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Tue Jan 15 14:49:19 GMT 2008

We'll never quantify either; but let's admit that the risk to the
patient for sexual abuse is as real as the risk to the provider of
malicious accusation.  This is not a one-sided exposure.

A chaperone is there for both of you.  Swallow your cynicism.  Don't
look for reasons to make the provider-patient relationship needlessly
adversarial.  Things are hard enough already.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of
czuehlke at frontiernet.net
Sent: Tuesday, January 15, 2008 9:36 AM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 55, Issue 13

I totally concur, going into a room without a chaparone or tech during  
a female-male exam is setting yourself up for possible law suit.  
Unfortunately, there are too many people who are looking for a reason  
to imply that you did something wrong. I think history is our greatest  
asset and I think you would benefit more to be safe and take someone  
in with you. You have worked hard to get your license and I would not  
recommend taking a chance with it. Just some advice from an ED nurse.
Carol Eisenbrandt

Quoting trauma-list-request at trauma.org:

> Send trauma-list mailing list submissions to
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>
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> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>    1. Standbys in Today's Medicine  (bensonblues at comcast.net)
>    2. Re: Standbys in Today's Medicine (Bjorn, Pret)
>    3. Re: Standbys in Today's Medicine (William Bromberg)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 14 Jan 2008 17:30:38 +0000
> From: bensonblues at comcast.net
> Subject: Standbys in Today's Medicine
> To: trauma-list at trauma.org
> Message-ID:
>
<011420081730.22568.478B9C3E0000A8CD0000582822120207849C0A9A040D02019C02
0A0D at comcast.net>
>
> Content-Type: text/plain
>
> After 15 years of being a program director in EM, I can give you   
> many horror stories of residents who have unknowingly and   
> idealistically tread where no man (or woman) should go: Examining   
> someone of the opposite sex without a friendly (preferrably   
> professional EMT, RN) chaperone. As always, it depends upon your   
> patient population. But, in general, we practicioners in Detroit   
> feel like Lottery Agents for the Michigan State Lottery - it seems   
> everyone wants to sue and made that fast and easy buck. We NEVER   
> exam a patient without a medic or nurse present who is of the   
> patient's sex, unless the patient is in extremis, and even then....
>
> To further complicate things, if a patient has gender identification  
>  issues, or, theologic/religious issues, it can be more confusing  
> and  difficult. There are a few moments each day when I wish I could  
>  transform into an amorphous, colorless, and asexual entity so that  
> I  can get my job done with more efficiency. I think my wife wishes   
> that as well....
>
> ------------------------------
>
> Message: 2
> Date: Mon, 14 Jan 2008 13:41:40 -0500
> From: "Bjorn, Pret" <pbjorn at emh.org>
> Subject: Re: Standbys in Today's Medicine
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <9CCE32ECAAFDEB4DA01EC771B6AD951BFB2661 at VALIER.me.emh.org>
> Content-Type: text/plain;	charset="us-ascii"
>
> Risk analysis??  I suppose hard data beats fear or cynicism as a
reason
> for decency and professionalism; but not by much.
>
> A patient's dignity and privacy are precious to him/her, as they
should
> be to us.  That we must invent or exploit other justifications to be
> respectful -- much less PROVE them -- is pretty pathetic when you stop
> and think about it.
>
> Whether an important medical examination becomes a heartless violation
> is chiefly up to the clinician.  Start by explaining what you're up to
> and why, and then insist on providing a chaperone as a demonstration
of
> your dedication to your patient's comfort and confidence.  Thus you've
> lost maybe twenty seconds putting everyone at ease.  Time well spent,
if
> you ask me.
>
> As is almost always the case in REAL LIFE, proper patient care will
> generally steer you clear from all manner of harm; but such should be
a
> benefit of your professionalism, not a motivation for it.
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of John Annen
> Sent: Sunday, January 13, 2008 1:25 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: trauma-list Digest, Vol 55, Issue 11
>
>
> While I'm sure there are many considered opinions based on anecdotal
> evidence and individual risk tolerances, I find myself wondering
whether
> the are any published studies out there that would allow for a solid
> risk analysis? Is anyone aware of any?
>
> John Annen
> Zurich, Switzerland
>
> Quoting trauma-list-request at trauma.org:
>
>> Send trauma-list mailing list submissions to
>>     trauma-list at trauma.org
>>
>> To subscribe or unsubscribe via the World Wide Web, visit
>>     http://list.mistral.net/mailman/listinfo/trauma-list
