To Expose or Not To Expose, That is the Question.

[Lone Star]

I'm just like any other guy on the face of the planet. I like checking out the female form whenever possible. But there are times it's appropriate, and there are times that it's not (not even gonna address the ones that I'd wish I didn't have to see ).

To expose a female patient just because she says "It hurts 'down there." isn't enough justification without exploring other avenues first; one of them being a detailed history that's as complete as possible.

To expose a patient 'just because we can' ranks right up there with the same thinking process of "This is the way we've ALWAYS done it!".

I WILL expose a female patient (with privacy concerns addressed as much as possible) IF there is enough evidence to support the action.

Having been both the practitioner and the patient, I can see both sides of the situation here. There is a place and time for everything we do, regarless of the level of licensure we hold.

Taking baseline vitals on scene, only helps the doctor decide if the patient is improving with what treatments we've adminstered or if the situation is still 'out of control'. It gives that doctor an idea of the condition of the patient when we 'found them'. I may not be able to do a great deal to mitigate the situation the patient is in, but that doesn't mean that taking baseline vitals and detailed assessments are a waste of time.

As far as not posting as much as I used to, I'm taking 15 credit hours per quarter (which translates into around 30 credit hours per semester). I've been quite busy with schoolwork, and I've got some pretty 'heavy classes' to deal with.

[ERDoc]

Just to add my 0.02. I don't think it is necessary for a woman to have an exam in the field under most circumstances. Obviously if she is giving birth then it might not be a bad idea to take a look. Heavy bleeding will be another reason, but should usually be obvious from the outside. In all other cases, you don't have the proper tools to do the proper exam, so why do it half assed? Does anyone carry a speculum on their ambulance? Has anyone been trained to do a bimanual exam? An exam by someone in the field will add very little (no, I do not mean that to put anyone down) to the pt's care. I would have to say in this case, keep the pt's dignity and let her go through the exam, only once, in the ER.

[spenac]

For those that actually added to the discussion with good facts or opinions rather than making asinine attacks thank you. The obvious answer was included in the poll it is the answer to most of what we do in EMS it is do it as needed, the third answer on the poll. When is it needed is more open to interpretation and probably more in the middle than the extreme I took as devils advocate and the extreme limits some placed in their comments.

[Riblett]

I really intended to stay out of this one, and it looks like a consensus has already been reached. But after reading all the replies, I think this issue is A. being blown way out of proportion (MATEO !) and B. Being made way too complicated.

Take it from a 20-something year old female, the population I believe that you are most likely to encounter with ob/gyn emergencies and the least likely to be educated about what exactly is going on. Pelvic/vaginal examinations, be they visualization or palpation, should be done a very strictly need-to-know basis. It will not and should not change our treatment, and spare me the 12 lead argument. There is just too much risk in this highly litigious society, especially for male providers, without any real proximate benefit. All we really need to be assessing for down there is excessive bleeding or presentation of a baby's head. If your patient is pregnant, a lot of that modesty is probably out the window anyway and a visual check for crowning is acceptable but should be done discreetly. If there is excessive bleeding you are probably going to see it. And even if you don't, you can ask in a way that even the stupidest chromosomal deficient piece of trailer trash can understand. A simple, how many times in the last 30 minutes have you had to change your pad or tampon question should give you an understanding of what you are dealing with. Some are claiming that we can't take the patient's word for how much they are bleeding and it may not be apparent, (ie we can't treat what we can't see). Well I say that any half-ass decent paramedic should be very closely monitoring any patient with vaginal bleeding, regardless of how much they claim it is or even what they see. Like Spenac said, they could be compensating with normal vitals. We should be prepared to aggressively treat hemorrhagic shock in these patients and checking out their crotch isn't going to be able make us any better prepared to do that than we already should be.

[ambodriver]

"Are you bleeding?" DO I see massive blood loss? Is a baby popping out? If I don't i'm not going in

I'm not looking unless both of those questions are 100% affirmative.

