Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?

Then be forewarned that, while you are under general anesthesia, medical students may be performing “practice” pelvic exams on you without bothering to first notify you or obtain your consent. Instead, the hospital assumes that you “consented” to the exam when you signed the general pre-operative surgery consent form, even though these forms typically do not mention the procedure. A few years ago, a short-lived media firestorm led to federal hearings on the issue; the American Association of Medical Colleges (which represents most of the nation’s medical schools and over 400 teaching hospitals) issued a statement condemning the practice as “unethical and unacceptable.”

But according to my colleague Robin Fretwell Wilson, who has done extensive research on the issue, the practice lives on at many teaching hospitals around the country. Incredibly, many doctors justify the practice by simply asserting that women will not consent if asked. Since medical students need to practice pelvic exams, they argue, the needs of the medical establishment should trump a woman’s right to be asked for permission before unnecessary medical procedures are performed on her. (In fact, their assumption that women won’t consent if asked is dubious; one study indicates that at least 50% of women do give permission when asked in advance.) According to Professor Wilson, some teaching faculty bluntly assert that poor patients who receive free or subsidized care at a teaching hospital “owe it to the facility and society” to participate. For more information on the controversy, see Professor Wilson’s article, Autonomy Suspended: Using Female Patients to Teach Intimate Exams Without Their Knowledge or Consent (available for download here at SSRN).

If you live in the great state of Virginia, you’re in luck. Thanks to Professor Wilson’s hard work and advocacy efforts, the Virginia legislature just enacted legislation requiring specific informed consent for the practice. (California has also enacted similar legislation.)

By the way, if you’re a man thinking that this issue doesn’t affect you, you might think again. If you ever go in for prostate surgery, think twice before you sign that general consent form: You may be signing up for a free rectal exam or two (or three), courtesy of whatever medical students happen to be on rotation that day.

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28 Responses

  1. clerk says:

    This sounds awful, but is there any indication of how often this actually happens and where this actually happens?

    Anecdotally, the people I know in med school (who do most of their rotations in large teaching hospitals) do their practice pelvic exams on “standardized patients”–people from the community who are paid to allow medical students to practice on them and who remain awake for the whole thing.

  2. clerk says:

    The first 2 lines of the abstract say Recent reports of medical students performing pelvic exams for training purposes on anesthetized women without their consent have produced a firestorm of controversy. Peter Ubel and colleagues found that 90% of medical students performed such exams during their obstetrics/gynecology rotations

    Just anecdotally, the 90% figure doesn’t seem right to me.

  3. The topic of ethical duties to the medical profession of patients at teaching hospitals was the subject of the ethics column in the NYT magazine a few months ago. A patient did not want to consent to having a student observe his office visit. I believe the ethicist told him that he did have some duty to the preparation of the medical profession but could possibly satisfy that duty by making a contribution elsewhere. Many wrote in to disagree that there was such a duty. I also disagree that your duty springs from your benefitting from the teaching hospital. Most of us go to the hospital or doctor on our insurance plan and have very little choice in going to the teaching hospital (and little if any subsidization for doing so).

    I went to college at a research university with a medical school/teaching hospital. In 1987, the school newspaper ran ads offering $12/hour to women volunteers for gynecological exams. The minimum wage at the time was about $3.15/hour. That sounds like a better way to handle the teaching problem.

  4. While I would certainly not suggest that this procedure passes ethical muster, I would also note that if you are admitted to a teaching hospital, there is always a chance that residents or even medical students may be performing procedures on you.

    I was particularly concerned about this in the context of pregnancy and the placement of epidurals, because any anesthesiologist will tell you that proper placement of it is a skill, and that getting the maximum possible analgesic effect takes no small measure of that skill. Given that it is unlikely that a resident or medical student can place the epidural as well as a trained and experienced anesthesiologist, the thought that this happens struck me as ethically problematic, to say the least.

    For the patient, the only way to really prevent these problems is to avoid teaching hospitals entirely, in which case the problem never arises. A trainee performing any medical procedure without adequate supervision is totally unacceptable from an ethical perspective, and may well run afoul of various regulatory, administrative, and disciplinary provisions.

  5. interesting says:

    The way the problem is framed is misleading, though the arguments the doctors make probably don’t help.

    Take 2 hypothetical scenarios:

    1. A patient goes into the teaching hospital with a tumor in her uterus that she needs taken out. The people working on her are an attending physician and a resident, and a med student is there to assist and learn. Both the attending and the resident need to do pelvic exams on the patient before operating so that they can see what they’re cutting. The attending tells the other two where the tumor is, how big it is and, accordingly, how the procedure should go. The attending then tells the medical student to perform a pelvic examination so that the medical student can locate the tumor, detect the same things that the other 2 did, and understand how the procedure is to work. The attending and the resident then perform the surgery while the medical student watches.

    2. A patient goes to the hospital for a procedure on her thyroid. Once she is under general anesthetic, the attending physician invites a couple of medical students in so that they can practice their pelvic exams, now that the patient is unconscious.

    I think #2 is totally inappropriate, and I think most doctors would agree. I’m not sure what’s wrong with #1, though. The other 2 people on the team need to perform pelvic exams so that they can see what they’re cutting, and there aren’t a lot of community volunteers who have uterine tumors. As Mr. Goldberg indicated, when you go to a teaching hospital, med students may do some of the work, and doctors may show medical students how they do their work and even sometimes let the medical students touch the patients as part of their training.

    The description of the article implies that #2 is what’s going on, but I tend to doubt it.

  6. Melissa Waters says:

    Regarding the last comment, I think it’s clear from the way Professor Wilson frames the problem (and the way I framed it in my post), that she’s only addressing unauthorized pelvic exams on patients who go in for some sort of obstretic/gynecological surgery. That would obviously eliminate scenario #2, above.

    In addition, I’m assuming that there is a third scenario: A patient goes in for OB/GYN surgery that does NOT require any sort of pelvic examination. (I’m no expert here, but I can certainly envision such a scenario.) If medical students are practicing pelvic exams in that scenario, I think this raises ethical (and legal) issues more akin to scenario #2 (the thyroid example) than scenario #1.

  7. anon says:

    Daniel Goldberg: I agree that in an ideal world, an inexperienced person would never give epidural. But in the real world, every experienced doctor was once inexperienced, and had to be trained on someone. The question is who should be the proper training object. My answer is — people who get health care for free. Those of us who pay (for our own health care and for the care of those who don’t pay) are entitled to get what we pay for. Every Medicaid/Medicare recipient should be told that, as a condition for receiving free medical services, they must agree to assist in physician training.

  8. Sarah L. says:

    Re Anon 1:25 a.m.:

    I don’t know anyone who pays for their own health care; who could afford it? Last time I was in the hospital the bill was over $100,000, but my out-of-pocket was $0. Why? Health insurance.

    When a person with health insurance goes into the hospital, he does not pay for his own care. The insurer does. The risk is spread over all who have purchased insurance from the patient’s insurer. That’s what insurance is all about.

    When a person with Medicaid goes into the hospital, he does not pay for his own care. The government does. The risk is spread over all taxpayers. That’s what government-provided insurance is all about.

    Moreover, many people who have health insurance don’t even pay their entire premium; their employer pays all or part of it. And what’s more, an employee doesn’t have to include the amount paid by his employer in his income, and the portion the employee pays is usually in pre-tax dollars. So if my employer pays $500 a month for my health insurance premium, and I pay $100, I don’t have to include any of the $500 in my income, and the $100 is pre-tax dollars. This means (essentially) that the government (i.e., all taxpayers) pays $210 (35%) of the $600. (See any discussion of tax expenditures for why this sort of exclusion by a taxpayer is equivalent to a payment by the government.)

