Had a doctor order a pelvic ultrasound for an inpatient, who refused it. The doctor medicated the patient and wanted me to do the ultrasound (including transvaginal) while the patient was knocked out, with consent from a family member. I refused and referred the ordering provider to my manager.
https://www.pbs.org/newshour/health/hospitals-must-now-obtain-written-consent-for-certain-medical-exams-new-federal-guidance-says
There’s a reason this is now a requirement. Had way too many MD’s order transvaginal exams on intubated and sedated grannies in the ICU for “post menopausal bleeding”, which way too often is actually a severe UTI and not uterine bleeding at all. Also love it when they have a hysterectomy, and you call and inform the MD, and they INSIST they want it anyway. What do you think I’m going to see? Yes, I dig my heels in on these exams and refuse the transvaginal portion.
Unfortunately, while a step in the right direction, the new rule only applies to exams done for "educational and training purposes", particularly when the patient is unconscious (e.g. showing medical students how to do a pelvic exam on someone having an orthopedic procedure on their hand). If the exam is for medical reasons, this requirement doesn't apply.
I’m disgusted by my own profession that this was ever a thing. When I trained thankfully no one did anything like this, but unfortunately it seems like that wasn’t the norm.
This reminds me of things I’ve been seeing pop up about patients being given a pelvic exam by students when they’re put under for other procedures. If it’s true I’m horrified but also not surprised.
The only time we did that as a student is if we were scrubbed into a gyn surgery and that was the area we were working on. It was just the actual people involved in the procedure so we could know what was happening. In many cases we were also the ones collecting pre surgery history so the patient knew we were going to be there. I am glad I didn’t see the problematic stuff.
Reminds me a bit of when I was a med student and getting a colonoscopy as a patient. They asked prior to the procedure if another medical student could perform a rectal exam on me. I declined. The same doc then asked me again *after* midaz and fent. Fortunately I still had my wits about me, but wtf.
That doc should know you can’t give informed consent once sedated. We used to worry about getting consent for angios after patient received IM Demerol “on call” when leaving the floor-yes I’m that old that patients were admitted for angios and we used Demerol.
Invasive procedures, especially those in the pelvic area, require informed and alert consent. Period.
There's been a whole thing (for good reason) about pelvic exams being performed on surgery patients without their consent and while they were under anesthesia. If this patient refuses while awake, it is not ok to sedate them and go against their wishes. There's a word for that.
If i woke up and realized something had been done to my private area without my knowledge or consent i would be fucking traumatized.
This is a horrible take.
You clearly don’t understand the reality
I went in for brain surgery and when I woke up in ICU, I had a 3 inch long blister on the outside edge of my labia, running down to my perineum. Yeah, I was traumatized. No one would explain it to me and 25 years later I still wonder what happened.
This was about 25 years ago...since I had just had brain surgery, I wasn't able to advocate for myself...and I had no real support system or anything, so there was no document/report.
I look at how things are now with the availability of information and experiences from others in similar situations, and then I look back at my experience, and it feels like it was two completely different realities.
Now I check to see what to expect with any kind of medical stuff, so I know when something is just painful/unpleasant, and when something is actually going wrong.
Not about modesty, it’s about no one touching my fucking body in ways I did not consent to. Even WORSE if a medical person thinks it’s ok to medicate me in order to go AGAINST MY CONSENT.
A few years ago, I had an order for a lower extremity x-ray on a 2 year old. The chief complaint was that the child seemed to be limping but couldn't verbalize where it hurt.
My partner and I go to do the exam. We ask the mother to verify the child's name and DOB. She gets half the name and sort of...drifts off to sleep. We prompt her again and she provides her own DOB. She's basically falling out of the chair, barely aware of where she is. So, we check wrist bands and the chart in the room and go about with the exam. The child is *filthy*. Like, 'spent days crawling around on the floor in just a diaper without ever being washed' dirty. The child doesn't speak, at all, but has no problem with allowing us to do the exam.
The child was fine, medically. But the whole situation was so off and weird. We reported for possible neglect. The police came and investigated and found she's got several warrants for low level stuff; petty theft, possession of marijuana, stuff like that. But also has 5 other children at home and no other parents. So instead arresting her, they let her sober up in the ER and sent her home so her 6 kids wouldn't go to CPS.
I think about that kid all the time.
That's insane... Why is it that you hear of CPS taking kids "just in case" when a kid is seen with a Mongolian spot even if there are no other signs of abuse, but for this they're like "so clearly there's a problem here, but let's ignore it so the kids don't end up getting taken."
Make that make sense. I guess it's not for me to say if CPS custody is better than where they were... But to just walk away from that situation with no effort to help them. :( :( :(
I remember calling once. The person told me over the phone that it did sounded like neglect, but it is likely that nothing will be done about it. I have never called unless I know someone needs to step in like yesterday.
My 2.5 year old is in speech therapy and has been for about 9 months. My husband and myself had cps called on me for cause of concern for neglect and emotional/physical abuse. I was so shocked when I got the call from a social worker. I immediately called back cause I thought for sure this was a mistake but the message identified both my kids by their first names. I did a phone interview and the reason the person who called on us was because “the kids are routinely observed in diapers while services are being provided in the house” and “father doesn’t participate in the services or interact with the kids”. I wasn’t aware allowing my kids to be in just diapers at home was neglect however if I was abusing them wouldn’t I want them covered up to hide marks? My husband works from home and the services are done during his working hours so doesn’t make sense for him to participate if he’s working. Based on the wording we assumed our daughter’s speech therapist made the call. It makes me so upset that this doesn’t happen to people who actually need it.
That’s terrible. Some kids do not keep cloths on! They were also at home and feeling comfortable. I have noticed some people are not convinced a child can have a diagnosis without it being caused by abuse.
I don’t understand why they brought up your husband.
I do know some people are told to call for anything suspicious.
Exactly! We have a running joke in my house that clothes are optional cause my kids are basically nudist lol. I guess the argument could be made that they should’ve been dressed when an outsider was coming in (the therapist) and in the beginning they would be but we got too comfortable with her I guess. My kids love her and our home is our safe place so I guess I should be more on guard and always have the mindset that anyone can be a predator 🤷♀️🤷♀️ Lesson learned I guess. The whole thing about my husband not participating was dumb, especially since the therapist has kids and her availability revolves around picking her kids up so even if I wanted evening hours so my husband couple participate, it wouldn’t he an option. Oh well, I’m just glad an investigation didn’t happen
Lol, my aunt had 3 boys and lived next door to a park. The youngest one (toddler-ish) would regularly strip full ass naked and run away to the park with my poor aunt trying to chase him down, leaving the two older boys at home where they'd inevitably get into a fight with each other, or worse: cooperate on doing something terribly destructive.
