Please note: This blog contains descriptions of sexual assault.
From Heart Failure, a book I wrote about my time at Tufts University School of Medicine: “I am all gloved up, fifth in line. At Tufts, medical students—particularly male students—practice pelvic exams on anesthetized women without their consent and without their knowledge. Women come in for surgery and, once they’re asleep, we all gather around; line forms to the left…We learn more than examination skills. Taking advantage of the woman’s vulnerability—as she lay naked on a table unconscious—we learn that patients are tools to exploit for our education.”
Using female patients to teach pelvic exams without their consent or knowledge remains “a dirty little secret about medical schools.” It is an “age-old” practice that continues to this day in med schools around the world. It’s been referred to as “the ‘vending machine’ model of pelvic exams, in which medical students line up to take their turn…” “Only it’s not a vending machine; it’s a woman’s vagina.”
It’s been called “an outrageous assault upon the dignity and autonomy of the patient…The practice shows a lack of respect for these patients as persons, revealing a moral insensitivity and a misuse of power.” Indeed, “it is yet another example of the way in which physicians abuse their power and have shown themselves unwilling to police themselves in matters of ethics, especially with regard to female patients.” Said a residency-program director at the Johns Hopkins University School of Medicine, “I don’t think any of us even think about it. It’s just so standard as to how you train medical students.”
What happened when this practice came to light in New Zealand? The chair of the New Zealand Medical Association got on television and said: “‘Until recently it wasn’t an issue…I’m very sorry that women feel they’ve been assaulted and violated in this way. That was never our intention.’ He had no idea then, asked the [TV] presenter, that women might object? ‘All I can say is that there have been no objections…’ ‘Could the reason be,’ asked the interviewer logically, “that it’s very hard for an anesthetized woman to know what’s going on?’”
The practice has been defended publicly by many medical schools and hospitals, contending “this touching is entirely appropriate and clearly falls well within the patient’s ‘implied consent’ to carry out the operation.” After all, “patients are aware they are entering a teaching hospital and therefore know that trainees will be actively participating in their care.” However, “researchers have found that many patients do not know when they have interacted with medical students, or even whether they are in a teaching hospital.” How can this be? “Deliberate lies and deception.”
“A survey of medical students found that 100% of them had been introduced to patients as ‘doctor’ by members of the clinical team,” and, as they go through training, there is, as a journal article is titled, an “Erosion in Medical Students’ Attitudes About Telling Patients They Are Students.” “Additionally, as medical students complete their clinical years of training, their sense of responsibility to inform patients that they are students is found to decrease,” especially if there is an opportunity to perform an invasive procedure. That may be why medical students seem to develop a “don’t ask, don’t tell” policy when it comes to seeking consent for pelvic examinations on anesthetized patients. More than a third of 1,600 medical students surveyed across the country strongly disagreed with the statement “Hospitals should obtain explicit permission for student involvement in pelvic exams,” as seen below and at 4:03 of my video Medical Students Practice Pelvic Exams on Anesthetized Women Without Their Consent.
After all, doctors “argue that performing a pelvic examination is no more intimate than placing one’s hands inside an abdomen during general surgery or attempting to intubate a patient” and assert that sticking your fingers in a woman’s vagina is “just as intimate” as an ophthalmologist looking into the back of your eye; any claim to the contrary is just “another attempt to justify the obsession with political correctness.” Said one medical school professor, “Personally, I would prefer to see a new generation of well-trained doctors…rather than a nation of women whose vaginas are protected from battery by medical students.”
The national survey concluded: “Patients admitted to teaching hospitals do not, however, by the mere act of admission relinquish their rights as human beings to have ultimate control over their own body and to be involved in decisions concerning their health care.”
Is it possible that women just don’t care? Studies show that up to 100% of women asked said they would want to know that vaginal exams were being performed by medical students. Since patients care deeply about being asked, why can’t we at least ask their permission? “We can’t ask women,” the medical school faculty replied. “If we do, they might say no.”
It’s jaw-dropping to me that I’m still trying to expose this practice more than 20 years after I first wrote about it. What’s to be done? Ending the Hidden Practice of Pelvic Exams on Unconscious Women Without Their Consent.