    It’s very hard for me to see why the Medicaid patient should get different treatment in this situation than the person whose health-care expenditure is to have all taxpayers pay 35% of his health insurance premium and his employer pay the bulk of the rest.

    (Note that my discussion of the tax expenditure related to health insurance premia was simplified and thus underestimated the actual percentage of the premia sponsored by all taxpayers. Some refinements would take into account the variation in individual income tax rates; that the exclusion would result in a reduction in payroll taxes (FICA and FUTA); and that there there would be an accompanying exclusion of income from state and local taxation. But you get the point.)

  9. David Schwartz says:

    Nobody, neither medical students nor attending physicians nor anyone else, should be performing unnecessary medical procedures on patients without their explicit consent.

    Even necessary procedures require informed consent. So certainly unnecessary procedures do. Patients expect that they are consenting to necessary procedures and might be surprised to find out that they are consenting to unnecessary ones. Uninformed consent is not consent.

    This is what separates medicine from assault and it is not negotiable.

  10. Al slawsky says:

    I would like to comment on this issue at hand i work at a karge teaching facilty as a surgical technologist .Ok yes most people I agree go in and say for a gyn surgey expect the Dr who requested the surgey will perform it and noone else .true the attending has to check the chief resident during the surgey depending on the surgey iteself..I have never witnessed a thyroidectomy or Breast biopsy or anything other than gyn surgey is someone subjected to a pelvic exam ..people need to understand that a resident in the or has completed many yrs of school and if you take anoter train of thought here .this isnt a sexual issue Ok violation No necessity yes ..I disagree becuse I work the field i scrub in assist the resident the attending and ok med student pain in the ass honestly but he will be the future dr and accuracy and practice and understanding If you have a tumor on your uterus i think you should be concerned with the fact that you are gettiing a double opinion ok and yes residents do challenge and can be a watchdog for the surgeon as i am also next what is it a violation i prep you and see your vagina No it is a job and belive me not interested in violating you by any means .But do to lawyers and jaccho and articles like this harm the medical proffesssion .If you are in labor the attending will do an internal and belive me your dr does not wait for you you wait for them .i understand the morality of this but honestly it isnt as the janitor is brought in to do a routine pelvic maybe look at this differently you said 50% would refuse Ok we are short Ob gyn and insurance companies are making it impossible .An exam will only be of what you are there for and is absolutly ludicris to start a panic that if you have yor tonsils out you are going to get a pelvic agree with some of what was said but maybe a need of understanding what we endure in the or and necessity.I have been involved in over 14,000 procuderes and understand this practice and it isnt all the time but if abdnormality exist that would help our future doc’s than i see no problem and me as a male hey a couple rectals wont hurt insurance if anything becuse what is going to happen next the rectals hey nothing and No if you live in the or every day as myself you would feel different I welcome any questions any one has regarding the facts I have worked 2 teaching facilities .as i do now and Ob/gyn is my field of expertise as is general surgery

  11. Mary says:

    This issue is self-determination, personal rights and freedom, “informed” consent and more. I am one woman who does not want men involved in OBJYN and similar care. Yet this expressed wish has been ignored time after time. Sorry, this is just wrong; and it is time it changed. Do I hear Patient Revolution??? To hell with the courts; let’s hit the streets. Let’s post flyers with pics of Drs. who violate our wishes. I can tell you if you glue them to the poles and then give it a light coat of shellac they are hard to remove.

  12. Mary Birmingham says:

    This happens in the V.A. every time. I have been put under anesthesia for three different surgeries, mastectomy, oopherectomy, and colonoscopy, and latter found out my request for all female staff was violated every time. Every time students were not only doing exams, but performing the surgeries against my knowledge and expressed will. The physicians simply ignored my requests, lied before and after surgery. I found the betrayal in the medical records or at least part of the betrayal. I have complained to the Chief of Staff, Sen. DeFazio, and others. I have tried to find legal counsel. Now, I am publishing. It seems there is little that we can do but start posting mug shots and Physicians NOT WANTED posters on these perps. It is time to call them what they are criminals and rapists.

    anyone interested in a class action against the V.A., email me

  13. MCKean says:

    You may find this news story interesting

    Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits

    http://www.opednews.com/articles/genera_mc_kean_080319_arrogance_2c_abuse_2c_fr.htm

    Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

    Did you know that:

    Large teaching hospitals are pulling bait and switches, and unauthorized pelvic, breast, and rectal exams as described in the story at link above. Even if a woman going under anesthesia requests no men were involved in her care at this time, she will be ignored. As soon as she is out, they will bring in students to probe and prod all over her body.

    Large V.A.s have a history as teaching hospitals, but as large state hospitals play less and less of a role in poor folks medical care, the V.A. patients have born a larger share of the burden.

    As states have passed laws regarding informed consent and unauthorized exams and bait and switches, as baby boomer physicians retire, the need for more patients rises. In response, ALL VA Facilities are about to become teaching facilities. No vet will be safe, and women will be battered on a regular base. Teaching Hospitals like OHSU in Oregon are trying to gain greater access to other facilities, but as their practices tend to result in a greater number of law suites (OHSU is sued on avg. twice a month and they earn more than they get), they cannot get all the access they want.

    Therefore, now all these women vets, harassed and raped at a much higher rate than the public will have the privilege of being raped for the rest of her life in the name of teaching Doctors. Not only will she be raped in the sense of unauthorized unwanted pelvic and anal (men also subject to this) exams, but after male CNAs and techs watch this abuse and disregard of women’s rights over their bodies, then the women while still under anesthesia are left in their care.

  14. MCKean says:

    You may find this news story interesting

    Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits

    http://www.opednews.com/articles/genera_mc_kean_080319_arrogance_2c_abuse_2c_fr.htm

    Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

    Did you know that:

    Large teaching hospitals are pulling bait and switches, and unauthorized pelvic, breast, and rectal exams as described in the story at link above. Even if a woman going under anesthesia requests no men were involved in her care at this time, she will be ignored. As soon as she is out, they will bring in students to probe and prod all over her body.

    Large V.A.s have a history as teaching hospitals, but as large state hospitals play less and less of a role in poor folks medical care, the V.A. patients have born a larger share of the burden.

    As states have passed laws regarding informed consent and unauthorized exams and bait and switches, as baby boomer physicians retire, the need for more patients rises. In response, ALL VA Facilities are about to become teaching facilities. No vet will be safe, and women will be battered on a regular base. Teaching Hospitals like OHSU in Oregon are trying to gain greater access to other facilities, but as their practices tend to result in a greater number of law suites (OHSU is sued on avg. twice a month and they earn more than they get), they cannot get all the access they want.

    Therefore, now all these women vets, harassed and raped at a much higher rate than the public will have the privilege of being raped for the rest of her life in the name of teaching Doctors. Not only will she be raped in the sense of unauthorized unwanted pelvic and anal (men also subject to this) exams, but after male CNAs and techs watch this abuse and disregard of women’s rights over their bodies, then the women while still under anesthesia are left in their care.

  15. MCKean says:

    You may find this news story interesting

    Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits

    http://www.opednews.com/articles/genera_mc_kean_080319_arrogance_2c_abuse_2c_fr.htm

    Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

    Did you know that:

    Large teaching hospitals are pulling bait and switches, and unauthorized pelvic, breast, and rectal exams as described in the story at link above. Even if a woman going under anesthesia requests no men were involved in her care at this time, she will be ignored. As soon as she is out, they will bring in students to probe and prod all over her body.

