Please don't touch me there: the ethics of intimate examinations: Informed consent failed to protect meBMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7402.1326 (Published 12 June 2003) Cite this as: BMJ 2003;326:1326
EDITOR—My personal experience of intimate examination dates back 23 years and illustrates how even explicit informed consent can fail to protect a patient.1
I was 20, a first year preclinical student, awaiting surgery for a large hiatus hernia, which had been causing supraventricular tachycardia. I was admitted to Adden-brooke's Hospital two weeks before clinical school finals. Preoperatively, somewhere between 12 and 20 people in white coats came to examine me. As I did not realise that medical students could examine patients unsupervised I assumed they were doctors.
All performed chest and abdominal examinations. Three performed breast examination (none performed otorhinolaryngological examination). All performed vaginal or rectal examination. Three performed both, which I found particularly distressing. Consent was obtained in the form of “if you don't mind, I need to,” and I consented by my physical position and an embarrassed “OK.”
I was upset by the examinations and felt vulnerable and unclean afterwards. After the first three examinations I wanted to go home, but I still consented. It did not cross my mind that I was in a position to refuse. You can ask, “Do you mind?”without making the patient feel that he or she is being given a clear run at saying “No.” I believed that the examinations were a part of the process of my care in the mysterious world of the hospital.
Looking back, I needed an advocate to both limit the number of examinations and empower me to refuse. Without one, as a patient, the sense of vulnerability and aloneness can be enormous.
Competing interests None declared.