HC Deb 06 February 1951 vol 483 cc1696-704

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. Popplewell.]

11.2 p.m.

Mr. F. Longden (Birmingham, Small Heath)

The subject I wish to raise has a very human appeal which, I hope, will reach the mind and heart of the Minister. Perhaps the best way to make the matter clear is to quote a question I put to the Minister of Health on 16th November last, and his reply. I asked: It his attention has been called to the common practice, in teaching hospitals, for patients to be examined intimately by groups of students, often against the natural inclination of the patients; and if he will issue a general regulation to the effect that the consent of every patient must be obtained before an examination may be performed. MR. BEVAN: I am not aware of any general dissatisfaction with the existing arrangements, or of any sufficient reason for suggesting they should be changed. My hon. Friend will realise that it is vital that medical students should have adequate clinical training."—[OFFICIAL REPORT, 16th November, 1950; Vol. 480, c. 1868.] I thought that reply was rather complacent for two reasons. First, everyone must know that clinical training of the best is necessary to our students, and, secondly, apparently no effort was made to find out the number of protests raised. Indeed, there are thousands of protests, but they are silent ones. The crux of this question can be seen in an intermediate phrase thrown in by the Minister in reply to a pretty rude supplementary question from the other side of the House: … It has always been the case that in teaching hospitals medical students must be taught with the clinical material available, that material being human beings. There is the rub—human beings. That is a rather different raw material from that in any other industry or profession.

I remember a specialist treating me some time ago, and he told me that the first thing he did was to understand his patient, not only in order to win his mental co-operation but—and medical men must know what this means—because he believed that the blood stream itself was improved as a result. There are a few pretty coarse consultants and specialists—very few. Thank goodness the overwhelming number of these men and women, specialists, surgeons and general practitioners, are all that we should wish, but in a minority of cases they certainly are not.

Two cases come to me after the Question I put. One youngish man told me that the death of his mother was hastened as a result of the mental agony she suffered in the intimate examination of her body against her will, her desire, and her very make up. A spinster came to tell me, in great distress, that she had had haemorrhoids of an extreme kind. She was laid naked in the clinic and examined, and the consultant uttered words I would not like to utter in public. That hurt her very much, but what hurt her more was that when the consultant left the room the students were left behind and watched her while she dressed, sniggering.

That sort of thing ought to be stopped at the earliest possible moment. It does happen, no matter what people may say. I think that only by quoting the experiences to be found in a number of letters I have received can the best case be made, so I hope I may be forgiven for making these several quotations in so short a debate. A lady stated in one letter: I know of several instances of young pregnant women who have been passed from the ante-natal clinic to the hospital clinic and have been pounced upon by as many as six young men who made very intimate examinations. … You can imagine the shock and the confused state of mind they emerge with from this ordeal, with more to come. This from a gentleman: My wife offered full permission for one student even to take active part at the birth, but refused a dozen spectators. She is a school teacher, so can hardly he thought irregular. … A group of students entered the labour ward, without escort or supervision, and commenced to examine mothers ad lib. My wife was sent home. … I respect my wife, and I expect others to do so. I respect that man too, very much. A mother says: I had experience concerning the disgraceful conduct of students with my daughter of 14 years of age suffering from cardiac trouble. I sent a detailed account to the Minister of Health. Of course she got the usual reply, that unsympathetic, unknowing reply I got from the Minister, and she says: I feel sure you are doing a great public service in pressing this matter in the House of Commons, and I sincerely wish you success in preventing the practice of students forcing patients to become victims, with no option. No option. That is the issue of this debate, as I see it.

