Who else is in the room?

REGULATORY

Mrs D, a 56-year-old civil servant, was admitted for a colonoscopy. She had presented with a two-month history of intermittent dull left hypochondrial pain, flatulence, bloating and loose stools. On two occasions she had painless bright red rectal bleeding. Blood tests were essentially normal, apart from a mild increase in her inflammatory markers. 

The gastroenterologist, Dr K, suspected diverticulitis and planned to carry out the procedure himself, along with a biopsy if required. Dr K discussed the colonoscopy and its possible complications with Mrs D and obtained her consent. As part of the usual preparation for the procedure, Mrs D was given conscious sedation with fentanyl and midazolam.

Dr K carried out the colonoscopy in accordance with standard practice, and found multiple diverticulae and a small polyp in Mrs D’s descending colon, which he removed for histopathology.

One week later, Mrs D submitted a formal complaint to the hospital. She complained about Dr K’s disregard for her modesty, the extreme distress she experienced while undergoing the procedure and the inappropriate hospital environment in which the colonoscopy took place. In the endoscopy room she said she had overheard unknown male voices, who she presumed were IT staff, close by. These male voices, she said, were laughing inappropriately and commenting on details inside the room. 

During the procedure Mrs D was obviously in a state of undress and she complained that this had caused her extreme upset both at the time and when she reflected on it later. She understood that a doctor and a nurse would be present throughout the colonoscopy, but when she overheard men’s voices discussing non-clinical matters like repairing computers and a printer, this was unacceptable to her while she was physically exposed.

Dr K confirmed that he had personally consented Mrs D and advised her of the usual risks and complications. He also confirmed that while the patient was getting prepared for colonoscopy, it was normal practice for them to be covered by a blanket or sheet so there would be no unnecessary exposure of intimate body areas. This, he said, had been explained to Mrs D before she’d been sedated.

It was possible, Dr K said, that Mrs D had overheard Dr K talking to another staff member, Mr D, an IT technician, in the corridor before the procedure, but at no time was there another male present in the room either before or during the colonoscopy. Dr K would, he said, have sought Mrs D’s consent before including any other male staff members in the room. But as it was, Dr K and the female nurse were the only personnel in the room with her. 

The patient complained to the Medical Council and Dr K sought the assistance of Medical Protection. We assisted him in preparing a full explanation in response to the Medical Council and the complaint was dismissed with no further action.

Learning points

Don’t forget that patients can sometimes overhear medical staff having conversations while invasive procedures are taking place. It is possible that, under pressurised conditions, when patients are feeling vulnerable, these might be misunderstood by the patient. Many sedatives can also cause anterograde amnesia, so memories can be unreliable.

It is important to inform patients if other staff members, eg medical students, may be present at the time of these procedures.

Don’t make any assumptions about patients’ expectations of procedures. It may be necessary to be explicit about seemingly obvious matters, such as the degree to which a patient may be exposed during a procedure.