Chaperones in the OR?

[Gambler 101]

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I was in the OR for the past few weeks and noticed some creepy behavior towards the unconscious, anesthetized patients i.e. Scrub techs uncovering patients to stare at private areas, comments made about sexually assaulting patients, sly groping etc. by multiple people in different rooms. I felt pretty helpless because the attending joined in on the comments as well...

I know for physical exams people can request chaperones. Has anyone ever seen chaperones in the OR?

 

[WedgeDawg]

I was in the OR for the past few weeks and noticed some creepy behavior towards the unconscious, anesthetized patients i.e. Scrub techs uncovering patients to stare at private areas, comments made about sexually assaulting patients, sly groping etc. by multiple people in different rooms. I felt pretty helpless because the attending joined in on the comments as well...

I know for physical exams people can request chaperones. Has anyone ever seen chaperones in the OR?

I mean, you could report this behavior as it's quite inappropriate. Generally healthcare staff are mature enough to not do this and I certainly haven't seen this in any OR I've been in, so chaperones aren't usually necessary in these instances.

 

[doc05]

I was in the OR for the past few weeks and noticed some creepy behavior towards the unconscious, anesthetized patients i.e. Scrub techs uncovering patients to stare at private areas, comments made about sexually assaulting patients, sly groping etc. by multiple people in different rooms. I felt pretty helpless because the attending joined in on the comments as well...

I know for physical exams people can request chaperones. Has anyone ever seen chaperones in the OR?

this is most unusual. I've never seen this in all my years in the OR. obviously this is inappropriate, and should be reported.

 

[calvnandhobbs68]

Your hospital likely has an anonymous reporting system for just these kinds of incidents. Utilize it. If you don't know how to report this, ask the risk management department at your hospital how you would be able to report an incident anonymously without divulging what it is. They'll be very happy to help you as they basically exist to prevent stuff like this from happening and the hospital getting sued out the ass.

 

[Gambler 101]

I'll look into the anonymous reporting at this place. I'm glad it's not a common problem

 

[Mad Jack]

I was in the OR for the past few weeks and noticed some creepy behavior towards the unconscious, anesthetized patients i.e. Scrub techs uncovering patients to stare at private areas, comments made about sexually assaulting patients, sly groping etc. by multiple people in different rooms. I felt pretty helpless because the attending joined in on the comments as well...

I know for physical exams people can request chaperones. Has anyone ever seen chaperones in the OR?

I've never seen any behavior like what you're describing in the OR. 10/10 on the report scale.

 

[gogodre]

This is odd. The worst I've seen is unkind comments about patients body habitus but this is fairly benign. I did feel somewhat weirded out getting in a line to do pelvics on gyn cases. I'm pretty sure the patient wouldn't have wanted 4 pelvic exams prior to the case.

 

[bc65]

I have never seen behavior like this. Patients are sometimes uncovered prior to prepping, so that could be explained away, but not the groping. I have never heard inappropriate comments, either. If you have seen such behavior it should be reported.

As for your original question, I am male, and I have routinely asked for staff changes in the OR when I found myself operating on a female patient and had an entirely male staff in the OR ( male anesthesiologist, male scrub tech, male circulating nurse ). I became concerned about this after reading and hearing about cases of female patients complaining about being molested in the OR. Many of these cases were attributed to Versed and other drugs given to induce anesthesia. Sometimes this staffing was difficult to achieve, and so far as I know I was the only one concerned about this in my OR, but I think it's a very real risk to the OR staff. Of course, having a female staff member present is no guarantee, but at least it's a start.

 

[SKaminski]

I have never seen behavior like this. Patients are sometimes uncovered prior to prepping, so that could be explained away, but not the groping. I have never heard inappropriate comments, either. If you have seen such behavior it should be reported.

As for your original question, I am male, and I have routinely asked for staff changes in the OR when I found myself operating on a female patient and had an entirely male staff in the OR ( male anesthesiologist, male scrub tech, male circulating nurse ). I became concerned about this after reading and hearing about cases of female patients complaining about being molested in the OR. Many of these cases were attributed to Versed and other drugs given to induce anesthesia. Sometimes this staffing was difficult to achieve, and so far as I know I was the only one concerned about this in my OR, but I think it's a very real risk to the OR staff. Of course, having a female staff member present is no guarantee, but at least it's a start.

I understand having a chaperone helps to deter risk, due to the fact that you have someone to collaborate your story. How does having a female reduce your risk, however?

