Doctors and medical students cannot perform pelvic, rectal or other sensitive exams on patients without prior written consent, according to new guidance from the Department of Health and Human Services.
The federal rule makes standards for medical schools in Ohio official, as the state previously didn’t have a law banning the practice.
In recent years, media reports and medical students raised concerns about students performing exams on patients who were often under anesthesia without their prior knowledge.
The actual number of these exams is unknown, but one study estimated there were more than 3.6 million unconsented exams nationally in the last five years.
The new rule won’t change student instruction at Case Western Reserve University's School of Medicine, as school policy didn’t permit it, said Dr. Lia Logio, the school's vice dean of medical education.
“Case has been very intentional about making sure when our students are involved in the care of patients, that there are consents in place," she said. "We actually never do exams for learning purposes only.”
Northeast Ohio Medical University didn’t respond to a request for comment on their practices.
Physicians have reported students can learn better by performing some medical exams on patients who are relaxed under anesthesia, and they ask for patients' permission when they can. However, patients who found out about the exams after the fact have described feeling violated.
CWRU medical students typically learn on mannequin simulations, which can even simulate conditions people may have, like a prostate nodule or a cervical lesion, Logio noted.
“I think there is something lost in the tactile stuff, but much less than ever before, because the technology has really helped us," she said.
Logio said she understands why some doctors would like to take rare opportunities that may come up in procedures to teach students techniques that will make them more capable doctors, but she added it’s not worth risking the patients’ trust in their care.
"We have a very strong ethos of not doing anything to patients that they are not aware of us doing and haven't given us permission to do," she said. "That's not part of being a doctor."
The new rule is part of a growing trend toward involving patients more in decisions about their treatment plans, Logio said.
"Patients probably had less agency to say no 30 years ago than they do now," she said. "Patients absolutely advocate for themselves. We encourage them to."
