Patients under anaesthetic are vulnerable

Patients anaesthetised for operations are being used to train medical students in "intimate examinations" - without their consent.
A survey of students in one medical school suggested a quarter felt examinations they carried out on sedated or anaesthetised patients may not have involved "adequate consent".

I was told in the second year that the best way to learn to do rectal examinations was when the patient was under anaesthetic



Fourth-year medical student

Guidelines from the General Medical Council state that the permission of patients must be sought prior to any check or treatment.

However, the survey, carried out at the University of Bristol Medical School, suggests that this good practice is not always adhered to.

Students said they were asked to carry out rectal and vaginal examinations "inappropriately".

The training of medical students on real-life wards is part and parcel of life at British medical schools.

However, patients should always have the right to turn down requests to be prodded and poked by a succession of trainees.

The study, published in the British Medical Journal, suggests that corners are being cut - and that some patients are suffering the most undignified examinations without their knowledge.

'They'd never know'

One fourth year student told the researchers: "I was told in the second year that the best way to learn to do rectal examinations was when the patient was under anaesthetic. That way they would never know."

Many said that they felt pressurised to carry out the examinations by consultants.

Practitioners need to learn to do vaginal and rectal examinations in a sensitive and competent manner



Jane MacDougall, Addenbrooke's Hospital

The researchers wrote: "Trust and respect are essential to the doctor-patient relationship, yet this study suggests that these are missing from students' experience of learning to do intimate examinations."

At Bristol, the revelation that best practice was not being followed led to a formal investigation and action to resolve the situation.

However, the researchers believe that it is possible that similar problems exist at some other medical schools.

Getting it right

Jane MacDougall, the director of postgraduate medical education at Addenbrooke's Hospital in Cambridge - which trains medical students from Cambridge University - said that it was unclear whether this bad practice was widespread.

She said: "Practitioners need to learn to do vaginal and rectal examinations in a sensitive and competent manner.

"Many women consider pelvic examination an unpleasant experience, and some have been traumatised by it in the past - of these most attribute their fear to a previous rough examination by a qualified doctor.

"We owe it to women to get it right every time and in particular the first time."

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