Shockingly, this “outrageous assault upon the dignity” of female patients continues to this day.
Medical Students Practice Pelvic Exams on Anesthetized Women Without Their Consent
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
These two videos contain descriptions that may be difficult to hear for some people —the practice of medical students performing pelvic exams on anesthetized women without their consent and without their knowledge. This has come under fire over the years, but obviously not enough, since it continues to this day.
From Heart Failure, a book I wrote about my time in medical school: “I am all gloved up, fifth in line. At Tufts [University School of Medicine], 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 knowledge or consent remains a dirty little secret about medical schools. It is an age-old practice that continues to this day in medical 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.” “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.” “I don’t think any of us even think about it,” said the director of resident and medical student education at the Johns Hopkins University School of Medicine. “It’s just so standard as to how you train medical students.”
When this practice came to light in New Zealand, the chair of the 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 reporter, that women might object? “All I can say is that there have been no objections . . . ” “Could the reason be,” asked the interviewer, “that it’s very hard for an anesthetized woman to know what’s going on?”
Many hospitals and medical schools have publicly defended the practice, 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.” Though researchers have found that many patients don’t know they are in a teaching hospital, or that medical students are involved in their care because of the deliberate lies and deception.
A survey of medical students found that 100 percent of them had been introduced to patients as “doctor.” And as they go through training there’s an “Erosion in Medical Students’ Attitudes About Telling Patients They Are Students.” As medical students go through training, their sense of responsibility to inform patients that they are just students is found to decrease, especially if the opportunity exists to perform an invasive procedure. That may be why medical students seem to develop this “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.”
After all, doctors argue, performing a pelvic examination is no more intimate than placing one’s hands inside a surgical incision. Sticking your fingers in a woman’s vagina is no more intimate than an ophthalmologist looking into the back of your eye, and any claim to the contrary is just another attempt to justify the obsession with political correctness. “Personally,” said one medical school professor, “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, by the mere act of admission, relinquish their rights as human beings…”
Is it possible women just don’t care? Studies show that up to 100 percent of women asked said they would want to know that vaginal examinations were being done by medical students. Okay, since patients care deeply about being asked, why can’t we at least ask their permission? “We can’t ask women,” medical school faculty replied. “If we do, they might say no.”
Please consider volunteering to help out on the site.
- Greger M. Heart Failure: Diary of a Third Year Medical Student. 2000.
- Greger M. Heart failure - miscarriage of justice. United Progressive Alumni.
- Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63.
- Frank T. Uproar over act of conscience. Wesleyan University Magazine. 2004;(1):27-9.
- Goedken J. Pelvic examinations under anesthesia: an important teaching tool. J Health Care Law Policy. 2005;8(2):232-9.
- Coxe MF. A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;189(6):1808-9.
- Markoe L. 'Nonconsensual' pelvic-exams under scrutiny. Chicago Tribune. June 25, 2003.
- Scheibel D. Appropriating bodies: organ(izing) ideology and cultural practice in medical school. J App Comm Research. 1996;24(4):310-31.
- Tishelman R. Don't touch. Hastings Cent Rep. 1994;24(4):45.
- Caruso DB. Many med schools halt no-consent pelvic exams. The Seattle Times. March 12, 2003.
- Coney S. The unfortunate experiment. Auckland, New Zeland. Penguin Books. 1988:206-7.
- Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63.
- Wall LL, Brown D. Ethical issues arising from the performance of pelvic examinations by medical students on anesthetized patients. Am J Obstet Gynecol. 2004;190(2):319-23.
- Gibson E, Downie J. Consent requirements for pelvic examinations performed for training purposes. CMAJ. 2012;184(10):1159-61.
- Ubel PA, Silver-Isenstadt A. Are patients willing to participate in medical education?. J Clin Ethics. 2000;11(3):230-5.
- Caldicott CV, Faber-Langendoen K. Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students. Acad Med. 2005;80(9):866-73.
- Friesen P. Educational pelvic exams on anesthetized women: Why consent matters. Bioethics. 2018;32(5):298-307.
- Silver-Isenstadt A, Ubel PA. Erosion in medical students' attitudes about telling patients they are students. J Gen Intern Med. 1999;14(8):481-7.
- Santen SA, Hemphill RR, Spanier CM, Fletcher ND. 'Sorry, it's my first time!' Will patients consent to medical students learning procedures?. Med Educ. 2005;39(4):365-9.
- Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;188(2):575-9.
- Association of American Medical Colleges. Research in medical education 1985: Proceedings of the twenty-fourth annual conference. 1985:146-53.
- Tocce K, Teal SB. Practicing pelvic examinations by medical students on women under anesthesia: why not ask first?. Obstet Gynecol. 2013;121(2 Pt 1):378.
- Kaushik NC. Please don't touch me there: the ethics of intimate examinations: what examination is not intimate?. BMJ. 2003;326(7402):1326.
- Cardozo L. Teaching vaginal examination. BMJ. 1992;305(6845):113.
- Graham J. The ethics of pelvic exams performed on anesthetized women without their knowledge. Deseret News. January 1, 2019.
Video production by Glass Entertainment
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
These two videos contain descriptions that may be difficult to hear for some people —the practice of medical students performing pelvic exams on anesthetized women without their consent and without their knowledge. This has come under fire over the years, but obviously not enough, since it continues to this day.
