“This attending can be pretty mean.”
During my first week of my general surgery rotation, a resident warned me about a particular attending. They clarified that the attending was “old-school” and might not accept “I don’t know” as an answer. I had heard several variations of this warning during my other rotations, but had completed all without event. I had heard about the reputations of surgeons being abrasive, but I thought 18 months of clinical rotations had mentally prepared me for a callous attending.
I wasn’t prepared, however, to witness this attending use physical punishment. In the OR, just 30 minutes after receiving the warning, the resident did something the attending didn’t approve of – a simple mistake. The attending noticeably paused before physically assaulting the resident. To protect the anonymity of the resident, I won’t describe the specifics, but the intention of the action was clearly to inflict punishment with no educational benefit. There were a few moments of deafening silence before the resident proceeded. Thankfully I had a surgical mask on so no one could see my jaw drop. I was appalled that an educator would violate the bodily integrity of a trainee.
In discussing the case after wheeling the patient to the recovery unit, I told the resident that they didn’t deserve to be treated that way. They replied, “I’m used to it.”
Throughout the rest of my rotation, I was keenly aware of when people physically touched each other, which I found happens frequently in surgery. I started trying to decipher the intention behind every physical touch I witnessed and received.
When I was physically touched, I most often concluded that it was in the name of either patient safety or my own education. While holding an instrument in the body cavity, I would frequently have my hand repositioned. It was often more forceful than I would have liked, but the intention was clearly to make the case run smoother – for the camera to be better positioned, for the suction tip to be hitting the right spot, for the organs we weren’t operating on to be retracted more outside of the surgical field. I never felt that anyone had the intention of harming me.
I mentally approved of these touches, but I never gave explicit consent. In medical training, we give unspoken consent: with the privilege of learning to do physical exams, procedures, or surgeries comes the expectation that you’ll be physically touched in an educational manner.
Most will agree that the use of physical punishment is wrong – that on the spectrum of good to bad touches, punishment is squarely bad. Along with this spectrum, though, is an axis of intention, from patient care and education, to inappropriate affection and punishment. In the context of these axes, perhaps unspoken consent is not enough.
We must remember the humanity of medical trainees, each of whom has their own history and experiences. For many, this includes a history of physical or sexual abuse. Furthermore, we should be practicing what we preach. As a future pediatrician, I think my patients deserve respect and bodily autonomy, regardless of their age. As an attending, I hope to instill in both my patients and my trainees that they have the right to not be touched without consent.
Medical students are required to rotate through each specialty, despite not being well-versed in the norms in each field. A student could finish their family medicine rotation on Friday, receive a brief orientation to their ob/gyn rotation on Monday, and be scrubbing into a surgery on Tuesday. As we move students from rotation to rotation, we should be orienting them to the environment they’ll be working in and what kind of physical touches they might expect: when doing a Pap smear, the supervisor will likely brush against you while they try to see what you’re seeing; when participating in a code, someone might physically tap you out from doing chest compressions; in the ED or OR, you can expect someone to put their hand on yours to guide you as you put in stitches.
The burden to discuss consent cannot fall solely on students, given they are already vulnerable at the bottom of the medical system’s totem pole. With the privilege of being an educator comes the responsibility to make trainees feel comfortable. While discussing the plan for an upcoming procedure or surgery, it only takes a few extra moments to discuss what the trainee can expect in terms of physical touching.
The resident I worked with shouldn’t be “used to” physical punishment, but we can create a training environment where each individual is used to, and prepared for, an educational touch.
What's a physical touch you didn't expect in medical education? Share in the comments.
Sarah MacLean grew up in the suburbs of New York City before attending The University of North Carolina at Chapel Hill. She is currently a fourth-year medical student at the Icahn School of Medicine at Mount Sinai and applying into pediatrics. She is particularly interested in a career that integrates primary care medicine with research and advocacy. She is a 2020–2021 Doximity Op-Med Fellow.