Letters

Please don't touch me there: the ethics of intimate examinations: Informed consent failed to protect me

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7402.1326 (Published 12 June 2003) Cite this as: BMJ 2003;326:1326
  1. Mary Selby (happyselby{at}btinternet.com), principal general practitioner
  1. Newmarket Rookery Medical Centre, Newmarket CB8 8NW

    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.

    Footnotes

    • Competing interests None declared.

    References

    1. 1.