Birdstrike

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“I asked a lady to remove her face veil for adequate communication, in the same way I’d ask a motorcyclist to remove a crash helmet,” says the doctor.

She complained. He was suspended.

What happens in your hospital, your ED?

 

turkeyjerky

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yeesh...tough all around. As a practical matter, if this situation were to arise, I think having a nurse ask the patient to remove the veil might go over better (less confrontational, plus nurses seem to be better protected from these type of complaints than doctors)

Although, I will add that I've never had much difficulty hearing someone who's wearing one of those things.
 

GonnaBeADoc2222

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I probably would not have done that unless the chief complaint directly involved the head.
 

Interpolfanclub

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Assuming this happened the way it is being reported it seems egregious to suspend him for simply asking. I could understand if she said no and then he pulled it off. But you get benched just for asking them to remove it? Seems insane, and the UK strikes me as less PC than the US.

I would probably have avoided the request just to stay out of the above scenario unless it was very important clinically. Like if you want me to treat a rash but refuse to remove some clothing. I tend to be very avoidant of risk and would have involved other staff or a house supervisor.

The above being said, it is impossible to eliminate all risk from situations where someone is going to be "offended." I can see how someone who is exhausted from a 12 hour ED beating makes a quick offhand request to the patient that they please remove their veil so they can be heard. If they refuse then move on and the matter should end there.
 

gro2001

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It feels like there must be more to how the interaction went down than what is described in the story.

I went to school in the Middle East and am currently working clinically in a conservative majority Muslim country. I've seen many patients with various degrees of religious covering, including the full niqab, across a variety of settings. Most remove the covering themselves without being prompted if it's at all clinically relevant. Some remove it in a clinical setting even if it's not directly relevant (not examining the face/neck, just to facilitate conversation). Same applies for covering of other parts of the body. I have never had a patient refuse something like that or complain, to me or the hospital administration. A minority of patients (maybe in the 10-15 % range) would ask for a female physician to perform a pelvic exam though.

Also, I have a hard time seeing how a niqab can be a barrier to hearing someone talk. It's a thin layer of cloth that's draped over the face. It's less of a barrier to speaking than a surgical mask.

It really feels like there must have been something more that led to this interaction going off the rales and resulting in a complaint. Particularly with the administration reacting so seriously to it. Perhaps something about tone and non verbal communication.
 
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cyanide12345678

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I'm sure he probably didn't mean anything demeaning. But you can definitely hear through those things and she's not even the patient so I guess that's just a little odd. Asking a person to speak louder or slower is probably a better bet than asking them to unveil themselves. It's an odd request when she's not the patient and you can simply have them repeat what they said.
 

BoardingDoc

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I'm sure he probably didn't mean anything demeaning. But you can definitely hear through those things and she's not even the patient so I guess that's just a little odd. Asking a person to speak louder or slower is probably a better bet than asking them to unveil themselves. It's an odd request when she's not the patient and you can simply have them repeat what they said.
Maybe he's mostly deaf and relies heavily on lipreading.
 

DokterMom

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Not exactly the most reliable source, so probably much more to the story...
 
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The Knife & Gun Club

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We get a ton of middle eastern patients at our hospital and this actually came up enough that eventually the hospital established a few protocols to keep everything uniform.

In the end hospital protocols are the only way to deal with this stuff, because it’s way today easy to accidentally come off as racist, and no one wants to be a racist.

Our rules are:
1) patients must remove the face covering, and may replace it with a surgical mask if they wish

2) patients Are welcome to refuse removal of any article of clothing, but the provider is allowed to refuse to treat the patient based on their refusal - even if not directly related to the cheif complaint.

3) patients are not allowed to choose the gender of their doctor, nurse, meal delivery person, etc, but can request a specific physician if they find one they’d like.

4) while inpatient everyone has to wear the hospital gown, with no head or face covering since it may impede rapid interventions during an emergency.
 

Merely

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We get a ton of middle eastern patients at our hospital and this actually came up enough that eventually the hospital established a few protocols to keep everything uniform.

In the end hospital protocols are the only way to deal with this stuff, because it’s way today easy to accidentally come off as racist, and no one wants to be a racist.

Our rules are:
1) patients must remove the face covering, and may replace it with a surgical mask if they wish

2) patients Are welcome to refuse removal of any article of clothing, but the provider is allowed to refuse to treat the patient based on their refusal - even if not directly related to the cheif complaint.

3) patients are not allowed to choose the gender of their doctor, nurse, meal delivery person, etc, but can request a specific physician if they find one they’d like.