A lady suffering from heart trouble was made to undress. She did not see the necessity, but her private parts were mauled. No such person should be experimented on or he subjected to such examination—like an operation—without conscious voluntary consent. A lady writes: Your remarks to the Minister of Health … regarding hospital patients will, I am sure, be greatly appreciated by the average citizen. I trust that you will receive sufficient support to enable you to bring this matter up again, and that eventually a measure of protection will be afforded to the unfortunate patients. I have another letter from a lady who is, I think, very capable and highly intelligent. She says: I have known many women who have been subjected to most embarrassing and humiliating experiences. … Whether she is 17 or 70, there is no thought for her acute mental anguish. I readily agree it is essential that medical students have every opportunity of getting a thorough training in all branches of their work, but surely it is only common decency for a patient to be consulted before being subjected to the ordeal of being watched by a group of students when an intimate examination of his or her body is being made. … It would be interesting to know the reaction of the Minister himself if surrounded by 12 young women students in like circumstances. I hope to have my first child next year. The prospect of going into our local hospital and being surrounded by young students while being examined, or while my child is being born, is a constant nightmare to me. … I am having my child at home, although I know it would he infinitely better from the viewpoint of medical attention if I went to the hospital. … You will undoubtedly gain the gratitude of thousands of women—and men—who certainly do not share the Minister's opinion that it is in order for the medical profession to treat our bodies with no more sense of respect or regard to modesty than they would show to an animal. As I have already said, I agree that most of the consultants are kindly and understanding in these respects. It is necessary that they should be, because their profession is positively unique. There are medical men I know personally who would not send patients to some consultants they know, and I am certain there are medical men in this House who could say the same. That should never be. Students should not merely be professionally taught and guided; they should be controlled in their treatment of men and women—their material, as the Minister rightly says.

Among the letters I have had from medical men is one from a medical man who was highly respected in the Birmingham area before he left—and we lost much with his leaving. He wrote: This is a most difficult problem, but I certainly think that in gynaecological clinics, even in teaching hospitals, individual patients should be asked if they are prepared to be examined. … I agree, and I think most reasoning people will. Let the Minister, therefore, seek information and suggestions from this overwhelming number of first-class and honourable consultants in our country, in order that they may find some means of preventing their profession from being sullied by a few in this respect. Otherwise let those with grievances shout them out.

11.15 p.m.

Dr. Hill (Luton)

As the hon. Member for Small Heath (Mr. Longden) was developing his case I wondered what his purpose was. It was not until his concluding remarks that he was good enough to suggest that this was a problem not too large in scope. I think he does a disservice if he seeks to give the impression that the brutal, inhuman treatment which he described was in any way characteristic—

Mr. Longden

I did not say that; just the opposite. I said the overwhelming number did the very opposite.

Dr. Hill

I recognise that the hon. Member in his concluding phrases sought to restrict the scope of his remarks, but for the bulk of his remarks he submitted a general criticism of a substantial problem. I want to put to the House three or four points very briefly. First, in all my experience of hospitals, and it is considerable, I have never seen or heard of such events, of unchaperoned examination of the kind he described. Secondly, the hon. Member must face, as everyone must face, the fact that if this country is to be happily served by efficient doctors, teaching on the diseased human body, as on the normal human body, is absolutely essential. I hope he will agree with me.

Mr. Longden

I have agreed.

Dr. Hill

But some of the hon. Member's remarks might lead people to think that this is an undesirable form of teaching, an undesirable practice. Thirdly, I would say that the vast majority of patients are only too glad to co-operate in the purposes of teaching, and furthermore, if the hon. Member will forgive me for saying so, some positively enjoy it.

Mr. Longden

But the hon. Member knows very well that all I am asking is that that kind of examination should not happen without the consent of the patient.

Dr. Hill

As I understood the hon. Member as he developed his case, it was to go far beyond a mere question of the consent of patients, and he used lurid and misleading language as he went on to describe what was happening. So I would say to him, the vast majority of patients collaborate in this work. I agree with him that a minority find this too difficult to bear. I agree with him further that where such persons register an objection to be used for teaching, they are fully entitled to register that objection and fully entitled to have that objection observed.

I want to make the point that such incidents as he has described I find difficult to believe, though I am not casting doubt upon such statements as he made based on letters received by him. There are lurid imaginations that get busily at work in this and other fields. I have not heard of such cases as he has described and in my experience the teaching hospitals particularly, under the aegis of the sisters, are especially careful to secure the utmost privacy, delicacy and complete. chaperonage in the examination of women patients.

I rise, recognising that I am stealing a minute or two of the time of the Parliamentary Secretary, to agree with the main point which the hon. Member sought to make, that the individual should give consent for such work, but to make a most emphatic protest at the language with which he sought to prepare the, way to his final suggestion, for I believe it to be utterly misleading, derogatory to the great teaching centres and almost completely unrelated to the facts of the daily experience in our teaching hospitals.