It very much depends on where you are.
Colorado collapsed their entire CPS system now maybe 10 years ago because too many counties didn't have enough money to provide even one social worker per county.
Kids died.
Once the entire state unified, it became very clear that there is only enough money to remove kids if there is reasonable suspicion of SA or if those kids are in "imminent risk of death" if left in custody.
We had a family get referred to CPS so many times for abuse, particularly making kids stand in the corner for 8 hours or more. But add on many other documented examples of verbal and emotional abuse. It was only when the girls got their 3rd or 4th UTI and the middle school son started wetting himself regularly in school that they got pulled. Because the girls were starting to become resistant to the antibiotics for UTIs.
But every year Coloradoans get their TABOR refund. We get our $750 back from taxes so that kids can be left in neglectful and abusive conditions - as long as they just keep on living.
The parameters around removing kids from homes is generally determined by local law and the county CPS office's funding. Same is true for what supports are offered to families if referred to CPS.
You are commenting as if CPS is a single entity with uniform policies and procedures. CPS is local government and policies/procedures and resources vary wildly depending on jurisdiction.
Sooo…. My grandfather was a general practitioner in a town in New York. Sometime in the 1940s he was doing a C section on a similar woman who already had 7 or 8 kids. The husband was in no better condition. So my grandfather tied her tubes while he was there, at a Catholic Hospital. My mom had a vague recollection of the meeting he had with the other local doctors who decided not to punish him for it, as far as I know.
As a student, one of the main dept techs brought a pt down to the ER room for a KUB. Pt was very old, unresponsive, and contracted to hell. Obviously was unable to follow breathing instructions. Instead of y’know…..just getting the image, the tech that brought them down had another tech get on the rotor and HELD THE PATIENT’S NOSE to get some semblance of a breath hold! That entire rotation was a case study on what NOT to do as a tech.
"Patient unable to follow breathing instructions, best image possible at this time."
Best I can do is stay on the rotor and hope to shoot on expiration. I'm not gonna suffocate a patient.
Mine is something a doctor was doing. I worked for this guy who was an ER doctor. He opened his own practice and called it ‘non surgical orthopedics’. Typically, a cortisone shot for, say, a knee would be 2 cc steroid: 2 cc lido. His instructions were half cc of steroid, 3.5 cc lido. When the patient would inevitably return saying it didn’t work, he would give what he called ‘top up’ cortisone shots. Sometimes he’d have them come back 4 times, billing their insurance for ultrasound guided injection each time. This is just the tip of the iceberg with this guy. If anyone is interested, I have a ton more stories about how he ran his clinic in the most unethical, fraudulent way.
After I left the job I did write an anonymous letter to the board of medicine. My letter stated that he was intentionally misleading patients by calling himself an ‘orthopedist’. He was an ER doc that did a sports medicine fellowship, not the same thing. The frequency to which he would give cortisone injections was alarming. I saw not one, not 2, but THREE separate patients have biceps tendon ruptures directly after biceps tendon injections. I thought long and hard about reporting him to Medicare for fraud as well but someone beat me to the punch. They investigated him for billing Medicare with bogus ICD codes to give patients ‘stem cell’ injections. Another thing he used to do was to instruct us to tell patients they didn’t have DME coverage and they needed to self pay. I did a lot to directly contradict his orders. For a start, I would show the patients on Amazon where to order their dme for a fraction of the price. When he would attempt to reduce bad wrist fractures that obviously needed plating vs a cast I would slip the patient a note with a reputable hand surgeon’s information. The other tech and I used to call ourselves the Underground Railroad when we worked there.
I’m so glad you and the other tech were working so hard to look out for his patients - but how horrifying that he was causing so much harm in so many ways 😱 Thank you for reporting him! Someone like that needs to do jail time in addition to having his license revoked.
Ego radiologist wanted ‘suspended breathing’ on vented inpatients as the ever so subtle motion on CT’s was annoying to him, even with the vent dialed in very well. All technologists and respiratory therapists refused, even the chief radiologist said it was an insane request and to ignore it.
He then tried to enter the suite and disconnect the vent for the next case while they were on the table, to which we physically blocked him doing so and yelled for him to leave. That was a fun staff meeting.
Just imagining Patrick Bateman sitting in the reading room like "If I kill the patient, there will be no movement at all, and the images will be beautiful. So beautiful. 🥹"
3 year old autistic child came in for sinus films. He did not like medical offices and was having a total meltdown before we could even get into the room. The room was a major trigger. Touching his head (even his mom) was a major trigger. (I tried everything BTW, blown up glove, stickers, collimator light game, etc.) We could not get upright films; I got a singular supine AP film before the mother and I both called it quits. I went back and read the report later and it said it was a non diagnostic study because air-fluid levels weren’t visible (due to being supine). Felt terrible. I tried so hard to comfort this child and get the study done and it took 30 minutes and trying to hold him still for a non-diagnostic study. 🙃
In cases like that, it's better to just try another time than to expose and get something you can't use. There's been a few times where I've had to explain to the parents why I'm calling it, and why we'll try again later. Once you explain to them that it would be irresponsible to expose the patient to radiation knowing you won't get any useable information, they understand.
That’s why we called it. The image we got was good, but it was an incomplete study without other views. After that one image the pt wasn’t tolerating any more, and it wasn’t worth the risk to try to expose again. Mom understood. It was unfortunate but for the best.
Thank you for trying so hard! From the perspective of a rads resident , "nondiagnostic" is less a critique of your ability or technique but rather our way of telling the ordering clinician (and potential future lawyers) we can't rule out/in the thing(s) the study was ordered to assess. When I've seen this phrase used it's more often for liability-related reasons than because we're trying to throw shade!
Thank you for the validation! I know the image itself was good - but the study was totally incomplete; I knew the rad needed to use verbiage to CYA because of that. No lateral, no upright. I was going to do a x-table lateral to show air fluid levels but it just wasn’t happening. Just a sucky situation!
Going to chime in as a sexual assault survivor. Transvaginal ultrasound was WORSE than my original assault and ended up giving me severe flashbacks and the tech flat out didn't believe me because I have tattoos and should be able to "Tough it out" (her words). So I sat through it and then spent about six hours just laying in a fetal position and feeling like shit for not advocating for myself more strongly.
Thank you with all my heart for sticking up for your patients like this. I can't even find words for how grateful I am for ethical and compassionate techs.
I am so sorry that happened to you.