Every argument i can think of implies that men are more likely to lie, or that men or more likely to sexually harass an individual.

 

[Yleio381]

I understand having a chaperone helps to deter risk, due to the fact that you have someone to collaborate your story. How does having a female reduce your risk, however?

Every argument i can think of implies that men are more likely to lie, or that men or more likely to sexually harass an individual.

Well, historically (and honestly currently) speaking, men are more likely to sexually harass an individual.

 

[bc65]

I understand having a chaperone helps to deter risk, due to the fact that you have someone to collaborate your story. How does having a female reduce your risk, however?

You mean "corroborate", not "collaborate".

How does having a female reduce your risk, however?

A chaperone is there to protect the patient from being touched inappropriately, and to protect the physician from false accusations. As the physician, I'm only concerned with the latter.

If I have a female chaperone, eg a nurse , in the room while I examine a female patient, she will be a credible witness for me that nothing untoward occurred during the exam. If I have a male witness, then the patient could plausibly claim that both I and the male nurse assaulted her, or that he witnessed the assault but didn't intervene because he enjoyed watching. I am aware that sexual orientations vary. Nonetheless, going with the majority here is quite reasonable. Also, rape by women is quite rare, whereas assault by men is more common, so yes, a female witness for the defense is much more believable.

 

[IlDestriero]

I was in the OR for the past few weeks and noticed some creepy behavior towards the unconscious, anesthetized patients i.e. Scrub techs uncovering patients to stare at private areas, comments made about sexually assaulting patients, sly groping etc. by multiple people in different rooms. I felt pretty helpless because the attending joined in on the comments as well...

I know for physical exams people can request chaperones. Has anyone ever seen chaperones in the OR?

I find this all hard to believe.
I'm in the OR every day for around 2 decades in many different locations and have never seen anything like this. Including lining up for a pelvic.

 

[dpmd]

The second two things I have never seen. I have seen people make a comment if something about a body part is atypical (like has a tattoo or piercing) to include breasts and genitals, but never in a sexual manner (even the times when someone commented on how big a penis was or how perky a set of breasts are it was more like wow, that is unusual rather than ohh baby that is hot). The commenting is probably as unprofessional as when I complain about how much adipose a patient has but I think both are drastically different than what is being described in the OP.

 

[Teddy.KGB]

Wow, this is a big deal. You basically witnessed an assault. Although the people in the OR may find this to be funny, your hospital's legal team will not. It's know it's easy for me to say as I don't have any skin in this game, but I would not bring this up to your hospital administration as an anonymous complaint. You should ask for a private (and off the books) meeting with someone at your hospital who will understand the ramifications of this in terms of liability and threat to the hospital's "brand". The head of your hospital's legal team will for sure, hopefully the dean of the medical school will as well. The reason I would start with the legal team is because they will also understand whistleblower laws and that you, as a medical student, may feel intimidated by the powers that be. They should be able to guide the process of making the necessary changes in your hospital while protecting you. Of course, if you are interested in doing surgery as a career, you suddenly have a lot more at stake here, in which case the anonymous reporting may be the safest way to go. Best of luck. Hopefully, if things go well, we won't hear about this on CNN.

 

[Gambler 101]

I ended up reporting the comments and groping anonymously through the hospital system. It seemed to happen just with just one attending (although I now selfishly hope I never need surgery).


Sent from my iPhone using SDN mobile app

 

[Teddy.KGB]

This situation actually kept me up at night thinking about it. Just imaging this sort of thing happening to my girlfriend, sister, or mother is sickening. I hope there has been some change at your school, at least with this attending.

 

[Siggy]

Well, historically (and honestly currently) speaking, men are more likely to sexually harass an individual.

Are men more likely to harass or are women more likely to complain? Of course... is it harassment if the victim enjoys it (i.e. women harassing men)?

 

[Psai]

Are men more likely to harass or are women more likely to complain? Of course... is it harassment if the victim enjoys it (i.e. women harassing men)?

?

 

[NickNaylor]

Are men more likely to harass or are women more likely to complain? Of course... is it harassment if the victim enjoys it (i.e. women harassing men)?

What is this I don't even

 

[IlDestriero]

I was stalked in college by a crazy and ridiculously hot Asian coed. It was awesome. Until it got kind of boring and predictable, then she went on to stalk someone else after about a year. Manipulating a stalker for your benefit 101. I should put that on my resume and join the lecture circuit.

 

[Siggy]

Let me put it another way...
"Well, historically (and honestly currently) speaking, men are more likely to sexually harass an individual."