11.19 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)

I am grateful for the intervention of the hon. Member for Luton (Dr. Hill) in this debate, because there is no doubt that his experience in this matter is of importance in getting a proper bearing on the question. Even though my hon. Friend the Member for Small Heath (Mr. F. Longden) attempted to limit the language of his remarks, I feel that if the sort of examples he used were to go out from this House without any repudiation, they would inevitably create a wholly misleading impression and might endanger the value of some of the important teaching work going on.

I think that in this issue we have to face a certain clash of interests, if one likes to put it that way. It is obvious that from one point of view we are dealing with clinical material, but it is true that the clinical material is composed of human beings. We are, therefore, very anxious to ensure the most careful treatment for the patients; at the same time it is vital to provide every possible opportunity to help the training of students who go forward through the teaching hospitals, and who today may in some cases be receiving instruction outside the ordinary teaching hospitals.

There has been no change in the principles of training medical students or in the use of patients in the teaching hospitals to enable students to get the clinical experience they must have. We are dealing with a problem that we have had to face for a long period—ever since we evolved our present methods of clinical teaching. The only difference is that we have perhaps more students going for training than we have had in the past, and therefore there may be more problems arising at one time or another. I want to put this point to my hon. Friend the Member for Small Heath, that unless this principle of the clinical examination of patients by students is accepted, much of the training that potential doctors have to undergo would be valueless; and we would indeed, be endangering the public if we did not ensure that there were opportunities, not merely for general examination, but also for detailed examination, of actual patients.

I am absolutely clear that it would be impracticable to get the consent of patients in advance. I would fully agree that where a patient has expressed unwillingness to agree to an examination by students, his objection should be dealt with sympathetically and understandingly; clearly there neither should nor could be any pressure used to enforce an examination against the wishes of a patient. We should at any time be most willing to investigate any cases put forward to us where it might be suggested that any such wrongful duress—and that is what it amounts to—had been used. But during the last year and a half, no more than three or four cases have been reported to us at the Ministry.

I admit that there may be many other cases where patients feel unhappy; I know that there are many patients who do not like this process. I understand that, and I am fully sympathetic with them. But the majority of patients appreciate the need for this procedure, although they may not personally like it. They may not care to have gaping students round about them—though some patients positively enjoy these things. Nevertheless, the great bulk of them realise how essential it is.

Sir Hugh Lucas-Tooth (Hendon, South)

I think the hon. Gentleman said inadvertently that a substantial number of patients did not like being subject to teaching. I do not think he meant to say that. I think he meant to refer to a small minority.

Mr. Blenkinsop

I am suggesting that there may be more than those few cases who put complaints into writing; but I would say that even those, and they are not very many, realise the importance of what is going on. So I would say to my hon. Friend, and I would say to any others, that if there are patients who feel that they have been wrongfully used, they ought to put their complaints to the appropriate quarter, to the hospital itself, and, if necessary, to us at the Ministry. We shall certainly and willingly examine them carefully.

What I have found is that sometimes a complaint arises out of lack of accommodation and the consequent difficulty of getting sufficient privacy for the patients. Sometimes this is caused by a great increase in the number of cases coming forward and the accommodation not being satisfactory and so giving rise to lack of proper accommodation. Lack of proper opportunity for privacy when dressing and undressing, and things of that kind, are connected with the question of examination by students. Complaints of that sort do occasionally come through, and we are trying to deal with them in the proper way by ensuring that more accommodation is made available.

But I am very anxious that in this House tonight we should do nothing to impede the vital teaching work which is being carried on throughout the country. I am anxious, too, that those vital, though, I admit, at times embarrassing examina- ions which may be necessary, should go forward with the full co-operation of the patients whenever possible. Should a patient in a rare case feel that he or she cannot bear the examinations which are required, then I am sure we would all desire that their wishes should be respected; and I am convinced that in fact they are respected by the professional people concerned. I hope that if my hon. Friend has any particular individual cases in his mind which are not too far back in history, he will refer them to me so that I can examine them and see whether there is any basis of fact behind them worthy of further examination.

Adjourned accordingly at Twenty-Eight Minutes past Eleven o'Clock.