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Subject: Re: Question for Vera, BetsyRN, other nurses


Author:
Thomas
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Date Posted: Thursday, July 12, 2012, 07:44: pm
In reply to: Barbara 's message, "Re: Question for Vera, BetsyRN, other nurses" on Sunday, June 24, 2012, 07:02: am
 Betsy, you said, "For a full physical the patient has on only an exam gown, which I simply remove for the genital rectal exam".

Did you really mean that? Do you, personally, untie a man's
gown and take it off him? I hope you meant to say you ask him to raise the gown (if he's standing), or ask him to slide it up to his waist (if he's supine of the table.

If I was the patient, it would be a little disconcerting if the examiner, male or female, removed my gown for me.
Or did I misunderstand you?
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Replies:
[> [> [> Subject: Re: Question for Vera, BetsyRN, other nurses


Author:
Ben F.
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Date Posted: Friday, July 13, 2012, 12:34: pm
Actually, that is the way my PCP does it, more or less. She has me start the exam wearing only my boxers and then she takes them down for the genital exam and the DRE. Actually, she lowers them and has me step out of them. I don't find it disconcerting, although I do find it subtly intimate. But for her part, she just does it very matter-of-factly. Somehow it fits her nature -- she is just a very direct person. For instance, she asked me if I had any erection problems a couple of exams ago, but she phrased it, "any problems getting hard and staying hard?".

So I think a lot of this just has to do with the woman and her style. I like hers. It is too the point and not evasive or overly cute or sterile & clinical. Friendly and human, really.

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[> [> [> Subject: Reply to Thomas


Author:
Betsy RN
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Date Posted: Friday, July 13, 2012, 05:00: pm
The doctors, other NP's and the PA in our office all do the physical the same way: Our aide brings the patient in the room, having checked the vision in the hallway, goes over the history questionnaire (on the tablet computer) and has him/her disrobe and put on a paper gown. She'll come back and get the vital signs, height and weight. When I come in I tells the patient that the aide assists with the exam & takes notes, asking his permission for her to stay. I'll review the history and complaints the patient may have, and do a mental screening exam.

With the patient sitting I examine the head & neck and do the neurological exam. He'll have to stand for part. I take the gown off the shoulders for examination of the anterior chest & heart, the last part with him supine, and roll the gown down to examine abdomen. Men don't mind having the chest exposed. The gown is just draped over his groin. I check the lower extremities and feet, looking for skin problems. I do the genital and DRE last, with the patient upright. When he is standing I take the gown to expose the genitals for examination. Yes the patient is nude for a couple minutes. One will find variations in how the exam is done. If he keeps his shorts on until the last, when he drops his shorts he's nude too. Some people on the board tell me before the genital exam they put the gown over the shoulders, and pull up the gown to expose the genitals. That's possible.

During the exam I tell the patient exactly what I'm looking at and the results. Actually what I'm doing is dictating to my writer--saving me documentation time. When I get to the genitals I'd be saying, as I went along, "The pubic hair pattern is normal. I'm going to put a finger into your groin from the scrotum; now turn your head and cough. Good. no hernia; let's do other side; cough again. None here either. Skin the penis and scrotum are normal; the penile shaft has no masses; the urethra is normal; the foreskin retracts; the meatus (slit at the end) is normal. Testes are smooth, soft, no masses. Right 18 ml; left 20 ml (the size)." What people comment on is our thoroughness. But no one ever complains about the brief nudity.

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[> [> [> [> Subject: Re: Reply to Thomas


Author:
zone
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Date Posted: Friday, July 13, 2012, 11:41: pm
Betsy RN do you give your younger male patients DRE? Also are the women who take notes secretaries or medical staff? If they're secretaries do they dress in street clothing or scrubs?

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[> [> [> [> Subject: Re: Reply to Thomas


Author:
George M.
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Date Posted: Saturday, July 14, 2012, 06:19: am
That seems like a remarkably thorough exam you give. At least compared to what I usually get (HMO in PA). What kind of medical organization do you work for?