    Large V.A.s have a history as teaching hospitals, but as large state hospitals play less and less of a role in poor folks medical care, the V.A. patients have born a larger share of the burden.

    As states have passed laws regarding informed consent and unauthorized exams and bait and switches, as baby boomer physicians retire, the need for more patients rises. In response, ALL VA Facilities are about to become teaching facilities. No vet will be safe, and women will be battered on a regular base. Teaching Hospitals like OHSU in Oregon are trying to gain greater access to other facilities, but as their practices tend to result in a greater number of law suites (OHSU is sued on avg. twice a month and they earn more than they get), they cannot get all the access they want.

    Therefore, now all these women vets, harassed and raped at a much higher rate than the public will have the privilege of being raped for the rest of her life in the name of teaching Doctors. Not only will she be raped in the sense of unauthorized unwanted pelvic and anal (men also subject to this) exams, but after male CNAs and techs watch this abuse and disregard of women’s rights over their bodies, then the women while still under anesthesia are left in their care.

  16. MCKean says:

    You may find this news story interesting

    Arrogance, Abuse, Fraud, and Medical Malpractice: How Some Physicians Beg for Lawsuits

    http://www.opednews.com/articles/genera_mc_kean_080319_arrogance_2c_abuse_2c_fr.htm

    Our health care system is much sicker than even Michael Moore understands. Greedy physicians addicted to money are literally abusing and battering patients for the sake of profit.

    Did you know that:

    Large teaching hospitals are pulling bait and switches, and unauthorized pelvic, breast, and rectal exams as described in the story at link above. Even if a woman going under anesthesia requests no men were involved in her care at this time, she will be ignored. As soon as she is out, they will bring in students to probe and prod all over her body.

    Large V.A.s have a history as teaching hospitals, but as large state hospitals play less and less of a role in poor folks medical care, the V.A. patients have born a larger share of the burden.

    As states have passed laws regarding informed consent and unauthorized exams and bait and switches, as baby boomer physicians retire, the need for more patients rises. In response, ALL VA Facilities are about to become teaching facilities. No vet will be safe, and women will be battered on a regular base. Teaching Hospitals like OHSU in Oregon are trying to gain greater access to other facilities, but as their practices tend to result in a greater number of law suites (OHSU is sued on avg. twice a month and they earn more than they get), they cannot get all the access they want.

    Therefore, now all these women vets, harassed and raped at a much higher rate than the public will have the privilege of being raped for the rest of her life in the name of teaching Doctors. Not only will she be raped in the sense of unauthorized unwanted pelvic and anal (men also subject to this) exams, but after male CNAs and techs watch this abuse and disregard of women’s rights over their bodies, then the women while still under anesthesia are left in their care.

  17. MC Kean says:

    Frank Van Cleave,

    This is as much information as I have to date. Please accept it as a response to Dr. James Tuchschmidt’s response letter dated March 12, 2008 sent to your office.

    In response to Dr. James Tuchschmidt’s claim that they were unaware of my need for male absence during the June and December procedures:

    When I was diagnosed w/breast cancer, I strongly expressed my resistance to having men around as I went through this type of surgery. I had requested OHSU take charge of my care, but the V.A. refused to refer. I requested OHSU accept me as a patient under Champ VA, but they insisted I go back to the V.A., saying I would have the same care there I would get at OHSU. I had signed papers at OHSU stating that I did not want students participating in procedures. I did not want to go to the V.A. and told Nancy Sloan it was for two reasons; first too many men around at a time when I am not going to want any men around, and second for such medical care, I needed to know I was in the hands of a good surgeon and in a clean safe environment. I told her that I was very insecure that the V.A. could meet these needs. Nancy Sloan, assured me that I would be safe, and all my needs cared for; so, I asked for Dr. Karen Kwong, a name I had been given by Joan at OHSU. James Tuchschmidt is right, this is not in the records, not the ones I was given. However, I was very upset and made quite a fuss about my fears of male presence as staff and patients. (I have found what is put in and left out of V.A. medical records is selective and at times more reflective of a physician‘s attitude or legal concerns than an actual account of events.) Even given the V.A.‘s alleged failure to note this conversation and these concerns; Tuchschmidt’s argument that they did not know better, in light of discovered deception, does not hold water. I was told by Dr. Kwong going into surgery how unusual an “all female team” was in surgery. Either she was not telling me the truth; or something changed. Either way she certainly knowingly lied after the fact, a clear indication that she was well aware of my objection to male participation in such a surgery. If they did not know I did wanted only women, then why did Dr. Kwong claim we were going in with “an all female team“? Why did she lie to me after the fact, but before the colonoscopy and thus, before my complaint? If she did not know I would find this objectionable prior to surgery, then at the point I asked about the man introducing himself to my husband (who has no legal say in the matter if my incapacitation is medically induced, such as with sedation), she would still have no knowledge of such objection. In the absence of such knowledge, one might expect a lie regarding student participation, (not that this is acceptable) but Dr. Kwong lied about male presence during the procedure all together. From the start the records I secured from the V.A. prior to my complaint hid the recently discovered fact that two men Dr. McConnell (Chief of General Surgery) was attending, and Dr. Adams (a urology resident?) was performing surgery at the June Mastectomy/bi-lateral oophorectomy. I was sedated before prep, and two hours before surgery. Sedated, it would seem, so men could get involved against my expressed will from prep onward. If they were not made collectively aware that I would object to men, why would I see nothing but women, why was I told there was an “all female team”, yet men were all over the place once sedated? There is only one reason I can think of for her to lie, one reason why men only appear after I am drugged, and one reason for a discrepancy between records I am given and those available to V.A. staff; Dr. Kwong, Dr. MCConnell, the staff, was well aware I did not want men participating in this surgery. Rather than accommodate those needs, they merely conspired to violate my civil rights and commit medical battery.

    The V.A. claims the right to keep things from you if they think knowledge it is not good for your health. (This was posted on the wall regarding patients rights and responsibilities). This sort of secrecy provides the space for and encourages the rationalization of keeping practitioners and/or practices that you may find objectionable hidden rather than respecting a patients autonomy, dignity, civil rights, and privacy. It is a way to overcome objections to what some patients may recognize as increased risks. Prolonging anesthesia, which carries many risks including the facilitation of cancer growth, to enable student training is one such example. (see http://www3.interscience.wiley.com/cgi-bin/abstract/112721174/ABSTRACT?CRETRY=1&SRETRY=0 ) If they know what they are doing can cause harm, increase risks, or that a patient would find it objectionable, they should not do it anyway, hide that fact, and then just hope no one heard the tree fall in the forest. The tree still fell, the harm is still done. In fact they create what feminist philosophers of sex call a “rape culture”. The relationship between the patient and care providers become an adversarial one; the environment becomes hostile, one in which the patient’s dignity, humanity, autonomy, and rights are treated as something to be challenged and overcome in the interest of education, profits (including kickbacks), other provider self interests.

