Latest status as of March 11, 2021

Imagine you are a patient who is undergoing abdominal surgery, perhaps you have a gynecological or prostate issue.  Naturally you gravitate to the best hospital in your network or you follow your physician. Many physicians wear two hats —they’re both caretakers and teachers.

For you, this means that medical students may be there, observing. But many will do far more. As the Yale University School of Medicine explains, this “involves hands-on teaching of invasive clinical skills, such as the pelvic exam.”  Pelvic exam is performed by inserting two gloved fingers into a vagina to assess gynecological health of a woman.

State Rep. Christine Conley has introduced legislation that would make sure patients understand and agree to be used for teaching. These rules requiring specific consent would apply only when a patient is “under deep sedation or anesthesia or unconscious.” Patients are in no position to police what is happening with them at such a vulnerable moment. They are asleep.

Conley’s bill is being blocked from a public hearing. There really is no reason not to air the concerns that many patients and students have about unconsented intimate exams. Students have led the charge across the nation for specific consent laws. Nine states in the last 20 months have regulated this practice. Students express deep distress at being asked to palpate patients’ intimate body parts without the patients’ specific consent. But they lack the power to stand up to attending physicians who control their fate in terms of residency.

Ironically, these younger students are more enlightened than their teachers who say that the exams have been authorized. In testimony submitted in 2019 on a similar bill, Yale reassured that “all consent forms contain specific language explaining the involvement of trainees in the decision making and procedural process.”

But a quick glance at Yale New Haven Health’s consent form shows otherwise. It reads:

“I understand that some of the system hospitals are teaching hospitals.  Doctors or other health practitioners who are members of the care team and are in training may help my practitioner with the procedure.”

It goes on to say:

I understand the purpose and potential benefits of the procedure in relation to my goals.

I give permission to my responsible practitioner to do whatever may be necessary if there is a complication or unforeseen condition during my procedure.

Helping care for the patient and performing an exam on a patient as a part of training are two different things.

These sentences do not alert patients that a pelvic or prostate examination may be performed for somebody else’s educational benefit. Indeed, they indicate that the procedure is to further the patient’s own goals.

No reading of “responsible practitioner” would include a medical student trainee. It is misleading to say that those in training “may help” without being candid that the exams are for the students’ education, not the patients’ care.

Representative Conley’s bill highlights the need for medical students to acquire informed consent from patients when conducting intimate exams for the students’ education.

Unfortunately, the bill is currently blocked from getting a public hearing. Courageous Yale College and Yale Law School students have sent countless emails to the members of the Public Health Committee, urging a hearing — but they are not being heard.

House Bill 5067 would place Connecticut within an emerging legislative trend to require healthcare providers to ask permission before using patients as teaching tools for intimate exams. Currently, 15 states require explicit consent.

For those Yale faculty who believe that students always get consent, we should ask whether they can really know what is happening at far-flung community teaching hospitals. Consider Quinnipiac University’s Frank H. Netter MD School of Medicine – it boasts partnerships with hospitals and healthcare centers in New England and Florida.

This should not be dismissed as a women’s issue. Unconsented intimate exams happen to both women and men.

If the COVID-19 pandemic has taught us anything, it is that trust in the health care system and professions is vital. House Bill 5067 would build enormous trust through the simple act of respect. And most importantly, it would assure medical students that they are not doing anything unethical. That teachable moment has arrived.

Terry Tsang is a Groton resident.  Prior to retirement, he was a Drug Development Director for Pfizer and a Program Leader for Merck KGaA.

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