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[> [> [> [> Subject: Re: Replies


Author:
Betsy RN
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Date Posted: Sunday, July 15, 2012, 01:37: am
Our aides/writers are a variety. Some are trained by us; entry level is clerical, & we move some women to the clinical side, with medical assistant training. Some are trained medical assistants--went to a 9 month training program. The most difficult skill is vocabulary, knowing what I'm talking about. It takes 3-4 months before they're good. By that time they've seen 2-300 physicals. Direct patient care staff wear uniform scrubs, color coded. The doctors, Nurse practitioners, & PA wear street clothes with a white coat. The clerical staff wear a different uniform.

We are a medium sized private clinic with 4 doctors, 3 nurse practitioners, a physician's assistant, and a gaggle of RN
LVN, assistants, lab techs, ekg tech, ultrasound/radiology tech, and a huge clerical staff. We have contracts with life insurance companies & other companies to do pre-employment and interval physical examinations. These exams account for 60% of my time. Some of the exams don't pay very well; the key to being profitable is to be efficient. We don't cut corners with the product (a complete exam). We just don't waste any time. The assistant composes the notes as I go along & has the report ready for an electronic signature at the end of the exam.

No, I will not tell you what the name of our practice.

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[> [> [> [> [> Subject: Re: Replies


Author:
Beth
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Date Posted: Sunday, July 15, 2012, 10:28: am
My former roomie worked in a small clinic, sounds smaller than what you describe but some of what she told me sounded similar too. She was hired in a clerical staff capacity and ended up with other duties. I believe she had some note taking duties and acted as a chaperone when the female physicians saw non-elderly male patients (I don't think they reuqired a chaperone for the elderly although I don't know what that age was, as the chaperone was for the protection of the female staff from assault which had happened in the clinic before the policy was put into place).

I know she had to get used to seeing things that most people never see. I know once or twice she came home traumitized and couldn't eat. I also know sometimes she liked some things she saw.

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[> [> [> [> [> [> Subject: Re: Replies


Author:
Greg B
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Date Posted: Sunday, July 15, 2012, 10:01: pm
I had minor arm surgery last week, and when I went in to pre op the nurse there told me to undress completely which kind of surprised me so I asked if I could leave my underwear on underneath the gown, and she said no I mustnt leave anything on. I did as she said and undressed completely, but she must have mentioned it to the OR staff since once I was on the table one of the nurses lifted up my gown a bit from the bottom, and said ok you took everything off like you were supposed to. I found it kind of embarrassing and I thought she could waited until I had the sedation and was thinking it was more to have a look, but I am not sure. It was my first day surgery in some time.

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[> [> [> [> [> [> [> Subject: Re: Replies


Author:
Steve
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Date Posted: Sunday, July 15, 2012, 11:34: pm
I had a dermatafibroma removed from the inside of my leg, just above my ankle, a couple of years ago. In pre-op, I was likewise told to remove everything, but I figured they were operating on my lower leg, so they had no reason for access to my privates. I left my undies on the whole time, and not a word was said. Had I felt there was legitimate need to be exposed, that would have been another story. We still have the right to our modesty and they don't have the "need to see".

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[> [> [> [> [> [> [> [> Subject: No undies for the surgery


Author:
Betsy RN
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Date Posted: Wednesday, July 18, 2012, 02:47: am
An outpatient surgical nurse told me they take the underwear so that if the patient has to urinate in surgery s/he just pees on the table. You can not stop the surgery. So if the patient has wet undies s/he has nothing to wear home.

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[> [> [> [> [> [> [> [> [> Subject: Re: No undies for the surgery


Author:
Thomas
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Date Posted: Wednesday, July 18, 2012, 06:35: am
When I had a knee operated on I asked the nurse why I had to remove my underwear and wear only the gown to the O.R.

