanying editorial (2) with a sense of
unease and professional shame. It revoked memories of my discomfort as a
medical student but I, unlike Coldecott, didn't dare draw attention to the
violation of personal rights I witnessed.
While courageous in highlighting current unethical practice, the
paper does not propose any different role for women, other than that of
some kind of animate manikin on which skills of intimate examination may
be practised.
The permission patients grant us to make intimate examinations must
never be taken for granted: preparation for this professional role as
important. (3) However there is a danger in relegating this to mere
technical competence. All examination must include communication between
patient and examiner. Public examination, when handled well, can be a key
moment disclosure of anxieties or past painful experiences.
We have an opportunity to make radical change by entering into
partnership with our women patients and enlisting them as teachers. There
are aspects of examination that need to be taught from a theoretical base
but surely there is no-one better placed to guide, teach and given
feedback to learners about the act of examination itself than the
empowered woman patient.
As a GP teacher, my experience in asking carefully chosen patients to
help in this key learning for a future doctor has been good. Women
welcomed the chance to do this; they perceive it as a service to medical
education and to women's future healthcare.
An earlier attempt to induce this more formally to the medical
curriculum was unsuccessful (4) but reports from Antwerp, New York, and
Australia should encourage us to utilise these potential teaching partners
in the UK. To fail to do so is to continue the medical colonisation (5)
by modernist medicine claims that patient’s body as its territory so
personal identity is lost.
Charles Campion-Smith.
General practitioner. Dorchester Dorset ccampions@aol.com.
References
1. Coldecott Y, Pope C, Roberts C. The ethics of intimate
examinations: teaching tomorrow's doctors BMJ 2003 326 97-101.
2. Singer P. Intimate examinations and other technical challenges in
medical education BMJ 2003 326: 62-63
3. Skrine R. Blocks and freedoms in sexual life. Oxford Radcliffe
1997.
4. Bell S. Political gynecology: gynecological imperialism and
politics of self-help in Brown (ed) Perspectives in modern sociology.
Prospect Heights Wavelength Press 1992
5. Frank A. The wounded storyteller: body, illness and ethics.
Chicago, University of Chicago Press 1995
Competing interests:
None declared
Competing interests:
No competing interests
08 February 2003
Charles Campion-Smith
GP & primary care Educator/ Chartered Clinical Psychologist
Rapid Response:
Intimate examinations by medical students
I read the paper (1) and accompanying editorial (2) with a sense of
unease and professional shame. It revoked memories of my discomfort as a
medical student but I, unlike Coldecott, didn't dare draw attention to the
violation of personal rights I witnessed.
While courageous in highlighting current unethical practice, the
paper does not propose any different role for women, other than that of
some kind of animate manikin on which skills of intimate examination may
be practised.
The permission patients grant us to make intimate examinations must
never be taken for granted: preparation for this professional role as
important. (3) However there is a danger in relegating this to mere
technical competence. All examination must include communication between
patient and examiner. Public examination, when handled well, can be a key
moment disclosure of anxieties or past painful experiences.
We have an opportunity to make radical change by entering into
partnership with our women patients and enlisting them as teachers. There
are aspects of examination that need to be taught from a theoretical base
but surely there is no-one better placed to guide, teach and given
feedback to learners about the act of examination itself than the
empowered woman patient.
As a GP teacher, my experience in asking carefully chosen patients to
help in this key learning for a future doctor has been good. Women
welcomed the chance to do this; they perceive it as a service to medical
education and to women's future healthcare.
An earlier attempt to induce this more formally to the medical
curriculum was unsuccessful (4) but reports from Antwerp, New York, and
Australia should encourage us to utilise these potential teaching partners
in the UK. To fail to do so is to continue the medical colonisation (5)
by modernist medicine claims that patient’s body as its territory so
personal identity is lost.
Charles Campion-Smith.
General practitioner. Dorchester Dorset
ccampions@aol.com.
References
1. Coldecott Y, Pope C, Roberts C. The ethics of intimate
examinations: teaching tomorrow's doctors BMJ 2003 326 97-101.
2. Singer P. Intimate examinations and other technical challenges in
medical education BMJ 2003 326: 62-63
3. Skrine R. Blocks and freedoms in sexual life. Oxford Radcliffe
1997.
4. Bell S. Political gynecology: gynecological imperialism and
politics of self-help in Brown (ed) Perspectives in modern sociology.
Prospect Heights Wavelength Press 1992
5. Frank A. The wounded storyteller: body, illness and ethics.
Chicago, University of Chicago Press 1995
Competing interests:
None declared
Competing interests: No competing interests