    How this all went down:

    As requested I was assigned and had gotten to know and trust Dr. Kwong. I researched her experience, liked her calm cool disposition, and the idea of small steady hands. I was comfortable with her. I also requested and was assigned a female OBJYN to do a bilateral oopherctomy at the same time. I had talked with the OBJYN surgeon and liked her as well. The day after the surgery a female resident came in to introduce herself as having assisted with the concurrent bilateral oophorectomy stating that I likely did not remember her as I was drugged; but that she had talked to me right before surgery. She was right; I did not remember her. It did not bother me; she was female, which is the criteria I had requested, and I was told she was supervised by the young woman to whom I had spoken. I did not realize it at the time; but in retrospect this was the first hint I had that I was not being allowed the right of “informed consent” in terms of who would be touching and cutting on my body while I was unconscious. While I was aware PDX VA was a teaching facility for OHSU; I also assumed I would be introduced to all people including students that would be involved in surgical, invasive, and/or intimate procedures in advance. While observation was something I figured I did not have control over (but should), student participation, student intimate exams, and broadcasts I assumed would require specific consent. Stupid me, I thought I had rights. Still, like I said, I did not find her participation particularly objectionable, and had I been asked would have consented to her participation in this surgery, so at this time I thought nothing of her visit. I liked her. No males came by as did she and introduced themselves as participants.

    A few days after the surgery, my husband told me that a man had come by, claimed he had spoken with me (if he did I was drugged at the time; I have no memory of him), said he would be sitting “second chair”. It took us quite some time to figure out who this man was. He did not look at his face, and did not get a good look at his name tag (he did not have on his glasses). He did think he saw that the man’s name tag, and introduction claimed he was the “Chief of something”. As I had requested women, and had been told going into surgery that I had an “all female team”, I asked Dr. Kwong about this mystery man at my follow-up appointment. She gave me the “dear in headlights” look that I have come to know as a leading indicator that a lie is coming. She denied the presence of a male surgeon. Not accepting Dr. Kwong’s first response that there were no males, I had asked Dr. Kwong if this male who spoke to my husband could have been a male student. She looked at my chart on the computer screen and denied that any male physicians or students were in the room, and stated that she performed the mastectomy. According to the records I was given upon request, Dr. Shabnam Chaugle did the surgery and Dr. Kwong supervised. I would not have consented to a resident performing the mastectomy. I was more worried about the mastectomy than the oophorectomy in terms of surgical expertise because of the cancer. I wonder if this had not been a teaching project would I be suffering less nerve damage pain. (Identification of and avoiding damage to nerves is one thing students are graded on when doing a mastectomy.) I selected Dr. Kwong based on both gender and risk assessment. My consent was not transferable to another surgeon. Still, Shabnam being a woman, given good pain management (it took eight months to get to any sort of viable pain management as pain meds cause my already troubled G.I. serious problems), I would have accepted this and moved on, save I knew men were in that room and I was being lied to about that fact; this I found very threatening. If they were willing to lie to me about male participation in the surgery, what else might they lie about? Very recently, I was told that another set of records maintained at the V.A., but not provided to me, indicate Gregory Adams, was the surgeon, and Donald McConnell the attending. I looked these names up and found that McConnell is Chief of General Surgery, and Adams a urology student.

    Before I had reviewed the records, but after my husband had told me about the male surgeon and Kwong had denied the same, I went in for a colonoscopy. I had postponed the colonoscopy until a while after the mastectomy due to a widening recognition of the fact that trauma (including surgery) can increase the growth rate of cancer. 1 The G.I. clinic was well aware of my concerns as I had stated my reasons for postponement. This alone would suggest it would be proper to ask about any trainee participation at the time of making the appointment. On the contrary, again such plans to involve students were intentionally concealed. When I was ready, I asked for and again was assigned a female physician. I was told I would have Dr. Collins. I told Dr. Collins I did not want men involved. Being concerned, I very specifically told her that I suspected I had been lied to by Dr. Kwong and did not want such a thing to happen again. She assured me “no men”. After I had been made very ill with an overdose of the laxative, after the I.V. was in, after something was injected into the I.V. to “help me relax”, after I was stripped, after I was stretched out in the procedure room (which I now realize was also a teaching room and likely more than one student was invited in after I was fully sedated), Dr. Collins came in with Dr. Mitchal Schreiner and Donald Miller, a nursing assistant they called a “tech”, and a female nurse to attend to anesthesia. Dr. Collins introduced Mitchal as her fellow and he shoved a consent form in my face to sign. I was not asked! I was told he would be doing the colonoscopy. I have since learned this is a strategy systematically and intentionally employed to overcome potential or expressed objection. It was dark (or at least seemed like it was through the fog of medication), I was lying down, and I had been throwing up from being overdosed with a third bottle of Sodium Phosphate. (Which I am now convinced I was given because Dr. Collins did not want to wait long enough to allow my system plagued by a recently proven slow motility to work. She had the results of the gastric empty test at the top of the records as the most recent procedure.) When Dr. Collins brought in the men, she quickly stood to the side where I could not even see her to object. I was forced to face the men if I wanted to object to their presence. I was shocked, embarrassed, and humiliated and did not have the physical strength to throw Dr. Schreiner out. I signed. I was not “compliant” and there was no “misunderstanding“; I was lied to, manipulated, drugged, humiliated, and battered. Dr. Collins had plenty of opportunity before the procedure room, to tell me about these men; she could have told me when she had me in a room to insist I need a third bottle of Sodium Phosphate. At that time, I could have and would have left. I was not given that choice. Rather than be honest, she hid the men from view and knowledge. I was also lied to by the tech about the role he would play. The tech introduced himself, said he was there to collect any polyps and take them to the lab. He said he realized I was not comfortable and would remain on the outside of the door. Then he went to the door, but remained in the room. He also participated in the procedure; he had his hands on the tube in my rectum, and likely had his hands on me. This is battery.

    Latter, Dr. Collins claims she explained JACHO to me. She did not. I did not hear about JACHO until I read it in the notes. I am not convinced JACHO requires both the tech and the fellow, unless she did not stick around or was teaching a group of students gathered in the room rather than tending to my care. Also, there are many female fellows in the G.I. department. I see no reason why I could not have been provided all females. If I had no right to have such a request honored, and/or they had no intentions of honoring this request, I should have been told at a time when I could still negotiate terms (like have a family member present), reject the situation and seek care elsewhere, or even simply give myself more time to recover emotionally from the June surgery. But I was not asked, nor informed of Dr. Collins intentions until all efforts had been made to place me in a position from which I would not feel free to object. By the time Dr. Collins introduced the male resident I already felt drowsy and week, clumsy and the room seemed dark. Given the female resident who stated she had introduced herself while I was drugged, given the male who introduced himself to my husband claiming to have spoken to me before surgery, and given my memory of what was done prior to the colonoscopy, it seems consent for student or other potentially offensive (to the patient) participation after patients are drugged. In my opinion the consent fails under these conditions and thus this once again, as in the first incident in June, rises to the level of sexual harassment and battery.

    Many women experience non-consensual penitration of any sort, including by physicians, as and act of violence. I have read many accounts of such violence against patients, how the patients object and some physicians/students rationalize this practice, while other physicians/students refuse to practice in this fashion. One doctor, who happens to be a personal friend, told me about her own training through practices of “medical rape” how much she regretted that something that turned out to be so harmful to the patient had been done for her own benefit, and how she had been used as a front to get uninformed consent for a parade of students who were subsequently brought in to follow her exam with a multitude of exams, the first of which was not medically indicated. Of course women are not alone. Male patients are abused as well. One man did not go all the way under, and suffered the trauma of 8 students practicing unauthorized rectal exams prior to a colonoscopy. I have read dialogues on medical chat boards between lawyers, who’s practice is to defend physicians, trying to tell them not to do this, and physicians. Some who listen, but others attack personally and without reason to a point where at least one attorney was contemplating crossing over to the other side. The most interesting, however was a male physician/patient who complained when he had told a student ‘NO” and yet following the attending’s orders the student plunged his finger up the good Doctors rectum before he knew what hit him. This physician/victim agreed, the act of unconsentual penitration is a form of violence, a form of violence that some have come to call, “medical rape“. This is why it should only be done in emergencies, not as a means of overcoming the inconvenience of consent or personal rights. There are many professionals who agree and some medical students have even risked their careers in refusing to do unauthorized exams. Therefore, in good company, I maintain the act of anyone examining our cutting on intimate parts of my body and to whom I did not give explicit and specific informed consent has committed patient battery. In cases where my request for female practitioners is also violated w/o reasonable prior consult and consent it is also a case of sexual harassment. Given this is occurring in a government facility; it is a violation of my civil rights.

