2012

Early Morning Stress Reduction Inspiration - 10/7/2012
5 Common Roadblocks to Finding Your Passion in Life
What Buddhism is not really about
Joan Halifax: Compassion and the true meaning of empathy
Dalai Lama appoints American as monastery abbot
Realizations
Pelvic Exams While Under Anesthesia Sparks Debate

Posted: 07 Oct 2012 11:00 AM PDT

"The earnest person is like fire. Fire burns away everything big or small. The greatest man and the smallest are equally consumed by fire. The fire of earnestness demolishes all the vanities, passions and terrors of life."

~The Buddha

Technorati Tags: Buddha Buddhist Buddhism Meditation Dharma

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5 Common Roadblocks to Finding Your Passion in Life

Posted: 07 Oct 2012 08:00 AM PDT

As I've helped more and more people find their passion, there are a few common obstacles that most fall into over and over again.

Finding your passion in life is, according to me, one of the most important things you can do, because there's a reason you feel excited about some things and not about others.

You are on this planet for a reason.

You have things to do here that can contribute to humanity as a whole.

While that may sound crazy, it's something I choose to believe, because it is empowering to do so.

Many people have beliefs that are negative but not necessarily true.

Would you rather believe something negative or something positive?

Let's take a look at the five common roadblocks.

Too Many Interests

One of the first roadblocks people run into is that they have too many passions. It's hard to choose.

But the real truth is that once you start to drill down, you will naturally discover that there are only a few topics that you are truly passionate about.

Many topics may seem nice at first, but they are not what you truly want once you get into them, which is why it's so important to take action and experiment.

You can't know what a new ice cream flavor tastes like until you taste it.

Perfection

The second roadblock is perfection. You don't have to be perfect to get started moving toward your dreams.

You just have to get started. And when you get started, you'll realize that when you take one step, the next step becomes clear. But nothing happens until you take action.

That's exactly what happened to me as I started following my passion. I wasn't sure of! where I was going. And I definitely wasn't doing things perfectly.

But once I got going, everything became clearer and clearer.

Foresight

You don't have to know exactly what is going to happen.

We are creatures of habit, which means we like to do things that are comfortable, familiar and certain.

The problem is that it stops you from going after your passion, because you will have to face fears and you will have to learn new things on your path to realizing your passion.

Get comfortable with being uncomfortable and you will make tremendous progress.

Know-How

Another common obstacle is that people often believe that they have to know exactly what to do in order to make their dreams come true and achieve their goals.

But that couldn't be further from the truth.

You see, when you start going after something and set a goal, your unconscious mind will automatically start bringing the right things to your attention.

For example, have you ever started thinking about buying a certain car, and when you start focusing on that car you suddenly start seeing it everywhere?

That's the power of your unconscious mind at work.

Obstacles and Fears

Last, but definitely not least are the obstacles and fears you will face on your path to your dream life.

It's not going to be easy, and even if you get started on your path, you still have to overcome the challenges you bump into.

This is how you grow as a human being.

You have to be willing to let go of the old, and embrace the new. You have to be willing to step outside the box and see what's out there.

Finding your passion in life is not a shortcut to happiness.

It takes work, like anything else worthwhile! . But it'! s work that's worth it. Well worth it.

What say you? What has been your biggest roadblock to finding and follow your passion?

Written on 10/7/2012 by Henri Junttila. Henri is a freelance writer and the founder of Wake Up Cloud, where he helps people turn their passion into a thriving lifestyle business. When you feel ready to take action, get his free special report.

Photo Credit:
John Talbot

Do you have a bucket list? Here are 101 things to do before you die. Includes a tutorial on how you can create your bucket list too!

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What Buddhism is not really about

Posted: 07 Oct 2012 07:00 AM PDT

In my own ad hoc survey, I find that most people who are interested in Buddhism seem to be suffering from emotional problems which include depression (mild or otherwise). Buddhism, they believe, can help them. Maybe seated meditation (zazen) will help with emotional problems or depression. The problem with this belief, is that Buddhism is not designed to relieve us of our emotional stress or depression anymore than it can take away a headache or prevent diarrhea. It can only provide us with a certain pattern of behavior whereby problems in the future will be less onerous.

