The Health and Disability Commissioner says she is "deeply concerned" over the findings of a study of medical students’ experiences of informed consent in patients’ treatment.
The study, published in the New Zealand Medical Journal on May 20, revealed that medical students are at times encouraged to breach informed consent guidelines by their supervisors.
All final year medical students at The University of Auckland who were graduating in 2019 were invited to participate in the study which was approved for three years.
A total of 93 out of 265 students responded to the survey, with most students reporting they were “not always compliant” with the national consensus statement for obtaining informed consent for almost all sensitive examinations.
Supervisor-related pressure was a common theme in the students’ comments. One student stated: “I was forced to perform an unconsented DRE [digital rectal examination] examination in theatre while a patient was under general anaesthetic. I objected to this but was coerced into performing it anyway by the urologist.”
“I explained the University policy, but he [supervisor] wasn’t concerned," another student said.
One student reported feeling abandoned by the medical institution, even after making formal complaints to it about non-compliance with the consensus statement.
“Essentially I felt like the medical school didn’t care when I contacted them about being forced to perform a male DRE under general anaesthetic WITHOUT consent… Even quite senior staff were contacted about this and simply were either unsure or unconcerned with this behaviour. I was essentially brushed off.”
The only exception was in the case of non-birth related pelvic examinations, which 85% of students saying they always performed with proper informed consent.
HDC 'deeply concerned'
Morag McDowell, Health and Disability Commissioner says she is very disappointed the issue is continuing, noting the same issue was raised in a separate 2016 study.
"I will be raising this matter directly with Health New Zealand, DHBs and medical schools to reinforce message that informed consent is at the heart of the Code of Health and Disability Services Consumers' Rights. I will also be asking what actions will be taken in response to the study’s findings."
McDowell says patients should be asked about the involvement of medical students in their care and their right to informed consent.
"Any unconsented sensitive examination is a clear breach of a patient’s rights."
She says a lack of clinical and ethical leadership is a system failure.
"These students have not been supported. Leadership from senior doctors and nurses must be shown in rectifying this."
"This requires positive and ethical role modelling, and students must feel empowered to question any examination if a patient has not given informed consent."
"I will be paying particular attention to people’s concerns as they raise them, and I encourage anyone who has knowledge of, or is concerned about sensitive examinations having taken place without informed consent to report their concerns to my office directly at 0800 11 22 33 or to make a complaint at www.hdc.org.nz."