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?

I agree with you OP, the Dr should have asked. But I suspect it is not uncommon on A and E for Drs to behave like this. On my face book a woman friend with a history of sexual abuse has actually just posted about a similar scenario. So I doubt it happened because you are a man, more that some Drs just don't think about these issues enough.

An A&E doctor is usually overworked and underpaid, and is likely to be most interested in discovering whether the patient is going to bleed out/start fitting/otherwise die, or whether the patient can be patted on the head and sent home.
Yes, the doctor probably could have been a little more considerate, but A&E is accident and emergency, not counselling. Sometimes a patient arrives in A&E unconscious: they aren't going to wait for that patient to wake up so that they can ask for permission to touch or examine, because the unconscious patient might die if immediate treatment isn't given.

I think YABU but totally justified given your history.

They should have asked or said what they were going to do. My experience is that they always have. However unless there was something else that made you uncomfortable such as they were rude/dismissive /did something inappropriate, please choose your words carefully when commenting, no one does everything perfectly and a complaint will make a caring doctor feel terrible and probably subsequent patients will get less good care as a result.

Sometimes a patient arrives in A&E unconscious

True. But this patient was conscious, so it's irrelevant how a doctor would behave with an unconscious patient. The rules that apply for conscious patients are in point and they weren't followed.

Is the "implied consent" pp are referring to the same as when a rapist says "but she made eye contact with me"?

Since when did the law cease to apply to NHS staff?

I think part of the problem is doctors speak in shorthand. So if he said, 'I'm going to check for a hernia, is that ok?' and you agreed, he thought you'd given permission. But in actual fact, he hadn't explained what checking for a hernia meant.
I'm sorry this was triggering for you. I think feeding back would be worthwhile. It may help someone else in your position in the future.

YANBU. When I experienced childbirth complications and was rushed into surgery it was an emergency scenario and every single medical professional swiftly explained/gained consent for what they needed to do before they did it, which made an out-of-control situation feel much less scary for me. If they could all manage it in those circumstances I don't see how an A&E doctor couldn't take 2 seconds to do the same, especially given they were aware of your history and diagnoses.
I recently had a negative experience with the NHS and I did provide feedback about it because I thought it could help future patients. Obviously I didn't go in all guns blazing, just explained that there had been an impact on my wellbeing and it was avoidable. If you feel able to, it might help you if you can do the same?
Sorry for all you've gone through.

im sorry you felt triggered by this.it must have felt so scary.and your now still feeling that after effect.
i dont have any the best advice to give on this as i can see both sides...
buuut i very very very much dnot think your being UR with how you felt then and reacted since.
try and be really kind to yourself tongight and tomorrow.get some sleep.
your thoughts race much worse at night too.
i know its hard.but your safe.
do you have any techniques that could help right now or something of comfort to do or snuggle with to help tonight.
what happened to you in your past was fucking horrific.you were very brave then and every day since.

OP, YANBU. Please repeat that to yourself and please make sure you contact PALS. I have a similar history also of right sided abdominal pain. Every doctor I've seen has always asked to examine me. It's your body. Don't let anyone tell you that you're wrong.

I spent three years trying to get a diagnosis. My pain was in my abdomen, very painful, often thought to be appendicitis. Was misdiagnosed with a multitude of ailments. It was a slipped disc, the pain was radiating to the front.

Hay, I'm so sorry this happened.
Abuse survivors see things differently to others. We have to carry it with us always. People don't get this.
I think maybe a message to PALS might be appropriate, the dr might just need that little nudge to remind him it's not just women that he needs to ask consent of.
I get a&e drs are rediculoisly over worked and doing their best for minimal pay, and I don't think you or I would say he should be fired, but he does need a reminder about taking a moment and seeing the person he's working with, not just the ailment.

@Frainbreeze do you have any one with you?
Do you feel able to tell anyone at the hospital that you’ve been made to feel uncomfortable?

Oh sorry, you are out of hospital now?
Do contact pals.

Yes I'm home now. Thanks for all the thoughts. Bile duct injury is the likely cause and am awaiting a routine surgical appointment now.

Ridiculous to compare the situation to emergency scenarios with unconscious patients. Shall we apply that to all medical procedures, no matter how intimate? Consent isn’t important because sometimes drs have to save the lives of unconscious people who are unable to give it

In OPs situation it would have been so easy and quick for the dr to be respectful and gain proper consent, in her situation there are really no excuses.