Real Buddhism is about awakening, that is, becoming buddha. It is only for those who have a heaven soaring spirit. In this regard, it is a mystical path we are to tread, forgoing our love affair with the mundane—the big home, the SUV and two kids. Yes!—this is what Buddhism is really about. Read the Sutras. It's on every page.

Those who come to Buddhism expecting it to solve their emotional problems (again, this includes depression) are really, in a very subtle way, harming Buddhism. By their mere presence, they are tacitly insisting that a Lama or a Zen teacher is there to serve their needs—out of compassion of course! More to the point, such people see Buddhism as something akin to an outpatient clinic for the emotionally distraught. These same people have no interest in listening to a commentary on the Avatamsaka Sutra or the Lotus Sutra. I mean, how can hearing a commentary help them if they are depressed and never get a good night's sleep?

When I began to study Zen with my teacher, I came off of a season of bicycle racing. I was healthy and emotionally sound. I came to Zen because koans intrigued me to no end. The more I didn't understand them the more I wanted to. So one day, I am wearing black robes with a shaved head! The only thing that was going on in my mind at the time was thinking about Buddhism (70%) and girls (30%). I have to confess, the word depression never popped up in the temple. Those who visited our temple were interested in mystical side of Buddhism—they wanted satori. Well, those were the good old days.

Thinking more about those who see Buddhism as a cure-all for what psychologically ails a person, they need to wake up to the fact that their problems are pretty much related to the terrible lifestyle of our society. For one thing, all of us have inadequate levels of vitamin D3 which acts to inhibit deep sleep which is necessary if the human growth hormone (HGH) is to kick in and repair our bodies. We also need deep sleep so that our emotions can be untangled and defused; so that when we awaken we feel good and emotionally sound. No one can achieve this by sitting on a zafu in a temple, as it were, hiding from the sun or outdoor physical activity.

It is only when we are emotionally and physically sound that we should study Buddhism; when our emotional state is not a burden to us. A person has to be in a high degree of emotional and physical health to even read a complicated Sutra like the Lankavatara. One has to live the life of a non-violent warrior, always well disciplined and healthy.

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Joan Halifax: Compassion and the true meaning of empathy

Posted: 07 Oct 2012 06:00 AM PDT

I want to address the issue of compassion. Compassion has many faces. Some of them are fierce; some of them are wrathful; some of them are tender; some of them are wise. A line that the Dalai Lama once said, he said, "Love and compassion are necessities. They are not luxuries. Without them, humanity cannot survive." And I would suggest, it is not only humanity that won't survive, but it is all species on the planet, as we've heard today. It is the big cats, and it's the plankton.

Two weeks ago, I was in Bangalore in India. I was so privileged to be able to teach in a hospice on the outskirts of Bangalore. And early in the morning, I went into the ward. In that hospice, there were 31 men and women who were actively dying. And I walked up to the bedside of an old woman who was breathing very rapidly, fragile, obviously in the latter phase of active dying. I looked into her face. I looked into the face of her son sitting next to her, and his face was just riven with grief and confusion.

And I remembered a line from the Mahabharata, the great Indian epic: "What is the most wondrous thing in the world, Yudhisthira?" And Yudhisthira replied, "The most wondrous thing in the world is that all around us people can be dying and we don't realize it can happen to us." I looked up. Tending those 31 dying people were young women from villages around Bangalore. I looked into the face of one of these women, and I saw in her face the strength that arises when natural compassion is really present. I watched her hands as she bathed an old man.

My gaze went to another young woman as she wiped the face of another dying person. And it reminded me of something that I had just been present for. Every year or so, I have the privilege of taking clinicians into the Himalayas and the Tibetan Plateau. And we run clinics in these very remote regions where there's no medical care whatsoever.

And on the first day at Simikot in Humla, far west of Nepal, the most impoverished region of Nepal, an old man came in clutching a bundle of rags. And he walked in, and somebody said something to him, we realized he was deaf, and we looked into the rags, and there was this pair of eyes. The rags were unwrapped from a little girl whose body was massively burned. Again, the eyes and hands of Avalokiteshvara. It was the young women, the health aids, who cleaned the wounds of this baby and dressed the wounds.

I know those hands and eyes; they touched me as well. They touched me at that time. They have touched me throughout my 68 years. They touched me when I was four and I lost my eyesight and was partially paralyzed. And my family brought in a woman whose mother had been a slave to take care of me. And that woman did not have sentimental compassion. She had phenomenal strength. And it was really her strength, I believe, that became the kind of mudra and imprimatur that has been a guiding light in my life.

