Standbys for Examinations

Charlene M Morris cvmmorris at gmail.com
Sun Jan 13 20:03:59 GMT 2008 

Perhaps the better question would be: is there someone willing to risk their
security and reputation to continue this practice in the 21st century?

C M Morris


On 1/13/08, John Annen <rjannen at yahoo.com> wrote:
>
> While I'm sure there are many considered opinions based on anecdotal
> evidence and individual risk tolerances, I find myself wondering whether the
> are any published studies out there that would allow for a solid risk
> analysis? Is anyone aware of any?
>
> John Annen
> Zurich, Switzerland
>
> Quoting trauma-list-request at trauma.org:
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> > Today's Topics:
> >
> >    1. Standbys in Today's Medicine (Charlene M Morris)
> >    2. Re: Standbys in Today's Medicine - ALWAYS (KMATTOX at aol.com)
> >    3. Re: Standbys in Today's Medicine - ALWAYS (Jeffrey Hammond)
> >    4. Hyponatremia and Pneumothorax (bfletcher at columbus.rr.com)
> >    5. Re: Hyponatremia and Pneumothorax (saad shebrain)
> >
> >
> > ----------------------------------------------------------------------
> >
> > Message: 1
> > Date: Sat, 12 Jan 2008 08:43:15 -0500
> > From: "Charlene M Morris" <cvmmorris at gmail.com>
> > Subject: Standbys in Today's Medicine
> > To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> > Message-ID:
> >     <ca095570801120543g28e0b3a1ycd3c71561d07f43a at mail.gmail.com>
> > Content-Type: text/plain; charset=ISO-8859-1
> >
> >  Recently, I began practicing at my original rural FP position in NC and
> I
> > have had several instances of needing to examine "private parts". In
> that
> > regard, I requested a standby, as that is what I have done for the
> > past several years. I would really like opinions: yay or nay? Does it
> matter
> > F-M, MM FF, or M-F?
> >
> > The NP with whom I work feels comfortable not conscripting a nurse or MA
> to
> > be in the room, although I was told to absolutely not do an unmonitored
> exam
> > at the ERs where I have worked. By way of history, I trained in the late
> > '70s with a lady Ob/Gyn and she told me to get used to doing my own
> exams,
> > because as a  female PA, I would be doing the pelvics without
> assistance.
> >
> > Opinions welcome and requested! It is the 21st century and we have other
> > concerns to ponder.
> >
> > C M Morris
> >
> >
> > ------------------------------
> >
> > Message: 2
> > Date: Sat, 12 Jan 2008 09:07:37 EST
> > From: KMATTOX at aol.com
> > Subject: Re: Standbys in Today's Medicine - ALWAYS
> > To: trauma-list at trauma.org
> > Message-ID: <d17.1e0458f5.34ba23a9 at aol.com>
> > Content-Type: text/plain; charset="US-ASCII"
> >
> > In my view, in today's litigious world, and with all "harassments" being
> > defined as being in the eyes of the beholder or recipient, the
> > "SAFEST" route is
> > for ALL examiners and interviewers to ALWAYS have some sort of chaperone
> or
> > mechanism to hear and document the conversation and examinations between
> a
> > patient and a physician, or someone acting under the supervision of a
> > physician.    Even if the patient being interviewed or examined
> > brought their own
> > witness, entrapment cases are not uncommon and the prudent
> > professional would
> > have someone accompany her or him with a patient, regardless  of the
> >  gender of
> > the examiner or the examinee.
> >
> > NOW, I am fully aware that both number of personnel AND COST constraints
> > prohibit the ideal and safest route.    This then raises  questions of
> > practicality.    One could also raise the same  question about
> > translators and mis
> > understandings by patients who do not  understand the language or
> > culture of the
> > doctor, clinic, or hospital that they  find themselves in.
> >
> > k
> >
> >
> > In a message dated 1/12/2008 7:44:04 A.M. Central Standard Time,
> > cvmmorris at gmail.com writes:
> >
> > Recently, I began practicing at my original rural FP position in NC
> and  I
> > have had several instances of needing to examine "private parts". In
> that
> > regard, I requested a standby, as that is what I have done for  the
> > past several years. I would really like opinions: yay or nay? Does it
> matter
> > F-M, MM FF, or M-F?
> >
> > The NP with whom I work feels comfortable  not conscripting a nurse or
