Anesthesiologist suspended for performing rectal exam

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www.9news.com.au

Anaesthetist Dr Adam Hill to return to work after ‘unnecessary’ rectal exam

A doctor who performed an unnecessary rectal examination on a patient will return to work after having his ...
www.9news.com.au www.9news.com.au

Bizarre case where an anesthesiologist was suspended for performing a rectal exam on a patient.

I admittedly haven’t read both articles completely, but the story goes that the anesthesiologist put the patient to sleep, at which time the colorectal surgeon asked the anesthesiologist to perform a rectal exam to feel the GIST tumor since it is rare and a learning opportunity. Surgeon supposedly took a picture during the exam as well to “distribute” it to other anesthesiologists.

Nurses complained that the patient hadn’t consented to a rectal exam from the anesthesiologist and it was unnecessary, anesthesiologist got suspended, but apparently has now been allowed to return to work. No punishment for the surgeon despite him taking the picture. Not sure if any lawsuit is being brought against the anesthesiologist by the patient.
 
It is deeply ingrained in us as doctors to share interesting findings with other doctors. It is central to our training culture. That said, colorectal surgeons get excited about the weirdest things.
 
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caligas said:
Idiots.
Click to expand...

Agreed, grossly unprofessional (and also probably assault). I suspect the "once in a lifetime opportunity" was the excuse concocted when they realized how deep the **** they were in. Even if it were the case, what possible reason does the surgeon have for photographing the anesthesiologist in the middle of said "once in a lifetime finding" and sending it to colleagues? I mean, I can guess the reason, but it won't be the one that they give in public.
 
I couldn’t even fake being interested in feeling some weird bump in a orifice as a med student, let alone as an attending anesthesiologist.

The patient didn’t consent, case closed.
 
Odd, In Australia there are many intensivist-anesthesiologists so who knows. I recently did a DRE looking for a perirectal abscess for Fever of Unknown origin for a prolonged elevated WBC and no identified source in the unit - we went hunting for zebras and found a prostate infection and mass. When it has to be done you "get up in there."
 
Nobody gave a second thought to doing pelvic and rectal exams on anesthetized patients 30+ years ago. Often several med students would serially do exams for an interesting finding. Never heard a peep out of nursing . This NYC. Times have changed.
 
dr doze said:
Nobody gave a second thought to doing pelvic and rectal exams on anesthetized patients 30+ years ago. Often several med students would serially do exams for an interesting finding. Never heard a peep out of nursing . This NYC. Times have changed.
Click to expand...

Even when I was a resident (recently), GYN surgeons encouraged this. You'd have like 3 residents and a few med students all throwing on gloves and doing a pelvic exam on the patient as soon as we tubed em. OR nursing actually was the one that put a stop to that, complained to the powers that be, and a rule was made that only a resident or student that was going to scrub in for the surgery could join in the fun.
 
We had an outside speaker come and instruct our group about how to avoid harassment in the operating room. One of many things he stressed was that if you do not speak up when someone says or does something inappropriate, then you will also be culpable.

An extreme example that was used was that an orthopedic surgeon's wife was having surgery (not from her husband). After anesthetizing a patient, the husband/surgeon, who had just finished a case next door, popped into the room, jiggled the anesthetized wife's breasts and said, these are the best investments I ever made. The offending orthopedic surgeon brought boatloads of money into the hospital. The case scenario ended there for us to discuss what the proper reaction should have been.

While I do not remember the exact consequences that occurred, it was more along the lines of what you might expect, no one did anything. This then led to a large lawsuit against the surgeon and anyone who did not try to stop this. The chief medical officer was fired for not punishing the surgeon.

A proper response would be to loudly say STOP! and GET OUT! Then proceed to call the hospital's chief medical officer, tell him what happened, and ask him to immediately suspend that orthopedic surgeon's privileges. Also document your efforts.

Even if you just hear a surgeon's outburst at the surgical tech across the drape, if you do not verbalize or maybe even document your attempt to de-escalate, then you might be disciplined, too.

At that meeting I learned that profanity is protected speech, but vulgarity is not, which is often the difference between using the F word as an adjective or a command verb. But I doubt the nurse writing the incident report will make that distinction, so verbalize some opposition.
 
I don't have any info that is not in the story, but can think of only one reasonable explanation for the anaesthetists behaviour.

Here in Australia - we do not have nurse anesthetists. All anaesthetics are given by doctors.

In order to address the fact that we have an enormous geographic area and a low population we train GPs (Family medicine doctors) to give anaesthetics - mostly to ASA 1 and 2 patients having low risk surgery in remote locations. They do 12 months training, and then they may do one list a week for example and the rest of their practice is "Family Medicine". I can see how doing a PR for educational purposes would be within scope for such a doctor.

Consent to perform the PR, is of course a completely seperate issue.


edit .... sadly the anaesthetist in question seems to be a specialist
 
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Just putting it out there, if mid-levels can do everything that doctors do because of their desire to "practice at the top of their licenses", then why is it when a doctor does a doctor thing even if it's not part of their specialty get in trouble. Are we exempt from practicing at the top of our licenses?
 
