Who hasn't heard of or been subjected to unnecessary procedures so doctors can bill your insurance company. This one just turned out to be a bit... kinky. But its the same strategy really.

Persaud is claiming that due to the rectal exam, he is now incapacitated by PTSD; he is seeking unspecified damages.

The hospital is getting off easy. Much worse can happen when you f*** a stranger in the a**.

Everyone’s favorite line of the story, which will be on away messages, premium super-pokes and tacky, homophobic bumper stickers, soon:

Not to mention T-shirts.

Annachech, the phrase -'kundi-hymen is intact' is more pj than pc.

The revelation about the rectal exam set off Persaud, who smacked a doctor during a struggle and yelled, “Where I came from, you don’t put anything in someone’s a———!”

Every doctor has such a story. "It was a million to one shot, Doc!"

sandeep, the point of the rectal exam is to test for spinal damage. This particular reflex is one of a set of reflexes which, if not functional, could point to a possible serious spinal/central nervous system injury which would need further workup.

As someone who is in the medical profession, i hope that you do not think that the rectal exam performed was done simply for insurance/ financial gains.

Annachech, the phrase -'kundi-hymen is intact' is more pj than pc.

I get it, I'm 33 and thus ancient...what does pj mean? To me, it means pajamas or someone named Patricia Jane.

5 · spram said

As someone who is in the medical profession, i hope that you do not think that the rectal exam performed was done simply for insurance/ financial gains.

No-win sitch. If they didn't do the exam and he was paralyzed, they'd be negligent, right?

No-win sitch. If they didn't do the exam and he was paralyzed, they'd be negligent, right?

At the point he is punching a doc out, is paralysis still a concern?

8 Rahul said

At the point he is punching a doc out, is paralysis still a concern?

Good point. I should have said, if he ended up being severely injured/if there was damage. I immediately think paralysis when it comes to spinal cord injuries, mea culpa, and other cheesy Enigma tracks.

anna, yes i think the doc would be negligent if he/she did not perform the exam. As physicians, we're taught in any trauma case, to "check all holes," meaning check the ears for bleeding/fluid which signify trauma to the head/brain, check the mouth for obvious trauma to the mouth/upper gastrointestinal tract/major cardiac vessels, check the nose for head trauma, and check the anus/rectum for sphincter tone and possible bleeding.

Don't get me wrong, i don't like performing the rectal exam, but you've gotta do it because injuries may not be that clearly obvious

I read this story a few days ago and it made me cringe (no pun intended). The thing is that since he was hit on the head and had a construction injury they really do need to check his spinal cord.

Now I can't for the life of me can't figure out why the hopspital couldn't do a better job of trying to convince him and bringing in someone to talk to him if they were really so concerned. I'm assuming if he was fine and it was a bump on the head he wasn't still sitting in the emergency room? Because god knows there are bleeding and people with broken limbs sitting around in pain in emergency rooms and the they don't do shit about it.

Either ways the hospital is screwed if it does and screwed if it doesn't. Again no pun intended :-)

3 · unni_kannan said

Annachech, the phrase

Forgot to add-- I'm a sucker for the "chech". 'Round your pinky, I am wrapped.

fortunately or unfortunately i'm also a physician in this terrible medico-legal nightmare of a time to practice medicine and even performing a cesarean section to save a fetus' life when the pregnant patient of "sound mind" objects is considered battery as we all know from that sad case in Utah (or Idaho- I get the two mixed up). I've had to get court orders and wake up judges at wee hours of the night to give me permission to save a life when a patient refuses intervention. It is sad when you care more about the patient and her baby then she does.

spram @ # 5 -- thanks for clearing that up.

he was probably afraid they'd find a gerbil in there or something

Happened to be with some attorneys and a resident for dinner last night, and we ended up talking about this story. They brought up that tests traditionally do not have risks. Since there are no health risks associated with this procedure, hospitals will go ahead and execute the test without consent. Also, in emergency room procedures, some argue you give up your right of consent. It's kinda inherent in the nature of an emergency room.

My two cents - if you want to bring up a point in a regulated system, it doesn't do any good to attack.

When I commence typing "Richard Gere", the first suggested search is "Richard Gere gerbil". He must love that.

