3rd Annual SMEC

The 3rd Annual Student Medical Education Conference (SMEC) was held on the 7th September 2007 at the Clinical Research Centre, Yong Loo Lin School of Medicine, National University of Singapore (YLL SoM, NUS), attendence being compulsory for the 2007-2008 batch of M1s.

J. was a facilitator for the group discussion. All 5 case scenarios were fairly relevant, including the one that J.’s group discussed, Case Scenario 4:

You are doing your obstetrics and gynaecology posting. As part of the posting you have to observe 2 deliveries and perform 2 deliveries. It is now the 6th week of your 8 week posting and you have only observed 1 delivery. Being a male student, you feel that it is harder for women to agree to your presence. On your last night call for the posting, you come across a woman who is friendly and talks to you but doesnot want you to watch or perform the delivery as she is scared of having too many people in the delivery suite.

Being a male student and having completed his O&G posting, J. was well-equipped to clarify any doubts the M1s might have about the situation which they (the men in particular) will assuredly go through in year 4. This scenario actually isn’t very difficult as there is only one ethical thing to do. Also, one thing it revealed is that people have the incredible power of rationalisation to suit what they want to do.

A couple of fast facts that J. shared with the group prior to discussion starting (led by the group leader, of course. The facilitator just makes sure things keep moving along.)

  1. Deliveries are few and far in between, particularly in NUH.
  2. It takes a long time to wait for a primigravid patient with a cervix at 3cm to deliver.
  3. Many patients don’t allow a medical student to watch, much less deliver.
  4. Many attempts are vetoed by the husband.
  5. It is possible (but not ethical) to hide behind a screen and watch the pregnancy without the mother noticing.
  6. Delivery suite nurses are very big on patient rights.
  7. It might be the last chance and only reason for many students to deliver a baby, since many people never go on to do an O&G HO/MO posting.

The initial discussion meandered about a bit, but ultimately, everyone would do the same things to begin with: charm the husband, charm the patient, find out what the patient’s concerns are, reassure patient, ask midwife (aka delivery ward nurse) to help ask, ask the medical officer / house officer to help ask, explain the importance of the student’s watching, reassure patient that student will only observe but will not do anything in the delivery

The important issue is “What if the patient still says no?”.

Some students said that they would [using the screen method] observe nonetheless, regardless of the patient’s right to privacy. However, they threw in a caveat – if watching the delivery is very important, it being probably the absolute last delivery they would see on their last night call/delivery room posting. They also did some rationalisation of how watching the procedure would do more good in the long run with respect to future deliveries – for the greater good.

There being only a few minutes left, J. tried to target the discussion by summing up the argument:

  1. Is it always ethically wrong to infringe on a patient’s right to privacy?

    The group had concluded during the discussion that it would be ethical if there was some greater good.

  2. If so, at what level of benefit and of benefit to whom would it be considered okay to infringe on the patient’s right to privacy?

    How much benefit is there to the patient? How much benefit is there to future patients? Is watching that one delivery so important? Is a high level of benefit to oneself sufficient reason to infringe on someone else’s rights?

    One student pointed out an interesting and relevant point: isn’t the real motivation for the students (who would infringe on the patient’s right to privacy) a selfish reason (of learning, of filling out the logbook) masquerading as an altruistic, rationalised reason (of benefiting future deliveries)?

The group eventually concluded that it would not be ethical to watch the delivery if the mother had said “No.” despite attempts to convince her otherwise. People who would do otherwise may have a different set of moral/ethical values but to do so would nonetheless be unethical.

Phew.

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