This is interesting. A 38 year old construction worker was taken to the ER after being hit a wooden beam. According to him he refused consent for a rectal exam and and restrained him and gave him an injection after he hit the doctor. He woke up in handcuffs. That’s his version :dubious: . Any medical dopers care to speculate on what really happened (or his his story legit)? A rectal exam is a SOP when checking for spinal injuries, isn’t it? But even so unless staff thought he wasn’t in his right mind (what’s the proper term) because of his injuries why would they give him one against his will?
I read about this case in this blog entry on the New York Times’ website. It mentions that “a rectal exam is part of the routine E.R. evaluation”, which surprises me. I can’t tell how a rectal exam is useful in diagnosing a spinal injury.
And the blog posting quotes a bioethicist that a patient with a head injury might not be capable of making rational decisions.
What’s the probability that alcohol was involved?
Oh yeah, I saw this one. Only it wasn’t in NYC, it was Quahog, RI.
The rectal exam is to assess the tone of the sphincter. If it is weak, that is an ominous finding for possible spinal injury.
But as far as I can see, they can’t have it both ways. It was either an incompetent patient who couldn’t withhold consent, in which case you don’t call the cops when he takes a swing at you, or it was a competent patient, in which case you need consent for the exam.
Thanks. While some of the posts (on both sides) sound extreme I’m starting to think that the hospital did screw up, but the guy’s overreacting (PTSD :eek: ). Still if his head injury made him unable to give informed consent why then did they try to press charges? :dubious: A mentally competent adult has the right to refuse care even if it’ll result in his own death.
I don’t see any police in the story linked in the OP. The “handcuffs” could have been restraints, which might have been appropriate given that he assaulted the doctor. I have no opinion about the rectal exam because that’s not my area of expertise.
ETA: I see it in the ethics piece. Whether or not he’s competent, I don’t know why one wouldn’t call the police; he was assaultive even if not competent, and the police can transport him somewhere for evaluation if he’s still not competent when he wakes up.
Maybe they thought he had a stick up his ass?
Charges against the patient have been dismissed, FWIW, and to the chagrin of the hospital folk based on the stories I’ve read.
In my EMT classes, a lot of emphasis was placed on providing treatment/transport against the wishes of a competent patient leaves you open to a criminal assault charge. I don’t know about NY, but in NC that also applies to ER staff up to and including the doctor. Should the guy be ruled competent, IMAO he should go for it.
The muscle tone of the sphincter as a test for spinal injury is something I’ve never heard of, but it’s also outside of the scope of my practice. I do know that priapism (a raging, long term erection) is a sign of spinal injury, and it’s likely the last boner the guy will ever have.
Nope. Considering where he got hit, they thought he had his head up his ass.
I don’t buy the “sphincter tone/spinal cord” connection. I was in a car accident where they had to strap me to a board with a neck immobilizer. No docs took a trip up my Hershey Highway. My friend is a carpenter and had a toolbox dropped on his head (he was wearing a hardhat at the time) so he was taken to the ER. No UFIA for him.
If this guy was at a bar, got drugged into unconsciousness and woke up feeling like his bunghole had been stretched without his permission, he could charge someone with rape. A doctor asks for permission to do a rectal exam and a patient who, according to medical records, was “alert and oriented times three” tells him no. Actually, as they were trying to force the exam on him he yelled, “Where I came from, you don’t put anything in someone’s a------!” So they drug him and do it anyway?! :dubious:
A patient who is lucid and can give consent for treatment can also refuse treatment. The doctor would have noted in the chart that the patient refused a diagnostic test against medical advice.
This hospital is way out of line.
I came across this story on a different site - there, the link summary says:
Making it sound as though when he refused the exam, the doctors smacked him around the head with a plank in order to sedate him.
It was his own fault; he was too cheap to pony up for the deluxe health insurance.
Must have had an HMO.
Well, we can only hope the experience doesn’t turn him gay.
As has already been said, rectal exams are pretty standard when checking for spinal cord injuries. And if it’s a suspected low cord injury, such as in the sacral region, it’s one of the best ways to check.
Plus, doctors just love poking their fingers up people’s bums. It’s considered one of the perks of the job.
Butt sorry he was hit on the head and the sacral region is waaaaayyy south of there. As I posted before, I’ve known people who have had head injuries who did not get rectal exams as part of the ER process. I know lots of people who have been to chiropractors or orthopedists for various back or spinal problems and they never got anal probes.
Have we just been going to the wrong places?
I think it’s because the location of the blow made them think that his spine might have been compressed. If your friends got hit on the head laterally, there wouldn’t be the same concern.
Shouldn’t a patient be allowed to refuse this, even if it’s routine? It may be a standard test, it may be wise, but if he really doesn’t want it, can they force him to have it? Do they make every woman who comes in with abdominal pain have a gyno exam?
StG
Anecdotal and from a while ago (and a lot less invasive), but when I was in college at UC Berkeley, any female student coming into the clinic with any complaint at all including a broken arm was given a pregnancy test.