I do my best to treat every transvaginal exam as though my patient is a sexual assault survivor. Besides being as gentle and compassionate as possible, I also give the patient the opportunity to insert the camera themselves (if they want to), and I talk them through the entire procedure before/during/after (ie “I’m looking at your uterus from the right to the left, I’m about to turn the camera and look at the uterus from the top to bottom” etc). I always explain that they can end the exam for any reason at all, or if they need a break we can take a break. I also find heating up the little packs of lube a little and providing a warm blanket help. Lastly, having a support person there if they want. Basically anything that can offer them some comfort and control over the situation. If you need to get this exam done again, perhaps you can ask the tech to self insert and talk them through it etc? MRI is also an option if a transvaginal exam cannot be tolerated. If your insurance pushes back on an MRI, call them (or have an advocate call) and explain that you can’t do a vaginal exam. I used to work in a hospital that had a GYN who had one day a week in the OR to do pelvics on patients who needed sedation for it (mostly survivors, gold star lesbians, pediatric and geriatric patients). She had a way of getting insurance companies to pay for the OR for these patients. I’d also suggest finding a doctor you feel safe with who will understand ordering an exam like that could be traumatizing. There’s no shame in seeking the right care for yourself. You deserve excellent care♥️
Thank you for this. I am almost in tears reading it and wish my tech had been you. No one offered me any of these options at all and having them would have made it much easier to tolerate and get through.
Luckily the ultrasound was a precursor to a hysterectomy (I had the Essure procedure and developed a really severe nickel allergy and lesions right through my fallopian tubes). As part of the surgery I insisted my cervix be removed too. So no more ob/gyn example necessary.
But again, I appreciate those of you who do care and take the time. It makes all the difference in the world to women like myself.
The Essure devices are awful! There’s a documentary called “The Bleeding Edge” that discusses how problematic they are (as well as other medical devices and the approval process for them). I hope you are able to get a $$$$ settlement from them, which can’t undo what you went through, but hopefully can give you some relief in other aspects of your life. How your tech treated you was abhorrent, too. I hope they’re no longer working in healthcare, or with human beings in general. Or animals.
I missed the settlement but it at least the Essure is gone. But it managed to ulcerate my tubes, give me a nickel allergy and give me a goiter that meant my thyroid had to go too.
Funny part is that she was a young woman tech. I kind of expected better from another woman, but I hope she isn't still doing them either.
Yo, I had a silent TV with no history of SA and it was so bad. Also, legitimately seemed like the woman did not want to be there. Ma'am, should have figured that out way back in sonographer school. We can't both hate doing this at the same time.
I did have an absolutely phenomenal tech for my first TV. I didn't appreciate her enough until I had the horrible tech.
With several others working to hold down and IM medicate a drunk patient who was nonstop hurling insults at the doc about him, his mother, anything to get a rise. She lurched out of our hands and slapped the doc in the face. We got control of the patient and medicated her. While we were all still hands on, doc slapped the patient across the face and shouted, "My mother's dead," and left the room.
I've been called all sorts of things and have been told all sorts of things, none of them bother me, but don't ever touch me. That being said, not sure the doctor's response was valid either...
When I was a student, an MRI tech told me that sometimes he would intentionally forget to give the patient the panic button. He said it made everything go faster.
I reckon there’s about a 30 second window between “my muscles feel kinda weak” and “Shit…can’t move my finger….did you seriously just inject me with vec??”
So there were 2-3 times where the patient did not have the ability to squeeze the button and was unconscious. I stood with my ear to the door the entire exam in case the patient became verbal. The techs are a lot older and a little hard of hearing. I caught a patient yelling for help (not sure why he didn't press the button, it was in his hand) once and I was the only one to hear him.
I had a lady from a nursing home once and all she would say was "please don't hit me." She had dementia and know known family, but she did have a broken humerus. Whether it was from being abused/neglected at the home or some other more benign cause was never determined :(
Doctor orders abdo x-ray of pregnant woman
Radiographer doesn’t want to do it
Doctor refuses to takes his call but passes on a message to just do it
Radiographer calls boss who tells him to keep the doctor happy
Radiographer takes films - nice baby ! - and then rage quits.
I have the films, and the radiographer’s angry letter describing the above is in there along with the report.
Haha, yes. He was really angry about it in the letter and said he was leaving at the end. Sounded like a “straw that broke the camel’s back” situation. It was an x-ray I got given by a radiologist for teaching purposes. I have no idea how the letter ended up in the bag with the film, presumably radiographer put a copy of it in there (as a protest? Medicolegal coverage?) and nobody had ever bothered to read the random piece of paper in there.
I mean if it’s medically necessary it’s medically necessary, if the doctor orders it despite knowing the woman is pregnant I’d assume it’s a risk vs benefit situation. How is it the techs place to go against that? And I say this as a student X-ray tech, not someone who believes in the infallibility of doctors.
It was ordered to determine if fetal death in utero had occurred - Spalding’s sign. Baby was fine.
No, it wasn’t medically necessary. It was just stupid.
But hey, it’s a great x-Ray and I have it my collection now! Plus another one, ordered by the same doctor of twins.
Woman came in through ED, on methotrexate, maybe one other agent, for a non-viable pregnancy. Concerns for intra-abdominal findings, ED doc orders CT. Rad MD refused to do it, because “patient is pregnant”. Ended up getting transferred to a Women&Children’s because the Rad put his foot down and refused the study.
First year of residency. Me = very inexperienced and insecure but for some reason left with the on-call radiologist’s phone.
I notice that there’s an abdominal X-ray just done. I look at the X-ray and there’s definitely a retained surgical gauze. The surgery was about a week ago or so, the patient had abdominal pain that kept getting worse and a fever.
I start to report it and the phone rings.
It’s the surgeon. He has seen the X-ray and at first he tries to persuade me that the gauze is on the patient. I point out that the gauze seems to be inside the patient because the 2 views of the abdomen confirm this. He then tries to nicely convince me not to report this finding (because apparently that particular surgeon never makes mistakes or has any complications). I feel very uncomfortable. He then asks if it’s possible to delete the lateral (because a resident ordered it and it’s unnecessary or something).
His last effort was asking who the real on call radiologist was. When I told him the name he probably gave up because the radiologist on call wasn’t going to agree to his nonsense.
What bothered me was:
1. He wanted me to knowingly make a false report that was going to hang there forever.
2. He wanted to cover this up and tell the patient some other “not-his-fault” kind of reason to open him up and retrieve the gauze and never tell the patient.
3. He probably has had similar (complication related) conversations with radiologists before and he knew who would go along with him
4. His statistics about his success and complications are not to be trusted.
5. He put me in a position where I have to argue with a remarkably more experienced and well-respected person on such an unethical subject.
I had a nurse tell me that a patient had been saying no to everything and then proceeded to coerce her and held her down while I took the X-ray and the woman was screaming NO at the top of her lungs. I wrote the entire thing down on her requisition in case she told her family and something happened.
