States seek explicit consent for pelvic exams
Savanah Harshbarger estimates she performed as many as 10 pelvic exams last year on patients before gynecologic surgeries, feeling for fibroid tumors or other abnormalities.
The Duke University medical student said the experience was a revelation.
“It’s pretty empowering to know this is something you can detect with a gloved hand instead of needing an MRI or some more expensive procedure,” Harshbarger said.
What was not always clear to her was whether the patients had agreed ahead of time to have a student do the exam while they were under anesthesia. The consent form, Harshbarger said, “definitely does not mention any specific things a student might be doing. It’s fairly vague language.”
Lawmakers in a number of states now want to eliminate any question about patient consent.
Bills introduced in roughly a dozen states this year would require that women undergoing gynecological surgeries give explicit approval to a pelvic exam beforehand. It’s a step that some medical experts say is an unnecessary intrusion into patient care.
Utah’s governor signed a pelvic exam consent bill into law earlier this year. A bill in New York passed the state Senate this week and is headed to the governor, and the Maryland Legislature unanimously sent legislation to Gov. Larry Hogan, who is expected to sign it.
Maryland state Delegate Heather Bagnall said the state’s teaching hospitals have informed consent as a best practice, but she felt it needed to be made explicit in state law to protect women undergoing surgery and as an assurance for medical students.
“So we have basically just spelled out in no uncertain terms, if a patient is going under anesthesia, if a patient is unconscious, that they have to have given consent for these exams,” Bagnall said. “They need this added level of protection, and they need this added level of peace of mind.”
During a committee hearing on the bill, Melanie Bell, a board member for the Maryland Nurses Association, said there have been times when patients have awakened during the procedures and felt violated.
“Clinical experiences are necessary and are important, and we must learn in a handson environment when we’re students,” she said. “However, we must treat patients with dignity and respect.”
A pelvic exam is standard practice before gynecologic surgeries to determine the position and mobility of the organs. It involves inserting fingers of a gloved hand in the patient’s vagina to feel her uterus and ovaries. Medical students sometimes do the exams as part of their training.
What’s not clear is how often patients are clearly told of student involvement ahead of time.
In general, the bills introduced this year would require explicit informed consent before a medical student is allowed to perform a pelvic exam on an anesthetized patient.