So we can ask: What is compassion comprised of? And there are various facets. And there's referential and non-referential compassion. But first, compassion is comprised of that capacity to see clearly into the nature of suffering. It is that ability to really stand strong and to recognize also that I'm not separate from this suffering. But that is not enough, because compassion, which activates the motor cortex, means that we aspire, we actually aspire to transform suffering. And if we're so blessed, we engage in activities that transform suffering. But compassion has another component, and that component is really essential. That component is that we cannot be attached to outcome.

Now I worked with dying people for over 40 years. I had the privilege of working on death row in a maximum security [prison] for six years. And I realized so clearly in bringing my own life experience, from working with dying people and training caregivers, that any attachment to outcome would distort deeply my own capacity to be fully present to the whole catastrophe.

And when I worked in the prison system, it was so clear to me, this: that many of us in this room, and almost all of the men that I worked with on death row, the seeds of their own compassion had never been watered. That compassion is actually an inherent human quality. It is there within every human being. But the conditions for compassion to be activated, to be aroused, are particular conditions. I had that condition, to a certain extent, from my own childhood illness. Eve Ensler, whom you'll hear later, has had that condition activated amazingly in her through the various waters of suffering that she has been through.

And what is fascinating is that compassion has enemies, and those enemies are things like pity, moral outrage, fear. And you know, we have a society, a world, that is paralyzed by fear. And in that paralysis, of course, our capacity for compassion is also paralyzed. The very word terror is global. The very feeling of terror is global. So our work, in a certain way, is to address this imago, this kind of archetype that has pervaded the psyche of our entire globe.

Now we know from neuroscience that compassion has some very extraordinary qualities. For example: A person who is cultivating compassion, when they are in the presence of suffering, they feel that suffering a lot more than many other people do. However, they return to baseline a lot sooner. This is called resilience. Many of us think that compassion drains us, but I promise you it is something that truly enlivens us.

Another thing about compassion is that it really enhances what's called neural integration. It hooks up all parts of the brain. Another, which has been discovered by various researchers at Emory and at Davis and so on, is that compassion enhances our immune system. Hey, we live in a very noxious world. (Laughter) Most of us are shrinking in the face of psycho-social and physical poisons, of the toxins of our world. But compassion, the generation of compassion, actually mobilizes our immunity.

You know, if compassion is so good for us, I have a question. Why don't we train our children in compassion? (Applause) If compassion is so good for us, why don't we train our health care providers in compassion so that they can do what they're supposed to do, which is to really transform suffering? And if compassion is so good for us, why don't we vote on compassion? Why don't we vote for people in our government based on compassion, so that we can have a more caring world? In Buddhism, we say, "it takes a strong back and a soft front." It takes tremendous strength of the back to uphold yourself in the midst of conditions. And that is the mental quality of equanimity.

But it also takes a soft front — the capacity to really be open to the world as it is, to have an undefended heart. And the archetype of this in Buddhism is Avalokiteshvara, Kuan-Yin. It's a female archetype: she who perceives the cries of suffering in the world. She stands with 10,000 arms, and in every hand, there is an instrument of liberation, and in the palm of every hand, there are eyes, and these are the eyes of wisdom. I say that, for thousands of years, women have lived, exemplified, met in intimacy, the archetype of Avalokitesvara, of Kuan-Yin, she who perceives the cries of suffering in the world.

Women have manifested for thousands of years the strength arising from compassion in an unfiltered, unmediated way in perceiving suffering as it is. They have infused societies with kindness, and we have really felt that as woman after woman has stood on this stage in the past day and a half. And they have actualized compassion through direct action. Jody Williams called it: It's good to meditate. I'm sorry, you've got to do a little bit of that, Jody. Step back, give your mother a break, okay.

(Laughter)

But the other side of the equation is you've got to come out of your cave. You have to come into the world like Asanga did, who was looking to realize Maitreya Buddha after 12 years sitting in the cave. He said, "I'm out of here." He's going down the path. He sees something in the path. He looks, it's a dog, he drops to his knees. He sees that the dog has this big wound on its leg. The wound is just filled with maggots. He puts out his tongue in order to remove the maggots, so as not to harm them. And at that moment, the dog transformed into the Buddha of love and kindness.

