Intimate Exams Without Patient Consent

Jan. 9, 2003 -- Medical students appear to be performing intimate examinations on anesthetized patients without their consent, often in violation of guidelines forbidding the practice. A survey at a U.K. medical school shows that up to a quarter of vaginal and rectal examinations conducted for teaching purposes may have been done without the patient's knowledge.

The study was conducted after medical students at England's University of Bristol expressed concern that guidelines requiring consent for intimate exams were not always being followed. But medical ethicist Peter A. Singer, who wrote an editorial accompanying the study in the Jan. 11 British Medical Journal, tells WebMD the practice is probably widespread in teaching facilities around the world.

"There is no reason to believe that any of the ethical challenges in medical education, including this one, are confined to the schools that are brave enough to study them," he says. "Performing intimate exams without patient consent is definitely among the most egregious of these ethical issues, but it is the tip of the iceberg."

Singer said all medical schools should adopt guidelines addressing the ethical challenges of training physicians and implement practical strategies for carrying them out. The director of the University of Toronto Joint Center for Bioethics, Singer says other ethical challenges routinely faced by medical students include being expected to perform patient tasks that exceed their capabilities and participating in substandard patient care.

"Every dean of every medical school in the world needs to acknowledge that these ethical breaches are common and they are not confined to just a few teaching facilities," he says. "They need to respond by enacting effective policies to ensure high ethical standards in medical education."

Want to learn more about how medical students feel about performing intimate exams without the patient's knowledge? Check out WebMD's in-depth interview with Clive Roberts, MD.

In the newly reported study, 386 medical students attending the British medical school completed anonymous surveys assessing the performance of vaginal and rectal exams during training. Second-year students failed to gain patient consent one-third of the time, and third-year students did not have consent for half of the exams they performed. It was not known whether the supervising physician had sought consent. Fourth-year students, who are required to do more exams, had a better record. They personally obtained consent for 95% of the exams they conducted.

"The students who were further along were much more aware of the necessity of obtaining consent," study researcher and University of Bristol Medical Clinical Dean Clive Roberts, MD tells WebMD. "The more junior students might not have had the self-assertiveness to refuse to do what they were invited to do by a superior."

Overall, the students reported that, to their knowledge, almost a quarter of the examinations they performed were conducted without consent, and three-fourths of the exams were conducted without written consent.

"Trust and respect are essential to the doctor-patient relationship, yet this study suggests that these are missing from students' experiences of learning to do intimate examinations," lead researcher and fifth-year medical student Yvette Coldicott writes. "Medical schools have a duty to deliver ethically informed training programs that develop doctors' skills and are acceptable to the patient volunteers who are a necessary part of medical education."