Yanbu. I have a history of serious sexual assault and have found some (not all) doctors completely insensitive and inappropriate. I.e. asking to examine me but not explaining or seeking my consent to carry out an internal examination. I had an emergency procedure and only found out when I asked explicitly that it would include an internal examination while I was under GA. I don’t know whether I see things differently because of what happened to me, or whether consent isn’t being properly taught to medical professionals.

Glad you are home @Frainbreeze
If waiting for surgery definitely speak with your consultant about what happened. Hopefully they will think about what they do. They can also learn from this so that someone else won’t be made to feel as you have.

I hate to use my "man" card, but a couple of the comments reading back sadden me. There are still so many male children who never disclose their sexual abuse, and disclosure carries the same stereotypes present 40 years ago. Those of a male experiencing an erection during, that same sad uncontrollable physiological reaction as women. That of being inherently gay, and many others. I just wish both sexes didn't have to suffer this most heinous of crimes.

And to the poster who questioned my resilience. My posts are strewn across the Stately Homes' threads for many years, if you care to delve. I can guarantee I have massive resilience, although you'd likely label the scars on my arms a distinct lack of!

In A&E with a bowel problem I have had a female chaperone when a male doctor needs to examine my backside. I don't know I would get one for a female doctor and maybe that's an issue. Perhaps the default should be to ask if a chaperone is need for same sex examinations.

Sadly I think it should, to protect both.

Sorry you’ve experienced this, OP. I can understand why you feel this way. I can also understand how a tired doctor or one who doesn’t fully know your history in detail might think that your initial consent was for the full examination. I’ve only ever known medical professionals ask for initial consent, not further consent for each component of the examination or treatment. Perhaps in such a pressured environment the doctor failed to understand that you needed more control than that. It’s definitely worth giving feedback but it does sound like your past trauma is colouring what most patients would experience as a normal examination.

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

I have to say that the 3 times I've been to A&E for abdominal complaints, they resulted in diagnoses of 1. Appendicitis. 2. A ruptured ovarian cyst. 3. A retained placenta, I was either in so much pain, or losing so much blood that I really couldn't have given a shiny shite who did what to whom. A cubicle in A&E is very likely the safest place you could ever be. I even agreed to have two students have a feel of my ovarian cyst. I'm in no way a brave person, but really, I was in so much pain l I was away with the fairies and just wanted them to fix me. Letting a couple of students have a feel of my cyst did not delay my treatment. I was oompos mentis enough to reason that I was in a teaching hospital and student doctors and nurses have to learn stuff.

Having said that, I can understand that it might be a bit different if you've had bad experiences, and your anxiety about that overrides common sense.

When my Mum was rushed into hospital at 3am she was conscious, but they didn't ask her if they could remove her nightwear. They just cut it right up the middle with a pair of scissors so that they could apply heart and breathing monitors. In an emergency there is no time for niceties. They saved her life at that moment, but she died a couple of days later.

Imagine the fuss I'd have kicked up if she'd refused to have them remove her nightwear. Or delayed treatment until she gave consent.
She'd have died anyway, but I wouldn't have known that was a given.
I would have thought how stupid it was for a doctor to need permission to do everything he/she can to save someone's life.
And I might even have blamed them for pissing about asking permission to apply life saving treatment, just in case she sued them later for cutting up her nightie.

There are some people for whom any bodily intrusion can trigger PTSD, But I think they are few and far between. And in the scenario of an accident and emergency department, most people are there of their own choice, because they are in immediate need of medical attention.

So yes, OP, YABU. But I can understand why you feel as you do.

Im a senior HCP ... he should have given you a heads up & explained what he needed to do before he did it.

Then he should have documented it.

You are not being precious... contact PALS or leave feedback on the hospital website.

HCPs need this feedback... trauma informed care wont improve unless they are told

i dont have anything productive to say but just wanted to send a hug and say im sorry those things happened to you x

Op quite clearly was not expecting talking therapy or counselling, don't be so dense.

I would personally give feedback to the hospital. Yes drs are overworked and understaffed and their priority is to rule out a life or death emergency, but they still need to explain what they're doing. Saying 'im just going to lower your waistband' doesn't add considerable time to an examination.