I believe that women and girls today have to partner in a powerful way with men — with their fathers, with their sons, with their brothers, with the plumbers, the road builders, the caregivers, the doctors, the lawyers, with our president, and with all beings. The women in this room are lotuses in a sea of fire. May we actualize that capacity for women everywhere.

Thank you.

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Dalai Lama appoints American as monastery abbot

Posted: 06 Oct 2012 06:00 PM PDT

Via NPR.

Michel Martin: if you wanted to predict just who the Dalai Lama might select to lead one of the faith's most important monasteries, you probably wouldn't think about a boarding school educated, globe-trotting New York photographer whose grandmother was one of the most celebrated fashionistas of her time, but that's just who the Dalai Lama did select, saying his, quote, "special duty is to bridge Tibetan tradition and the Western world," unquote.

Nicholas Vreeland is the new abbot of the Rato Monastery in India and he joins us from there now. Welcome. Thank you so much for joining us.

NICHOLAS VREELAND: Thank you. It's an honor to be here.

MARTIN: Now, in my introduction I made it sound as if you're some sort of fish out of water, but when I think about it, probably not. You were born in Switzerland, lived in Germany and Morocco and New York. Your father was a diplomat. Your mother was a poet, and fashionistas will certainly know that your late grandmother was the longtime editor of Vogue magazine.

So I wanted to ask if, in a way, all this was preparation for your life now.

VREELAND: Well, I don't know that it was preparation. I suppose that living in a lot of countries prepared me for living in a Tibetan refugee settlement where the monastery that I belong to was reestablished, but I've been here now – I've been a member of this monastery for over 27 years, and so it's sort of home.

MARTIN: How did you first learn about Buddhism? And if you can describe it, what do you think it was that appealed to you?

VREELAND: I was in a French school in Germany and I began reading Tintin books when I was about six or seven, so Tintin and Tibet was my first introduction to Tibetan culture, to Tibetan Buddhism. Then I went to – I should say I came to India in 1972 to visit my godfather, who was the political officer in a little then country, now part of India, called Sikkim. It was a Tibetan culture that Sikkim had with Tibetan Buddhism as their religion. That was my introduction.

MARTIN: What is it that you think appealed to you, if you can even describe it?

VREELAND: It puts the responsibility for where you are on your shoulders. We, by our past actions, determine where we are today. How wealthy I am, how healthy I am, the opportunities that I have – all of those things are determined by my own past virtuous or non-virtuous actions.

MARTIN: Can you remember when you decided to become a monk? And I am assuming that that's kind of a complex process and decision, but to the degree that you can, can you tell us why you think you chose this path?

VREELAND: I was working as the picture editor for the Vanity Fair that was being reestablished. We were working on the dummy issue and I was studying with my teacher, a Tibetan Lama in New York, and my mother had been discovered to have cancer, and all these different influences made me realize that to devote my life to a spiritual path was the most valuable thing I could do.

MARTIN: If you're just joining us, this is TELL ME MORE from NPR News. We're have a Faith Matters conversation with the venerable abbot Nicholas Vreeland. He is abbot of one of the most important monasteries in Tibetan Buddhism, the Rato Monastery in Southern India, and he's telling us about his journey to that place.

And you know I want to ask you your family reacted when you told them that you were becoming a monk. I can imagine that Diana Vreeland, who was so committed to style and fashion, was not as enthusiastic as one might think about your shaving your head and committing to a life of saffron and red robes.

VREELAND: No. She wasn't very enthusiastic, but she understood it. She had seen me become more serious about my study of Buddhism, my practice of Buddhism. We were very close. The years before I came here to become a monk, I spent a few of those years actually living with her. My parents were both very supportive and understanding and have remained supportive, as has my brother.

MARTIN: Now, could you tell us about how you reacted when his holiness, the Dalai Lama, selected you to become the abbot of this important place in Tibetan Buddhism? How do you – how did you react to that?

VREELAND: Well, it was really a surprise. I must say that I'm sitting in the abbot's chambers in the monastery here in the south of India. I helped design and rebuild the campus of the monastery recently and never would I have imagined that I would be inhabiting these quarters. I mean, it's just – I might have designed it rather differently had I thought that I would end up here. It came as a big surprise.

MARTIN: Could you tell us about the ceremony when you were officially enthroned?