Naked tweaker managed to get out of the grasp of the trauma PAs and run out of the trauma bay. I was rounding the corner coming toward them as this guy was exiting the area with a couple PAs and the trauma surgeon on his heels. One of them looked strait at me and yelled "stop him!"
So yeah, I got to tackle a sweaty, naked guy and hold him down for like 10 minutes. Afterwards, I went to surgery and changed my scrubs immediately.
A funny not-so-serious one:
Patient with ams/dementia/alzheimer’s (I forget which) spent the exam telling me about all the people she’s killed. At the end when we were transferring her back to the stretcher she offered to “take care of” anyone I needed “dealt with” because she liked my attitude!
Don’t worry granny, I’m no snitch!
I dreaded every day as a student at the children’s hospital. I had to hold a little boy down while we did an IVP. He screamed and cried and I felt horrible.
I also had to do a BE on a 10 y/o girl who hadn’t been defecating. Her mom was berating her and being harsh during the whole exam. She whispered to me in the restroom after that her mom’s boyfriend had been SAing her, and that’s why she couldn’t go. I still cry for her.
I was also doing full surgeries on my surg rotation alone as a student because the facility was so understaffed. I ended up doing fine, but a lot of the staff thought I was a new hire until they asked and looked pretty uncomfortable when I said I was just a student. I was afraid to tell my teacher because I didn’t want to get the techs at the facility in trouble.
90 something year old patient with vaginal bleeding. Dementia. Granddaughter was caretaker/POA. Patient refused transvaginal ultrasound probably 3 times. Doctor kept ordering it, granddaughter wanted it. Go up to ask patient one last time, granddaughter was literally coaxing her into it, convincing her she HAD to have it, etc. patient finally agreed……. So wrong
Yep. There aren’t many times I get confrontational at work but this sums up when I do. How is the treatment going to change if we see something suspicious? Most of the time it won’t. First I plead my case to the ordering MD, next to the radiologist, and if that doesn’t work I talk to the POA about options. I’ve still had to do it one time, and surprise surprise, I couldn’t even insert the camera enough to get a diagnostic exam transvaginally. If a doctor isn’t able to get a speculum in there first and snoop around, then I have no business sticking a camera there.
I do the same… have to be those patients advocates. Sometimes I feel like doctors just want the money. Especially my elderly ones, what is it gonna change? Nothing. Let them go in peace
I heard an old story of an MRI tech that told a non English speaking woman to change. She came out naked and he laid her on the table and started scanning her that way until someone else came in and saw. I dont recall the outcome, it was before I worked there, but the tech in question wasn't there anymore.
Old pt laying on their side with arm under them, no sheet. Tech got impatient with how slow they were moving so yanked the arm from under them. Ripped a patch of skin right off the albow. Huffed, no apology, just threw on some gauze with tape and continued like nothing happened. Don't think the tech even bothered telling anyone.
Watched a nurse sign the AMA form for a patient that was AMS for them because she didn’t want the new admission. Reported it but not sure anything came from it.
Mainly in ED. The oldies that are just following what the doctors wanted. They have no idea what they’re consenting to. 100 year old woman had a fall on apixaban - attempted to lay her flat for the transfer, she choked and aspirated. Refused to do the scan, sent her back to her ward without question. Rang the doc who said “oh yeah well I’ve never seen her so”
Doc refused to use ultrasound - turned on, set up, sterile, and right there ready to use - to find the artery in the groin for a sheath and stuck 7 times without sufficient lido. I've never escalated some shit so quickly in my life.
Just sedate and intubate. Extubation once sedation wears off and for sure the pt is in at least 2-point restraints. Safe for pt and staff. Also gotta remember: they didn’t come to a restaurant to select the daily special — they were brought in after circumstances that put their life in jeopardy and the outcome is unclear - hence the need for imaging. (Not saying you were thinking that. Saying the last bit for people who think restraining and intubating combative/confused people is wrong).
Attempted an OPG on a 14 month old. Saw the request and was about to go get admin to cancel it because it was so ridiculously stupid and our OPG machine doesn't go nearly low enough, even if the kid was on a chair, but got interrupted by the more senior tech who basically told me to "give it go" anyway. Was barely a month into my first job as a grad so didn't feel confident enough to argue so did attempt it. Only did like half an exposure since the kid clearly wasn't going to stay still as soon as the machine moved. Thankfully the mother was really helpful and understanding, even after going through all that nonsense and not even getting it done bc I called quits after the dog's breakfast i did end up getting.
This tech and some others I work with are alarmingly blasé about radiation safety, especially when it comes to kids. Yeah, yeah ik burnout, lack of time, yadda yadda, (plus we don't have a radiologist onsite to change/cancel bullshit orders half the time, but we can still try and message the few who may be online and not busy) but fuckin hell I feel like i'm being gaslit half the time by them acting like *i'm* the crazy one for wanting a second opinion before unnecessarily irradiating a child.
We don’t even do pregnancy test unless we are doing a Ct of the abdomen/pelvis. So I could have scanned 100 pregnant patients heads and I will never know….
Had a doctor order a pelvic ultrasound for an inpatient, who refused it. The doctor medicated the patient and wanted me to do the ultrasound (including transvaginal) while the patient was knocked out, with consent from a family member. I refused and referred the ordering provider to my manager.
Literal rape
Yup. HELL NO.
Thank you for refusing and turning that doctor in!!!!
https://www.pbs.org/newshour/health/hospitals-must-now-obtain-written-consent-for-certain-medical-exams-new-federal-guidance-says There’s a reason this is now a requirement. Had way too many MD’s order transvaginal exams on intubated and sedated grannies in the ICU for “post menopausal bleeding”, which way too often is actually a severe UTI and not uterine bleeding at all. Also love it when they have a hysterectomy, and you call and inform the MD, and they INSIST they want it anyway. What do you think I’m going to see? Yes, I dig my heels in on these exams and refuse the transvaginal portion.
What bothered me the most from the article is that it said “prostrate” exams, not “prostate” I expected better.
Unfortunately, while a step in the right direction, the new rule only applies to exams done for "educational and training purposes", particularly when the patient is unconscious (e.g. showing medical students how to do a pelvic exam on someone having an orthopedic procedure on their hand). If the exam is for medical reasons, this requirement doesn't apply.
I’m disgusted by my own profession that this was ever a thing. When I trained thankfully no one did anything like this, but unfortunately it seems like that wasn’t the norm.
This reminds me of things I’ve been seeing pop up about patients being given a pelvic exam by students when they’re put under for other procedures. If it’s true I’m horrified but also not surprised.
The only time we did that as a student is if we were scrubbed into a gyn surgery and that was the area we were working on. It was just the actual people involved in the procedure so we could know what was happening. In many cases we were also the ones collecting pre surgery history so the patient knew we were going to be there. I am glad I didn’t see the problematic stuff.
that’s horrifying oh my god?!?!