    After the colonoscopy, my rectum hurt more than it should. I took a mirror and looked, it was badly bruised. I called Dr. Collins who had no medical explanation for the physical trauma. She stated that there were no problems with the procedure and no reason for the bruising and pain. I found this very alarming. I asked her had I not made myself clear that I did not want men involved. She said I had, and that she was sorry. I asked her why the “tech” did not leave the room as he said he would. She said she did not know why he did not step outside the door, but that she also heard him say that he would not stay inside the room. I knew I could no longer talk to her without losing it; I thanked her for her apology and hung up. I was angry that after telling Dr. Collins I did not want men, she did what she wanted anyway. I was angry that I had been lied to by Dr. Collins before the procedure. I hate being lied to as it takes away my freedom. I cannot make free choices; I cannot protect myself if I am being manipulated by lies and the concealing of information. Now it was obvious to me I was being abused for the sake of training, and I was still not being told the whole truth about who was doing what to me once they put me under anesthesia. After researching practices at OHSU/PDX V.A., it is reasonable to assume that Dr. Schreiner was likely not the only male trainee in attendance that day, not the only male who performed a rectal exam, and he was certainly not the only male involved in the procedure.

    After the gastric empty study and colonoscopy, I expected a follow-up appointment in the G.I., but had to ask for one. I thought I would be going back to the Dr. Kanigge, who ordered the test, but the appointment was made with Dr. Collins. I accepted; I wanted to tell her to her face how I felt about what she did. She seemed to have no answers to my questions. Honestly one would think she was not there. She acted like she was either not there, or was working hard to bite her tongue regarding the source of the physical trauma. After this appointment, Dr. Collins wrote in my notes that she had informed me that the male tech would be involved in the procedure. This is a lie. She said nothing about the tech. (This was my first indication that he had been involved beyond polyp delivery to lab.) She introduced the fellow, told me he would be doing the procedure, and then the “tech” Mr. Miller introduced himself, and said he would be outside the door only to retrieve and deliver polyps to the lab. Dr. Collins did not introduce this man, nor did she say anything to me about Mr. Miller. In spite of saying he would leave, he remained in the room and participated in the procedure. In 2004 a colonoscopy plus upper G.I. (w/three folks involved) took 20 minutes in Roseburg for both procedures. It took four people over twice as long to do this colonoscopy as it did three people to do two procedures, a colonoscopy and upper G.I. in 2004, and in 04 there were more polyps removed. Why should an uneventful colonoscopy in PDX take 45 minutes? Was my health being risked for the sake of training multiple students? More students seem to have been involved in the June surgery than I had been informed of before or after the surgery, and physical symptoms support this suspicion. A physical exam by another physician revealed fissures and a “butter fly shaped” infection that seemed to be concentrated on only one side of my rectum. This “infection” was very painful, itchy, and took it’s own good time getting better.

    After the colonoscopy, I decided I should take a closer look at my medical records. This is when I found Dr. Shabnam Chaugle, was named as the surgeon for the mastectomy, and noticed all the men that had been involved in my care while I was under anesthesia in June. Dr. Kwong had straight up lied. In spite of her reassurance there were no men, “on the team”, there were men all over me. The records I was given upon request name one who did an EKG named Curt Basham, one who was involved in prep and surgical count named Ronald Gschwend, one Jeffery Hoke who was in charge of my care after the surgery while I was still under the influence of sedation. While not in the records I was given, according to a person with insider access to V.A. records, a Gregory Adams was listed as the surgeon in the records she accessed, and Donald McConnell as the attending. (McConnell explains the mystery “Chief of something” who spoke to my husband.) I was not introduced to these men before or after surgery (or at least not before being drugged). These men were hidden. As a result of this deception, I now have no confidence in male or female physicians. The V.A. web site claims that women do not use the V.A. due to ignorance of availability. Women do not use the V.A. due to fear of this sort abuse. Many women veterans myself included have suffered prior sexual abuse my medical professionals in military hospitals. We move on with our lives, but have learned to be careful of male doctors; then the V.A. subjects us to conditions that are not only offensive and intolerable (male care under anesthesia) but risks repeated sexual assault. These events have left me incapable of thinking about having to once again go under anesthesia. As I cannot trust female physicians, I have been left with knowing that the next time I need care requiring anesthesia, I will either have to negotiate family presence throughout the entire time I am under the influence, or reject care.

    It was obvious they had made no effort to consider my expressed need for females, for dignity, autonomy, privacy, and security. I would NOT have consented to male participation had I been told. I DO NOT WANT MEN AROUND ME WHILE I AM UNDER ANESTHESIA. Furthermore, I was much more worried about the mastectomy than the oophorectomy. Had anyone bothered to ask; I would have said yes to the two OBGYN physicians, and only those two WOMEN. If asked, I may have approved of two more female students performing exams prior to sedation, no more than two, not while under sedation, and no men. NO MEN!!! Not observing, not participating. I absolutely did not want men around me while I was having my breast severed from my body, having GYN surgery, and certainly did not want them participating in the process. The V.A. knew this and rather than respect me, my autonomy, my rights, they lied. They made no attempt to limit male participation, only to hide such participation, to hide their dirty little secret. This is a perfect triangle of abuse; the perpetrators, the silent partners, and the victims.

    Not only is this a failure of “informed consent”, and a case of battery, as the V.A. is a federal institution, it is a violation of my civil rights. Dr. Kwong had a duty to inform me that she would not be performing the surgery. The consent forms (signed in advance, though I now suspect they have other forms they have you sign after you are drugged) make it sound like the “resident” getting the consent is doing just that and no more, and that the “supervising” is the surgeon (supervising the resident and consent) who does not have time to fill out all this paperwork. In my case, a woman was the resident who attained the consent, Michelle Ellis. Michelle is the resident I thought would be assisting Dr. Kwong and helping with post surgical care. I did read the forms (presented as consent on the 16th two days before surgery), and the consent form being a bit obscure asked questions. (It would take an attorney for a patient to know they were signing a consent for anyone to do the surgery and for multiple unnecessary intimate exams, and then they would argue over what such general language really means.) I asked Michelle Ellis, and again I was told Dr. Kwong was doing the surgery. This misrepresentation violates the patient’s right to rely without reservation on the belief that her doctor will act only to protect her body, dignity, and safety, and not expose her to unnecessary risks without her knowledge and consent. If Michelle is present in O.R. she is there as a unidentified student. As students are not listed in the records to which I have access, I have no idea how many male students, staff, may have been in attendance during these procedures. I only know there were men present and participating, some are listed in the medical records I was provided and some are not.