> MA to
> > be in the room, although I was told to  absolutely not do an unmonitored
> exam
> > at the ERs where I have worked. By  way of history, I trained in the
> late
> > '70s with a lady Ob/Gyn and she told  me to get used to doing my own
> exams,
> > because as a  female PA, I would  be doing the pelvics without
> assistance.
> >
> > Opinions welcome and  requested! It is the 21st century and we have
> other
> > concerns to  ponder.
> >
> > C M Morris
> > --
> > trauma-list : TRAUMA.ORG
> > To change your  settings or unsubscribe  visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> >
> >
> > **************Start the year off right.  Easy ways to stay in shape.
> > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489
> >
> >
> > ------------------------------
> >
> > Message: 3
> > Date: Sat, 12 Jan 2008 13:20:00 -0500
> > From: Jeffrey Hammond <hammond at umdnj.edu>
> > Subject: Re: Standbys in Today's Medicine - ALWAYS
> > To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> > Cc: trauma-list at trauma.org
> > Message-ID: <fc572d194f1a.4788be80 at umdnj.edu>
> > Content-Type: text/plain; charset="us-ascii"
> >
> > An HTML attachment was scrubbed...
> > URL:
> >
> http://list.mistral.net/pipermail/trauma-list/attachments/20080112/46fd4bcf/attachment-0001.htm
> >
> > ------------------------------
> >
> > Message: 4
> > Date: Sat, 12 Jan 2008 19:11:22 -0500
> > From: <bfletcher at columbus.rr.com>
> > Subject: Hyponatremia and Pneumothorax
> > To: trauma-list at trauma.org
> > Message-ID:
> >     <32726757.691011200183082358.JavaMail.root at hrndva-web14-z01>
> > Content-Type: text/plain; charset=utf-8
> >
> > Has anyone ever seen a case of hyponatremia due to pneumothorax.
> > Had a patient who developed profound hyponatremia without a
> > reasonable cause (no head injury, meds etc).  Has some rib fx, scap
> > fx, transverse process fx and a Pneumothorax.
> >
> > When reviewing the literature, a cause of SIADH is pneumothorax.  If
> >  so Why?  Any ideas.
> >
> > Thanks
> >
> >
> > ------------------------------
> >
> > Message: 5
> > Date: Sat, 12 Jan 2008 18:03:53 -0800 (PST)
> > From: saad shebrain <shebrain1 at yahoo.com>
> > Subject: Re: Hyponatremia and Pneumothorax
> > To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> > Message-ID: <582556.27464.qm at web32603.mail.mud.yahoo.com>
> > Content-Type: text/plain; charset=iso-8859-1
> >
> >
> >  The mechanism of SIADH induced by pnemothorax can be explained ,
> > theoretically, by the both chemical (hypoxia) and Mechanical
> > (decreased pulmonary blood flow) that stimulate
> >  the volume receptor and baroreceptor in the left atrium, which
> > thus regulate ADH release. The vasoconstriction caused by hypoxia
> > may also influence left atrial
> >  blood filling. Some investigators have also reported that atrial
> > natriuric polypeptide plays an important role in patients with SIADH
> >  .The increase in circulating
> >  blood volume caused by an inappropriate secretion of ADH induces
> > atrial natriuric polypeptide secretion and thus results in urinary
> > sodium excretion.
> >
> >
> >  SS
> >
> >  Ref
> >  A Syndrome of Inappropriate
> >  Secretion of Antidiuretic Hormone
> >  Associated with Pleuritis Caused
> >  by OK-432
> >  Takeshi Hanagiri
> >  Hiroyuki Muranaka
> >  Mitunori Hashimoto
> >  Akira Nagashima
> >  Department of Chest Surgery,
> >  Kitakyushu Municipal Medical Center,
> >  Kitakyushu, Japan
> >  OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
> >
> >
> > bfletcher at columbus.rr.com wrote:  Has anyone ever seen a case of
> > hyponatremia due to pneumothorax. Had a patient who developed
> > profound hyponatremia without a reasonable cause (no head injury,
> > meds etc). Has some rib fx, scap fx, transverse process fx and a
> > Pneumothorax.
> >
> > When reviewing the literature, a cause of SIADH is pneumothorax. If
> > so Why? Any ideas.
> >
> > Thanks
> > --
> > trauma-list : TRAUMA.ORG
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> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > ------------------------------
> >
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> > End of trauma-list Digest, Vol 55, Issue 11
> > *******************************************
> >
>
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