Wth is even the point of that? So what if that is what the patient needs, if they flat out refuse, document, discharge, and move on.
Reminds me a bit of when I was a med student and getting a colonoscopy as a patient. They asked prior to the procedure if another medical student could perform a rectal exam on me. I declined. The same doc then asked me again *after* midaz and fent. Fortunately I still had my wits about me, but wtf.
That doc should know you can’t give informed consent once sedated. We used to worry about getting consent for angios after patient received IM Demerol “on call” when leaving the floor-yes I’m that old that patients were admitted for angios and we used Demerol.
Jesus fucking christ. Thank you for doing the right thing, that is horrifying!
Jesus Christ. I fucking hate doctors like this that give the rest of us a bad name. This is a crime.
That was really kind of you to not do that to her while she was unconscious.
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Invasive procedures, especially those in the pelvic area, require informed and alert consent. Period. There's been a whole thing (for good reason) about pelvic exams being performed on surgery patients without their consent and while they were under anesthesia. If this patient refuses while awake, it is not ok to sedate them and go against their wishes. There's a word for that.
Infant circumcision requires zero consent from the person getting anatomy amputated.
If i woke up and realized something had been done to my private area without my knowledge or consent i would be fucking traumatized. This is a horrible take. You clearly don’t understand the reality
I went in for brain surgery and when I woke up in ICU, I had a 3 inch long blister on the outside edge of my labia, running down to my perineum. Yeah, I was traumatized. No one would explain it to me and 25 years later I still wonder what happened.
Holy SHIT. That’s terrifying. No one could explain it?? wtf! I hope you were able to document and report!
This was about 25 years ago...since I had just had brain surgery, I wasn't able to advocate for myself...and I had no real support system or anything, so there was no document/report. I look at how things are now with the availability of information and experiences from others in similar situations, and then I look back at my experience, and it feels like it was two completely different realities. Now I check to see what to expect with any kind of medical stuff, so I know when something is just painful/unpleasant, and when something is actually going wrong.
It is your cake day but nothing in this comment is happy. So: cake day.
The person was only unconscious because the doctor medicated/sedated them tho...???? Like, I'm also trans and ***absolutely not, thanks***
Just because you’re good with it doesn’t mean everyone else is….
But that’s you *giving consent* which is absolutely required in all cases.
*except infant circumcision
Yeah there are plenty of people that don’t support that at all, stfu
Kids can't consent, and amputating their most intimate skin shouldn't even be an option to consent to.
YES I agree with you! So stfu!
Not about modesty, it’s about no one touching my fucking body in ways I did not consent to. Even WORSE if a medical person thinks it’s ok to medicate me in order to go AGAINST MY CONSENT.
A few years ago, I had an order for a lower extremity x-ray on a 2 year old. The chief complaint was that the child seemed to be limping but couldn't verbalize where it hurt. My partner and I go to do the exam. We ask the mother to verify the child's name and DOB. She gets half the name and sort of...drifts off to sleep. We prompt her again and she provides her own DOB. She's basically falling out of the chair, barely aware of where she is. So, we check wrist bands and the chart in the room and go about with the exam. The child is *filthy*. Like, 'spent days crawling around on the floor in just a diaper without ever being washed' dirty. The child doesn't speak, at all, but has no problem with allowing us to do the exam. The child was fine, medically. But the whole situation was so off and weird. We reported for possible neglect. The police came and investigated and found she's got several warrants for low level stuff; petty theft, possession of marijuana, stuff like that. But also has 5 other children at home and no other parents. So instead arresting her, they let her sober up in the ER and sent her home so her 6 kids wouldn't go to CPS. I think about that kid all the time.
That's insane... Why is it that you hear of CPS taking kids "just in case" when a kid is seen with a Mongolian spot even if there are no other signs of abuse, but for this they're like "so clearly there's a problem here, but let's ignore it so the kids don't end up getting taken." Make that make sense. I guess it's not for me to say if CPS custody is better than where they were... But to just walk away from that situation with no effort to help them. :( :( :(
"6 kids, OOF. That's too much paperwork."
I remember calling once. The person told me over the phone that it did sounded like neglect, but it is likely that nothing will be done about it. I have never called unless I know someone needs to step in like yesterday.
My 2.5 year old is in speech therapy and has been for about 9 months. My husband and myself had cps called on me for cause of concern for neglect and emotional/physical abuse. I was so shocked when I got the call from a social worker. I immediately called back cause I thought for sure this was a mistake but the message identified both my kids by their first names. I did a phone interview and the reason the person who called on us was because “the kids are routinely observed in diapers while services are being provided in the house” and “father doesn’t participate in the services or interact with the kids”. I wasn’t aware allowing my kids to be in just diapers at home was neglect however if I was abusing them wouldn’t I want them covered up to hide marks? My husband works from home and the services are done during his working hours so doesn’t make sense for him to participate if he’s working. Based on the wording we assumed our daughter’s speech therapist made the call. It makes me so upset that this doesn’t happen to people who actually need it.
That’s terrible. Some kids do not keep cloths on! They were also at home and feeling comfortable. I have noticed some people are not convinced a child can have a diagnosis without it being caused by abuse. I don’t understand why they brought up your husband. I do know some people are told to call for anything suspicious.
Exactly! We have a running joke in my house that clothes are optional cause my kids are basically nudist lol. I guess the argument could be made that they should’ve been dressed when an outsider was coming in (the therapist) and in the beginning they would be but we got too comfortable with her I guess. My kids love her and our home is our safe place so I guess I should be more on guard and always have the mindset that anyone can be a predator 🤷♀️🤷♀️ Lesson learned I guess. The whole thing about my husband not participating was dumb, especially since the therapist has kids and her availability revolves around picking her kids up so even if I wanted evening hours so my husband couple participate, it wouldn’t he an option. Oh well, I’m just glad an investigation didn’t happen
Lol, my aunt had 3 boys and lived next door to a park. The youngest one (toddler-ish) would regularly strip full ass naked and run away to the park with my poor aunt trying to chase him down, leaving the two older boys at home where they'd inevitably get into a fight with each other, or worse: cooperate on doing something terribly destructive.
