Consent for intimate examinations
Twenty students are huddled around a patient trying to auscultate a cardiac murmur. Others try to percuss the chest of a patient with emphysema, oblivious of the patient's agony each time the plexor strikes the pleximeter. An elderly gentleman complaining of difficulty in passing urine finds that all the students in the department will perform rectal examinations to feel his enlarged prostate, apparently unaware of the discomfort this could cause. The primigravida in the pangs of labour finds she is subject to a succession of students estimating the dilatation of the os in a per vaginal examination.
 
Such memories came back to me when I read an article on the ethics of having medical students learn through intimate physical examinations (1). Students responding to a questionnaire described how they had performed intimate examinations, including on sedated patients, without consent; often, many students examined the same patient. The report generated a heated debate on the ethics of such examinations for teaching purposes.
 
How many medical colleges in India even have written policies and guidelines on the subject? Once I asked a class of third-year medical students what they understood of medical ethics. Eight out of 20 said they had never heard of the term. What would their experiences be on learning how to conduct physical examinations?
 
This blasé attitude is common in our outpatient departments. Students are enthusiastic about developing their skills even as they ignore the patient's perspective. Today, people challenge the notion that such practices can be justified because of the need to train students. Patients cannot be used as teaching aids without their consent. They must be treated with dignity.

 

 

Ashish Goel, Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra  442102, India. e-mail:ashgoe@indiatimes.com
 

In India drug companies are the major sponsors of local, state and national medical conferences, paying speakers and their travel and accommodation costs, as well as individual registration fees for certain doctors.
 
We approached a chemist's shop and obtained the prescriptions written over one month by four physicians in this area. Three of the four, who are known to be sponsored by a particular drug company on various tours, turned out to be major prescribers of this company's products. The fourth physician, who prescribed cheaper products, is not invited to such functions at all. Further, this doctor has been ostracised by his own colleagues.
 
Few doctors raise their voices against sponsorship by drug companies. Sponsorship is flourishing like a disease, particularly in cities. The industry must have its wings clipped.

 

Reference
1. Bhan A. IMA meetings: down in the dumps. Issues in Medical Ethics 2003;11:60.
 
H S Bawaskar, P H Bawaskar. Bawaskar Hospital and Research Centre, Mahad, Raigad, Maharashtra, India. e-mail:himmatbawaskar@rediffmail.com 
 

A recent visit to the United States included visits to dentists, general medical practitioners, consultants and university hospitals. Three things impressed me vis-à-vis the rights of patients.
 
Most doctors have displayed their consultation charges in the waiting room or at the receptionist's desk. Second, all hospitals have information on patients' rights displayed clearly in wards, waiting areas and lobbies. These rights include the right to refuse treatment, to a second opinion and to privacy. It is clear that patients are informed of their rights before treatment or surgery. Third, HIV, HBsAg and HCV tests are not done on patients. It is felt that if the patient's immune status should be declared, so should the surgeon's, because either can infect the other.
 
I am writing this particularly to highlight the controversy raised in India over the display of medical fees, and on the compulsory testing for HIV status, something that all of us do preoperatively.
 
P Madhok. Ashwini Nursing Home, 15th Road, Khar, Mumbai 400052, India. e-mail:pmadhok@im.eth.net

---