3/24/2001 – Med school study reveals unethical practices

Thanks to Daryl Duhamel in Canada for sending us an article from Canada’s
National Post newspaper.

The National Post online alert.

March 23, 2001

Med school study reveals unethical practices
Unnecessary exams, practising on dead at teaching hospitals

Margaret Munro
National Post

Medical students frequently face pressure to act
unethically and most say they have seen their clinical teachers acting
unethically as well, a study by researchers at the University of Toronto has
found.

The study surveyed 108 medical students and found that
47% said
they “very frequently,” “frequently” or “occasionally” felt pressure to act
unethically. Almost two-thirds of the students had also seen their teacher
behave unethically.

The study listed some of the unethical activities,
including practising procedures on dying patients and conducting unnecessary
examinations on unconscious ones.

Some students at the University of Toronto’s teaching
hospitals were asked to conduct vaginal exams on patients under general
anaesthetic without their consent. One described being told to perform an
unnecessary “femoral stab,” which involves locating a vein, on a dying
patient who was in a vegetative state and without getting any family consent.

Another watched as a woman who had asked not to be given
narcotics as she gave birth was given the potent drugs without her knowledge.
The study was conducted by five young doctors who recently trained at the
university. The results will be published in the British Medical Journal on
Saturday.

“It’s not as if it happens every day,” says co-author
David Robertson, who is about to graduate from the medical school. But it is
disturbing to know it happens at all, he says.

The students, some of whom reported being “scared to
death” of professors barking orders at them, also described how patients’
identities and medical problems were described in public places. The students
were also expected to perform procedures they were not competent to handle,
such as closing wounds, assessing unstable patients and giving psychotherapy.
They also report that patients were sometimes asked to return to clinics for
unnecessary follow-up visits that were only for the students’ benefit.

U of T medical school officials say they are familiar
with the study’s findings and are working to put an end to such
“reprehensible” activities.

“We’re aware of it and distressed by it and trying to
stamp it out,” said Dr. Rick Frecker, associate dean of
the university’s undergraduate medical education.

Dr. Frecker said no action was taken against professors
involved, as the identities of the students and doctors were protected as
part of the study, which was conducted a few years ago.

He said there would be serious repercussions for
professors if the students were to bring such cases of unethical behavior to
his attention today.

Dr. Frecker said he was approached a few years ago by Mr.
Robertson and a group of concerned students wondering what
could be done about the unethical activities and coercion that have long been
part of medical training. He said he encouraged the students to document
specific cases in a bid to raise awareness of the problem.

He and other university officials were surprised to learn
yesterday that the findings will be showcased in the
prestigious British Medical Journal, which is publishing the students’
findings and has an editorial and commentary condemning the “hypocrisy” in
the medical profession.

“There may have been a time when doctors could get away
with being trustworthy in public, but despicable in private, but this is an
age where no secret is kept for long and really all doctors should know
better,” says the commentary by Andrew West and colleagues at Oxford
University.

“The medical profession urgently needs to learn respect
for the living and for the dead, and thereby earn the public respect that is
its lifeblood,” they conclude.

In the editorial, medical ethicist Len Doyal, of the
Royal London School of Medicine and Dentistry, says the Toronto findings are
likely relevant to medical education in schools around the world. They
reinforce the need for detailed codes of acceptable activities in medical
education to prevent abuse of both patients and students, he wrote.

Mr. Robertson said in an interview that such policies
need to be backed by a culture that is receptive to change.

He said the University of Toronto medical school is
“moving in the right direction.”

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