Complaints from student doctors about doing sensitive examinations on unaware patients stun researchers
New research has revealed some University of Auckland student doctors are performing sensitive examinations without patients knowing they're 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 check-ups.
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 in fear their registrar could destroy their future career with a bad reference.
The lead researcher, Auckland University associate professor in clinical medical ethics Dr 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.
Chair of the New Zealand Medical Council and surgeon at Middlemore Hospital Andrew Connolly said not getting consent was technically an assault.
“You never know someone’s
personal situation. A woman could have been sexually assaulted earlier in the past and it might have taken everything she had to actually come to the hospital that day for an examination.”
Connolly said he was shocked 14 students had reported performing on patients who had not given consent.
“There must be explicit consent. It’s mandatory [and] just unacceptable that these patients were not given the right to consider if they were happy for the student to examine them.”
Connolly said he “completely dismissed” the excuse that there wasn’t enough time to get consent.
“If there is not the time, then the student cannot be involved.”
Ministry of Health chief medical officer Dr Andrew Simpson said the
ministry sympathised with both the students and the patients as New Zealand overall had a very good framework for seeking and obtaining informed consent for medical examination and treatment.
“The Ministry will be working with all DHBs with responsibility for training medical students, and their Chief Medical Officers, to ensure there are good processes for obtaining informed consent.”
University of Auckland medical programme head Professor Warwick Bagg, one of the report’s authors, said: “We’re definitely concerned and that’s why [we’re] speaking out.”
Malpas’ team published a number of recommendations to ensure this practice was stopped. They included:
● More information provided to patients and their families about the likelihood of medical and other allied health students being involved in their treatment and care under supervision.
● Increasing the emphasis on the importance of ethical leadership within the supervisory environment is critical.
● Further research to be undertaken to improve knowledge of the prevalence and type of sensitive examinations that were observed or performed without consent, including the medical settings in which such examinations took place.
There must be explicit consent. It’s mandatory. Andrew Connolly, NZ Medical Council