>> or, via email, send a message with subject or body 'help' to
>>     trauma-list-request at trauma.org
>>
>> You can reach the person managing the list at
>>     trauma-list-owner at trauma.org
>>
>> When replying, please edit your Subject line so it is more specific
>> than "Re: Contents of trauma-list digest..."
>>
>>
>> Today's Topics:
>>
>>    1. Standbys in Today's Medicine (Charlene M Morris)
>>    2. Re: Standbys in Today's Medicine - ALWAYS (KMATTOX at aol.com)
>>    3. Re: Standbys in Today's Medicine - ALWAYS (Jeffrey Hammond)
>>    4. Hyponatremia and Pneumothorax (bfletcher at columbus.rr.com)
>>    5. Re: Hyponatremia and Pneumothorax (saad shebrain)
>>
>>
>>
----------------------------------------------------------------------
>>
>> Message: 1
>> Date: Sat, 12 Jan 2008 08:43:15 -0500
>> From: "Charlene M Morris" <cvmmorris at gmail.com>
>> Subject: Standbys in Today's Medicine
>> To: "Trauma &amp, Critical Care mailing list"
<trauma-list at trauma.org>
>> Message-ID:
>>     <ca095570801120543g28e0b3a1ycd3c71561d07f43a at mail.gmail.com>
>> Content-Type: text/plain; charset=ISO-8859-1
>>
>>  Recently, I began practicing at my original rural FP position in NC
> and I
>> have had several instances of needing to examine "private parts". In
> that
>> regard, I requested a standby, as that is what I have done for the
>> past several years. I would really like opinions: yay or nay? Does it
> matter
>> F-M, MM FF, or M-F?
>>
>> The NP with whom I work feels comfortable not conscripting a nurse or
> MA to
>> be in the room, although I was told to absolutely not do an
> unmonitored exam
>> at the ERs where I have worked. By way of history, I trained in the
> late
>> '70s with a lady Ob/Gyn and she told me to get used to doing my own
> exams,
>> because as a  female PA, I would be doing the pelvics without
> assistance.
>>
>> Opinions welcome and requested! It is the 21st century and we have
> other
>> concerns to ponder.
>>
>> C M Morris
>>
>>
>> ------------------------------
>>
>> Message: 2
>> Date: Sat, 12 Jan 2008 09:07:37 EST
>> From: KMATTOX at aol.com
>> Subject: Re: Standbys in Today's Medicine - ALWAYS
>> To: trauma-list at trauma.org
>> Message-ID: <d17.1e0458f5.34ba23a9 at aol.com>
>> Content-Type: text/plain; charset="US-ASCII"
>>
>> In my view, in today's litigious world, and with all "harassments"
> being
>> defined as being in the eyes of the beholder or recipient, the
>> "SAFEST" route is
>> for ALL examiners and interviewers to ALWAYS have some sort of
> chaperone or
>> mechanism to hear and document the conversation and examinations
> between a
>> patient and a physician, or someone acting under the supervision of a
>> physician.    Even if the patient being interviewed or examined
>> brought their own
>> witness, entrapment cases are not uncommon and the prudent
>> professional would
>> have someone accompany her or him with a patient, regardless  of the
>
>>  gender of
>> the examiner or the examinee.
>>
>> NOW, I am fully aware that both number of personnel AND COST
> constraints
>> prohibit the ideal and safest route.    This then raises  questions
of
>> practicality.    One could also raise the same  question about
>> translators and mis
>> understandings by patients who do not  understand the language or
>> culture of the
>> doctor, clinic, or hospital that they  find themselves in.
>>
>> k
>>
>>
>> In a message dated 1/12/2008 7:44:04 A.M. Central Standard Time,
>> cvmmorris at gmail.com writes:
>>
>> Recently, I began practicing at my original rural FP position in NC
> and  I
>> have had several instances of needing to examine "private parts". In
> that
>> regard, I requested a standby, as that is what I have done for  the
>> past several years. I would really like opinions: yay or nay? Does it
> matter
>> F-M, MM FF, or M-F?
>>
>> The NP with whom I work feels comfortable  not conscripting a nurse
or
> MA to
>> be in the room, although I was told to  absolutely not do an
> unmonitored exam
>> at the ERs where I have worked. By  way of history, I trained in the
> late
>> '70s with a lady Ob/Gyn and she told  me to get used to doing my own
> exams,
>> because as a  female PA, I would  be doing the pelvics without
> assistance.
>>
>> Opinions welcome and  requested! It is the 21st century and we have
> other
>> concerns to  ponder.
>>
>> C M Morris
>> --
>> trauma-list : TRAUMA.ORG
>> To change your  settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>>
>> **************Start the year off right.  Easy ways to stay in shape.
>> http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489
>>
>>
>> ------------------------------
>>
>> Message: 3
>> Date: Sat, 12 Jan 2008 13:20:00 -0500
>> From: Jeffrey Hammond <hammond at umdnj.edu>
>> Subject: Re: Standbys in Today's Medicine - ALWAYS
>> To: "Trauma &amp; Critical Care mailing list"
<trauma-list at trauma.org>
>> Cc: trauma-list at trauma.org
>> Message-ID: <fc572d194f1a.4788be80 at umdnj.edu>
>> Content-Type: text/plain; charset="us-ascii"
>>
>> An HTML attachment was scrubbed...