VREELAND: Initial ceremony was the investiture, which took place in California, actually. His holiness, the Dalai Lama, proclaimed me the abbot and I made three prostrations and made an offering to him and he then offered me a scarf and said congratulations to the new abbot of Rato Monastery and then advised me on just what he wished me to do.

I then came to India to assume my position. It was a sort of formal procedure. Early in the morning, at 5:00, I was led from my room in the monastery to the abbot's chambers and I was told to sit on the throne and then the administrators made three prostrations before me and made symbolic offerings. And then, after prayers were said in my room, I was led to the temple and there in the temple were all the monks of Rato seated and they all bowed when I came in and I made my three prostrations to the throne of his holiness, the Dalai Lama, and assumed my position on the throne of the abbot.

And then each of the monks in the monastery came and offered me a symbolic white scarf, which is a sort of Tibetan way of showing one's respect. And that was it. I was the abbot.

MARTIN: And there it is. As we mentioned earlier, the Dalai Lama, his holiness, said that he felt that your mission is to unite the two or to be a bridge between the traditions and the Western world, so I hope that we will speak again, that maybe we could be part of that, you know, bridge.

But before we let you go, I wanted to mention that you've been the director of the Tibet Center in New York for some time now, and so I envision that you'd be going back and forth. What else do you think it means to be that bridge? Do you have any sense of how else you envision that role?

VREELAND: What I can bring as a Westerner, as someone born, raised and educated in the West, to this very, very traditional, ancient world – Tibet was a country that was totally closed off to the rest of the world until 1959 and the monastic traditions helped maintain a curriculum which was extraordinary – which is extraordinary, and I wouldn't want to, in any way, tamper with that.

However, it is necessary that we bring modern day procedures to this society, so that's one part of my responsibility. The other is helping to bring my knowledge and experience of this world, this Tibetan world, to the West as a Westerner.

But ultimately all I can really do is be myself wherever I am, and my self is a Tibetan Meditation monk. My self is an American. And so wherever I go, just being myself as best I can is the way in which I might be actually bridging these two worlds.

MARTIN: The venerable Nicholas Vreeland is the abbot of the Rato Monastery. It's in Southern India. He's also the director of the Tibet Center in New York, but we were able to reach him in India.

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Realizations

Posted: 06 Oct 2012 03:00 PM PDT

realizations

31/12 2005

I came across this article in a newsgroup today and as it is the beginning of a new year (2006) it was the perfect article to share. It is by Kristen M. Neiling — www.thecamino.com.ar.

A time comes in your life when you finally get it — when, in the midst of all your fears and insanity, you stop dead in your tracks and somewhere the voice inside your head cries out "ENOUGH!" Enough fighting and crying or struggling to hold on. And, like a child quieting down after a blind tantrum, your sobs begin to subside, you shudder once or twice, you blink back your tears and begin to look at the world through new eyes. This is your awakening.

You realize it's time to stop hoping and waiting for something to change or for happiness, safety, and security to come galloping over the next horizon.

You come to terms with the fact that you are neither Prince Charming nor Cinderella. And that, in the real world, there aren't always fairy-tale endings (or beginnings, for that matter). And that any guarantee of "happily ever after" must begin with you — and in the process, a sense of serenity is born of acceptance.

You awaken to the fact that you are not perfect and that not everyone will always love, appreciate, or approve of who or what you are…and that's OK. They are entitled to their own views and opinions.

And you learn the importance of loving and championing yourself — and in the process, a sense of new-found confidence is born of self-approval. You stop complaining and blaming other people for the things they did to you (or didn't do for you) and you learn that the only thing you can really count on is the unexpected.

You learn that people don't always say what they mean or mean what they say, and that not everyone will always be there for you, and that it's not always about you. So you learn to stand on your own and to take care of yourself — and in the process, a sense of safety and security is born of self-reliance.

You stop judging and pointing fingers and you begin to accept people as they are and overlook their shortcomings and human frailties — and in the process, a sense of peace and contentment is born of forgiveness.

You realize that much of the way you view yourself and the world around you is as a result of all the messages and opinions that have been ingrained into your psyche. And you begin to sift through all the junk you've been fed about how you should behave, how you should look, how much you should weigh, what you should wear, what you should do for a living, how much money you should make, what you should drive, how and where you should live, who you should marry, the importance of having and raising children, and what you owe your parents, family, and friends.

