The technique is especially popular in orthopedic and thoracic procedures. The defendant anesthesiologist argued that his actions were part of his general anesthetic plan and were covered by the patient's implied consent to anesthesia. He also pointed out that the patient had been told of the suppository postoperatively, and that no attempt had been made to deceive the patient. The GMC held for the plaintiff. Complicating the case was the fact that the anesthesiologist mistakenly inserted the suppository into the patient's vagina instead of her rectum, which had initially led the patient to fear that she had been a victim of sexual assault.
Many clinicians forget how uncomfortable patients are with vaginal and rectal examinations.
This may be particulary true with day case patients undergoing minor procedures who remain in street clothing. In a letter in the Brirish Medical Journal about this matter, one author indicated that almost all the patients he surveyed would expect to be forewarned about the intended use of a suppository, and over half would have declined in favor of alternate means of analgesia. This case raises important points for clinicians who take for granted that we can carry out any clinically appropriate procedure in the absence of specific consent above and beyond that implied in the surgical consent process. Rather, they make their patients feel rushed, give superficial explanations and spend less time with them. This emphasizes the point that skilled communication is one of the best guards against mediolegal actions.