palpation for edema, is this normal?

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thetaiota

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I had a clinical skills session recently at my medical school. The instructor is a youngish or middle aged woman who also taught me last semester. Last semester, she never did the thing that I'm about to describe. This session was the first time this has happened. And by the way, during this session, she was wearing a high waisted skirt that went up to her mid-back. Her shirt was tucked into this skirt.

During this session, we were learning how to percuss and auscultate the back. As part of this we were supposed to palpate for sacral edema. So we found partners, which were our classmates, to practice on. So at first, my partner and I were working through the material and practicing on each other. But later on, my partner called the instructor over in order to ask her a few questions. One of these questions was about how to palpate for sacral edema. And at this point, the instructor turned around so her back was facing us. Then she pulled out her shirt so it was no longer tucked in. And then in order to show us her lower back, she pushed down the back of her skirt quite far. And as it turns out, she pushed down her skirt a little too far since we could see a few inches of her undergarment. She then described what we're supposed to look for when we're palpating. And when she was done explaining, she pushed her skirt outwards to tuck her shirt back in. But since her skirt was pushed outwards, we could see pretty much all the way down for about a second.

My partner didn't seem fazed by this. And outwardly, I didn't seem fazed either since I managed to avoid showing my emotions. But on the inside, I was quite shocked by this. And the instructor herself was very nonchalant about exposing her undies like that, as if she doesn't care. What do you think? Do you think this was normal and not a big deal?
 
I had a clinical skills session recently at my medical school. The instructor is a youngish or middle aged woman who also taught me last semester. Last semester, she never did the thing that I'm about to describe. This session was the first time this has happened. And by the way, during this session, she was wearing a high waisted skirt that went up to her mid-back. Her shirt was tucked into this skirt.

During this session, we were learning how to percuss and auscultate the back. As part of this we were supposed to palpate for sacral edema. So we found partners, which were our classmates, to practice on. So at first, my partner and I were working through the material and practicing on each other. But later on, my partner called the instructor over in order to ask her a few questions. One of these questions was about how to palpate for sacral edema. And at this point, the instructor turned around so her back was facing us. Then she pulled out her shirt so it was no longer tucked in. And then in order to show us her lower back, she pushed down the back of her skirt quite far. And as it turns out, she pushed down her skirt a little too far since we could see a few inches of her undergarment. She then described what we're supposed to look for when we're palpating. And when she was done explaining, she pushed her skirt outwards to tuck her shirt back in. But since her skirt was pushed outwards, we could see pretty much all the way down for about a second.

My partner didn't seem fazed by this. And outwardly, I didn't seem fazed either since I managed to avoid showing my emotions. But on the inside, I was quite shocked by this. And the instructor herself was very nonchalant about exposing her undies like that, as if she doesn't care. What do you think? Do you think this was normal and not a big deal?
Is this a doctor or a standardized patient? If the former that would be really weird. The latter, meh they have varying degrees of professionalism and could have done this without considering how it comes across. I don’t think they meant any harm.

In what setting does anyone palpate for sacral edema? Not sure I learned that from my doctor books or training…
 
This is normal in a class demonstrating how to look for physical exam findings.
Look at the body part you are trying to examine and get used to seeing patients with parts of their bodies uncovered.
Yea but usually patients are in a gown on an exam table and if it’s younger patient a chaperone is present even if it’s not a super sensitive exam… the appropriate clinical setting is what helps medical professionals look at a body part just as a body part rather than another human flashing them. I can see how the OP was taken aback if someone relatively young just came and uncovered a “sensitive” part without a gown or clinic table to buffer that experience
 
Is this a doctor or a standardized patient? If the former that would be really weird. The latter, meh they have varying degrees of professionalism and could have done this without considering how it comes across. I don’t think they meant any harm.

In what setting does anyone palpate for sacral edema? Not sure I learned that from my doctor books or training…
She is a doctor, not a standardized patient. So you don't agree with the person who commented before you?

And also, the school has said that female students are encouraged to come in a sports bra if they feel comfortable. And male students are encouraged to take off their shirt if they feel comfortable. But that's just the top half of the body, not the bottom half. I know that we're going to use standardized patients for the bottom half, so that's why I was taken aback.
 
She is a doctor, not a standardized patient. So you don't agree with the person who commented before you?

And also, the school has said that female students are encouraged to come in a sports bra if they feel comfortable. And male students are encouraged to take off their shirt if they feel comfortable. But that's just the top half of the body, not the bottom half. I know that we're going to use standardized patients for the bottom half, so that's why I was taken aback.
This doesn’t sound like this person intentionally exposed their undergarments. They were trying to demonstrate the area of the body in question, which is not really a “sensitive” area. In doing so you accidentally saw her undergarments.

I guess I don’t know what you will do with the information of whether this was “normal” or not. I don’t think it matters.
 
She is a doctor, not a standardized patient. So you don't agree with the person who commented before you?

And also, the school has said that female students are encouraged to come in a sports bra if they feel comfortable. And male students are encouraged to take off their shirt if they feel comfortable. But that's just the top half of the body, not the bottom half. I know that we're going to use standardized patients for the bottom half, so that's why I was taken aback.
If you guys were already dressed in your casual clothes for exam she could have had you do the checking on each other, I guess .
 
I don't think this is that weird, considering the context.

Yes, it's weird to see your instructor's underwear. Perhaps quite weird I should say. And yes it's weird they exposed it more when they tucked in their shirt--my guess is they weren't really thinking about where they were and went into "autopilot" and just tucked in their shirt how they would at home when getting dressed. In fairness to the instructor, you really shouldn't be looking all the way down their behind when they're tucking in their shirt, but I'm guessing it happened too suddenly for you to realize what was going on and that you might see more than you should've.

Still, I'm not sure what else would expected. Most of the sacrum is below the elastic line of one's underwear (if you wear normal-rise), so I don't see how one can evaluate the sacrum appropriately without seeing at least a few inches of the person's underwear.

To evaluate the entire sacrum, you really need the person to either be wearing yoga pants or to take their pants off. We evaluated sacral pain all the time in outpt PM&R clinics--it's very up close and personal. We had our patients in gowns and with their permission we'd pull it aside (they had underwear on) so we could evaluate it appropriately. It's part of being a doc.

It sure beats the rectal exam...

Still, it would be rather awkward to have practiced sacral anatomy on the other med students, much less a professor. To me that's the weird part.
 
Ya I mean nbd in the grand scheme of things you will see as a doctor. If you weren’t looking down their clothes as they tucked it back in then it wouldn’t have been a problem. Not to blame you as it can happen quickly when eyes are still gazing lol. But if you hadn’t seen then this wouldn’t be a thread. You gotta get used to the human body if you’re going to be a doctor. If you aren’t sexualizing this then it’s not a problem. I doubt the teacher was sexualizing it and that’s why she just exposed the area to show then covered herself back up and went on with the lab.
 
I’ve debrided many sacral wounds in bed bound patients. Never was it edematous….
You probably don’t look after many patients with heart failure then. It’s not a huge amount, but you get some pitting if you press on it
 
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