She told me that if the surgery took longer than expected, they might have to catheterize me. Having no underwear on means they wouldn't have to interrupt surgical position they had me in at the time in order to remove my underwear to insert the catheter.

She added that catheterization is rarely necessary during knee procedures, but they have to be ready, just in case.

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[> [> [> [> [> [> [> [> [> [> Subject: One More Comment


Author:
Thomas
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Date Posted: Wednesday, July 18, 2012, 08:34: am
I find it hard to believe what Betsy's friend, the surgical nurse, told her. She said no underwear is allowed
so that the patient may urinate while being operated on.

Why would the surgical team allow their patient to wet the table and maybe the floor? If a procedure is expected to last a long time, isn't a catheter inserted at the start?

Or, if a procedure goes over the expected time, wouldn't they prefer to have a catheter ready to use? Why would they
allow a big mess in the OR when it can be easily avoided?

Wasn't that nurse just putting Betsy on?

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[> [> [> [> [> [> [> [> [> [> [> Subject: Catheter or pee on the table?


Author:
Betsy RN
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Date Posted: Thursday, July 19, 2012, 02:58: am
I have no reason to believe she's putting me on. She's the RN in the outpatient department admitting and discharging the patients, not the surgical nurse. As to using a catheter: Putting in a catheter is an invasive procedure. Yes they are used on a long procedure. If that's the case you don't need your undies. If one pees on the OR table most of it will be contained in the sheets, which are tossed in the laundry anyway. The floor is going to mopped after each procedure anyway, so a little pee isn't going to be a big deal.

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[> [> [> [> [> [> [> [> [> [> [> [> Subject: Re: Catheter or pee on the table?


Author:
Greg B
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Date Posted: Thursday, July 19, 2012, 08:53: pm
Well I got the impression they were going to take my underwear off in the OR if I hadnt done so, and since I objected they checked to make sure I had. I figured it was better to do what she asked then make a scene, and it turned out I was right it would have been worse in OR. I also think it was kind of rude to look she could have just asked.

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[> [> [> [> [> [> [> [> [> [> [> [> [> Subject: Re: Catheter or pee on the table?


Author:
Steve
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Date Posted: Thursday, July 19, 2012, 10:37: pm
Some people bask in their own perceived "authority". They have forgotten who they work for - the patient. Without patients coming through their doors, they would have no job, no paycheck, and no "authority". Patients pay the bills and keep the doors open, not caregivers. People like that nurse need to become patient-centered, rather than self-centered. Kindness works wonders. A dear friend of mine is a unit secretary in a VA Medical Center. She truly understands that without Veterans needing care in their facility, she would be out of work.

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[> [> [> [> [> Subject: Re: Replies


Author:
tom
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Date Posted: Wednesday, July 18, 2012, 09:44: am
Steve,

You mentioned you left your underwear on since you thought it wasn't necessary. How wrong you are. In an OR environment many things can go wrong. Why should they have to deal with removing patients underwear if the need arose to be cathed.

You're in an OR. They decide what is necessary not the patient. You remind me of my sisiter in law who never goes to any type of doctor. She broke her ankle and needed surgery. They asked her to get undressed and put a gown on. She was annoyed and felt she could have stayed fully clothed and they could just push her pant leg up to access her ankle. I told her she was ridiculous. Suppose they had to cath her or she went into cardiac arrest. Could you imagine trying to undress someone whose unconscious? All that dead weight. She still stuck by her reasoning.

Look, standardized rules are made to avoid any problems that may occur. Trying to decide on what stage of undress a patient should be in depending on the OR procedure is just plain bad logistics. It's a hospital. Leave your modesty at the front door.

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[> [> [> [> [> [> Subject: Re: Replies


Author:
Steve
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Date Posted: Wednesday, July 18, 2012, 10:37: pm
I will decide how much of my modesty to check at the door. Scissors will remove underwear in short order, if the need arises. Having to cath a patient in the middle of a surgery is just plain out poor planning. It should have been done before-hand.

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