In two separate cases in Illinois, dozens of women have accused their OBGYNs of committing medical and sexual battery while undergoing exams.

The cases raise questions for patients. The relationship between a patient and a doctor requires trust, clear communication and integrity. So, what happens when a patient feels like a doctor hasn’t upheld professional responsibility? What is a patient supposed to do if touched inappropriately or made to feel uncomfortable?

For most people, it is difficult to talk about and find the words to describe what happened. In the October 2021 case of Chicago-area OBGYN Fabio Ortega, it was only after the doctor pled guilty to two criminal sexual assaults of patients that dozens of other women came forward.

That case has had wider repercussions. In June of 2022, Tamara Holder, an attorney representing 36 victims, filed six new lawsuits against Ortega and his former employers – NorthShore and Swedish Covenant. The suits allege that hospital officials allowed Ortega to continue working despite being under criminal investigation for sexual assault.

In August of 2022, a suburban OBGYN, Dr. Vernon Cannon, was accused of

sexual battery by two women while working at Duly Health and Care in Arlington Heights. Additional misconduct lawsuits accuse Cannon of performing medical procedures while intoxicated.

In these cases, women are trying to hold doctors and the institutions that hired them accountable for alleged crimes.

When it comes to obstetrics and gynecology care, what should patients know before seeing their doctor? How can patients stay safe? WBEZ posed these questions to Kavita Shah Arora, head of the American College of Obstetricians and Gynecologists’ Ethics Committee and Jody Madeira, a professor and Co-Director of the Center for Law, Society and Culture at Indiana University’s Maurer School of Law.

The right to a full explanation

Shah Arora, an associate professor at the University of North Carolina Chapel Hill, said that patients have a right to understand what is happening to your body during an appointment.

“Exams should be explained appropriately,” said Shah Arora. “There should be a minimum amount of physical contact required to obtain data for diagnosis for treatment, there should be draping involved so that the exposure is minimized during the exam.”

Most importantly, Shah Arora said, patients should have the opportunity to ask questions and raise concerns at any point during the visit. “It is also recommended that a chaperone be present for all breast, genital and rectal examinations, when possible.”

Madeira said patients should try and have someone else in the room during their exam. A nurse can be present, a trusted friend or both.

“It doesn’t matter why we’re asking,” said Madeira. “It is a reasonable request for a patient to make, and it’s not something we should feel bad about or that we’re inconveniencing the provider.”

Understand the boundaries of the patient-doctor relationship

Shah Arora said patients should know that they can stop and walk away at any point during a visit or even during an exam. Furthermore, there should always be someone in the clinic or office that a patient can talk to about their concerns.

That can be a practice manager in a local practice setting, a division director or chair in the academic setting, a patient relations or an ombuds person in the hospital setting, or even the state medical board.

“I think patients should speak up. I think a lot of times people blame themselves, or they’re not familiar with what should or shouldn’t happen during a visit,” said Shah Arora. “If it didn’t feel okay, if you’re questioning what happened or didn’t happen, I think the best thing to do is to speak up and ask for clarification.”

Madeira said during the exam, stay in touch with your feelings, try to remain present and be aware of what the doctor is doing. She suggests asking questions.

“If you suspect that something is up, ask ‘What are you doing now? Are you inserting something in me? What is that? Can you show me?’ ” said Madeira. “If a physician says they are inserting something in you and you ask to see it, and he or she holds up their hand with nothing in it, and that doesn’t feel like what necessarily was inserted, that might be a mismatch. Patients should be very present in the moment and ask questions.”

Know the power dynamics

Shah Arora says the relationship between patients and OBGYN has fundamentally changed. It’s no longer a paternalistic “doctor knows best” approach but a partnership in a shared-decision making model where patients are the experts in their lives and the physician is the expert in the medical knowledge.

Shah Arora said doctors also are now more focused on trauma-informed care. Trauma-informed care is an approach where doctors and nurses treat patients by centering the need to understand a patient’s life experiences with the goal of effectively treating the patient.

“It’s really important that this method of delivering care is delivered universally. So it’s important to mitigate our own biases, and not try to judge what patients need trauma-informed care and which don’t,” said Shah Arora. “Even the words we use, the body language we have in the exam room is a component of trauma-informed care. It also goes well beyond the physician and really the entire office.”

Trust your gut

Madeira said patients should always trust their instincts.

“When we go in to talk with a doctor or to be examined by a doctor, the consent we give is limited,” Madeira said. “It is for a clinical touching, not a sexual touching, not a touching that is in any way is non-therapeutic. Any touching that is delivered, that is not therapeutic, that is meant for the physician’s gratification is not a touching to which we consent as patients.”

Madeira recommends taking action before anything unfortunate or traumatic happens.

“If we consistently have experiences, for example, a certain provider is creepy, if the doctor caresses our arms and tells us how good we look, and that has nothing to do with what we’re there for, that might be a warning sign,” said Madeira. “We might want to get out of that doctor-patient relationship and find another provider if we can, who does not do that, that does not raise that gut instinct.”

Make a record of your experience

Madeira said when it comes to the law, a patient cannot prosecute a doctor based on a feeling – but there are often indications that something is wrong.

If you suspect something went wrong during a medical visit, Madeira recommends talking to a lawyer first, because you don’t know if what happened was a crime.

“Just write down what happened, get what happened down on paper, or preferably on a computer where it can be saved,” said Madeira. “I think that it might help to reach out to a medical malpractice attorney and just talk through what happened. Also, get your medical records, and it’s always possible to make a complaint to the medical licensing board and the state in which the physician practices.”

Corrections: This story has been updated to correct the spelling of Kavita Shah Arora, head of the American College of Obstetricians and Gynecologists’ Ethics Committee, and correct a quote from Shah Arora about not trying to judge which patients need trauma-informed care.

Araceli Gómez-Aldana is a reporter and host at WBEZ. Follow her @Araceli1010.