MN jury opinion please (work related issue)

[HicDraconis]

I'm an anaesthetist. This is probably totally trivial but I wondered I was BU with something at work yesterday.

I was on call and a young girl (early 20s) came in with abdominal pain, she was booked for a diagnostic laparoscopy. Had to be done later in the evening for various reasons (7ish). It's keyhole surgery where you can see what the internal organs etc look like on screens. Mostly the patient is covered but there are parts (beginning and end - before and after drapes) when they are more exposed.

A member of staff who works within the theatre area but not in a patient care role (washes used instruments and puts them in packs through the steriliser) asked if she could come in to watch.

I felt uncomfortable with this as I didn't think being in the room for her would improve patient care in any way and I wasn't happy with the thought of a stranger's surgery being used as entertainment for a bored staff member. I also felt it would be inappropriate to ask a scared, possibly vulnerable young girl, in pain, for permission to have an extra person in theatre essentially as she arrived as it makes it difficult to say no. Medical information regarding the patient would be discussed in theatre (and was) and again I was uncomfortable with someone else being privy to that information who really had no need to know it.

However the theatre nurse who asked me if I minded this person being present was clearly surprised and annoyed when I said yes and outlined my reasons. So - was I being overly precious? Should I arrange for this theatre person to watch someone's surgery next week?

[InTheRedCorner]

I think you did the right thing. If I had been asked as the patient I would have said no.

It would be different had you been asked as part of someone development with career.

[ComeIntoTheGardenMaud]

Seems to me that you were absolutely right. Surely surgery isn't a spectator event (unless there is some element of staff training, which there wasn't here) and having onlookers brings hygiene and infection risks?

[AlpacaPicnic]

Someone with a good reason to be there... I would have no problem with them observing. It wouldnt have to be that they were a trainee doctor or whatever - maybe if they needed a similar procedure and wanted to see how it happened, I wouldn't mind as long as the patient agreed.

But I would say in this example YANBU. They just wanted to stickybeak.

[DramaAlpaca]

I think YANBU and did absolutely the right thing. There was no medical reason, in any way, for that person to be there.

[timidviper]

I think you did the right thing by erring on the side of caution. If this had been flagged up to management as an issue you can bet the theatre nurse would have said she had asked you!

I would be inclined to ask management if there is a guideline or protocol for who is allowed to observe and when, just to cover your back

[ChazzerChaser]

You were absolutely right. I'm stunned that the rights of the patient to privacy wouldn't just be a given. Surely ethical concerns like this are covered heavily in training? I'm meaning for the nurse, not re you.

[MintyChops]

YWNBU, I would have hated that as the patient.

[olympicsrock]

I would have said yes I think but it depends on the reasons given. Is the person considering a side ways move within the theatres environment? I think they would have seen what an important role they play and might have offered some interesting points on what is used, how the packaging of instruments effects the role of the scrub nurse, irritation of the team and delays caused by any defective equipment that were avoidable.
However you are right to have concerns about confidentiality in the health service and some discussion was needed with them by someone senior.

[YouStayClassySanDiego]

You did the right thing and acted on your instinct and professional thought.

Dont feel obliged to make things better next week.

[Kevinsbowel]

I have just had laparoscopic hysterectomy and oophorectomy. If I had been asked at pre-OP stage if someone could observe, I would have been fine with it- provided there was a sensible reason.

However, I am a 52 year old veteran of three births. If I had been 20 and in pain, and you,had asked me on the day, I would have been upset, I think.

And even at my advanced age and shamelessness I would like people to have a sensible reason to be there. But I would understand wanting to feel part of things. As long as s/he didn't pass out during the gory moments and cause mayhem.

So I would pick a more robust patient, ask them earlier and make sure there's a chaperone if they puke everywhere. Which does rather beg the question- is it worth it? I mean, there are plenty of videos of surgery they can watch if they are just curious.

[olympicsrock]

Timid viper is right paperwork should have been completed and this discussed in advance.

[octopusinasantasack]

YANBU. There must be a proper procedure for these requests to be made rather than just asking the medical staff at the time, I'd have thought it should go via their manager and your manager at the very least.

