Consent for intimate examinations

Twenty students are huddled around a patient trying to auscultate a cardiac murmur. Others try to percuss the chest of a patient with emphysema, oblivious of the patient’s agony each time the plexor strikes the pleximeter. An elderly gentleman complaining of difficulty in passing urine finds that all the students in the department will perform rectal examinations to feel his enlarged prostate, apparently unaware of the discomfort this could cause. The primigravida in the pangs of labour finds she is subject to a succession of students estimating the dilatation of the os in a per vaginal examination.

Such memories came back to me when I read an article on the ethics of having medical students learn through intimate physical examinations (1). Students responding to a questionnaire described how they had performed intimate examinations, including on sedated patients, without consent; often, many students examined the same patient. The report generated a heated debate on the ethics of such examinations for teaching purposes.

How many medical colleges in India even have written policies and guidelines on the subject? Once I asked a class of third-year medical students what they understood of medical ethics. Eight out of 20 said they had never heard of the term. What would their experiences be on learning how to conduct physical examinations?

This blase attitude is common in our outpatient departments. Students are enthusiastic about developing their skills even as they ignore the patient’s perspective. Today, people challenge the notion that such practices can be justified because of the need to train students. Patients cannot be used as teaching aids without their consent. They must be treated with dignity.