Please don't touch me there: the ethics of intimate examinations: Consent is crucial—but don't go too far, for students' and patients' sakes

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.1326-a (Published 12 June 2003) Cite this as: BMJ 2003;326:1326
  1. Aneel A Bhangu (aneelbhangu{at}yahoo.co.uk), fourth year medical student
  1. University of Birmingham Medical School, Birmingham B15 2TT

    EDITOR—I agree that patients' consent to procedures is crucial and should be achieved whenever possible and fully, or practice becomes poor and the doors are opened for harm to be done.1

    However, students must be educated, and with more and more students consent is becoming an increasingly serious issue. We had to catheterise a model in groups of four owing to too few patients and too many students. If the opportunity arises for me to perform a procedure at the end of an operation I am observing, should I (a) turn it down as I don't have consent, (b) hope I do get the informed chance before I qualify, or (c) wait to do it for real unsupervised at 2 am as a preregistration house officer?

    I have assisted in a hydrocoele (I held a small retractor and cut sutures), and I gained valuable experience and did no harm—but should I have had consent? Did I need consent to watch a gynaecological operation from behind the diathermy machine? When I take a diabetic history for an assessed case presentation I am bringing no benefit to the patient, so should I be doing it?

    I agree that informed consent is important and I try to obtain it whenever possible, but let's not go too far. If the point is reached where each student needs written consent to listen to every patient's pansystolic murmur radiating to the axilla, doctors will have neither the time nor inclination to teach a small firm of 15 students, and I'll have to gain my experience at 2 am.


    • Competing interests AAB is a medical student who needs experience.


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