Exposed?

October 28th, 2010 Comments

Update: Check out this interesting discussion at EMS1.com

When I first began my medical career, I would get nervous around exposed patients.  I was young, full of testosterone, and very curious about the opposite gender.  It made me all hot and bothered, but other care providers would tell me that it wasn’t an issue for them.  “We’re all professionals,” they’d say. “It’s really not an issue.”  So, why was I so bothered?  Was I not a “professional?”

Maybe I was just a loser?  Maybe I was a pervert?  Maybe I was just weird?

I remember taking a 21-year-old unconscious female to the local trauma center.  She was attractive, and just a year or two younger than me.  As I gave my report to the receiving staff, they stripped this young woman down to her underwear.  I got distracted by the polka-dots. But when I looked up, one of the nurses was glaring at me.  Oops, the patient wasn’t the only one exposed.

Over the course of my career, and my own maturation, I learned to be more professional and more considerate of my patients’ privacy.  I now realize that our patients are often in a very vulnerable position, and it is our responsibility to protect them during the time they are with us.  Sometimes learning to be professional comes with time, and experience.

So, now that I’m older and wiser, what do I do with partners who haven’t yet learned this lesson – or matured as professionals?

A few months ago we responded to the home of a 40-year-old female who was complaining of chest pain.  She met us at the door and appeared in no acute distress.  However, upon questioning, she described new onset cardiac chest pain.  It was appropriate to do a full cardiac workup on this young woman, but I was surprised when my partner asked her to fully unbutton her blouse.  I didn’t know what to say, or how to respond – so I moved up front and drove the ambulance to the hospital.

Just the other day we treated a very attractive 40+ year-old woman who had experienced several syncopal episodes in the last 12 hours.  Although there was no evidence of seizure activity, her family described a period of confusion after the event.  Clearly, something was going on in this woman’s brain.

In both of these cases I was left irritated and confused…

During the relatively short transport, I watched my partner, in the rear-view mirror, prepare to do a 12-lead on this woman.  I was, again, caught speechless.  First, there was no indication that a 12-lead was necessary; second, there was barely enough time to give a radio report to the hospital, let alone further diagnostic tests; third, it is difficult to do an effective 12-lead in a moving ambulance; and finally, this patient’s care and treatment would not be affected by the results of this EKG.

In both of these cases I was left irritated and confused.  I didn’t like what I observed and it seemed as if my partners were taking advantage of their position.  It wasn’t professional, it was an invasion of privacy, and it could very well expose the company to unnecessary liabilities.  Not to mention, it is degrading all of us when one of our own acts irresponsibly.

What would you do in this situation?  Do you think it was appropriate for these men to expose these women in this manner?  Could you justify a 12-lead?  Is it possible to do a 12-lead without exposing a woman’s breasts?  Is it possible to perform a 12-lead while protecting their modesty?  Is modesty an issue?

After thinking about this for a while, and talking it over with a couple of trusted colleagues, I’ve decided on a plan of action for next time.

  • In the first scenario, if my partner asked a woman to fully unbutton her blouse, here’s what I’d do next time.  I don’t want to embarrass my partner in front of the patient, so I’d ask her to wait while I get a sheet.  Then, after covering her with the sheet, I’d give her permission to continue.  Afterwards, I’ll talk to my partner about the situation.
  • In the second scenario, I’d ask my partner to poke his head through the crawl through passage.  I’d ask him, in a non-judgmental tone, why he thinks a 12-lead is necessary.  Then I’d probably ask him to refrain – and I’d definitely talk to him later.

What do you think?  How would you handle these situations?  How have you handled them before?

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Comments

  1. another medic says:

    I thought I was the only one who couldn’t help but look at the pretty ladies. At least I’ve learned to be professional about it. This seems pretty blatant though.

    1. Johnny Gage says:

      So, how do we go beyond just “pretending” to be professional – and actually “be” professional?

  2. It’s really difficult to tell whether a 12-lead is necessary in the scenarios you’ve presented. Obviously, it’s a judgement call – and one can rarely be faulted for being overly cautious. However, in this day and age, I think it is especially important to be overly cautious in the area sexual/gender arena.

