What you don't know. . .

The promised article:
Do you know who's been in your vagina recently?


This is a tough one for me.

Because if I dig deep down in my heart and soul, I have no problem, whatsoever, with students practicing exams on unconscious patients. None at all.

It's not something we do here in Israel as far as I know. But, we did learn how to draw blood and insert IVs during our internal medicine rotation, and if we were feeling nervous we were often directed to the intensive care room to practice on the most sedated, senile, and least-likely-to-feel-and/or-respond-unfavorably patients. It makes sense. We're inevitably going to cause pain with our first clumsy attempts to insert needle into vein. Practice on those who aren't going to scream, refuse, or suffer the mental anguish of my 20 minutes of blood-drawing ineptitude. (I was shaking so much the first few times I couldn't unwrap the needle without getting the wrapper stuck to my glove, tearing my glove in the process of removing wrapper, and then knocking something over, such as a lamp or a wandering patient.) It's best to spare patients the mental anguish of an encounter with untrained, terrified, needle-wielding me.

And now, during surgery, I touch people's intestines without consent, I learned how to do stitches yesterday on a real patient without his consent. (Big busy surgeon demonstrated one stitch, handed me the needle, said "do the rest," and left. I couldn't leave the poor guy open!)

But of course I see the other side. I understand patients' wierdness about having a bunch of students up in there. I agree 100% that patients should be informed about everything that is going to happen to them.

A pelvic exam just seem so benign to me. No pain, no lasting damage, really just sticking a light in and looking. Especially compared to leaving a permanent scar on someone with my first-ever stitching attempt, or the trauma of my first attempt to localize the radial artery with yet another shaking needle.

So I would love to obtain every patient's consent for every little thing we do to them in the name of learning. And I would love it if patients would offer up their bodies on the altar of our education. I would love it if they understood that they have found themselves in a teaching hospital and part of the game is to let blossoming little student doctors practice doctor things until one night (May 19th for me) they go to sleep caterpillars, melt into a little puddle of goo, and reemerge as full-fledged MD butterflies.

So this is a tough one for me.

What do you think?