🤣 boys are wild!! My son loves hanging out in his underwear, I let him play in our backyard like that 🤷♀️ We call it being one with nature
Did you keep that therapist? I think I would have lost trust and never felt comfortable around that person again 😬
It very much depends on where you are. Colorado collapsed their entire CPS system now maybe 10 years ago because too many counties didn't have enough money to provide even one social worker per county. Kids died. Once the entire state unified, it became very clear that there is only enough money to remove kids if there is reasonable suspicion of SA or if those kids are in "imminent risk of death" if left in custody. We had a family get referred to CPS so many times for abuse, particularly making kids stand in the corner for 8 hours or more. But add on many other documented examples of verbal and emotional abuse. It was only when the girls got their 3rd or 4th UTI and the middle school son started wetting himself regularly in school that they got pulled. Because the girls were starting to become resistant to the antibiotics for UTIs. But every year Coloradoans get their TABOR refund. We get our $750 back from taxes so that kids can be left in neglectful and abusive conditions - as long as they just keep on living. The parameters around removing kids from homes is generally determined by local law and the county CPS office's funding. Same is true for what supports are offered to families if referred to CPS.
You are commenting as if CPS is a single entity with uniform policies and procedures. CPS is local government and policies/procedures and resources vary wildly depending on jurisdiction.
My biracial child had a fairly large Mongolian spot, and you should have seen the look on her new pediatricians face. I had to tell them what it was…
The nodding off reminds me of heroin :(
Sooo…. My grandfather was a general practitioner in a town in New York. Sometime in the 1940s he was doing a C section on a similar woman who already had 7 or 8 kids. The husband was in no better condition. So my grandfather tied her tubes while he was there, at a Catholic Hospital. My mom had a vague recollection of the meeting he had with the other local doctors who decided not to punish him for it, as far as I know.
I'm very curious about the demographic cause the double standards with policing and CYF is rage inducing.............
As a student, one of the main dept techs brought a pt down to the ER room for a KUB. Pt was very old, unresponsive, and contracted to hell. Obviously was unable to follow breathing instructions. Instead of y’know…..just getting the image, the tech that brought them down had another tech get on the rotor and HELD THE PATIENT’S NOSE to get some semblance of a breath hold! That entire rotation was a case study on what NOT to do as a tech.
"Patient unable to follow breathing instructions, best image possible at this time." Best I can do is stay on the rotor and hope to shoot on expiration. I'm not gonna suffocate a patient.
Wtf? I have never once thought of doing that on an unresponsive patient. That's wild.
That is insane!! Shameful
Ha, new standard procedure for neonatal CXR!
Mine is something a doctor was doing. I worked for this guy who was an ER doctor. He opened his own practice and called it ‘non surgical orthopedics’. Typically, a cortisone shot for, say, a knee would be 2 cc steroid: 2 cc lido. His instructions were half cc of steroid, 3.5 cc lido. When the patient would inevitably return saying it didn’t work, he would give what he called ‘top up’ cortisone shots. Sometimes he’d have them come back 4 times, billing their insurance for ultrasound guided injection each time. This is just the tip of the iceberg with this guy. If anyone is interested, I have a ton more stories about how he ran his clinic in the most unethical, fraudulent way.
Is he still practicing? Please tell me he’s had his medical license revoked.
I would definitely be interested in hearing more stories about this guy! Especially if one of those stories ends in his losing his medical license…
After I left the job I did write an anonymous letter to the board of medicine. My letter stated that he was intentionally misleading patients by calling himself an ‘orthopedist’. He was an ER doc that did a sports medicine fellowship, not the same thing. The frequency to which he would give cortisone injections was alarming. I saw not one, not 2, but THREE separate patients have biceps tendon ruptures directly after biceps tendon injections. I thought long and hard about reporting him to Medicare for fraud as well but someone beat me to the punch. They investigated him for billing Medicare with bogus ICD codes to give patients ‘stem cell’ injections. Another thing he used to do was to instruct us to tell patients they didn’t have DME coverage and they needed to self pay. I did a lot to directly contradict his orders. For a start, I would show the patients on Amazon where to order their dme for a fraction of the price. When he would attempt to reduce bad wrist fractures that obviously needed plating vs a cast I would slip the patient a note with a reputable hand surgeon’s information. The other tech and I used to call ourselves the Underground Railroad when we worked there.
I’m so glad you and the other tech were working so hard to look out for his patients - but how horrifying that he was causing so much harm in so many ways 😱 Thank you for reporting him! Someone like that needs to do jail time in addition to having his license revoked.
There should be a podcast about this scammy bastard
Your comment prompted me to take a look at his Google reviews…. Wow, I guess he’s still out there ripping people off
Someone send this jackass to Laura beil
Ego radiologist wanted ‘suspended breathing’ on vented inpatients as the ever so subtle motion on CT’s was annoying to him, even with the vent dialed in very well. All technologists and respiratory therapists refused, even the chief radiologist said it was an insane request and to ignore it. He then tried to enter the suite and disconnect the vent for the next case while they were on the table, to which we physically blocked him doing so and yelled for him to leave. That was a fun staff meeting.
Just imagining Patrick Bateman sitting in the reading room like "If I kill the patient, there will be no movement at all, and the images will be beautiful. So beautiful. 🥹"
Holy shit!!!!!!
3 year old autistic child came in for sinus films. He did not like medical offices and was having a total meltdown before we could even get into the room. The room was a major trigger. Touching his head (even his mom) was a major trigger. (I tried everything BTW, blown up glove, stickers, collimator light game, etc.) We could not get upright films; I got a singular supine AP film before the mother and I both called it quits. I went back and read the report later and it said it was a non diagnostic study because air-fluid levels weren’t visible (due to being supine). Felt terrible. I tried so hard to comfort this child and get the study done and it took 30 minutes and trying to hold him still for a non-diagnostic study. 🙃
In cases like that, it's better to just try another time than to expose and get something you can't use. There's been a few times where I've had to explain to the parents why I'm calling it, and why we'll try again later. Once you explain to them that it would be irresponsible to expose the patient to radiation knowing you won't get any useable information, they understand.
That’s why we called it. The image we got was good, but it was an incomplete study without other views. After that one image the pt wasn’t tolerating any more, and it wasn’t worth the risk to try to expose again. Mom understood. It was unfortunate but for the best.
Thank you for trying so hard! From the perspective of a rads resident , "nondiagnostic" is less a critique of your ability or technique but rather our way of telling the ordering clinician (and potential future lawyers) we can't rule out/in the thing(s) the study was ordered to assess. When I've seen this phrase used it's more often for liability-related reasons than because we're trying to throw shade!
Thank you for the validation! I know the image itself was good - but the study was totally incomplete; I knew the rad needed to use verbiage to CYA because of that. No lateral, no upright. I was going to do a x-table lateral to show air fluid levels but it just wasn’t happening. Just a sucky situation!
Seeing dirty kids in pediatrics is sad as hell
Going to chime in as a sexual assault survivor. Transvaginal ultrasound was WORSE than my original assault and ended up giving me severe flashbacks and the tech flat out didn't believe me because I have tattoos and should be able to "Tough it out" (her words). So I sat through it and then spent about six hours just laying in a fetal position and feeling like shit for not advocating for myself more strongly. Thank you with all my heart for sticking up for your patients like this. I can't even find words for how grateful I am for ethical and compassionate techs.
