News Release

Resolving the ethical pitfalls of intimate examinations

Letters: Please don’t touch me there BMJ Volume 326, pp 1326-8

Peer-Reviewed Publication

BMJ

Intimate examinations are one of patients' greater worries. In this week's BMJ, readers respond to a survey of medical students published earlier this year, which suggested that many examinations are carried out without adequate patient consent.

"I was admitted two days before surgery for a hiatus hernia," says Mary Selby. "During that time 12-20 medical students examined me vaginally. Whilst all asked permission, and I consented, it never occurred to me that I was in a position to refuse. I was upset by the examinations and felt both vulnerable and unclean after them. Having no advocate on the ward makes it very difficult for patients to refuse examinations which they would very much like to avoid. I still wish I had refused."

But how do students acquire clinical skills without practising on patients? A new approach using manikins with actors has been developed. This ensures that students are prepared to deal with contextual challenges of real work settings, writes Debra Nestel of Monash University, Australia.

Another training programme has been developed to deal with these legitimate problems. Students at Antwerp University in Belgium perform three procedures, supervised by intimate examination assistants. Attention is focused on personal attitude, the students' technical ability and communication skills. Students reported feeling more secure while performing intimate examinations, and paid more attention to patients' feelings, integrity, and privacy.

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