You learn to open up to new worlds and different points of view. And you begin reassessing and redefining who you are and what you really stand for. You learn the difference between wanting and needing and you begin to discard the doctrines and values you've outgrown, or should never have bought into to begin with — and in the process, you learn to go with your instincts.

You learn that it is truly in giving that we receive. And that there is power and glory in creating and contributing and you stop maneuvering through life merely as a "consumer" looking for your next fix.

You learn that principles such as honesty and integrity are not the outdated ideals of a bygone era but the mortar that holds together the foundation upon which you must build a life.

You learn that you don't know everything, it's not your job to save the world and that you can't teach a pig to sing.

You learn to distinguish between guilt and responsibility and the importance of setting boundaries and learning to say NO. You learn that the only cross to bear is the one you choose to carry and that martyrs get burned at the stake.

Then you learn about love. How to love, how much to give in love, when to stop giving and when to walk away.

You learn to look at relationships as they really are and not as you would have them be. You stop trying to control people, situations, and outcomes. And you learn that alone does not mean lonely.

You also stop working so hard at putting your feelings aside, smoothing things over and ignoring your needs.

You learn that feelings of entitlement are perfectly OK, and that it is your right to want things and to ask for the things you want — and that sometimes it is necessary to make demands.

You come to the realization that you deserve to be treated with love, kindness, sensitivity, and respect — and you won't settle for less.

And you learn that your body really is your temple. And you begin to care for it and treat it with respect. You begin to eat a balanced diet, drink more water, and take more time to exercise.

You learn that being tired fuels doubt, fear, and uncertainty and so you take more time to rest. And, just as food fuels the body, laughter fuels our soul. So you take more time to laugh and to play.

You learn that, for the most part, you get in life what you believe you deserve — and that much of life truly is a self-fulfilling prophecy.

You learn that anything worth achieving is worth working for and that wishing for something to happen is different from working toward making it happen.

More importantly, you learn that in order to achieve success you need direction, discipline, and perseverance.

You also learn that no one can do it all alone — and that it's OK to risk asking for help. You learn the only thing you must truly fear is the greatest robber baron of all: FEAR itself.

You learn to step right into and through your fears because you know that whatever happens you can handle it and to give in to fear is to give away the right to live life on your own terms. And you learn to fight for your life and not to squander it living under a cloud of impending doom.

You learn that life isn't always fair, you don't always get what you think you deserve, and that bad things sometimes happen to unsuspecting, good people. On these occasions you learn to not personalize things. You learn that God isn't punishing you or failing to answer your prayers. It's just life happening. And you learn to deal with evil in its most primal state — the ego.

You learn that negative feelings such as anger, envy, and resentment must be understood and redirected or they will suffocate the life out of you and poison the universe that surrounds you.

You learn to admit when you are wrong and to build bridges instead of walls.

You learn to be thankful and to take comfort in many of the simple things we take for granted, things that millions of people upon the earth can only dream about: a full refrigerator, clean running water, a soft warm bed, a long hot shower.

Slowly, you begin to take responsibility for yourself by yourself and you make yourself a promise to never betray yourself and to never, ever settle for less than your heart's desire.

And you hang a wind chime outside your window so you can listen to the wind. And you make it a point to keep smiling, to keep trusting, and to stay open to every wonderful possibility.

Finally, with courage in your heart and God by your side, you take a stand, you take a deep breath, and you begin to design as best you can the life you want to live.

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Pelvic Exams While Under Anesthesia Sparks Debate

Posted: 06 Oct 2012 02:00 PM PDT

CREDIT: Woman and doctor photo via Shutterstock

As a medical student, Dr. Shawn Barnes had an experience that he says left him feeling ashamed and conflicted. During his rotation through the obstetrics and gynecology ward of a teaching hospital in Hawaii, Barnes performed pelvic exams on women under anesthesia without the women's explicit consent to the procedure.

The women were all having gynecological surgery, and had signed a long form indicating they agreed to allow medical students to be involved in their care.

However, to Barnes, the "implicit consent" patients gave when signing the forms didn't ensure they understood exactly what happened while they were unconscious — a relatively inexperienced medical student palpated their ovaries and uteruses to check for, and better understand, potential abnormalities in these organs.

