Education and debate

The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first

BMJ 2003; 326 doi: 10.1136/bmj.326.7380.97 (Published 11 January 2003)
Cite this as: BMJ 2003;326:97

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The teaching of vaginal and rectal examinations poses ethical problems for students and educators, and guidelines exist to protect patients from unethical practice. Yvette Coldicott and colleagues report an exploratory survey, whose findings suggest that best practice is not always followed and that in many cases consent has not been given for procedures

The ethics of intimate examinations—teaching tomorrow's doctors

  1. Yvette Coldicott, final year medical studenta,
  2. Catherine Pope, lecturer in medical sociologyb,
  3. Clive Roberts, medical clinical deanc (c.j.c.roberts@bristol.ac.uk)
  1. a University of Bristol Medical School, c/o Centre for Medical Education, Bristol BS2 8DZ
  2. b Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR
  3. c University of Bristol Medical School, Centre for Medical Education, Bristol BS2 8DZ
  4. Department of Obstetrics and Gynaecology, UllevDl University Hospital, 0407 Oslo, Norway
  5. Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge CB2 2SW
  1. Correspondence to: C Roberts
  • Accepted 28 November 2001

The teaching of vaginal and rectal examinations poses ethical problems for students and educators, and guidelines exist to protect patients from unethical practice. Yvette Coldicott and colleagues report an exploratory survey, whose findings suggest that best practice is not always followed and that in many cases consent has not been given for procedures

The ethical integrity of doctors is under fire. Public concern after the Bristol inquiry into paediatric heart surgery,1 the Alder Hey inquiry into organ retention and storage without consent,2 and other cases of malpractice has put pressure on the medical profession and government to ensure that unethical practices are challenged and prevented. Alongside this, consumers of health care have higher expectations not only of the standard of services and level of care provided, but also of the manner in which care is delivered. Patients now actively participate in deciding their care. The legal framework is also changing. Articles 8 and 9 of the Human Rights Act 1998 imply that doctors should inform patients about their medical care and respect their privacy, and this is endorsed by the General Medical Council's ethical code for practice—Duties of a Doctor.

The problem facing doctors is that ethical values change. What was once acceptable may become unacceptable. Student doctors face special difficulty in trying to balance their learning needs with these ethical duties. Reports from Oxford and Canada have illustrated that medical training may need refining to meet the demands and expectations of modern …

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