4) while inpatient everyone has to wear the hospital gown, with no head or face covering since it may impede rapid interventions during an emergency.
You should be allowed to choose the gender of your doc if it’s practical ..that’s kinda bs...and I’m an atheist/liberal
 

The Knife & Gun Club

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You should be allowed to choose the gender of your doc if it’s practical ..that’s kinda bs...and I’m an atheist/liberal
Yea but what about the men that refused to be treated by a female physician?

Also, you know...Myocardium doesnt really wait for the Prefered gender cardiologist to come in from home.
 
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Merely

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Not in the EMERGENCY department. Finding a PCP/OB/GYN/Etc? Knock yourself out.
IF ITS PRACTICAL...let’s see I have a genital complaint and I don’t want a guy looking at my vagina because of my beliefs..yeah that should be allowed I don’t think that should be controversial...
 

RustedFox

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IF ITS PRACTICAL...let’s see I have a genital complaint and I don’t want a guy looking at my vagina because of my beliefs..yeah that should be allowed I don’t think that should be controversial...
Okay everybody. You heard it here, first.

Lets staff every ER with one male and one female physician at ALL times so that our patients can choose who they want to see because reasons.
 

Merely

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Okay everybody. You heard it here, first.

Lets staff every ER with one male and one female physician at ALL times so that our patients can choose who they want to see because reasons.
Are you being intentionally obtuse?
 

Hercules

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IF ITS PRACTICAL...let’s see I have a genital complaint and I don’t want a guy looking at my vagina because of my beliefs..yeah that should be allowed I don’t think that should be controversial...
I get what you’re saying but what about when there is no female on shift? And again, presumably you came to the ED because it was an emergency that couldn’t wait long enough to see your regular PCP/obgyn of your preferred gender.
 
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thegenius

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I do not cede to patient requests for a new ER doctor. Most of these are because you are not giving them what they want. Like Dilaudid.

If a female patient wants a woman doctor, and it's a pelvic / breast complaint, I have no problem if there is a female provider around. I asked one patient to go back to the waiting room as it will take another hour of time and she did.

I've had a few squirrely guys come in with a penis / GU complaint and only wanting a female physician. I think that is creepy.
 

Dr.McNinja

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To extend this line of reasoning, what if they wanted a black/white/jewish/asian doctor?
At what point in the emergency department is it unreasonable?
Always. It's always unreasonable. The majority of EDs do not have double or sextuple coverage. When it's single coverage, what you see is what you get. If you want to refuse, that's fine.
 

thegenius

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To extend this line of reasoning, what if they wanted a black/white/jewish/asian doctor?
At what point in the emergency department is it unreasonable?
Always. It's always unreasonable. The majority of EDs do not have double or sextuple coverage. When it's single coverage, what you see is what you get. If you want to refuse, that's fine.
Undoubtedly all of this is unreasonable. But it appears that the only people who really believe ER's are for emergency medical conditions are ER doctors.

Everybody else views the ER as immediate care, dump care, a pain clinic, and a variety of other things it's not designed for. I could extend your logic a different way and say that 1/2 of the people who go to the ER should just be categorically discharged immediately because they don't have a life-threatening emergency medical condition. They shouldn't be taken care of.

But of course we have to deal with EMTALA, we deal with our hospital admin who don't want to handle patient complaints, bad press, and a variety of other bad things.

We are in a service industry. Even the ER. In the service industry we do things to please people, within reason.

It's certainly not unreasonable to ask for a female doctor if that is possible to have. Obviously in single coverage you get what you get. But if the female doc agrees to see the pt later, and the patient is willing to wait, then honestly what is the big deal? Why are you going to stand on this pedestal to put your foot down on inappropriate ER use?
 

RustedFox

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Why are you going to stand on this pedestal to put your foot down on inappropriate ER use?
I hear you.

It comes down to this (for me, and I suspect this sentiment is pretty common amongst our brethren).

One of the most disheartening aspects of our jobs is the loss of faith in humanity (especially the US population) that comes with the turf.

I will estimate that 5-8 of the 25 patients that I see in an 8-10 hour shift (on average) need to be told to "get a grip and go the hell home". My primary job site is in the "country club" area of town, so I am exposed to this more often (I'm guessing) than the average ER doc. With regularity, I see the 18 year old drug in by his parents who demand a "drug test", or the 55 year old female wearing 400+ dollars of designer athletic wear (at 3 AM) who demands "sleeping pills" and smells like a few bottles of pinot grigio. I do the right thing in my opinion, and I document HARD. I don't concede a lot of turf. The RN staff generally love it when I work nightshifts, because I have a black belt in "get the hell out and go back to sleep".