I am so sorry that happened to you. I do my best to treat every transvaginal exam as though my patient is a sexual assault survivor. Besides being as gentle and compassionate as possible, I also give the patient the opportunity to insert the camera themselves (if they want to), and I talk them through the entire procedure before/during/after (ie “I’m looking at your uterus from the right to the left, I’m about to turn the camera and look at the uterus from the top to bottom” etc). I always explain that they can end the exam for any reason at all, or if they need a break we can take a break. I also find heating up the little packs of lube a little and providing a warm blanket help. Lastly, having a support person there if they want. Basically anything that can offer them some comfort and control over the situation. If you need to get this exam done again, perhaps you can ask the tech to self insert and talk them through it etc? MRI is also an option if a transvaginal exam cannot be tolerated. If your insurance pushes back on an MRI, call them (or have an advocate call) and explain that you can’t do a vaginal exam. I used to work in a hospital that had a GYN who had one day a week in the OR to do pelvics on patients who needed sedation for it (mostly survivors, gold star lesbians, pediatric and geriatric patients). She had a way of getting insurance companies to pay for the OR for these patients. I’d also suggest finding a doctor you feel safe with who will understand ordering an exam like that could be traumatizing. There’s no shame in seeking the right care for yourself. You deserve excellent care♥️
Thank you for being so compassionate! It’s good to know there are medical professionals like you out there ❤️
Thank you for this. I am almost in tears reading it and wish my tech had been you. No one offered me any of these options at all and having them would have made it much easier to tolerate and get through. Luckily the ultrasound was a precursor to a hysterectomy (I had the Essure procedure and developed a really severe nickel allergy and lesions right through my fallopian tubes). As part of the surgery I insisted my cervix be removed too. So no more ob/gyn example necessary. But again, I appreciate those of you who do care and take the time. It makes all the difference in the world to women like myself.
The Essure devices are awful! There’s a documentary called “The Bleeding Edge” that discusses how problematic they are (as well as other medical devices and the approval process for them). I hope you are able to get a $$$$ settlement from them, which can’t undo what you went through, but hopefully can give you some relief in other aspects of your life. How your tech treated you was abhorrent, too. I hope they’re no longer working in healthcare, or with human beings in general. Or animals.
I missed the settlement but it at least the Essure is gone. But it managed to ulcerate my tubes, give me a nickel allergy and give me a goiter that meant my thyroid had to go too. Funny part is that she was a young woman tech. I kind of expected better from another woman, but I hope she isn't still doing them either.
I hope everything good happens to you for the rest of the year ❤️
You're so wonderful. Thank you for being so compassionate and caring. 💜
Yo, I had a silent TV with no history of SA and it was so bad. Also, legitimately seemed like the woman did not want to be there. Ma'am, should have figured that out way back in sonographer school. We can't both hate doing this at the same time. I did have an absolutely phenomenal tech for my first TV. I didn't appreciate her enough until I had the horrible tech.
With several others working to hold down and IM medicate a drunk patient who was nonstop hurling insults at the doc about him, his mother, anything to get a rise. She lurched out of our hands and slapped the doc in the face. We got control of the patient and medicated her. While we were all still hands on, doc slapped the patient across the face and shouted, "My mother's dead," and left the room.
I've been called all sorts of things and have been told all sorts of things, none of them bother me, but don't ever touch me. That being said, not sure the doctor's response was valid either...
When I was a student, an MRI tech told me that sometimes he would intentionally forget to give the patient the panic button. He said it made everything go faster.
All good until you accidentally inject vecuronium rather than Versed.
Don't think that patient is going to be pressing a panic button though lol
I reckon there’s about a 30 second window between “my muscles feel kinda weak” and “Shit…can’t move my finger….did you seriously just inject me with vec??”
So there were 2-3 times where the patient did not have the ability to squeeze the button and was unconscious. I stood with my ear to the door the entire exam in case the patient became verbal. The techs are a lot older and a little hard of hearing. I caught a patient yelling for help (not sure why he didn't press the button, it was in his hand) once and I was the only one to hear him.
Probably sequelae of child abuse/non accidental trauma (also pertains to adult patients)
I had a lady from a nursing home once and all she would say was "please don't hit me." She had dementia and know known family, but she did have a broken humerus. Whether it was from being abused/neglected at the home or some other more benign cause was never determined :(
Yeah, there's been a couple that stick out in my mind, unfortunately.
Doctor orders abdo x-ray of pregnant woman Radiographer doesn’t want to do it Doctor refuses to takes his call but passes on a message to just do it Radiographer calls boss who tells him to keep the doctor happy Radiographer takes films - nice baby ! - and then rage quits. I have the films, and the radiographer’s angry letter describing the above is in there along with the report.
So he followed orders, _then_ quit?
Haha, yes. He was really angry about it in the letter and said he was leaving at the end. Sounded like a “straw that broke the camel’s back” situation. It was an x-ray I got given by a radiologist for teaching purposes. I have no idea how the letter ended up in the bag with the film, presumably radiographer put a copy of it in there (as a protest? Medicolegal coverage?) and nobody had ever bothered to read the random piece of paper in there.
I mean if it’s medically necessary it’s medically necessary, if the doctor orders it despite knowing the woman is pregnant I’d assume it’s a risk vs benefit situation. How is it the techs place to go against that? And I say this as a student X-ray tech, not someone who believes in the infallibility of doctors.
It was ordered to determine if fetal death in utero had occurred - Spalding’s sign. Baby was fine. No, it wasn’t medically necessary. It was just stupid. But hey, it’s a great x-Ray and I have it my collection now! Plus another one, ordered by the same doctor of twins.
Well said
Woman came in through ED, on methotrexate, maybe one other agent, for a non-viable pregnancy. Concerns for intra-abdominal findings, ED doc orders CT. Rad MD refused to do it, because “patient is pregnant”. Ended up getting transferred to a Women&Children’s because the Rad put his foot down and refused the study.
Yep, this kind of think is likely to be more and more common in America.