Who wants to be up in someones nasty junk?

Hahaha

Edited October 27, 2010 by ambodriver

[DwayneEMTP]

Who wants to be up in someones nasty junk?

Hahaha

Would it change your answer if you knew that she had really hot, sexy junk?

Dwayne

[spenac]

"Are you bleeding?" DO I see massive blood loss? Is a baby popping out? If I don't i'm not going in

I'm not looking unless both of those questions are 100% affirmative.

So if there's bleeding but no baby your not looking? That's bad patient care.

No I did not give you a negative but I understand why someone did.

[uglyEMT]

Well this thread popped back up and I now have a real life situation

Dispatched to a male with groin pain. Get there there is blood on the bathroom floor and the guy waiting patiently wearing jeans. I ask the simple question, whats the blood from? Oh I had a cathader removed earlier today was his response. I asked was he bleeding still and he said didnt think so. I asked if he would mind if I checked him out. He allowed me to and dropped pants right there. Very little blood at that point but I still put some gauze and tape for the transport.

So I guess there is a time to expose and check. I did it tactfully and with the utmost regard for the patient's respect and feelings.

[mobey]

Well this thread popped back up and I now have a real life situation

Dispatched to a male with groin pain. Get there there is blood on the bathroom floor and the guy waiting patiently wearing jeans. I ask the simple question, whats the blood from? Oh I had a cathader removed earlier today was his response. I asked was he bleeding still and he said didnt think so. I asked if he would mind if I checked him out. He allowed me to and dropped pants right there. Very little blood at that point but I still put some gauze and tape for the transport.

So I guess there is a time to expose and check. I did it tactfully and with the utmost regard for the patient's respect and feelings.

I do find however, that males are alot more comfortable exposing themselves than women.

from a provider standpoint, I believe anecdotally that we are at much less risk of a lawsuit/wrongful acusal, from visualizing male genitalia, than female. Overall, i would say that women are wayy more sensitive to sex crimes than men, hence guys will drop trou upon request.

[secondarybigdaddy]

I do find however, that males are alot more comfortable exposing themselves than women.

from a provider standpoint, I believe anecdotally that we are at much less risk of a lawsuit/wrongful acusal, from visualizing male genitalia, than female. Overall, i would say that women are wayy more sensitive to sex crimes than men, hence guys will drop trou upon request.

Like someone else here said I think the consensus here is that if you can justify a Visual examination by saying that it will definitively alter your course of action by doing it, then one in good conscious should be doing one. I don't feel right basing my call on whether or not to perform one on sex "females might sue more".

I had a scenario very similar to the poster above with a Male, a slight language barrier, and a Catheter. In this case I was in training (not yet cleared for Pt Care) and the Male Pt was complaining of throbbing Groin pain. We were asking him all sorts of questions, Hernia, Exercise, had he been to the hospital lately. I said "should we take a look?" the crew members I was training with both agreed " I'm not taking a look!" "You want to Go Ahead". I was embarrassed and I felt I did not have their support, so if I had found something I felt I might be on my own. So I didn't look.

We arrived at the hospital which was two blocks from the scene, and it turned out the guy had a catheter tube that had been in for over two weeks and was badly infected. I mean we were asking this guy everything, and he didn't say one thing about a Catheter. We felt pretty stupid giving report to the ER Nurse and Not having had any knowledge of this.

Now in this case, would it have made any difference, other than us saving face? Probably not. But it made me think right from the very beginning of my EMT career about to expose or not expose. I for one am glad the OP brought this up as I am new here and have not read a lot of old threads.

On a side note someone posted that a friend of theirs was fired for what seemed to be a justified exposure, even though he was found to have been justified. That is disheartening, I have to base my judgment on what is best for the Pt. and if I think taking their pants down might make the difference even if it's just to Upgrade the call to "Emergent" that's what I should do. Shame on the company for not standing by their employee.

...and shame on his wife for not standing by him while he was out of work.