>> URL:
>>
>
http://list.mistral.net/pipermail/trauma-list/attachments/20080112/46fd4
> bcf/attachment-0001.htm
>>
>> ------------------------------
>>
>> Message: 4
>> Date: Sat, 12 Jan 2008 19:11:22 -0500
>> From: <bfletcher at columbus.rr.com>
>> Subject: Hyponatremia and Pneumothorax
>> To: trauma-list at trauma.org
>> Message-ID:
>>     <32726757.691011200183082358.JavaMail.root at hrndva-web14-z01>
>> Content-Type: text/plain; charset=utf-8
>>
>> Has anyone ever seen a case of hyponatremia due to pneumothorax.
>> Had a patient who developed profound hyponatremia without a
>> reasonable cause (no head injury, meds etc).  Has some rib fx, scap
>> fx, transverse process fx and a Pneumothorax.
>>
>> When reviewing the literature, a cause of SIADH is pneumothorax.  If
>
>>  so Why?  Any ideas.
>>
>> Thanks
>>
>>
>> ------------------------------
>>
>> Message: 5
>> Date: Sat, 12 Jan 2008 18:03:53 -0800 (PST)
>> From: saad shebrain <shebrain1 at yahoo.com>
>> Subject: Re: Hyponatremia and Pneumothorax
>> To: "Trauma &amp, Critical Care mailing list"
<trauma-list at trauma.org>
>> Message-ID: <582556.27464.qm at web32603.mail.mud.yahoo.com>
>> Content-Type: text/plain; charset=iso-8859-1
>>
>>
>>  The mechanism of SIADH induced by pnemothorax can be explained ,
>> theoretically, by the both chemical (hypoxia) and Mechanical
>> (decreased pulmonary blood flow) that stimulate
>>  the volume receptor and baroreceptor in the left atrium, which
>> thus regulate ADH release. The vasoconstriction caused by hypoxia
>> may also influence left atrial
>>  blood filling. Some investigators have also reported that atrial
>> natriuric polypeptide plays an important role in patients with SIADH
>
>>  .The increase in circulating
>>  blood volume caused by an inappropriate secretion of ADH induces
>> atrial natriuric polypeptide secretion and thus results in urinary
>> sodium excretion.
>>
>>
>>  SS
>>
>>  Ref
>>  A Syndrome of Inappropriate
>>  Secretion of Antidiuretic Hormone
>>  Associated with Pleuritis Caused
>>  by OK-432
>>  Takeshi Hanagiri
>>  Hiroyuki Muranaka
>>  Mitunori Hashimoto
>>  Akira Nagashima
>>  Department of Chest Surgery,
>>  Kitakyushu Municipal Medical Center,
>>  Kitakyushu, Japan
>>  OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
>>
>>
>> bfletcher at columbus.rr.com wrote:  Has anyone ever seen a case of
>> hyponatremia due to pneumothorax. Had a patient who developed
>> profound hyponatremia without a reasonable cause (no head injury,
>> meds etc). Has some rib fx, scap fx, transverse process fx and a
>> Pneumothorax.
>>
>> When reviewing the literature, a cause of SIADH is pneumothorax. If
>> so Why? Any ideas.
>>
>> Thanks
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>> ------------------------------
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> End of trauma-list Digest, Vol 55, Issue 11
>> *******************************************
>>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
________________________________________________________________________
> ____________
> Never miss a thing.  Make Yahoo your home page.
> http://www.yahoo.com/r/hs
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
> ------------------------------
>
> Message: 3
> Date: Mon, 14 Jan 2008 15:43:05 -0500
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Subject: Re: Standbys in Today's Medicine
> To: <trauma-list at trauma.org>
> Message-ID: <478B8309.85AB.003A.0 at memorialhealth.com>
> Content-Type: text/plain; charset=US-ASCII
>
> I',m tempted to tp reply that this was too much information but   
> instead I'll just pass along my condolences. :-)
>
>>>> <bensonblues at comcast.net> 1/14/2008 12:30 PM >>>
> After 15 years of being a program director in EM, I can give you   
> many horror stories of residents who have unknowingly and   
> idealistically tread where no man (or woman) should go: Examining   
> someone of the opposite sex without a friendly (preferrably   
> professional EMT, RN) chaperone. As always, it depends upon your   
> patient population. But, in general, we practicioners in Detroit   
> feel like Lottery Agents for the Michigan State Lottery - it seems   
> everyone wants to sue and made that fast and easy buck. We NEVER   
> exam a patient without a medic or nurse present who is of the   
> patient's sex, unless the patient is in extremis, and even then....
>
> To further complicate things, if a patient has gender identification  
>  issues, or, theologic/religious issues, it can be more confusing  
> and  difficult. There are a few moments each day when I wish I could  
>  transform into an amorphous, colorless, and asexual entity so that  
> I  can get my job done with more efficiency. I think my wife wishes   
> that as well....
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> End of trauma-list Digest, Vol 55, Issue 13
> *******************************************
>

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Chaperones (was RE: trauma-list Digest, Vol 55, Issue 13)