Impromptu said:
We had an outside speaker come and instruct our group about how to avoid harassment in the operating room. One of many things he stressed was that if you do not speak up when someone says or does something inappropriate, then you will also be culpable.

An extreme example that was used was that an orthopedic surgeon's wife was having surgery (not from her husband). After anesthetizing a patient, the husband/surgeon, who had just finished a case next door, popped into the room, jiggled the anesthetized wife's breasts and said, these are the best investments I ever made. The offending orthopedic surgeon brought boatloads of money into the hospital. The case scenario ended there for us to discuss what the proper reaction should have been.

While I do not remember the exact consequences that occurred, it was more along the lines of what you might expect, no one did anything. This then led to a large lawsuit against the surgeon and anyone who did not try to stop this. The chief medical officer was fired for not punishing the surgeon.

A proper response would be to loudly say STOP! and GET OUT! Then proceed to call the hospital's chief medical officer, tell him what happened, and ask him to immediately suspend that orthopedic surgeon's privileges. Also document your efforts.

Even if you just hear a surgeon's outburst at the surgical tech across the drape, if you do not verbalize or maybe even document your attempt to de-escalate, then you might be disciplined, too.

At that meeting I learned that profanity is protected speech, but vulgarity is not, which is often the difference between using the F word as an adjective or a command verb. But I doubt the nurse writing the incident report will make that distinction, so verbalize some opposition.
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So the surgeon’s wife sued her husband (and others)? Can’t think of anyone else who would have standing to file a suit.
 
I remember attendings and older residents telling me that I should try and get good at placing IVs by practicing on patients who were turned during a procedure so that the hand would be nearby. However, practicing like this on patients was disallowed.

As a resident on an ICU rotation I wanted to practice my bronchoscopy skills on a long term intubated patient that we had done a bronchoscopy on the day before. This was also not permitted.

For better or worse, patients are not to be used as practice mannequins when not specifically required for the procedure.
 
2Fast2Des said:
Just putting it out there, if mid-levels can do everything that doctors do because of their desire to "practice at the top of their licenses", then why is it when a doctor does a doctor thing even if it's not part of their specialty get in trouble. Are we exempt from practicing at the top of our licenses?
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It is alarming how many here don't seem to understand the concept of consent....

Most are conflating it with entirely different issues.
 
There’s a vast difference between feeling neck nodes or a thyroid mass and a breast mass or a rectal exam. I guess I’ve palpated a bony mass in an arm before as well. Generally I only care about what might affect my practice. The cool once in a lifetime rectal mass probably isn’t so cool, nor once in a lifetime, nor of any interest to me. The photo was just the nail in the coffin. The surgeon would be sanctioned at my shop for participating and taking an unnecessary photo let alone sending it to others.
 
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DrZzZz said:
Even when I was a resident (recently), GYN surgeons encouraged this. You'd have like 3 residents and a few med students all throwing on gloves and doing a pelvic exam on the patient as soon as we tubed em. OR nursing actually was the one that put a stop to that, complained to the powers that be, and a rule was made that only a resident or student that was going to scrub in for the surgery could join in the fun.
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"Could join in the fun"... Thankful for OR nursing with a conscience


Why non consented anesthetized patients? There are plenty of people who would consent, including paid positions (link below). Is a power issue to do it to a helpless unconscious patient who is unaware?

observer.com

It’s Pelvic-Exam Season! Med Students Meet Gyno-Martyrs; Don’t ‘Feel,’ ‘Examine’

For a woman who had spent the previous evening sprawled across an examining table, receiving what she estimated was her 3,091st gynecological pelvic exam, Robin Burdulis looked remarkably spry when…
observer.com observer.com
 
LineAndBerry said:
Do you apply this rule to practicing difficult intubation techniques (Fast Track LMA, for example) on normal patients with good airways?
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I apply it to superfluous procedures, like extra IVs. Securing an airway is still a part of the procedure, and I can exercise my judgement on choosing which way to secure it, which has been my stance in the past, as long as there is no significant difference to the patient.

Recently, hospitals are getting more particular about billing for utilizing their equipment, like the flexible fiberoptic bronchoscope. If my "practice" might impose an additional charge to the patient, then I will avoid the practice method. Instead, I might look for people that I could go either way on, and in those cases go with the "safer" and more "conservative" approach, which might let me keep up my skills at the same time.
 
My point is more directed to the use of an airway technique (I used the example of the Fastrack LMA) being used when there was no indication except the need for a secure airway. The airway could have been easily secured with routine laryngoscopic intubation.
I ask because this seems to be an almost standard practice, especially in training programs, for learning techniques that are very rarely needed. The rationale is when needed on a truly difficult airway, it's not the time to be trying a complex technique for the first time.
Do you feel that this is unethical as well?
 
LineAndBerry said:
My point is more directed to the use of an airway technique (I used the example of the Fastrack LMA) being used when there was no indication except the need for a secure airway. The airway could have been easily secured with routine laryngoscopic intubation.
I ask because this seems to be an almost standard practice, especially in training programs, for learning techniques that are very rarely needed. The rationale is when needed on a truly difficult airway, it's not the time to be trying a complex technique for the first time.
Do you feel that this is unethical as well?
Click to expand...

