Examining without patient consent
AUCKLAND: New research has revealed some University of Auckland student doctors are performing sensitive examinations without patients knowing they are still in training.
More than 20 students — who had worked at general practices and hospitals around the country — told researchers they felt uncomfortable with the situation and said some senior clinicians responded that it was too difficult to explain to ‘‘uneducated’’ patients.
The University of Auckland study, published in the New Zealand Medical Journal today, received 100 reports from students about patient consent which raised ethical concerns.
Of those, 21 detailed consent issues around particularly sensitive examinations — including breast and genitalia checkups.
In 14 cases, the students performed the examination without the patient knowing they were in training.
Others observed the examination without consent while some students refused to carry it out without permission.
Issues raised in the reports included:
Senior consultants having no intention of asking for consent or explaining to the patient what the student would be doing.
Patients being unconscious and unaware student doctors had been performing sensitive examinations on them.
Students reporting patient consent often went out the window in order to maximise time and get through the theatre list.
Students feeling discomfort when their supervisors commented that getting consent ‘‘would take forever to explain to someone [the patient] that is uneducated’’.
Students not raising concerns for fear their registrar could destroy their future career with a bad reference.
The lead researcher, Auckland University associate professor in clinical medical ethics Phillipa Malpas, said they wanted to publish the research because this practice was ‘‘absolutely unacceptable’’ and needed to stop. She had received reports for the last eight years and each year students had reported performing sensitive examinations without consent.
‘‘Our students are legitimate members of the medical team but of course they are in training and under supervision and it’s important that patients understand that.’’
She said students were examining deeply personal parts of a patient’s body and it was really important that people were aware that this kind of examination was happening and why, and who was examining.
‘‘We know that when patients are asked if a medical student could observe or perform a sensitive examination, most patients say yes but most want to be asked,’’ Prof Malpas said. — NZME