    Given the prevalence of this practice of not telling patients that the surgeon they think will be operating is only supervising (which may or may not mean they are in attendance), of failing to introduce patients to residents, students, or trainees, who will be performing exams and/or procedures, given what I have learned about teaching hospital practices in general, and OHSU/PDX practices in particular, given an infection in my pelvis after the first surgery, and the trauma and infection in my rectum after the colonoscopy, there is reason to suspect that teams of students, were not only observing but performing unauthorized exams such as breast, pelvic, and rectal exams while I was under anesthesia. This sort of bait and switch and mass participation, unrestrained by informed consent and empowered patient control, has not served my medical or psychological health. I have suffered unnecessary pain, physical and psychological trauma, and multiple infections. Furthermore, it places women at greater risk of sexual misconduct while under anesthesia by establishing a culture in which women’s autonomy is meaningless, in which women are not self determining subjects, but objects to be subjected to the will and interests of others, all while women are the most vulnerable, completely incapable of defending themselves.

    It is hard enough for a woman to go through a mastectomy, some may not mind male participation, but for others, to have unwanted males involved is stressful, even scary, to do so without informing the patient well ahead of time and in an appropriate fashion is abusive, violent and harmful. I cannot say I did not know this was a teaching facility; but I certainly did not know they would not inform me of, even conceal the extent of, student and/or male participation. All autonomy, all dignity, all subjectivity was stolen. I am very upset that a woman in this day and age with all the female practitioners cannot go through a mastectomy, oopherectomy, or colonoscopy without the security and peace of mind knowing that men will have access while she is under anesthesia. I have been assured no man in the V.A. would take advantage in a situation where a woman had been dosed with a date rape drug or other anesthesia, where he could expect to get away with it and no one would know. Excuse me if I do not buy the B.S. This is exactly what Dr. McConnell evidently did, take advantage of me while I was under anesthesia, to substitute my autonomy for his own will. My requests for male absence during these procedures was not unreasonable. Statistics for rape are horrific. 10% of males admit that they find extreme violence (with little sexual content) against women erotic, and half find rape erotic. (A good reason not to want males present during a mastectomy.) 60% of male college students asked said they would rape if they knew they could get away with it, and the Military culture is known for being abusive of women from recruitment to the V.A. 2 (A good reason not to want males providing care while under anesthesia.) While patient advocacy compared my opposition to male involvement in such procedures to racism, the analogy is not a valid one. Asians do not go about systematically abusing and raping white men. Asian care providers are not members of a population that is a real and current threat to any other demographic; male care providers are members of a population that remain a threat to women. Women are sexually assaulted by male care providers every day. These instances of concealment and blatant disregard for my very clearly expressed feelings regarding males participating in my care amount not only to sexual harassment, medical battery, and a violation of my civil rights, but given stats above also endangerment. I had a right to exclude men from a surgery the likes of a mastectomy and oophorectomy, and procedures the likes of a colonoscopy. If OHSU/PDX V.A. could not or did not want to respect that, I should have been told right away, by Nancy Sloan. At that point I could have freely chosen to seek care elsewhere, chose alternative care, tried to negotiation something I would be comfortable with at the V.A. (Such as family member presence by my side at all time during anesthesia), or even exercise my right to refuse care all together.

    These physicians have caused me grave psychological trauma and inflicted unnecessary pain and suffering. This is a breach of Dr. Kwong’s and Dr Collin’s fiduciary duty in relationship to me and my health care. The entire V.A. staff and especially the physicians had a duty to do all that was necessary and reasonable to ensure I made it through this tragedy with as little physical and mental health risk as possible. If that was not their top priority, if my dignity, autonomy, health, was to be subordinate to education or the whims of Chief of Surgery, they should have informed me that their primary interest was their own, allowing me to seek more patient friendly care elsewhere. This breach of the special doctor-patient relationship in favor of other interests has lead to a complete and total loss of trust in medical professionals and has caused me much, pain, distress, humiliation, and may have resulted in a sexual assault w/resulting STD. Hear me out.

    After the bruising went away, the pain subsided a bit then came back worse. I went for an STD screen (western Blot), it came back positive for Herpes 2. I was told this was a good test (Western Blot) and the chances of a false positive were very low. My partner with whom I have been in a monogamous relationship for 20 years, subsequently tested negative. I had a pap done in Feb of 07. This pap could be de-stained and tested for the HSV 2 DNA and antigen. 3 If negative this would prove the exposure occurred sometime in the last year. I asked for those slides and was refused. I was also told by a man in Pathology that “I did not have HSV then, and I do not have it now.” I am not giving up on accessing those slides. He claims they will do me no good as they will only indicate if there were an outbreak at the time. However, it is my understanding the slides can be tested for the antigen. If negative this would indicate I had not been exposed prior to the date the pap sample was collected. While the V.A. may make excuses for not relinquishing the slides, OHSU did not refuse me access to the biopsy slides. Rather than obstructing this investigation the V.A. should be assisting me and taking steps to find the source if contracted in the last year, and remedy the means of transference. (NO, there has not been a single recorded case of contracting Herpes 2 from toilet seats and door knobs.) If not exposed by Feb of 07, the most likely exposure came from the V.A., through improperly sterilized temperature controlled equipment, or sadly sexual assault while under anesthesia.

    While Dr. Dryden claims I was attended to by the female nurse until I became “alert”; this is insufficient to ensure a lack of opportunity. “Alert” does not imply recall. My first memory is back with my husband both times after anesthesia, in June and December. I did not remember transport, which does not occur until you are “alert”. The medical records provide evidence that at times males have been involved in pre-surgical prep, intimate exams and procedures, and after care while still under anesthesia. I have discovered this much in spite of efforts to hide male involvement. Odds are there has been further male involvement which I have been unable to uncover.

    The “flag” referred to by the V.A., according to Dr. Collins, supposedly states “don’t even ask”. After much research, I am now well aware of the “don’t ask, don’t tell” training practices used by OHSU faculty on “public“ patients. This seems to be exactly the practice Dr. Kwong/Dr. McConnell employed when he stepped in with Dr. Adams, and she lied before and after surgery about who was present and involved. I have every reason to believe that I will be lied to and my requests ignored should I once again find myself anesthetized by PDX V.A. I can have no confidence in what I am being told by people who I know as a matter of practice mislead, misinform, obscure truth, and outright lie, all to manipulate patients, by people willing to secure UNINFORMED consent after administering mind and/or mood altering drugs.

    Under these conditions of deception and prioritizing physician education over patient health and safety, how can I even have confidence that I had cancer? OHSU/PDX VA needs to train students, OHSU faculty at PDX VA have demonstrated that teaching is their priority over and above veterans’ health and well being; OHSU is in control of both imaging and pathology upon which diagnosis is based. Pathology is not an exact science, and OHSU has a strong incentive to diagnose female veterans with breast cancer as they can train students on us without the risk and liability the suffer at OHSU. In September of 2007 I rec’d a letter from Nancy Sloan telling me my mammography at OHSU had turned out OK. I called her to let her know that was not so good as I had a mastectomy. She checked it out and said that it was the MRI of the right breast the letter referred to, but the letter did not say MRI it said mammography. I would have, and did at the time, just assumed this was an innocent error; but now, I realize I can never assume innocence concerning OHSU/PDX VA. (I checked the stats. Female Veterans are twice as likely to be diagnosed with breast cancer as women in the general population. Why? Are they just twice as likely to be diagnosed? Or, have they suffered some Military specific exposure, in which case breast cancer should be recognized as a service connected condition?)