Yet, we are told by so many people to accommodate them. The family. The admin. The whoever. Fail to do this, and you have to deal with patient complaints, which is the quickest way for an ER doc to lose his/her job.

Thus, the only way we can control our environment is by trying to improve it from within, which is to put our *foot* down somewhere, and hope that people take note and alter their behavior accordingly.
 

ERCAT

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I HATE it when I can’t see a patient’s entire face when I talk to them. I can’t read them if I don’t. Drives me crazy when you talk to someone and they turn their face away. Or, my favorite, when they lay there with their eyes closed and talk to you (are you F-ing kidding me... you’re drinking iced tea but you can’t be bothered to open your eyes and look at the person who’s trying to care for you in the eye). Or people with a positive sunglasses sign. I ask these people to take off their sunglasses or open their eyes in some semi serious semi lighthearted kind of way and they always comply. This case with the doc is CLEARLY different, though; this isn’t a patient being a dipsh$t... this is someone who is uncomfortable being asked to remove their religious garb. However, poor doc probably feels the same way as I do about wanting to see is patient and thought nothing of his request (and that’s what it was, a request). If someone is getting fired for ASKING a patient to do this... if these are the kinds of things we get fired for... I will not have a job in ten years.
 

Dr.McNinja

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Undoubtedly all of this is unreasonable. But it appears that the only people who really believe ER's are for emergency medical conditions are ER doctors.
I believe they should be, but I know they aren't
Everybody else views the ER as immediate care, dump care, a pain clinic, and a variety of other things it's not designed for.
Correct, but they still can't choose who they see if they're just showing up with no pre-planning.
I could extend your logic a different way and say that 1/2 of the people who go to the ER should just be categorically discharged immediately because they don't have a life-threatening emergency medical condition. They shouldn't be taken care of.
People without life threatening EMC probably shouldn't be taken care of in the emergency department. But not that they shouldn't be taken care of at all. And yes, every nonemergent patient causes a delay in care to the patient with an emergency who hasn't crossed over the threshold of dying yet. Anybody waiting in the waiting room is a potential time bomb.
It's certainly not unreasonable to ask for a female doctor if that is possible to have. Obviously in single coverage you get what you get. But if the female doc agrees to see the pt later, and the patient is willing to wait, then honestly what is the big deal? Why are you going to stand on this pedestal to put your foot down on inappropriate ER use?
How many people have you discharged after MSE this year? My ER Has seen 1862, and 222 were MSE. That means we send home ~12% without needless and unnecessary testing. I can only do so much. Just like I could probably help my community more by having my tax rate be 100%.
Nobody is saying these people shouldn't be kicked to the curb, but at the same time continuing to dump on us as literally being the only 24/7 speciality in most communities will only result in more burnout.

It's funny, there's been a huge thread on twitter recently about how apparently we "don't do it right" in the US because we drain bartholin's under local, instead of having OB/Gyn do it under general anesthesia.
 

Merely

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I get what you’re saying but what about when there is no female on shift? And again, presumably you came to the ED because it was an emergency that couldn’t wait long enough to see your regular PCP/obgyn of your preferred gender.
If there’s no female on shift then the patient is going to be seen by a male lol. I’m not saying that ED docs need to move heaven and earth so that they can accommodate the preferences of the patient. All I’m saying is if there are both a free male and female ED doc waiting in their booth or whatever they call it, and the patient wants a female it shouldn’t be a huge deal for the female to see her. Now if the female doc has 5 other patients waiting and the male doc is just chilling obv that’s not gonna happen. Just basic human respect and decency is all I’m asking for not to make the ED doc a slave and subservient to the demands of the pt.
 

