A growing number of states require patient consent for medical students to perform pelvic exams

COLUMBUS, Ohio (AP) — A new group of states is considering enacting levels of informed consent for medical students performing pelvic exams for educational purposes on unconscious patients.

At least 20 states already have consent laws for this exercise.The Governor of Montana signed the bill in AprilMissouri has a bill that requires the governor’s signature to become law, and lawmakers in Ohio are also considering it..

Colorado lawmakers want to go one step further, and Democratic Gov. Jared Polis is expected to sign the bill into law. One bioethicist called it the most extensive he’s seen, because the students involved had to be pre-designated and referred to the patient, and said it may have gone too far. there is

Elizabeth Newman, public policy director for the Colorado Anti-Sexual Assault Coalition, who testified in favor of the bill, said supporters “see the Colorado bill as a model they hope other states will pass.” There are,” he said.

It is difficult to track and quantify the frequency with which medical students are asked to perform work-ups such as pelvic, rectal and prostate exams on anesthetized patients. Opponents of the various bills and laws, mostly doctors, argue that the government’s overreach could undermine the trust established between patients and health care providers and should be left to the recommendations of the Medical Association. are doing.

Patients typically sign a number of forms giving broad consent to a variety of procedures that may be medically necessary during anesthesia. This may also include consent for educational purposes.

Colorado Rep. Jenny Wilford, a co-sponsor of the bill, said, “Most people think they can just sign and get the care they need.”

But Newman said patients often don’t know they’ve been tested while unconscious, and even if they do, they may be afraid to come forward. Additionally, medical students who might report it are often afraid to voice their concerns to her boss, who has power over her own career, she said. .

Colorado’s bill would mandate an informed consent process, as well as pelvic, breast, rectal, and prostate exams to ensure that patients are within the scope of treatment. This is necessary even without the student, but in emergency situations the practitioner is excluded from the consent process.

The bill goes beyond other bills across the country to include whistleblower protections for medical students who want to speak out and liability for doctors and hospitals when they don’t follow consent rules. Also unique is the requirement that participating students be named on the consent form and referred to the patient prior to the procedure.

Clinical ethicist Kate Spector-Baghdadi said Colorado’s proposal was the most extensive she’d seen, and that listing the names of the students involved could limit learning opportunities. He said he was worried that Consent is usually obtained days or weeks in advance, but students may not be able to attend on the day, and Colorado’s proposed law would not allow others to intervene and learn, she said. Told.

“We want people to know in general how to care for women, and (these exams) are a key component of that,” said the Association of Professors of Gynecology and Obstetrics in its 2019 recommendations. Co-author Spector Baghdadi said. test. “It’s a balance between respecting patient autonomy and ensuring that the next time a patient sees a doctor, the doctor knows how to properly care for the patient.”

Association’s 2019 recommendationsThe group, which is backed by leading obstetrics and gynecology professional associations, says students should only have pelvic exams that are “explicitly consented” and “related to the planned procedure.”

But Professor Newman said this obligation is important not only for patients to give full informed consent, but also for medical students to know that their clients have consented and to learn the rules governing the consent process. Stated.

On the first day of her rotation at OhioHealth Hospital in Columbus, Ohio University medical student Alexandra Fountain was asked by the doctor overseeing Fountain’s training to perform a pelvic exam on an unconscious female patient.

Fountain said she didn’t know if a woman who was anesthetized for an abdominal operation that didn’t require a pelvic exam would have consented to the operation.

Fountain also told the Associated Press that he didn’t ask the doctor if the woman had consented, and that students were being taught “to be seen and not to be heard.” Ms. Fountain assured me that her doctor had no problem doing a pelvic exam and that she was “for education,” she said.

“At first I was frozen,” said Fountain, who ended up not getting tested, but said she did when she turned her back on the doctor. The experience prompted Fountain to testify before a House committee in Ohio. Her school supports her students’ “professional journeys,” she said.

OhioHealth, which has multiple teaching hospitals, told the Associated Press in a statement that its policy “regards patient consent and is consistent with current law,” and that attending physicians are “part of the medical education process.” He said he was overseeing the testing of a patient.

Phoebe Friesen, a bioethicist at McGill University in Montreal, said there can be a large disconnect between patients’ understanding of consent and procedures and their understanding of health care providers, and the study helped fuel the #MeToo movement. It has helped bring focus back to the practice.

Health care providers regard these unconscious tests as strictly medical or educational. No special informed consent is required as the vagina and other intimate areas are “just part of the body”.

But for patients, Friesen believes it’s absolutely necessary. Such tests can make patients feel disengaged and can re-traumatize survivors of sexual assault.

“The solution is very simple,” says Friesen. “Ask people if they are happy with this particular practice.”


Jesse Bidain reports from Denver.


Samantha Hendrickson and Jesse Bedine are members of the Associated Press/United States Congressional News Initiative Report.Report for America is a non-profit national service program that sends journalists to local newsrooms to cover cover-up issues.

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