I think there’s a world of difference between working on our emergency skills relevant to our practice (difficult airways) that can literally save lives versus some ***** encouraging all comers to do a rectal exam. You do NOT, I repeat NOT, have your first live AFOI or whatever your difficult airway device of choice to be on some angioedema/neck XRT disaster - this is understood and accepted at academic, training institutions. To keep my skills up I’ll go to a different modality if it’s a soft call and I have the time so I can keep my skills up.

An anesthesiologist should never be doing a rectal. A colorectal surgeon should never be doing an awake intubation. We both need to keep our respective skills up to snuff, though, and so if another colleague is called in to see something interesting and it’s aligned within the specialty then it’s fine.
 
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Modanq said:
Odd, In Australia there are many intensivist-anesthesiologists so who knows. I recently did a DRE looking for a perirectal abscess for Fever of Unknown origin for a prolonged elevated WBC and no identified source in the unit - we went hunting for zebras and found a prostate infection and mass. When it has to be done you "get up in there."
Click to expand...

Right but the point is it didn't "have to be done" here. If you have a clinical reason for doing the exam, that's always defensible. Presumably you also ask the patient before you stick your finger up there and if you're in the ICU and the patient isn't consentable, then it's part of emergency treatment (like for a fever of unknown origin).

This is not that case.
 
Planktonmd said:
Most people who choose anesthesiology as a career don't have any interest doing rectal exams on anyone.
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You're a board certified physician whom is capable of performing a simple DRE and giving a proper report if needed... at least I hope.
 
calvnandhobbs68 said:
Right but the point is it didn't "have to be done" here. If you have a clinical reason for doing the exam, that's always defensible. Presumably you also ask the patient before you stick your finger up there and if you're in the ICU and the patient isn't consentable, then it's part of emergency treatment (like for a fever of unknown origin).

This is not that case.
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Agree.
 
Along the lines of this, technically I guess we can be sued for not consenting the patient to allow med student or resident do intubation? We should specifically tell them resident/student will be intubating ?
 
anbuitachi said:
Along the lines of this, technically I guess we can be sued for not consenting the patient to allow med student or resident do intubation? We should specifically tell them resident/student will be intubating ?
Click to expand...
I always introduce the student or the resident as part of the anesthesia team. I also speak in terms of "we" will do this or that, when describing the anesthesia plan (as part of the informed consent).

One doesn't get to just waltz in and do a procedure in one of my rooms.
 
FFP said:
I always introduce the student or the resident as part of the anesthesia team. I also speak in terms of "we" will do this or that, when describing the anesthesia plan (as part of the informed consent).

One doesn't get to just waltz in and do a procedure in one of my rooms.
Click to expand...

I can't even count how many times on our OB/GYN rotation the attending would tell us to do a vaginal exam just after the patient was induced. There would be 1-2 medical students, 1-2 residents and then the attending and we never spoke to the patient before.
 
Drangue said:
I can't even count how many times on our OB/GYN rotation the attending would tell us to do a vaginal exam just after the patient was induced. There would be 1-2 medical students, 1-2 residents and then the attending and we never spoke to the patient before.
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(Sexual) Assault and battery.
 
anbuitachi said:
Along the lines of this, technically I guess we can be sued for not consenting the patient to allow med student or resident do intubation? We should specifically tell them resident/student will be intubating ?
Click to expand...
Don't teaching hospitals have a part of the consent form that talks about trainees anymore?
 
VA Hopeful Dr said:
Don't teaching hospitals have a part of the consent form that talks about trainees anymore?
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Not mine. Also when I consent, the student or resident may be introduced, but I don't specifically tell them the student/resident will do it. I've also seen anesthesiologists let resident put in a 2nd IV for practice after doing to sleep when all the patient needed was 1 IV for the case. Assault?
 
anbuitachi said:
Not mine. Also when I consent, the student or resident may be introduced, but I don't specifically tell them the student/resident will do it. I've also seen anesthesiologists let resident put in a 2nd IV for practice after doing to sleep when all the patient needed was 1 IV for the case. Assault?
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You can always defend a second IV as needed for patient safety reasons. Put in a central line, just for training, and it IS assault and battery.

Basically one should never do unneeded procedures on the patient, regardless how benign. Ethics 101.
 
VA Hopeful Dr said:
Don't teaching hospitals have a part of the consent form that talks about trainees anymore?
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It's not the form that's the legal informed consent. It's the discussion. The form is toilet paper to discourage the patient from suing for lack of consent (one of the newer malpractice asstorney tricks).
 
FFP said:
You can always defend a second IV as needed for patient safety reasons. Put in a central line, just for training, and it IS assault and battery.

Basically one should never do unneeded procedures on the patient, regardless how benign. Ethics 101.
Click to expand...


Yet it is so widespread that there is an acronym for that....MRB. Before ultrasound guided blocks were a thing, I remember doing a landmark/nerve stim supraclavicular block during residency. Never did another one until ultrasound became widespread.
 
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