Patient consent for medical student pelvic exams under anesthesia: an exploratory retrospective chart review

Abstract

ABSTRACTBackgroundLegal requirements and clinical practices of securing patient consent for medical student pelvic examinations under anesthesia (EUA) vary widely, while ethical arguments and patients’ preferences for being asked for consent are well known.ObjectiveThis study was performed to examine patients’ choices to permit or refuse medical student pelvic EUAs during planned gynecologic procedures.Study DesignAn exploratory retrospective chart review of electronic consent forms at a single academic medical center, using contingency table and logistic regression to explore relationships between patient and provider characteristics and consent.ResultsElectronic consent forms were downloaded for a census of 4000 patients undergoing gynecologic surgery from September 2020 through calendar year 2022 and linked to anonymized medical record information, including patient age, race, religion, and insurance carrier, along with physician name. Physicians were coded by gender, departmental affiliation, and status (attending, resident, or fellow). Of the 4000 patients, 142 (3.6%) patients were removed from analysis because of uncertainty about the EUA consent. Of the remainder, 308 (8.0%) were asked for EUA consent more than once. Overall, of 3858 patients, 3308 (85.7%) consented every time asked and 550 (14.2%) refused or limited EUA consent at least once. Nine patients limited their consent to female students, and 2 patients refused medical student participation at all. Of the 308 asked more than once, 46 were not consistent. Exploratory multiple logistic regression Consent for pelvic exams under anesthesia analysis showed that patients identifying as Black or African American (OR=0.482, p<0.001) or Asian (OR=0.303, p<0.001), or of Moslem/Muslim/Islamic faith (OR=0.598, p=0.008) were substantially less likely to grant EUA consent than other patients. Moreover, male physicians were somewhat more likely to secure consent from patients than their female colleagues (OR=1.427, p=0.016).ConclusionsThe finding that some patients are more likely than others to refuse a pelvic EUA magnifies the dignitary harm from a nonconsensual invasion of intimate bodily integrity and perpetuates the historic wrongs visited upon vulnerable people of color and religious minorities. Patient’s rights to control over their own bodies can only be respected if their physicians take seriously the ethical obligation to inform their patients and ask them for permission.