[citation needed]

 

[Psai]

I was stalked in college by a crazy and ridiculously hot Asian coed. It was awesome. Until it got kind of boring and predictable, then she went on to stalk someone else after about a year. Manipulating a stalker for your benefit 101. I should put that on my resume and join the lecture circuit.

Which college was it? I want to avoid getting an education there, seems much too distracting


Also, thread needs pics

 

[evilbooyaa]

I find this all hard to believe.
I'm in the OR every day for around 2 decades in many different locations and have never seen anything like this. Including lining up for a pelvic.

Not necessarily 'lining up' but I've seen a MS3, intern, PGY-3 Gyn res, and attending all perform a pelvic exam under anesthesia on a patient the gyn-onc team was operating on. On some more crowded services I heard of 2 MS3s or a MS3 and a MS4 performing the exam.

 

[maxxor]

Not necessarily 'lining up' but I've seen a MS3, intern, PGY-3 Gyn res, and attending all perform a pelvic exam under anesthesia on a patient the gyn-onc team was operating on. On some more crowded services I heard of 2 MS3s or a MS3 and a MS4 performing the exam.

If they are about to have their hands in the bookwalter, it seems reasonable for them to feel the pathology when at an academic medical center.

Pulling med students from other ORs or people not in the surgery is a bit over the top.

 

[Psai]

Not necessarily 'lining up' but I've seen a MS3, intern, PGY-3 Gyn res, and attending all perform a pelvic exam under anesthesia on a patient the gyn-onc team was operating on. On some more crowded services I heard of 2 MS3s or a MS3 and a MS4 performing the exam.

I've seen me, a resident and an attending examine an umbilical hernia as the patient was under anesthesia. I mean, we were lining up to perform a belly

 

[evilbooyaa]

If they are about to have their hands in the bookwalter, it seems reasonable for them to feel the pathology when at an academic medical center.

Pulling med students from other ORs or people not in the surgery is a bit over the top.

Agree

I've seen me, a resident and an attending examine an umbilical hernia as the patient was under anesthesia. I mean, we were lining up to perform a belly

I know what you mean but the obvious intimate/uncomfortable nature of a pelvic exam is the difference here.

 

[Donald Juan]

I know what you mean but the obvious intimate/uncomfortable nature of a pelvic exam is the difference here.

If the patient had some unique pathology or physical exam finding related to the procedure that was about to be performed, having the team about to perform the procedure examine the patient is warranted. If they are just lining up because, "hey, here's a chance to practice a bimanual!" then it's a little different. Basically, I don't think it's the intimacy of the exam that makes it different, it's whether or not the exam under anesthesia is warranted.

 

[Psai]

Agree



I know what you mean but the obvious intimate/uncomfortable nature of a pelvic exam is the difference here.

I would be pretty uncomfortable if someone came and started palpating my umbilicus. I've also done an indirect inguinal hernia exam if that makes you feel better. Sorry that no no spots get sick too

When a patient is anesthetized it's actually a great time to do a physical exam as their muscles are all paralyzed including the abdominal wall.

I frequently have students palpate stuff once the patient is asleep. You can feel tumors, hernias, all kinds of stuff.

Nice man, you're a great teacher

 

[evilbooyaa]

If the patient had some unique pathology or physical exam finding related to the procedure that was about to be performed, having the team about to perform the procedure examine the patient is warranted. If they are just lining up because, "hey, here's a chance to practice a bimanual!" then it's a little different. Basically, I don't think it's the intimacy of the exam that makes it different, it's whether or not the exam under anesthesia is warranted.

Fair enough. And yes, I agree that the example I gave was appropriate, but if you ask the general population who doesn't understand the need for medical students and residents to get this experience somewhere before they become attendings, it would not get as much supportive feedback.

Let me put it this way - on an awake patient, the med student, intern, junior, and senior, and the attending will all push on a belly to verify what the previous person did. However, there have been times where certain people in the line have skipped doing a rectal especially when they're all seeing the patient concurrently (although generally the senior will), due to the more invasive/intimate nature of the procedure. I can't speak to pelvic exams b/c I don't have to do them this year.

 

[dpmd]

Fair enough. And yes, I agree that the example I gave was appropriate, but if you ask the general population who doesn't understand the need for medical students and residents to get this experience somewhere before they become attendings, it would not get as much supportive feedback.

