Consent issue or AIB precious? (A&E)

[Frainbreeze]

I've been in A&E over the bank hol. I've a history of childhood sexual abuse, emotional abuse and neglect. Diagnoses of PTSD and cPTSD. Presented with excruciating abdominal pain, right side. Don't want this to be identifiable but cannot see how it won't be .

I'd detailed the PTSD's and doctor aware. During the exam he proceeded to partially pull my PJ bottoms and underwear down. I wasn't asked if I was ok with this. In terms of thoroughness incredible doctor, but this keeps niggling away - that I didn't have any control,

Male. Am I being precious here?

Pulled trousers down or moved waistband from waist to hip to examine abdomen ?

Do you mean the doctor moved the waistband lower to fully examine your abdomen?

I think that hospitals are a place where it’s very easy for your boundaries to be tested. Busy doctors, sadly not necessarily thinking of you as an individual, just seeing a health issue to solve.

That doesn’t make it ok - they should be asking you for consent, and it’s ok for you to assert your boundaries and say if you feel they are being crossed.

Perhaps put a patient suggestion in. A&E doctors are very over worked but a reminder about bedside manner doesnt hurt or even a dialogue as to what they are going to do next

When you say ‘male’, do you mean you or the doctor? If you’re female, were you offered a chaperone?

Also, did the doctor lower the waistband or actually pull your trousers down?

I am assuming your genitals were not exposed and he was just moving your clothes to look at your abdomen? I also assume that in being there you wanted the doctor to examine you to assess what was wrong? It doesn't sound to me like the doctor acted inappropriately at all but maybe with you background you are just more sensitive than most.

Ideally he would ask. However I think he would argue he had implied consent - you were there by choice and wanted an abdo exam. Plus doctor likely has a different perspective on you not having any control - you could say if you were uncomfortable at any time, didn't like anything, could ask him to stop.

Unfortunately it is impossible to do a proper abdo exam without pulling your waistband down and I suspect most don't think it is as big an issue in males as it is in females, which obviously is not the case.

You had serious abdo pain, bad enough to be in the emergency dept.
He examined your abdomen.
You are being U.

Is it because you felt that this was unnecessary/unexpected and would not have give permisson or because you were not asked prior and would have given permission?

@captaincabinets my DH was given a chaperone when a male doctor wanted to check his anus...it seems they do it for both sexes

YABU completely

Unless you are unconscious (and therefore unable to provide consent), a HCP must ask for permission to touch you. For example, when my DF was recently in A & E, he was asked by every person that he had contact with if it was ok to look at his back, raise his shirt, take his BP etc etc.

YANBU.

I think the OP knows it was necessary for him to look, but feels that he should have let her know what he needed to do and asked "Is it OK if I pull your waistband down", or maybe asked her if she would prefer to do it herself? Doctors really need to get in the habit of letting patients know what is going on, what's happening next for everyone, not just vulnerable people.

YANBU

• When you say ‘male’, do you mean you or the doctor? If you’re female, were you offered a chaperone?

Also, did the doctor lower the waistband or actually pull your trousers down?*

Both male.

Waistband to below my butt. He mentioned he was checking for a hernia when detailing everything.. I've no intention of taking things further - except sending a card saying thank you. I have a deep intrinsic fear of men, which is driving my uncomfortable thoughts.

Unless you are unconscious (and therefore unable to provide consent), a HCP must ask for permission to touch you

That is not correct. There is implied consent in many scenarios. For example if an HCP says she wants to check your blood pressure and you hold your arm out, she doesn't need to ask for permission to put the BP cuff on.

As Anna says, the doctor probably felt that he had implied consent in the situation but giving feedback via PALS (as opposed to making a formal complaint) could be helpful, so he can avoid accidentally distressing other patients in the future.

I've been in hospital wards and departments a few times recently; have been warned/asked permission every time an HCP has needed to examine me, move my clothes or carry out a procedure. I guess this is gold standard, they should all do it and I quite understand why it bothered you that you weren't asked.

Did he ask you before he did the exam? If he did then I would think that would mean he felt he had permission to move your clothing to complete the examination.

Is it because you felt that this was unnecessary/unexpected and would not have give permisson or because you were not asked prior and would have given permission?

The latter.

My doctor always explains what he is going to do before he does it. I don’t have your painful history so to me it seems over the top - but I totally understand why some people need this.

It was insensitive- particularly given he had knowledge of your history.

My mum used to work in hospital management and always said you should complain if something happens - otherwise things will never improve. Doesn’t need to be an angry letter - just point out your boundaries weren’t respected and the examination was unnecessarily stressful for you, might help the next person.

I am so sorry about your childhood experiences - no one should ever go through that.

Law and professional guidance for doctors is clear that you should have been asked first and given consent first. Otherwise, legally it's assault.

But the NHS gives no fucks about patient consent.

Yes you should have been asked permission first. Yes they are busy but it would have taken seconds and been no extra inconvenience.

I remember from pregnancy scans the Doppler needing to go further down than my waistband and I was always asked permission beforehand. Just basic respect and consent.

Don't bother complaining. They'll protect the staff member over you and dismiss the complaint, so you'll just cause yourself stress for nothing.

Legally, medical staff who do this to patients have committed assault. But nobody will do anything about it. So it happens again and again to more and more traumatised patients.

How did he manage to pull the trousers down to your bottom if you were lying down? Surely you'd have to have adjusted your position to allow that otherwise they wouldn't shift

A&E docs are there to save lives, not for talking therapy.

A physical exam of your tummy would have saved your life - if you had been seriously ill, which wasn't the case.

I suggest you think about how you'd feel if you had needed emergency surgery. Would you be on MN complaining then?

Maybe see this an opportunity to learn resilience through the counselling.