[HicDraconis]

Thanks all for comments. Olympicsrock, good points re: observing how instruments are used in theatre and whether that would help improve their care in sterile supplies.

I doubt there's a protocol or guideline for who can observe - it's mostly left to "if the surgeon, anaesthetist and patient don't mind".

The theatre nurse was obviously annoyed with me for saying I minded. Maybe I'll have a chat with her next week about arranging an observation opportunity on an elective list where the patient can be asked in a less pressured environment. Also where the diagnosis is known (which it wasn't in this case) so there's less of an issue regarding confidentiality.

[elvislives2012]

To put a different side across. How do u know the staff member was bored? I'm a nurse and observing operations were an essential part of my training and early career. It helps by understanding the role of theatre and the different ways people work as a team. Not only that but helps people understand the care and respect that patients experience when sedated. It's a whole other side of medicine. The member of staff was also employed by the trust and therefore all necessary vetting had been done. I think YABU to have said no and to infer that their reasons were not valid. Perhaps next time involving the patient would have been impowering for them and there are ways you can ask to help them not feel nervous about it

[pomdereplay]

I think you absolutely did the right thing, you sound like a very caring advocate for your patients.

[Tabby1963]

OP, as a patient I am nobodies entertainment and in this example I would have said "no" if asked.

I have had procedures done where I have been asked beforehand if a trainee doctor can observe (I give permission) would this nurse have asked the patient for their agreement? Would she have explained that the member of staff 'just wanted to watch and wasn't a doctor in training?

YWNBU.

[HicDraconis]

Elvislives - she was bored, we all were. We had done nothing all day until this patient came in. And while you found watching surgery important to your job - her job does not involve patient contact at all, so I don't see how her observing surgery will improve things for her or the patient. It's not part of the training for her role either.

[StillNoFuckingEyeDeer]

If she said she just wanted to observe because she was bored, I would've told her to go to the coffee room and read a magazine/watch tv.
If she wanted to learn about surgical instruments/see what working in theatre was like for a genuine reason, I'd have let her stay, but I'd expect her to listen to explanations and ask/answer questions like a nursing/medical student.

[DejaVuAllOverAgain]

YANBU I think the nurse was out of order in being annoyed. In fact I don't think she should have been asking in the first place. The girl was going through an operation, she's not the entertainment of the day.

[julieann42]

Where I work we have student nurses and they are allowed to watch surgery but only if they are following the patient through..ie they admit the patient, take them to theatres,watch the op, recover the patient in recovery and escort back to the ward..all with patient and consultant permission first! You did the right thing

[StephenKatzCrackerHat]

You did absolutely the right thing (trained nurse here). You acted as an advocate for a young patient, and thought of her best interests first and foremost. Something the theatre nurse should also have done

[PicaK]

I think you did the right thing. It is very frightening having an operation - no matter how sensible you are being i think a lot of people tremble inside. I remember looking with open mouthed disbelief at an anaesthetist who said my op was "just routine" and spluttering "i shuffle bits of paper for a living. There's nothing routine about today for me."

So i think you're great and you made the right call. I do think there's a slight element of you being dismissive of someone's motive cos they are not clinical staff. If you want to come out of this with top marks i'd make time to talk to them personally, explain what your concerns were and encourage them to attend a more planned op.

In my early 20s i gave permission for someone to watch my op (just a mole removal). I trusted there was a good reason for them to be there. I remember feeling quite angry and let down when i realised he was a gcse student whose dad knew the chief surgeon. Felt very used. Glad you saved someone else from that.

[wonderstuff]

YANBU and did the right thing. I think confidentiality is the key thing really, to make a patients confidential details known to someone who has no good reason to know them is ethically wrong surely.

[Laurel1979]

YANBU. What was the opinion of the surgeon doing the operation? I can't see any benefit to a non medic watching the surgery. As a GP I have in the past as part of my training observe (and assist) in the operating theatre. But this has always been strictly regulated, fully discussed with the patients beforehand and a consent form signed. And there was never and pressure put on the patient to comply, in the few cases where consent was refused, I was more than happy to have an hour or two in the tea room with a newspaper! I can't see what was to be gained by his member of staff observing the operation.

[Laurel1979]

Sorry I realise my grammar was terrible in my post - I'll blame the iPad!