[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body.

Not in India at least. Suicide is illegal - if you wanna do it, better get it right the first time as far as the law is concerned.

In the US - what about assisted euthanasia when the patient requests it?

6 · A N N A said

I get it, I'm 33 and thus ancient...what does pj mean?

Don't feel bad. PJ is an Indianism.

PJ means Poor Joke. It doesn;t mean that the joke is poor, or the delivery of the joke is poor. All it means is that the joke made you go *groan*, usually PJ is used to describe puns

What a sad story.

Stinky pinky too kinky for monkey, pucker plucker flickers recur, now seeks succour, others snicker.

In the US - what about assisted euthanasia when the patient requests it?

Illegal and considered murder, a crime.

One can sign a document, assuming you have your faculties, prior to entering a hospital to determine at what stage life saving procedures are to be terminated. You can also have someone designated as your health care proxy (usually a family member) who would decide when life saving measures are to be terminated. i.e.: cardio-pulmonary support. In both instances, a formal document is required and usually entered into prior to the patient's admittance.

19 · Pagla said

Don't feel bad. PJ is an Indianism.

LOVE IT. Thank you so much for the explanation! Four years of this site and I had no idea "pj" meant anything more than matchy-matchy crap worn to impress your bed sheets. :D

PJ means Poor Joke.

That would be some PJ party.

SPOILER ALERT for MILLION DOLLAR BABY

Illegal and considered murder, a crime.

Then tech speaking, was what happened at the end of million dollar baby, a crime?

prior to entering a hospital to determine at what stage life saving procedures are to be terminated.

Thanks for the information. What about outside the hospital - say I have no hands and legs and need help to die? If that's illegal, then so much for my right to my body.

I never heard of PJ either. Then again, until yesterday, I didn't know what DDLJ was (referenced by someone in the V for Rockstars thread). I wiki'd it and it seems to be short for a hit Hindi movie. (By the way, it looks like I saw that movie on Turner Classic Movies a while ago and it sucked. I can't believe that movie with that one melody they keep repeating to death was such a hit).

matchy-matchy crap worn to impress your bed sheets. :D

So...you had some of these?

Thanks for the information. What about outside the hospital - say I have no hands and legs and need help to die? If that's illegal, then so much for my right to my body.

Don't even say such things. You have no legal right to kill yourself or have someone else do it for you. (outside of what I outlined above) You do have a fundamental right of privacy which extends out to your body, that's a whole other thread and other nest of issues. And HMF, the answer is yes, depending on what happened at the end of that movie.

To keep it on thread, how many fingers did the doc use? One's bad enough but more than that...ughh (shuddering). Can any docs tell us what's standard for this kind of exam or whether they could have used a less invasive measure?

27 · bess said

So...you had some of these?

Can't see the link but if by these you mean "Underoos" and Wonder Woman ones at that, then no. I had R2D2. ;) I was the most popular girl in first grade, and it was entirely by accident. My mom didn't know who the hell R2D2 was, she just wanted me to stop saying "underoos".

Alert and oriented times three refers to a person knowing who they are, where they are, and the date and time. (I think those are the three) For somebody suffering from a knock to the noggin, I imagine the docs just wanted to know how bad the damage was.

Jangali Jaanwar, with regards to the rectal exam, the main point is to check sphincter tone. Basically, you use one finger and ask the patient to squeeze on the inserted finger (i know, it sounds awful). If the doctor can feel pressure on his/her finger, then there is sufficient tone. If not, there may be some spinal cord damage, and the doctor can consider other diagnostic techniques to find the location/cause of the problem.

And no, there is no other, less invasive method. Patients undergo rectal exams everyday. I know it's uncomfortable for the patient, but it really is for the patient's own good. Does anyone think docs actually enjoy doing it? Of course not, but as cliche as it sounds, they have a responsibility to their patients. In fact, this is probably the least invasive, most harmless technique.

And HMF, the answer is yes, depending on what happened at the end of that movie.

I figured most have seen this by now, so what the heck. Hilary Swanks character requested to be euthanized, and Clint Eastwood's character complied in the end, because she was mo'cushle.

underoos
woohoo
and R2D2 to boot?
too cool
I bet you were cute
and not just in 1st grade!

