The Body Politic

At teaching hospitals, medical students regularly perform pelvic exams (and occasionally prostate exams) on unconscious patients, who might never know. Does it matter? Jennifer Tsai, MD, examines where the contemporary understanding of consent confronts the conventions of academic medicine.

- Jennifer Tsai

In 2016, Carrie Flynn had just started her first clinical rotation for the Yale School of Medicine. For six weeks, she would work in Bridgeport Hospital’s ob-gyn department, during which time she’d be shepherded in and out of operating rooms by residents and attending physicians. Flynn, then 28, rarely met patients before their surgeries. Instead, the third-year student would often show up at an operating room, where the female patient was already unconscious, and observe or perform whatever maneuver her superiors requested. (She remembers once asking if she could pre-round on patients before surgery in order to introduce herself. She was told no.)

Flynn once performed a pelvic exam on a woman who was under anesthesia. This involves placing two fingers into the vagina while a second hand is placed on the patient’s abdomen to feel for ovaries, masses, and uterine mobility. Pelvic exams, a regular part of gynecological visits, are necessary before gynecological surgery, as they allow physicians to examine anatomy before performing procedures like hysterectomies and fibroid removals. At teaching hospitals, where medical students are involved in patient care, students regularly perform these exams for educational training. They’re often the third or fourth person to conduct the procedure, after an attending physician and one or two residents. Flynn had not met the female patient before she inserted her fingers into her vagina. She didn’t know if the patient even knew she was in the room. “I’m certain [she] did not give consent,” Flynn says now, three years later. “I would be shocked if the [resident or attending] did on my behalf.”