Why You Should Have a Personal Advocate For Surgery?

All patients should consider having a personal advocate present in surgery with them. The advocate could be a spouse, family member, friend, or a medical professional not employed by the hospital where the procedure is taking place. The advocate would be present in pre-op, surgery, and post-op. Patients who are sedated or under anesthesia are totally vulnerable.

A personal advocate would help to keep the surgical team accountable in many instances including: not allowing the team to ignore patients’ wishes for modesty, as well as protecting a patient's wishes regarding allowing only same-sex personnel to be present for the surgery. With any surgery, the doctors, nurses, and medical personnel enter into an agreement with the patient; an advocate would maintain those preferences and not allow any deviances from the agreement unless medically necessary.

A husband in San Antonio told a male scrub technician he could not come into the operating room with his wife who was having a C-Section and the technician followed his request. Having an advocate present would also help to cut down on medical mistakes, sexual abuse, and deaths because the surgical team would be observed by a personal advocate.

The patient advocate could also require that the medical professionals wash their hands in front of her/him to help decrease infections. Many hospital-acquired infections are caused by medical professionals not properly washing their hands.

Another instance where an advocate present in surgery would be invaluable is when a specific doctor is replaced—because of umpteen reasons—by another doctor.

For example: A patient was scheduled to have a more experienced surgeon to do a balloon angioplasty of peripheral arteries in her legs, but for some reason(s) an inexperienced surgeon substituted him and operated on the patient instead. The patient bled to death because one of her main arteries ruptured. A nurse who was present in the OR told the lady’s daughter what happened, but would not testify against the doctor perhaps due to the possibility of losing her job. Check out an article in Outpatient Surgery Magazine about a chief nursing officer who was fired for reporting safety concerns at a hospital she worked at. The surgery outcome could have been different if the patient’s daughter had been her advocate, been present during surgery, and been able to protest the change of surgeon. An anesthetized patient cannot speak up for themselves.

Check out this article: OR Crowd Control about letting too many people in operating room. It seems ridiculous that many medical facilities have policies prohibiting one family member or a friend from being present for patients’ surgeries. Many facilities use the excuse: “We cannot let you in because of germs.” But then they let various people such as medical students and/or non-medical professionals—a janitor or sales rep—come into the operating room carrying germs.

For many years, husbands were not allowed in the delivery room with their wife. Check out this interesting article about how men ended up in the delivery room, How Did Men End Up in the Delivery Room? Women and husbands actually had to fight to change hospital policies to allow husbands in delivery rooms.

In the 1950s and 1960s men succeeded in being allowed in labor rooms with their wife. Here—“alone together”—couples shared intimate moments, holding hands, reading together out loud, playing cards; husbands often rubbed their wife’s back during contractions. In the 1970s, hospitals and physicians gradually relented and permitted men to be in delivery rooms where they were positioned at the head of the table and could encourage laboring women in their work. The men were happy to be there. With women’s encouragement, men continued to press for change in hospital policies and practices. Even so, some fathers felt out of place in a delivery room which remained medical territory. In the 1970s and 1980s, bowing to couples’—albeit consumers’--wishes, hospitals opened birthing rooms and combined labor rooms with delivery rooms; all were decorated more like home bedrooms rather than operating rooms.

Medical care consumers need to fight against hospital policies that discourage and/or forbid a family member or another person the patient chooses from being present during surgeries. Choosing to have a personal advocate present during surgery should be the right of every patient entering the OR and for any other surgeries.

For example: a C-Section is major surgery; to be present, husbands are asked to put on scrubs and shoe coverings for their wife’s procedure. These same requirements could be followed for other surgeries and procedures.

How to Respond to Arguments By Medical Professionals:

1) Will my family be allowed in the Operating Room? (One hospital policy)
No, in order to maintain the highest level of sterility in the surgical environment this is not allowed.