    Medical care providers have to be careful about false accusations also – I would always err on the side of protecting my reputation.

  3. medstarchick says:

    i agree caution is the best policy and i dont think male medix should be overly anxious to do 12 leads on women

    in fact i often offer to do these for my partners and that eleminates the problem of false accusations as well as protects our patients privacy

  4. Scott says:

    You can do a 12-lead and protect the patient’s modesty. Both of you are in the poop if your partner is busted for this. Him for doing it and you for not reporting it.

    1. Johnny Gage says:

      Yeah, Scott, that is another concern of mine. I did talk to my Captain about it.

  5. Flobach says:

    You state she describes having new onset cardiac pain, states she needs the full cardiac workup, then I see a 12 lead as necessary.

    Ensure modesty, and especially ensure a colleague is in the back with you at all times in case some shouts ‘rape!’

    Gotta be careful, nit only clinically.

    1. Johnny Gage says:

      I agree on both points! Thx

  6. MedicDan says:

    The 1st situation sounds like a pervert, 2nd I would have done a 12 lead. Any syncope pt I do 12 leads on. Prolong QT, especially common in women and many drugs cause it. But this reminds me of a late 30s woman who fell in her bathroom. Nude, covered only in a cold wet towle. My 20yr old male trainee was quick to try and pull it off. I was able to stop him, as I was putting a blanket over her and the towle then sliding the cold wet towle from under the blanket, keeping her covered I explained to both my of and trainee what I was doing and why. She seemed grateful but said she wasnt to worried about staying covered. I assured her it is better for her to stay warm and dry. Sure, under a different set of circumstances I would have loved to see her naked, but we have a job to do and they call us in their time of need, and we are given the patients trust. We owe it to them, our self and the profession to not ruin that trust.

    1. Johnny Gage says:

      we have a job to do and they call us in their time of need, and we are given the patients trust. We owe it to them, our self and the profession to not ruin that trust.”

      Great conclusion!!

  7. minimedic says:

    Another female medic (and sometimes the ONLY female on shift, period) throwing her two cents in.

    1st situation: “New onset chest pain.” Yup, defintely merited a 12-lead!

    2nd situation: In the systems that I’ve worked in, any sort of syncope episode merited EKG monitoring, if not the whole 12-lead. She sounds like she was stable enough for you to stay and perform one, and given her age, it probably wasn’t a bad idea…however, our ambulance rides could turn NSR to a-fib, so I would have avoided performing it enroute.

    In my systems, we would do our best to avoid completely exposing the upper half of the torso for 12 leads, especially if they were alert and conversing with us. Male or female, we’d do our best to work around their clothing, and if we needed to move something, we said something along the lines of “Hey, I need to move your *insert article of clothing here* up/away/around so I can place this little sticky pad on your chest, which will allow us to see if there’s anything wrong with your heart.” Won’t lie this was a bit difficult with some female patients at times, but 95% of the time we managed to apply electrodes without gross exposure of their chest.

    This was motivated by both patient modesty and comfort, as the temperatures in our next of the woods tended to be a little chilly during certian months.

    I agree, both of these male medics were a bit eager to “expose” your patient. Talk to your chief next time it happens, because if the patients finds out that this isn’t a standard practice across the board, she might say something, and it will come back to bite you in the ass!

    1. Johnny Gage says:

      Thanks @Minimedic for a great reply. (BTW, I love your blog!)

      I agree both of these women should be assessed with a 12-lead. It’s just the way it was done that I struggled with. Since I originally wrote this, I’ve learned much. One of the women I worked with “suggested” that she do all 12-leads on women – which I was relieved to hear.

      In fact, for the the protection of my own marriage, my overactive hormones, and my coworkers inappropriate “desires,” I do my best to model extreme modesty at all times. Just the other day we transfered a 47 yo woman to another facility for angiography. Even though this woman was not attractive to me, I had her remove the hospital’s EKG leads herself, while I turned my back.

      My male partner didn’t take the hint, and our pt didn’t care, but sometimes teaching and changing culture is a slow process.

      Thanks again for chiming in!

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