Let me put it this way - on an awake patient, the med student, intern, junior, and senior, and the attending will all push on a belly to verify what the previous person did. However, there have been times where certain people in the line have skipped doing a rectal especially when they're all seeing the patient concurrently (although generally the senior will), due to the more invasive/intimate nature of the procedure. I can't speak to pelvic exams b/c I don't have to do them this year.

Actually, on an awake patient with a tender belly and concordant imaging I think it is worse for multiple people to examine than for multiple people to gently do a pelvic or rectal.

 

[Gambler 101]

I felt uncomfortable with the anesthetized pelvic exams in Ob/Gyn as well. My resident said it was part of my training i.e. I had to go along with it. For me, it's a consent issue. I didn't ask the patient in advance if I could perform an invasive pelvic exam. If I was the patient, I wouldn't want extra people examining me. Frankly, it didn't give me any special knowledge that made me better at assisting in the surgery...

 

[Psai]

I felt uncomfortable with the anesthetized pelvic exams in Ob/Gyn as well. My resident said it was part of my training i.e. I had to go along with it. For me, it's a consent issue. I didn't ask the patient in advance if I could perform an invasive pelvic exam. If I was the patient, I wouldn't want extra people examining me. Frankly, it didn't give me any special knowledge that made me better at assisting in the surgery...

Except you're not an extra person, you're a physician in training who should be familiar with pathology and physical exams

 

[dpmd]

People sometimes don't want to be naked or have people see parts of their body but it is a necessary part of surgery. Having all those on the surgical team know the abnormality leading to surgery is another necessary part of surgery. When i assist with a breast case i still examine the breast so i know where the lesion is that way i can make sure the incision is appropriate to remove it and i can retract in such a way to help expose it. I am an extra person who has not asked the patient permission but no one would ever question it. Now a student is obviously not going to be able to help the way i can, but they can observe what is going on and conceptualize how the lesion is getting dissected out in relation to where they felt it on exam and ask questions if they don't understand so that in the future they will have a better understanding. Plus who knows, maybe they will have some useful input based on their exam.

 

[tiedyeddog]

Frankly, it didn't give me any special knowledge that made me better at assisting in the surgery...

Your job as a medical student is to build a base of general knowledge that you will build off of for the rest of your life. Doing a pelvic exam before and after an OB/GYN procedure is a core principal of understanding gynecological procedures. They aren't doing those exams for giggles, its to assess the person's anatomy before doing a procedure. All surgeons should do this. You as a student should be doing this.

Have you ever actually looked at the surgical consent at your institution? At mine it includes that residents and students will be participating. When I consent people I tell them that residents and other students will be participating in their procedure. It's a teaching institution.

 

[hmockingbird]

Your job as a medical student is to build a base of general knowledge that you will build off of for the rest of your life. Doing a pelvic exam before and after an OB/GYN procedure is a core principal of understanding gynecological procedures. They aren't doing those exams for giggles, its to assess the person's anatomy before doing a procedure. All surgeons should do this. You as a student should be doing this.

Have you ever actually looked at the surgical consent at your institution? At mine it includes that residents and students will be participating. When I consent people I tell them that residents and other students will be participating in their procedure. It's a teaching institution.

At my school, multiple exams before surgery happened when the patient had pathology that was easily palpable by the bimanual exam so we could learn. I witnessed OBs getting consent and there were parts that included that there would be a pelvic exam after they had gone under anesthesia but before the surgery started to locate the pathology and that students and residents would participate in the surgery. If it was just like, "oh hey here's a random unconscious patient to practice your pelvics on!" that would be totally different, but I felt comfortable that patients were informed about what would happen. I believe we did have the occasional patient who didn't want students in their surgery, and that was respected. I had heard about the multiple pelvic exams before, and worried about it, but my opinion changed once I saw the OBs doing the consent and realizing the patients were made aware of this and given a chance to say no to having students participate in their surgery.

Regardless, what the OP describes is inappropriate IMO and I'm glad you reported it.

 

[Teddy.KGB]

I think what this comes down to is what is the intention of the interaction. When patients come to an academic institution for the medical care, there is an understanding that there will be trainees involved in their care who will be performing in a role that is simultaneously student and provider. If the physical examination is done in that context, this should be expected although more sensitive examinations (e.g. pelvic exams) should be communicated to the patient. If however, as in the OP, the intention of the interaction was not to deliver medical care, but rather to exploit an unconscious patient, then what we are talking about is assault.

I realize that most of my posts on SDN have been rather tongue-in-cheek, but this thread has really gotten to me. I haven't done clinical rotations yet, but I hope that when I do, if I see something that I will say something.