From Heart Failure, a book I wrote about my time in medical school: “I am all gloved up, fifth in line. At Tufts [University School of Medicine], 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 knowledge or consent remains a dirty little secret about medical schools. It is an age-old practice that continues to this day in medical 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.” “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.” “I don’t think any of us even think about it,” said the director of resident and medical student education at the Johns Hopkins University School of Medicine. “It’s just so standard as to how you train medical students.”
When this practice came to light in New Zealand, the chair of the 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 reporter, that women might object? “All I can say is that there have been no objections . . . ” “Could the reason be,” asked the interviewer, “that it’s very hard for an anesthetized woman to know what’s going on?”
Many hospitals and medical schools have publicly defended the practice, 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.” Though researchers have found that many patients don’t know they are in a teaching hospital, or that medical students are involved in their care because of the deliberate lies and deception.
A survey of medical students found that 100 percent of them had been introduced to patients as “doctor.” And as they go through training there’s an “Erosion in Medical Students’ Attitudes About Telling Patients They Are Students.” As medical students go through training, their sense of responsibility to inform patients that they are just students is found to decrease, especially if the opportunity exists to perform an invasive procedure. That may be why medical students seem to develop this “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.”
After all, doctors argue, performing a pelvic examination is no more intimate than placing one’s hands inside a surgical incision. Sticking your fingers in a woman’s vagina is no more intimate than an ophthalmologist looking into the back of your eye, and any claim to the contrary is just another attempt to justify the obsession with political correctness. “Personally,” said one medical school professor, “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, by the mere act of admission, relinquish their rights as human beings…”
Is it possible women just don’t care? Studies show that up to 100 percent of women asked said they would want to know that vaginal examinations were being done by medical students. Okay, since patients care deeply about being asked, why can’t we at least ask their permission? “We can’t ask women,” medical school faculty replied. “If we do, they might say no.”
Please consider volunteering to help out on the site.
- Greger M. Heart Failure: Diary of a Third Year Medical Student. 2000.
- Greger M. Heart failure - miscarriage of justice. United Progressive Alumni.
- Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63.
- Frank T. Uproar over act of conscience. Wesleyan University Magazine. 2004;(1):27-9.
- Goedken J. Pelvic examinations under anesthesia: an important teaching tool. J Health Care Law Policy. 2005;8(2):232-9.
- Coxe MF. A change in medical student attitudes of obstetrics-gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;189(6):1808-9.
- Markoe L. 'Nonconsensual' pelvic-exams under scrutiny. Chicago Tribune. June 25, 2003.
- Scheibel D. Appropriating bodies: organ(izing) ideology and cultural practice in medical school. J App Comm Research. 1996;24(4):310-31.
- Tishelman R. Don't touch. Hastings Cent Rep. 1994;24(4):45.
- Caruso DB. Many med schools halt no-consent pelvic exams. The Seattle Times. March 12, 2003.
- Coney S. The unfortunate experiment. Auckland, New Zeland. Penguin Books. 1988:206-7.
- Wilson RF. Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. J Health Care Law Policy. 2005;8(2):240-63.
- Wall LL, Brown D. Ethical issues arising from the performance of pelvic examinations by medical students on anesthetized patients. Am J Obstet Gynecol. 2004;190(2):319-23.
- Gibson E, Downie J. Consent requirements for pelvic examinations performed for training purposes. CMAJ. 2012;184(10):1159-61.
- Ubel PA, Silver-Isenstadt A. Are patients willing to participate in medical education?. J Clin Ethics. 2000;11(3):230-5.
- Caldicott CV, Faber-Langendoen K. Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students. Acad Med. 2005;80(9):866-73.
- Friesen P. Educational pelvic exams on anesthetized women: Why consent matters. Bioethics. 2018;32(5):298-307.
- Silver-Isenstadt A, Ubel PA. Erosion in medical students' attitudes about telling patients they are students. J Gen Intern Med. 1999;14(8):481-7.
- Santen SA, Hemphill RR, Spanier CM, Fletcher ND. 'Sorry, it's my first time!' Will patients consent to medical students learning procedures?. Med Educ. 2005;39(4):365-9.
- Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;188(2):575-9.
- Association of American Medical Colleges. Research in medical education 1985: Proceedings of the twenty-fourth annual conference. 1985:146-53.
- Tocce K, Teal SB. Practicing pelvic examinations by medical students on women under anesthesia: why not ask first?. Obstet Gynecol. 2013;121(2 Pt 1):378.
- Kaushik NC. Please don't touch me there: the ethics of intimate examinations: what examination is not intimate?. BMJ. 2003;326(7402):1326.
- Cardozo L. Teaching vaginal examination. BMJ. 1992;305(6845):113.
- Graham J. The ethics of pelvic exams performed on anesthetized women without their knowledge. Deseret News. January 1, 2019.
Video production by Glass Entertainment
Motion graphics by Avo Media
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Medical Students Practice Pelvic Exams on Anesthetized Women Without Their Consent
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Content URLDoctor's Note
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. Stay tuned for the next video Ending the Hidden Practice of Pelvic Exams on Unconscious Women Without Their Consent.
Please note: This video contains descriptions of sexual assault.
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