Our rebuttal: This is misguided. Overall, we should be more concerned about medical professionals having germs rather than an outside advocate who could easily shower with sterile solution and put on scrubs. Why are janitors, medical students, and sales representatives—who may be “dirty”—allowed in the operating room? Many have handled other patients prior to that particular patient. Sometimes, doctors and nurses will take a break during surgery and then return. Also, many surgical staff members eat in the hospital cafeteria throughout the day wearing the same scrubs. Think about how the cafeteria is full of germs and how these same surgical personnel could bring germs to the operating room.

Another issue to consider is that many surgery staff members take bathroom breaks. How unsterile is a hospital’s restroom? Every time a person flushes a toilet with an open lid, bacteria spray into the air from that toilet. Check out this article about how toilets spread germs. Most toilets in public restrooms do not have lids. Most nurses are not told that flushing a toilet can spread germs.

Maintaining a sterile operating room does not hinge on forbidding a patient to have his or her advocate present during surgery. Generally, having more people in the operating room produces more germs.

2) I would caution those who are unsophisticated in an operating room environment such as a family member as an "advocate" to be present during the patient's surgery since a vaso-vagal reaction such as fainting from observing what was going on will cause them to become a "second patient" needing attention or provide, by making verbal complaints at the time, perhaps a disruption to what should be a routine procedure. (One doctor’s argument)

Our rebuttal: There are some family members who can handle blood and surgery. Any patient can find out surgery and operating room information and then determine who would be a good personal advocate. For example: if a husband does not handle blood well, it probably would be best for his wife to have a friend who can better handle the OR setting be her advocate instead. Or maybe the patient can hire a male or female nurse from another hospital to be his or her personal advocate. It is very important to have advocates present for surgeries to make sure the patient’s wishes are honored. Surgery patients who are sedated or under anesthesia cannot speak up and advocate for themselves.

One of the main reasons hospitals do not want family members to be present for surgeries is because they do not want them to see any medical mistakes which may occur. This is provider-centered healthcare rather than patient-centered healthcare. A patient may be promised that his or her underwear will not be removed, but once the patient is under anesthesia the medical personnel could remove the underwear regardless since the patient cannot speak up. Medical malpractice suits are very difficult to win because only medical professionals are present during surgeries. Most medical professionals are not willing to testify against a negligent medical professional.

A woman from Minnesota required a hysterectomy, but she did not want to be put under general anesthesia and she wanted to be 100 percent guaranteed that she would have an all-female surgery team; also, that her husband could be present for her surgery. This patient was completely upset when her first female gynecologist said those wishes could not be accommodated. She decided to find another gynecologist. She shared her view with Medical Patient Modesty: My husband found Medical Patient Modesty after I decided to walk out of the first doctor’s office and it gave us the positive motivation to look for the right doctor. My husband kept researching doctors and found one he was sure was a good doctor, then called the doctor for me. During our first meeting, I actually felt comfortable with this doctor. She was so confident, and answered everything in straight-forward, frank terms. She guaranteed me an all-female staff. After consulting with hospital management and anesthesia, they agreed to allow my husband into the OR. The staff respected my wishes. I was allowed to keep my gown on. They covered the windows, and no males—other than my husband—were allowed in. I would never have gone through with the operation if it were not for finding this one remarkable doctor who had both compassion and was a master of the healing arts. She didn`t put me through unnecessary exams.

The above case’s scenario—explaining how a female patient was allowed to have her husband present for her hysterectomy—shows that we as medical care consumers can fight to have our chosen personal advocate protect us during surgery. Surgery is a big moneymaker for hospitals. These facilities will give in to demands if patients stick together and demand these choices. For those people who are passionate about having a personal advocate present for surgery, consider starting a petition at your hospital which allows each patient to have his/her choice of an advocate present during surgeries. Please use this sample petition and modify it.

Unnecessary Underwear Removal For Surgeries

OR Crowd Control

How Did Men End Up in the Delivery Room?

Surgery and Your Modesty