(And, yes, the pic is a package of wonder woman underoos)
She fights the power of evil!

spram@10: anna, yes i think the doc would be negligent if he/she did not perform the exam.

This case is a test of informed consent, not negligence. I don't think spram's view would be upheld by his/her ER counsel, in this instance,
because:

Dr. Irving Friedman, a neurologist and psychiatrist hired by Mr. Persaud's lawyers, wrote: Although a rectal exam is part of the routine E.R. evaluation, this patient clearly refused. His life was not in danger. He did not have any signs of abdominal trauma. He had full range of motion and movement of all four extremities. A reasonable analysis of his situation could have been obtained without checking for "rectal tone."

desi mom@13: I've had to get court orders and wake up judges at wee hours of the night to give me permission to save a life when a patient refuses intervention.

There is a fundamental disconnect b/w physicians and many litigants (I have not personally advocated on behalf of any, yet) on this point. Cardozo established in 1914, and many cases have subsequently established precedent, that an adult who passes a series of simple cognitive tests, can turn down *any* treatment. Seems pretty clear that Persaud was in this category. The hospital should pay up and saction the physician.

Spram, thank you for the information and vivid description.

32 · HMF said

I figured most have seen this by now, so what the heck.

I haven't, which is why I edited your "spoiler alert" to be more specific. :)

Mutineers, if this case were about Rita Persaud hitting her head on an icy pavement, and the rest of the story stood, would you feel any different about the probability of malpractice by a male ER physician? Just curious.

HarlemSun, what cut do you think this Dr. Friedman is getting from the plaintiff's team to say what they want him to say. I'm sure we can find plenty of other docs who would have advocated performing the rectal exam.

In the end, this is one of the many reasons why the healthcare system in this country is so screwed up. Ask yourself, why would the doctor in question have peformed this technique, if not for patient benefit? The doctor gets no added benefit. The rectal exam, in and of itself, likely has no additional financial compensation. I understand the confusion if the doctor went straight ahead to do some other tests, say an MRI, which would charge the patient a ton of money and be extremely more time and labor intensive and uncomfortable, but a rectal exam is standard procedure with little if no additional financial benefit to the doctor or the hospital.

Mutineers, if this case were about Rita Persaud hitting her head on an icy pavement, and the rest of the story stood, would you feel any different about the probability of malpractice by a male ER physician?

I have to tell you-- I wouldn't. I think a lot of this is rooted in homophobia and the sense that something as well-meaning as a medical procedure can be construed as "gay". Once I started reading how this is a legitimate way to check for spinal cord injuries, I just kind of shrugged because I grokked it. I can't stand a speculum but it's used for a reason, and that reason isn't battery or assault. I get that you can decline treatment, sign a form that says, "I acknowledge I am now in the running for a Darwin award" and walk out, but isn't the issue that the ER didn't think he was capable of doing so?

I could be entirely wrong about all of this but I know that I will be instantly corrected, so I don't mind ignorantly tip-toeing out on to this trembling branch...I kept reading that being combative is one of the signs of head trauma. At what point do you say, this person's angry behavior perhaps indicates that my fears about an injury are true instead of this person has agency? I understand that Mr. Persaud felt violated, believe me, I understand that, but I don't think the ER residents are heartlessly trying to prey on a man's worst fear by doing unnecessary rectal exams. They're damned if they do (sadists!), damned if they don't (negligent!!).

spram@38: HarlemSun, what cut do you think this Dr. Friedman is getting from the plaintiff's team to say what they want him to say. I'm sure we can find plenty of other docs who would have advocated performing the rectal exam. In the end, this is one of the many reasons why the healthcare system in this country is so screwed up. Ask yourself, why would the doctor in question have peformed this technique, if not for patient benefit?

Spram, I didn't mean to imply the ER physician is getting anything out of the exam. I admire ER doctors tremendously, they do a difficult job under difficult circumstances.

Dr Friedman is a paid expert for the plaintiff, in the same way the hospital will trot out paid experts with contrary testimony. Again, I don't think this test is about the negligent care. It is about doctors understanding the informed consent law and abiding by it, even when they feel they "might better."

desi mom@13: It is sad when you care more about the patient and her baby then she does.