"For three weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women," Barnes wrote in an editorial published in the October issue of the journal Obstetrics and Gynecology.

Teaching hospitals should stop this practice, Barnes told MyHealthNewsDaily. Instead, patients should be asked to "explicitly consent" to the procedure, meaning they specifically say they will allow a medical student to conduct a pelvic exam.

Two doctors at a Boston hospital, writing in a counterpoint to Barnes' editorial, say they agree that obtaining only implicit consent is "morally unsound," but also say that this practice has largely faded away. Guidelines from doctors' groups say that women should be fully informed about the procedure, they noted.

"We have many providers who trained in other institutions, and in conversation with them," it's clear that women are usually asked specifically for their consent to a student-performed exam, said Dr. Carey York-Best, an obstetrician and gynecologist at Massachusetts General Hospital and one of the doctors who wrote the counterpoint to Barnes' editorial.

But Barnes says the exams are done without explicit consent more often than these doctors indicate. A 2003 survey of Philadelphia medical students found that 90 percent reported being asked to perform pelvic exams on women who had not explicitly consented to the procedure.

Both Barnes and York-Best said there are no recent data available on exactly how many hospitals nationwide are not abiding by the guidelines recommending that explicit consent be obtained.

In any case, Barnes said that guidelines do not govern real-world practice — for this, laws are needed. During his residency, Barnes said he raised his concerns regarding pelvic exams with his superiors, but was told these exams were a long-standing, standard practice. "In fact, I was told I was the first medical student or resident in institutional memory to express concern over the practice," he wrote in his editorial.

York-Best said such laws would potentially overregulate doctors' activities, and that the field is already far more regulated than many others.

Why not just ask for permission?

Performing pelvic exams on anesthetized women just prior to surgery provides medical students with a unique and valuable learning experience, Barnes and York-Best both said. For one, muscles relax under anesthesia, allowing the exam to proceed more easily and giving the surgeon and medical student a clearer picture from which to plan the details of the surgery.

Additionally, women undergoing surgery have conditions that make their anatomy abnormal. Most patients who come in for routine exams performed by medical students don't have gynecological diseases, but medical students need to be able to recognize and diagnose abnormalities. [5 Things Women Should Know About Ovarian Cancer]

In his editorial, Barnes presented the arguments he heard — from attending physicians, residents, and other medical students, along with published medical literature — that a woman's signature on a long form was sufficient proof of her consent.

One argument is that such consent forms are simply the standard practice, so the exams are not an issue. But the fact that professional guidelines — from groups such as the American College of Obstetricians and Gynecologists and the American Medical Association — say that explicit consent is needed shows that this should not be the standard practice, Barnes said.

Another argument he heard is that medical students don't ask for specific permission to retract tissue or cut sutures during surgery, and that the pelvic exam portion of the procedure is no different.

But Barnes argues that it is different. In fact, male medical students must be chaperoned when performing pelvic exams on conscious patients, but not when they remove surgical staples — this requirement reflects an understanding on the part of medical practitioners a pelvic exam is a more personal practice.

Do guidelines do enough, or are laws needed?

York-Best and her co-author, Dr. Jeffrey Ecker, suggest that the physician responsible for the patient's care should ask the patient for permission to allow a student to perform the exam, ideally well before the surgery. Patients should also be given the opportunity to meet the medical student prior to the surgery, they write.

Most patients are willing to let the student do an examination when asked by their own physicians, York-Best said, pointing to a 2009 study in which 74 percent of patients consented to a student performing a pelvic exam when they were asked by their doctor. In contrast, another study found that 53 percent consented when they were asked by students.

"When it is a stranger, especially a nervous or awkward student, who asks, they do not yet know if they can trust that person, and are likely to err on the side of saying no," York-Best said.

It's important for doctors at teaching hospitals to advocate for the teaching process in order to ensure that their students receive adequate training, she said.

Barnes called this "a good idea," but maintained that laws are needed to make sure that women understand what they are consenting to.

Hawaii is now one of four states (California, Illinois and Virginia are the others) where doctors are legally required to obtain specific consent for pelvic exams under anesthesia. The Hawaii law grew out of Barnes' outreach to lawyers about the issue, and he testified before the state legislature regarding the practice while the bill was under consideration.

Pass it on: Medical students still perform pelvic exams on anesthetized women.

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