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?

Sorry, but this is the sort of argument that defence lawyers make during rape cases, if the victim was wearing jeans, say - it's disgusting, and takes no account of the way people freeze up when they feel they're being violated

The OP was voluntarily in an A&E department. With abdominal pain.
And the man was a doctor, examining her, trying to find out which bit hurt. (Layman's terms, obvs). It's ludicrous to compare it to what might happen on the way home from a nightclub at 3am, with a random bloke trying to grope you.

Glad you are home - hope the pain has eased.

I read back my post and called you She when you are a he. Sorry. Doesn’t change any of what I said, but I should have been more careful in reading your thread. I was, and still am, incensed on your behalf.

Have a good nights sleep - hope they gave you good pain meds.

Dear OP,
I am sorry you experienced this. I am a HCP and need to remind pps who are wondering why you are upset, that consent is not an added extra, something nice but OKto forget. It is an absolutely fundamental part of medical care and consenting to one part of a procedure or examination does not imply consent to another part. Consent is an ongoing process and the Dr should check that you are OK with each part. They should also monitor your non verbal responses and body language to ensure that they match with your verbal consent. The chaperone should also be doing the same. I would suggest (if you feel able) that you write to the hospital to provide this feedback to both the Dr and the chaperone. You can also provide the positive feedback but it is important that both the Dr and the chaperone reflect on your feedback in order to improve care for other patients. Do not doubt yourself. Your feelings are completely valid. Take care x

Em, I'm a little bit on the fence about this one.

That it's male/male doctor/patient probably means (though I don't know - I'm female) that a chaperone isn't required?

What usually happens for me is that a doctor will first ask whether it's ok to examine my abdomen and will secondly request ME to full my trousers down to wherever they require.

I've never actually had a doctor pull my trousers out of the way once - and believe me I've been in hospital A LOT.

So I don't know really. I've no similar experience to work off. I'm drawn towards siding with the doctor, at the same time, I'm not you and I was not there.

The OP has said they are male - not female.

I think what I'm finding so difficult is that it's only this past couple of years I've been strong enough to mention anything about my childhood. Taking this scenario I was brave and strong enough to mention my diagnoses, which invariably leads to the asking of "what's cPTSD" and "why", questions I never want to respond to let alone in an impersonal A&E department. Easier to simply freeze, which has been my go-to for decades. Slowly bucking the trend...

The chaperone should also be doing the same

There wasn't a chaperone. If there had been at least I could've read between the lines somewhat. I just wanted to stress again I thought the dr was amazing, in a way I don't want to criticise what was outstanding care, but can easily see "another me" in the same situation.

I think that YANBU to find this uncomfortable. My brother was braindead (God, that's hard to type), yet every single doctor and nurse in ITU spoke to him and told him what they were going to be doing first.

It's up to you whether you contact PALS and emphasise that this was great doctor, you feel that it would benefit staff to have training in Complex PTSD and to consider offering chaperones in same sex examinations.

Something you could potentially do is, as people do with allergies, etc, make a card to carry in your wallet saying something along the lines of

'I have a diagnosis of Complex Post Traumatic Stress Disorder.

If I require medical treatment or examination, I need a chaperone present during examinations, irrespective of the gender of the Health Care Professional.

I may not feel able to ask for this at the time, but please provide a chaperone on all occasions'.

That way, if you're conscious, you can hand them the card to read, and if you're not, the chances are that they are going to be looking through your wallet to find your ID anyway, so will see it.

I don't know whether that would help you, but it might, as it frees you from the initial expectation to speak about it?

@Frainbreeze ... there was some research published a few years ago that showed that police officers were more equipped to communicate with survivors of cPTSD than ED staff.

I work with survivors of cPTSD and many find it very distressing to go to ED.

I’ll never get my head around the insensitive nature of the internet. I won’t single out MN because it’s rampant across all boards. A person has said they’ve been sexually abused and some posters tell them they need to build resilience WTAF
I’d love to meet these arseholes in real life and see how many would tell a person who had suffered SA, sexual assault and rape to build resilience.
frainbreeze
I know exactly where you’re coming from

Firstly thank you for talking so openly about your sexual abuse, it is hard for anyone to talk about child sexual abuse but there are some real prejudices stacked against boys.
I am not sure that all posters are aware that freezing is the most common response to trauma, you don't get to choose if your body goes into flight, fight or freeze it just picks one for you and cracks on.
I would mention it to the hospital, it sounds as though Dr was in full diagnosis mode and had stopped thinking holistically. I also wonder if they were less careful as it was a same sex examination.
You sound very resilient from here.

OP, I'm so sorry for everything that's happened to you.