This will make patients and doctors happier, and avoid triggering litigation, something that physicians like to complain about (not judging the veracity of the complaints).

How do we know Brian Persaud is Desi?

How do we know Brian Persaud is Desi?

He's most likely Indo-Guyanese.

Harlem Sun,

I understand your position. But if Anna's hypothesis is correct and that aggression is a sign of head trauma, how do the doctors know they have truly received an informed consent. Alert and Oriented x3 as I understand it is simply a baseline test as to knowing time, place (and I forget the third one). In and of itself, do you believe doctors should rely upon Alert and Oriented x3 to indicate that the patient has full mental faculties such that he can demand the avoidance of the test. I'm not advocating a position (I'm torn on this one - bad choice of words) just wondering.

anna@39: I kept reading that being combative is one of the signs of head trauma. At what point do you say, this person has agency instead of this person's angry behavior perhaps indicates that my fears about an injury are true?...They're damned if they do (sadists!), damned if they don't (negligent!!)

A N N A, you're right it can be (used to play hockey :) And you're right, the physician is between a rock and a hard place in terms of outcome. This is exactly where the law can be helpful to guide clear ER policies. A series of cognitive queries are on the books -- date & time, location, name, profession etc. -- designed to gauge agency and basic cognitive function. The issue is, often the physician's healer/god (depending on perspective) instinct kicks in, superceding the patient's lack of consent to a procedure the physician knows from experience, has a high probability of being the "right" choice.

My answer to that is, a cliche of a question - who knows best what is right for an adult? Informed consent was a hard-won battle in the early twentieth century and has been the bedrock on which Roe v. Wade was built among other pivotal personal health laws. No matter what you think about individual decisions to accept treatment or not, nobody knows the whole story better than the patient (among factors that nuance this decision think insurance, religion, time to recovery, employment...) and I think a physician owes him/her agency and power over their own body just as much as they owe medical advice.

Alert and Oriented x3 = Alert and Oriented as to person, place and time.

as soon as i read the word 'kundi' i knew it had to be an anna post :)

I'm with HarlemSun on this one. Noone is disputing that, objectively speaking, the rectal exam was called for and would be beneficial to the patient. The point is that the patient is entitled to consent or refuse treatment--his/her subjective evaluation of things governs the day, as long as he/she is not declared unfit to make such a determination. Here, it seems Cornell should have brought in a psychiatrist to declare Persaud mentally incompetent before they performed a forcible examination on him--I mean, really--talk about a "God complex"! The hospital wouldn't be liable for not performing the procedure as long as they determined him to be competent and he refused. To emphasize, I'm not saying that the rectal exam was unwarranted in a rational, objective sense. It's just that that's not the test--voluntariness/consent is quite important--indeed, it governs here.

Was Persaud informed about the reasons for the procedure? People in the ER, with any injury or illness are scared as hell, usually. It's hard to think rationally when you are stressed physically and mentally. And people w/ a head injury sometimes get personality changes from what i have heard. Of course, only the ER staff and Persaud know what really took place, I guess. (Or wasn't the guy sedated or something after punching the Dr out?)

This case reminds of a comedian talking about how his doctor was "like a homeless guy trying to get the last nickel out of a payphone." during that procedure. Then at the end the doctor tells the comedian he'll see him next year to which the comic replies, "No, I'll be seeing you in court next week for molestation." (It was on Comedy Channel awhile back. I forgot the comic's name and the show.)

I'm a lawyer, but not in NY. Without doing any research, but just relying on my general knowledge of that area of law, I think the doctor is screwed.

Cover my ass language to follow:
Check with your own lawyer to determine the laws of your state as they may apply to you. This above should not be considered legal advice.

This situation is a beautiful illustration of the conflict between utilitarianism (which says "go ahead and give him the rectal exam") and a rights-based view (which says, "his right to give or refuse consent is paramount, regardless of whether it's objectively stupid to withhold consent"). Utilitarianism focusses on getting the best result, the rights-based approach ignores outcomes and protects the process (here, consent). You have the same conflict regarding, say, government seizure of land (could be in public interest--i.e., outcomes good), but problematic from a consent perspective.