    As OHSU expands it teaching operations to all Oregon V.A. facilities, as all V.A.s across the country become teaching outlets, abuse will also expand. As the V.A. allows teaching institutions access to all V.A. facilities, as all Veterans suffer a heavier burden of training medical students, female vets will be super exploited. Being in short supply relative to the demand for training opportunities in female specific care, women will suffer a greater number of practice exams and a greater number of student errors. In the absence of informed consent as a limiting or controlling factor female veterans who seek V.A. care will suffer a greater risk of battery.

    While some physicians claim that unauthorized exams and ghost surgeries are necessary to education as no one would consent to student care; research indicates this is simply not the case. Research shows that 87% of patients when asked will allow student participation in their care. 4 Most will want to negotiate numbers, such as limiting the number of students who can perform pelvic or rectal exams; some will want to negotiate gender specification for intimate procedures. Most will want information about the level of supervision and student participation. This is a patients right, and research indicates time after time patients prove to be amazingly generous. Patients have proven to have more confidence in the students than the students do in themselves, and when included in the process as a subject rather than an object patients can offer highly constructive feedback. It is not necessary to teaching residents in a surgical setting to employ sexual harassment, deception, manipulation and even a form of battery some, including this patient, have come to call, “medical rape“. In terms of practice exams (which require a high volume of student training), if there are not enough willing patients, such exams can be performed on paid subjects, called “standard patients” just as models are paid in art classes. Medical schools may need to expand their pool of patients served and be more willing to ask every patient (not just the “public” patient) to participate, spreading the burden out over a reasonable number of FULLY informed consenting patients. In cases of surgery, the physician and student may have to take some time with the patient. The student may have to take the time to get to know the patient and provide some amount of care for the patient prior to surgery. In the end this has to be the patients free, (not a coerced, manipulated, and selectively informed even misinformed) choice.

    What needs to be done:

    I want full and complete disclosure as to who was present during, who performed exams, and who participated in these procedures. I had a pap February of 2007. The slides are on file at PDX VA. Per instructions for me to, “go through proper channels”, my physician Dr. Margaret Philhower, ND, PC has requested these slides. She sent a copy and I faxed a copy to PDX VA myself, called and was told the request has been sent to pathology. I want these slides surrendered for an independent test for HSV DNA and antigens. If this sample test negative, I would like for all staff involved in my care while under anesthesia be tested for Herpes 2, as well as the patient the colonoscopy equipment was used on prior to me. I would like video of relevant hallways, recovery room, and O.R. while I was in their care to be reviewed to ensure that all who had access are identified and tested. Those who test positive should be tested further for the particular strain, which could be subsequently evaluated for a match with my infection. If a match is found, the means of infection may need to be investigated. If sexual assault is indicated, I want full cooperation from the V.A. in seeking all evidence and information required for an effective prosecution. Either way, if this bait and switch and inclusion of male residents was Donald McConnall’s call, and as Chief of General surgery one would assume it was his call, he should be forced into retirement for violating my civil rights, patient battery, sexual harassment, and (as I was left in the care of at least one male while under anesthesia) endangerment. He should also be charged criminally. By stepping in and taking over this surgery, knowing full well I did not want him and other men involved, this man has proven his willingness to, perhaps even passion for, committing patient battery in the form of what is increasingly labeled “medical rape.” He should be removed as Chief of General Surgery at PDXVA. The man is 66 years old. It is time he retire. Given all the deception (which they like to call a “missunderstanding”); I cannot know for sure who all may have been involved in any of these procedures.

    I would like policy regarding informed consent be changed. I have enclosed a copy of The American Medical Student Association’s, “Principles Regarding Patient Rights”, as well as, a “Draft of Proposed Legislation Concerning Informed Consent and Medical Accountability”, by Eileen Marie Wayne, M.S. 6 ALL consent forms should be presented at least 48 hours before surgery, and ALL participants and any student exams revealed and explained verbally and in writing. The goal should be full disclosure, not tricking, manipulating, or deceiving a patient. When a woman indicates in any way she is not comfortable with males participating in her care, staff should immediately ask questions necessary to record in detail patients limitations on male participation and then those limits should be respected save an unforeseen emergency. If undesirable male participation will be hard to avoid, or in a particular case not in the patients best interest (as would be the case that a particular staff member is the only one well trained on a particular procedure) the patient should be informed, introduced to the male and honestly told in full the extent of his expected participation and why she is better off in his care. I am not opposed to ALL male participation in my care and I resent staff implications that this is the case. One man involved in my pre-surgical sentinel node mapping, either sensitive to my discomfort, or to women’s discomfort in general, informed me that he was on the team that invented the procedure being done, had done it on hundreds perhaps thousands of women. He was good, professional, and had an excellent “bed-side manor”, he was not severing my breast from my chest, or poking around orifices, and most important, I was not under sedation. Not a problem. Though I do not think this should be assumed for all women. Some women will need ALL female care providers and the V.A. has a responsibility to provide such for women who have suffered MST, just as person with their leg blown off should be provided a prosthesis.

    What I am personally opposed to, is not being able to control male participation, from restrictions to prohibitions depending on the care being provided, whether or not I will be sedated, and the hit I get off those participating when introduced. I am opposed to being lied to by my medical providers, confidence in whom is of utmost importance. This is a reasonable request being made by a reasonable woman.

    According to the, “Principles Regarding Patients’ Rights“, published by the American Medical Student Association, http://www.amsa.org/about/ppp/pr.cfm, Patients have the right to choose whether, how, and under what conditions to participate in training of medical students. However, “in many cases permission is sought at the last moment, making it difficult to refuse.” It seems, in some cases a “better to ask forgiveness rather than to ask permission” strategy is employed. In others a “don’t ask, don’t tell” policy is used. The AMSA suggests a patient, should be told when the appointment is made and given all information necessary for consent to be informed including status, experience level, supervision level, and sex.

    1. http://books.google.com/books?id=A96zJ1wmftgC&pg=PA176&lpg=PA176&dq=surgery+increase+growth+rate+of+cancer&source=web&ots=-hoghDaC1r&sig=GOAmOxJI5l3LvwKE-Ip-uuvNm30&hl=en

    http://goliath.ecnext.com/coms2/summary_0199-4953332_ITM

    2. http://hardright.blogspot.com/2005/08/rape-and-consequences.html

    http://www.dianarussell.com/menrape.html

    3.

    4.

    5.

    6.

    Cc: Peter DeFazio

  18. Phleb Trainee says:

    When I was training to draw blood I had to work in a clinic for a week. I made sure that before I drew any blood from a patient I informed them that I was a student. I always requested their permission before I proceeded with the proceedure. I only had one patient refuse my care. Most people are willing to allow students to work on them, but it is a betrayal of trust if you do so without consent. SHAME on any medical professional that does such an action.

  19. Cul2 says:

    I agree with all the sentiments expressed on this blog. But I note that most of these horror stories are told by women. How do you women feel about the double standard men have to go through when they need intimate exams and procedures. Because most of the staff doing these procedures are female (nurses, medical assistants, technicians, CNA’s), men usually have no choice for any kind of intimate care or procedure. If by some slight chance there’s a male nurse available, the man may be accommodated. But if a man asks for this accommodation, they’re often considered sexest. If a woman wants a female nurse instead of a male, she’s assertive and taking control of her body and is always accommodated. And if a man asks for an all male team to do an operation on him, it’s considered a joke? They won’t even lie to him and say they’ll accommodate him. So it goes both ways, and men and women need to work together to help each other with these unethical practices.

  20. kyle says:

    For a male oriented view of the conditions

    discussed on this blog, please see Dr. Maurice Bernsteins’s Patient Modesty Blog, now in

    5 volumes.