I agree with PPs that you should write to PALs - not because you want to be negative about the doctor, but because you want to improve patient experience for others in the future.

I find it striking that so many PPs have said they have always had HCPs asking permission -- I wonder whether there is a slightly gendered aspect to that, i.e. that HCPs are more 'careful' around women because conversations around consent have centred a lot on women's experiences. Like others, I have never had a HCP so much as shift my waistband down (and this has happened a lot in pregnancy!) without checking first. It might be helpful for you to highlight that all patients, regardless of gender, can be vulnerable in ways that make it necessary to take a bit of extra time and ensure that the patient is consenting and comfortable in anything that could be termed an intimate examination.

Write feedback to via PALS - you don’t have to be very negative. Say what you feel (ie grateful for his thoroughness) but you are sensitive about this issue (for understandable reasons which you had tried to highlight) and just wished to have been asked first or perhaps offered a chaperone. Sometimes Drs are less careful with people of the same gender as themselves because they assume the patients will feel less awkward.

I think putting it in writing (like you have on mumsnet) may help you process it. They may or may not reply but what you are doing is reasonable and you may be avoiding problems with future patients.

Also -do try and request a chaperone up front next time you go to doctors (you have done NOTHING wrong - it might just be helpful to highlight the problem to the dr).

YANBU. I was in A&E a few weeks ago with DH who had severe abdominal pain, and every member of staff, male or female always and without fail asked his permission first, and told him what they were going to do, before examining him.

Sorry op, I'm a bit confused. I thought you said that the Dr asked permission to examine you and detailed to you what he was doing throughout? Was it upsetting because you was not expecting your lower garments to be moved as part of this examination?

He detailed the exam afterwards.

I think people are forgetting just how many pervy doctors there are nowadays. Local to me, we have had a few where the complaints have got nowhere other than one doctor who I think even went to court. Anyway, I've had an abdominal exam for pain and never had to take clothes off that low!

I think this is probably one that's impossible to call unless directly observed.
Consent is a lot more nuanced than a direct 'is it ok if...'. When a patient physically adjusts themselves for an examination - like the BP example above, it's often considered implied consent. And for the vast majority, it is. But not for everyone as this post shows. Even if directly asked and patient says something is ok, they aren't always feeling like it is ok really. As doctors it's really easy to forget you're in a position of power and people don't always feel able to speak up if they're not happy with something. Recognising that and trying to help with it is important.
You seem to have excellent insight into the situation and your own needs OP. You write very eloquently and if it would help you process the event id suggest you write a note to PALS with some feedback - it doesn't have to be a complaint, if you're worried about that you can explicitly state that you don't want it taken as a complaint.
You've mentioned a few times that you tend to freeze. I wonder if it would help to keep something written that explains your needs - have a read online about 'hospital passports' maybe. Doubt you'd need anything quite as in depth as that but something along those lines.

@JQBased any undergraduate medical textbook will tell you that a patient should he 'exposed from nipples to knees' for a proper abdo exam.

In practice we would try to avoid this potential indignity and pick out the parts of the exam that are absolutely necessary based on the history.

But please don't suggest that any additional exposure is 'pervy'.

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.

I don't practice now but I do teach.
I am ashamed I've never thought of this as an issue.
I don't know if this helps, but you've educated one person and that might help educate more. My best wishes to you and I hope your symptoms are sorted out.

@FrowningFlamingo I suggest you have a read of the cases that come before the MPTS every week before you conclude that there are no ‘pervy’ doctors. There are. Lots.

@Racerback
I didn't say there are no 'pervy' doctors FFS.
The poster I was replying to spoke about 'pervy' doctors and said they'd never had to take clothes off that low for an abdominal examination for pain. I was trying to highlight that sometimes that is necessary and does not automatically mean the doctor is being inappropriate. Otherwise anyone reading that who later needs a more involved examination might feel unnecessarily concerned.
My apologies if that was not clear, though I think it was.

You admit earlier that you shifted your bodily position to allow him to pull the waistband down. What is that if not if not implied consent?

I'm sorry that this experience triggered your PTSD. I'm a nurse and also have PTSD, not from abuse so its a bit different but I have some perspective. If the doctor had understood about your PTSD then he was being insensitive certainly but not malicious. He'll have done an abdo exam so many times that it'll be muscle memory for him to move your clothing down but he should have taken the time to explain and check that you were ok with it. I've seen countless fantastic doctors forget about a patient's dignity, exposing patient's naked breasts without asking to do echo scans or ECGs etc. When I point it out to them afterwards they're always mortified but they do learn and want to improve and ultimately are grateful. I'd suggest writing them a thank you card and suggesting an improvement to their practice they could reflect on.