Medical Ethics!

These days, the ethical issues I faced during my final years of medical school have resurfaced in my mind. I wrote about them once, about 15 years ago, on a blog in Myanmar language. 

At that time, we were assigned to obstetrics and gynecology units in groups for practical training. I was interested in that area, but I witnessed how postgraduate students were treated and humiliated by their teachers in front of patients, and it made me terrified of pursuing that path.

It was a dark era, with little understanding of human rights, and without social media, they had no choice but to endure these humiliations and degrading treatment in order to graduate. Occasionally, the postgraduate students taught us in the wards, and we admired them. One graduate student from that period I knew has even reached retirement age now.

One day, the assigned instructor told our group to meet her at the outpatient unit. When we arrived, there was a patient on the examination bed. The area lacked privacy, with only a small portable curtain separating the examination bed from the waiting area, and the patient was not fully covered. I was the only female student in the group, and the instructor asked me to put on gloves and perform a vaginal examination on the patient.

I followed her instruction, but as I approached the patient, she started pleading with me not to do the examination. She said, "I am a virgin, please don't do that," and was on the verge of tears. I looked at our instructor, who firmly told me to proceed, but when I looked at the patient, I couldn’t bring myself to do it. We hadn't been taught how to perform a vaginal examination yet, and even if I had done it, I wouldn’t have known what to look for. I decided to take off my gloves and said, "I won’t do that."

The instructor was angry and told me, "I won’t teach you anything today." But I couldn’t hear anything she said after that. I stood there, emotionally numb. She dismissed us, and when we left, my male classmates blamed me for upsetting the teacher. 

At the time, I wasn’t sure if I had done the right thing. I didn’t know anything about informed consent back then, but something inside me couldn’t allow me to act against a patient’s plea.

Years later, I realized it had been an ethical issue. 

I also recalled a moment in the lecture hall when one of my classmates whispered to me during a lecture on ethics in cesarean sections. The lecturer, a well-known obstetrician and gynecologist, was reputed to perform cesareans unnecessarily, highlighting the gap between her teaching and practice. I’m still unsure whether practices in the field have significantly changed.

About two years ago, I consulted with a well-known obstetrician and gynecologist. She asked my age and when I had last had a cervical smear. It had been a long time, and without further discussion, she prepared the instruments and took a sample. She didn’t ask for my consent, and I was left thoroughly confused.

Reflecting on these experiences, both as a medical student and as a patient, I can’t help but wonder how far we’ve come in ensuring ethical treatment. Not everyone is like those I encountered, but these moments still stay with me, raising important questions about patient autonomy and consent in medical practice.

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