  21. Cul2 says:

    I’ve seen that blog and I find it interesting. What I’m asking is for any comments by those on this blog. I don’t see this so much a gender issue as one of informed consent, patient modesty, respect for the dignity of each person, and choice. Men and women both suffer from the healthcare systems lack of concern for these issues.

  22. Ghost surgery and medical procedures performed without our informed consent are slam-dunk battery cases. But our “laws” are only as good as those enforcing them.

    Elizabeth LaBozetta

    Central Ohio Patient’s-rights Service

    Citizens for Medical Safety

  23. Ghost surgery and medical procedures performed without our informed consent are slam-dunk battery cases. But our “laws” are only as good as those enforcing them.

    Elizabeth LaBozetta

    Central Ohio Patient’s-rights Service

    Citizens for Medical Safety

  24. MCKean says:

    “But if a man asks for this accommodation, they’re often considered sexest. If a woman wants a female nurse instead of a male, she’s assertive and taking control of her body and is always accommodated.”

    No, we are also called sexists. I was called a sexist for requesting males not perform intimate exams and procedures while I was under anesthesia. After I found out they lied and violated that request I complained only to be called a sexist over and over again. Sexist, crazy, and greedy. It is just a projection of the sexist greedy abusive docs including women.

    You are right. It is an issue of informed consent and we do need to work together for patient rights. My husband is now afraid to get a colonoscopy.

  25. Cul2 says:

    MCKean — Patient modesty and privacy is not a one-gender issue. It goes both ways. Your case demonstrates that. But the odds are, with so many women as nurses, med assts and techs, that there won’t be a male nurse for a man and there will be one for a woman. But, as you point out, it’s an issue for both sexes. You have the basis of a complaint to the medical ethics board, the licensing board and even the Joint Commission. Recently, the Joint Commission came out with a new set of accreditation guidelines that included patient safety. That includes the kinds of bullying and intimidation you received by being by not beint taken seriously and being called sexest.

  26. Cul2 says:

    MCKean — Patient modesty and privacy is not a one-gender issue. It goes both ways. Your case demonstrates that. But the odds are, with so many women as nurses, med assts and techs, that there won’t be a male nurse for a man and there will be one for a woman. But, as you point out, it’s an issue for both sexes. You have the basis of a complaint to the medical ethics board, the licensing board and even the Joint Commission. Recently, the Joint Commission came out with a new set of accreditation guidelines that included patient safety. That includes the kinds of bullying and intimidation you received by being by not beint taken seriously and being called sexest.

  27. Cul2 says:

    MCKean — Patient modesty and privacy is not a one-gender issue. It goes both ways. Your case demonstrates that. But the odds are, with so many women as nurses, med assts and techs, that there won’t be a male nurse for a man and there will be one for a woman. But, as you point out, it’s an issue for both sexes. You have the basis of a complaint to the medical ethics board, the licensing board and even the Joint Commission. Recently, the Joint Commission came out with a new set of accreditation guidelines that included patient safety. That includes the kinds of bullying and intimidation you received by being by not beint taken seriously and being called sexest.

  28. Juliet says:

    I’m sorry to hear of your upsetting experience – the deception is unjustifiable and disgraceful.

    I think patient modesty goes both ways, but women face a bigger problem.

    The long history of disrespect, inappropriate behavior and sexual assault by male doctors and other males in medical settings.

    I worked at the Medical Board as a young lawyer and found the cases upsetting – I also felt quite angry…

    At that time women were laughed at if they asked for a female doctor (including by other women) yet every day I was listening to male doctors abusing their position of trust.

    We know for every complaint – there are 1000’s that we never hear about…the woman avoids doctors and internalizes her distress at the violation of trust and her body.

    The fact women are not given risk information for cervical and breast cancer screening is a disgrace – women are bullied into procedures that may end up harming them. Others are “required” to have unnecessary and invasive intimate exams and tests.

    It is not possible to provide informed consent when you’re required to submit to get the Pill or are not given risk information.

    Women are free to reject any and all exams and tests and see the Dr of their choice.

    I’ve found the only way to manage the harm is to be informed and stand up for yourself, which can be difficult considering the power dynamic between doctor and patient.

    I only see female doctors and have found they accept and respect my informed decisions.

    I refused to participate in cervical screening 30 years ago (after doing extensive research) – the risks FAR outweighed the benefits for me.

    I’ve found women generally are not aware of the real risks with this screening….why would they be? The information is not disclosed or just the bare minimum…

    The UK screening lobby were recently forced to release risk information for cervical and breast screening to every women in the UK…the screening lobby is powerful – doctors, pathologists, specialists make a fortune from screening.

    The smear is an unreliable test for an uncommon cancer = false positives and negatives.

    Some senior doctors have been brave enough to speak out – notably Prof Michael Baum (top UK breast cancer surgeon) and Dr Angela Raffle (cancer screening expert)….

    Did you know 1000 women have to be screened for 35 years to save one woman from cervical cancer? (Raffle)

    Did you know in an unscreened population only 1.58% of Aust. women would get this cancer?

    Did you know with regular screening 77% of women will have a colposcopy and possibly, biopsies.

    The conclusion – a few are helped and thousands are harmed…

    I think every women should do her reading and do a personal risk v benefit assessment before she agrees to cancer screening.

    The evidence against mammograms is also bad – new research shows regular screening may increase your chances of getting breast cancer – they suspect from bruising the tissue. Mammograms also have false positives.

    Screening has uncovered a slow moving cancer (Ductal Carcinoma In Situ) many older women have this cancer – they will invariably die way before this cancer bothers them. Once detected though, a biopsy can cause the cancer to become invasive. Also, once discovered, Drs are obliged (fearing litigation) to remove the breast.

    Their is lots of evidence to say routine rectal and pelvic exams are unnecessary in asymptomatic women and can be harmful. (my Dr readily agreed on that one)

    There is also little clinical value in breast exams on women under 40…

    Women starting the Pill need a blood pressure check, but are often forced to have invasive exams. These exams are unnecessary and can be refused…

    I’m now 50 so have decided instead of mammograms to have my breasts examined once a year by a female breast cancer specialist.

    I do fear every having to go into hospital – but I have private health insurance which gives me a bit more power – choice of Dr….

    Also, when you’re paying, hospitals want you to have a positive experience – it’s good business.

    I’m amazed no one has opened an all female and all male private hospital – you’d make a fortune…

    I know many men would prefer all-male staff for urological exams and procedures.

    Discrimination laws would not pose a problem when you consider the reasons for the hospitals. Female gyms were approved, so a gynaecology or urology hospital would have no problem at all.

    Sorry if I’m a bit off topic. but I just wanted to highlight that disrespect and inappropriate treatment is a common theme in female “health care”….

    Good for you for speaking out – it’s only when we make a fuss, that others will listen and perhaps things will change.

    It wasn’t long ago when anesthetized women were subjected to multiple invasive exams by medical students and others. It was the medical students that had a problem with the ethics and the question of consent – many older doctors couldn’t see a problem.

    There has been some talk over the years about patient companions – someone who would accompany you when you’re unconscious ensuring your wishes are respected and your dignity protected…

    I read many cases of women being left exposed and vulnerable while orderlies leered at them or doors were left open – it horrifies me – dehumanizing treatment.

    In these cases no one covered the woman and/or closed the door – it seems no one took responsibility for the patient’s dignity and well-being. As a result, the patient is often traumatized and scarred for life.

    These things should NEVER happen….and if they do, scream loud and clear – force change.

    We’re human beings, not lumps of meat.