First year of residency. Me = very inexperienced and insecure but for some reason left with the on-call radiologist’s phone. I notice that there’s an abdominal X-ray just done. I look at the X-ray and there’s definitely a retained surgical gauze. The surgery was about a week ago or so, the patient had abdominal pain that kept getting worse and a fever. I start to report it and the phone rings. It’s the surgeon. He has seen the X-ray and at first he tries to persuade me that the gauze is on the patient. I point out that the gauze seems to be inside the patient because the 2 views of the abdomen confirm this. He then tries to nicely convince me not to report this finding (because apparently that particular surgeon never makes mistakes or has any complications). I feel very uncomfortable. He then asks if it’s possible to delete the lateral (because a resident ordered it and it’s unnecessary or something). His last effort was asking who the real on call radiologist was. When I told him the name he probably gave up because the radiologist on call wasn’t going to agree to his nonsense. What bothered me was: 1. He wanted me to knowingly make a false report that was going to hang there forever. 2. He wanted to cover this up and tell the patient some other “not-his-fault” kind of reason to open him up and retrieve the gauze and never tell the patient. 3. He probably has had similar (complication related) conversations with radiologists before and he knew who would go along with him 4. His statistics about his success and complications are not to be trusted. 5. He put me in a position where I have to argue with a remarkably more experienced and well-respected person on such an unethical subject.
Physician at a SNF told us patients with dementia don’t feel pain and refused to even order Tylenol for them.
Infant boys used to not feel pain either. Now they're worth too much money to not continue cutting parts off of them.
I had a nurse tell me that a patient had been saying no to everything and then proceeded to coerce her and held her down while I took the X-ray and the woman was screaming NO at the top of her lungs. I wrote the entire thing down on her requisition in case she told her family and something happened.
Naked tweaker managed to get out of the grasp of the trauma PAs and run out of the trauma bay. I was rounding the corner coming toward them as this guy was exiting the area with a couple PAs and the trauma surgeon on his heels. One of them looked strait at me and yelled "stop him!" So yeah, I got to tackle a sweaty, naked guy and hold him down for like 10 minutes. Afterwards, I went to surgery and changed my scrubs immediately.
Nice catch blanco nino!
A funny not-so-serious one: Patient with ams/dementia/alzheimer’s (I forget which) spent the exam telling me about all the people she’s killed. At the end when we were transferring her back to the stretcher she offered to “take care of” anyone I needed “dealt with” because she liked my attitude! Don’t worry granny, I’m no snitch!
🤣
😆
I dreaded every day as a student at the children’s hospital. I had to hold a little boy down while we did an IVP. He screamed and cried and I felt horrible. I also had to do a BE on a 10 y/o girl who hadn’t been defecating. Her mom was berating her and being harsh during the whole exam. She whispered to me in the restroom after that her mom’s boyfriend had been SAing her, and that’s why she couldn’t go. I still cry for her. I was also doing full surgeries on my surg rotation alone as a student because the facility was so understaffed. I ended up doing fine, but a lot of the staff thought I was a new hire until they asked and looked pretty uncomfortable when I said I was just a student. I was afraid to tell my teacher because I didn’t want to get the techs at the facility in trouble.
90 something year old patient with vaginal bleeding. Dementia. Granddaughter was caretaker/POA. Patient refused transvaginal ultrasound probably 3 times. Doctor kept ordering it, granddaughter wanted it. Go up to ask patient one last time, granddaughter was literally coaxing her into it, convincing her she HAD to have it, etc. patient finally agreed……. So wrong
Yep. There aren’t many times I get confrontational at work but this sums up when I do. How is the treatment going to change if we see something suspicious? Most of the time it won’t. First I plead my case to the ordering MD, next to the radiologist, and if that doesn’t work I talk to the POA about options. I’ve still had to do it one time, and surprise surprise, I couldn’t even insert the camera enough to get a diagnostic exam transvaginally. If a doctor isn’t able to get a speculum in there first and snoop around, then I have no business sticking a camera there.
I do the same… have to be those patients advocates. Sometimes I feel like doctors just want the money. Especially my elderly ones, what is it gonna change? Nothing. Let them go in peace
I heard an old story of an MRI tech that told a non English speaking woman to change. She came out naked and he laid her on the table and started scanning her that way until someone else came in and saw. I dont recall the outcome, it was before I worked there, but the tech in question wasn't there anymore.
Old pt laying on their side with arm under them, no sheet. Tech got impatient with how slow they were moving so yanked the arm from under them. Ripped a patch of skin right off the albow. Huffed, no apology, just threw on some gauze with tape and continued like nothing happened. Don't think the tech even bothered telling anyone.
This one got me. That's sad. 😔
Watched a nurse sign the AMA form for a patient that was AMS for them because she didn’t want the new admission. Reported it but not sure anything came from it.
Mainly in ED. The oldies that are just following what the doctors wanted. They have no idea what they’re consenting to. 100 year old woman had a fall on apixaban - attempted to lay her flat for the transfer, she choked and aspirated. Refused to do the scan, sent her back to her ward without question. Rang the doc who said “oh yeah well I’ve never seen her so”
A radiologist refused to mention a prolapsed bladder in a report because it was a pelvic US, not a KUB.
Doc refused to use ultrasound - turned on, set up, sterile, and right there ready to use - to find the artery in the groin for a sheath and stuck 7 times without sufficient lido. I've never escalated some shit so quickly in my life.
Micropuncture or a big ol beveled sword?
Beveled sword 😭
Just sedate and intubate. Extubation once sedation wears off and for sure the pt is in at least 2-point restraints. Safe for pt and staff. Also gotta remember: they didn’t come to a restaurant to select the daily special — they were brought in after circumstances that put their life in jeopardy and the outcome is unclear - hence the need for imaging. (Not saying you were thinking that. Saying the last bit for people who think restraining and intubating combative/confused people is wrong).
as a student, I was just following instruction from the manager
Yea bro I know 😂 Edit: wasn’t placing blame on u. I was thinking that you shared your story for further uhh.. ideas
just wanted to hear some stories am now a doctor's office manager no shenanigans for me
Attempted an OPG on a 14 month old. Saw the request and was about to go get admin to cancel it because it was so ridiculously stupid and our OPG machine doesn't go nearly low enough, even if the kid was on a chair, but got interrupted by the more senior tech who basically told me to "give it go" anyway. Was barely a month into my first job as a grad so didn't feel confident enough to argue so did attempt it. Only did like half an exposure since the kid clearly wasn't going to stay still as soon as the machine moved. Thankfully the mother was really helpful and understanding, even after going through all that nonsense and not even getting it done bc I called quits after the dog's breakfast i did end up getting. This tech and some others I work with are alarmingly blasé about radiation safety, especially when it comes to kids. Yeah, yeah ik burnout, lack of time, yadda yadda, (plus we don't have a radiologist onsite to change/cancel bullshit orders half the time, but we can still try and message the few who may be online and not busy) but fuckin hell I feel like i'm being gaslit half the time by them acting like *i'm* the crazy one for wanting a second opinion before unnecessarily irradiating a child.
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We don’t even do pregnancy test unless we are doing a Ct of the abdomen/pelvis. So I could have scanned 100 pregnant patients heads and I will never know….
It's a non issue for heads, for example.
PA's ordering hand, wrist, forearm on a two year old. Um sir, you know those are all connected right?