theseeker4

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If there’s no female on shift then the patient is going to be seen by a male lol. I’m not saying that ED docs need to move heaven and earth so that they can accommodate the preferences of the patient. All I’m saying is if there are both a free male and female ED doc waiting in their booth or whatever they call it, and the patient wants a female it shouldn’t be a huge deal for the female to see her. Now if the female doc has 5 other patients waiting and the male doc is just chilling obv that’s not gonna happen. Just basic human respect and decency is all I’m asking for not to make the ED doc a slave and subservient to the demands of the pt.
Basic human respect and decency is provided without having to provide a physician of the patient's preferred gender. If a patient checks into triage and says "I would prefer a male/female physician if possible" and they are able to accommodate that, perfect. Everyone is happy. This is almost never how it goes down. Usually, a patient comes in with a complaint such as vaginal irritation / pelvic pain / bleeding, and is brought back to the first available module / the first physician available signs up for the patient. They go into the patient's room, do the basic history and physical, labs if necessary, treatment if necessary, then when finally ready to do the pelvic with the appropriate chaperone, the patient says "I want a woman to do the exam." What is the problem with simply grabbing the nearest female MD/DO? Several. First, this is an unpleasant examination, both for the patient and the physician, and you are basically pushing your dirty work off to someone else. Even at the patient's request, you are making someone who is not the treating physician do something that no one wants to do. Not fair to her. Second, there is the liability aspect. The instant that other physician touches the patient, any potential liability is now shared. If the patient ever develops anything that could in any way in the twisted mind of a plaintiff's attorney be turned back on you, not only is the treating physician being sued, but now the female who simply did an exam is going to be on the hook as well, for a patient she had nothing else to do with and has no ability to make decisions about. The other side of the liability coin is that if I do a pelvic exam, I know what I saw/felt. If someone else does it, regardless of what they tell me, I have no clue what the exam actually demonstrated, because I did not perform it myself. Now I am treating a patient with incomplete information, and if something was missed by the helpful female physician, I am on the hook for that. Why not transfer the patient completely to the other physician? well I just spent time getting a history and physical, ordering and interpreting labs, /other tests, etc. and now the other physician will have to redo everything (well not the labs of course) wasting both of our time and the patient's time. AND the liability is still shared.

So what is the option to protect basic human respect and decency? The patient always has a right to refuse any examination or procedure they wish (if of sound mind). If a patient comes in for pelvic pain/irritation/bleeding, they have no EMERGENT need for a pelvic exam, so if they don't want me to do one I am happy to document this and treat the patient on the information I have, and recommend the patient see their OBGYN for follow up for the examination to be performed by them if needed. If they have a life-threatening condition such as they are exsanguinating or some such, they still have a right to refuse and I would treat them to the best of my ability with the information I have. This is really no different than a patient refusing a rectal exam; document the refusal and move on. Nothing REQUIRES another physician to do part of your job for you, even if the patient requests it. If the complaint is that emergent, the patient needs to allow the available physician to deal with it, or accept that care may be substandard due to their refusal to allow the physician to do his/her job. If the complaint is not that emergent, they can go find their own outpatient doctor of their preferred gender/skin color/religion/political affiliation/etc. if they are unwilling to allow the available physician deal with it.
 

dadaddadaBATMAN

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If there’s no female on shift then the patient is going to be seen by a male lol. I’m not saying that ED docs need to move heaven and earth so that they can accommodate the preferences of the patient. All I’m saying is if there are both a free male and female ED doc waiting in their booth or whatever they call it, and the patient wants a female it shouldn’t be a huge deal for the female to see her. Now if the female doc has 5 other patients waiting and the male doc is just chilling obv that’s not gonna happen. Just basic human respect and decency is all I’m asking for not to make the ED doc a slave and subservient to the demands of the pt.
Several problems here.
1.) the situation you described where there are two equally available m/f physicians basically does not exist. If you've worked in an ed busy enough to justify double coverage, this is obvious. If you haven't, I don't think I can really explain it to you.

2.) as pointed out by theseeker, you are giving liability, an unpleasent task, and poor patient care (loss of first hand knowledge of exam)

3.) this only goes one way: it results in women being asked to do more work than men. Never even heard of a male physician being requested for an exam (occasionally a very creepy frequent flyer will be a male only pt ).

4.) the duplication in work delays the care of other ed patients

Er residency and practice are basically an exercise in learning to hide how overwhelmed you are at most times, while giving the best care you can/remaining the calm center. Its hard when you see 3-4/hr in a busy late evening, and that is inevitably when three of your male colleagues walk up and say they need a female physician for a pelvic.
 

EsTxDr

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It's funny, there's been a huge thread on twitter recently about how apparently we "don't do it right" in the US because we drain bartholin's under local, instead of having OB/Gyn do it under general anesthesia.
Count me in.
 

Goro

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“I asked a lady to remove her face veil for adequate communication, in the same way I’d ask a motorcyclist to remove a crash helmet,” says the doctor.

She complained. He was suspended.

What happens in your hospital, your ED?

Britain. 'Nuff said.
 

Zebra Hunter

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It's funny, there's been a huge thread on twitter recently about how apparently we "don't do it right" in the US because we drain bartholin's under local, instead of having OB/Gyn do it under general anesthesia.
Saw that thread. Am I the only one that doesn’t place a Word catheter for these? I usually just drain, probe, and +/- abx. The evidence for Word catheters is absolute garbage and recurrence rates are still fairly high for them on the limited studies available (~10%) and the only RCT comparing Word catheter to simple I&D showed an 11% recurrence rate with simple I&D, although the catheter group was 0% in that trial (although N was tiny).
 
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