The hospital wouldn't be liable for not performing the procedure as long as they determined him to be competent and he refused.

Rob,

I think you underestimate the juries and courts of the state of New York. If he had left that hospital and had suffered some massive spinal cord event as he left the hospital (even after all the precautions that you mentioned), I'd be willing to bet a week's pay that he'd have a sympathetic jury and a good chance at a negligence verdict. Especially where all the hospital had to do is use one finger to rule out the injury. From a practical standpoint, the hospital chose the lesser of two evils. By doing the test, even though it may have been ill-advised, they insulated the cap of their liability. So they are liable for penetrating him for a potentially beneficial test. What's that worth? That's a far cry from letting him leave the hospital and find that he's more seriously injured than thought. In terms of what a jury might award in any situation, they certainly would pay less in the first situation than the latter. Like I said earlier, I'm torn, I see the privacy issues but I have a hard time finding fault with the doctors.

51 JangaliJaanwar

I see what you're saying but if they had a psych. evaluation that he's competent, why couldn't you get it dismissed in summary judgment so it wouldn't get to the jury??

Rob,

IMO, all that the plaintiff would need to defeat summary judgment (legal papers dismissing the plaintiff's case) is an expert to say that the hospital deviated from acceptable procedure and further, a psych eval. wouldn't ascertain physical damage to the spinal cord while the finger test is more likely to do so. (The first being more likely to be subject to human error while the second relies on a firmer tactile response.) (just an argument - no need to buy it and take home) The hospital has its expert affidavit in its moving papers, asserting the contrary. You now have dueling expert affidavits. In my experience, it takes a brave judge to grant summary judgment when he has dueling experts. More likely, the judge says to himself/herself, "I've got two experts who disagree on the standard protocol of care and what is reasonable in this situation, I'm not a doctor and I don't want to rule on something that I can get easily appealed on, I'll let a jury determine which expert is more credible" and thus, you have an issue of fact defeating summary judgment.

Its certainly possible that a judge could grant summary judgment based on your scenario and I would certainly take that tact if I were the hospital's attorneys in that situation, but I wouldn't bet more than lunch on it.

JJ,
It seems unfair to the hospital to not protect them if they respect the patient's rights, but you may be right. I'm not up on the practical probability of getting summary judgment in a malpractice case.

Jangali Jaanwar@51: By doing the test, even though it may have been ill-advised, they insulated the cap of their liability. So they are liable for penetrating him for a potentially beneficial test. What's that worth?

JJ, this is not borne out by my experience in NYC. If the hospital broke informed consent, Persaud has a good battery case. If that were upheld, any litigation would be leveraged several times over any negligence suit if he walked out and had spinal injuries, because of the mitigation of several hospital staff testifying that Persaud was a)competent and b)was informed of the dangers of refusing the exam and vigorously refused. Juries in NYS weigh in favor of patients' rights (generally in the last 10 yrs), and in the latter case he would have shot himself in the foot by adamantly refusing treatment after passing cognitive tests. This is another reason why doctors need to understand informed consent and hospitals need to train up. As rob suggests, a psych opinion would have sealed the deal on consent and released the physician.

rob@50: Utilitarianism focusses on getting the best result, the rights-based approach ignores outcomes and protects the process (here, consent).

Rob, while I agree with the general sentiment, I think this case, and most informed consent cases are more utilitarian than process oriented, to follow your classification. Persaud could have a litany of utilitarian reasons not to take the exam, i.e. reasons that support the best outcomes for him. Extreme examples of these cases are what Dr. Kevorkian aspired to highlight and fight, whereby physicians who think they are making a utilitarian, professionally correct decision by keeping patients alive, on a tube, with aspirator, punishing drug therapies etc.; are in fact negatively impacting the patients' lives and health outcomes (per Kervorkian). The process is the enemy for many end-of-life patients in the U.S. It is indeed a complex issue, but again, if you believe in the agency of adults, it is difficult to see Persaud's case as a process issue.

This should have read this way:

Its It's certainly possible that a judge could grant summary judgment based on your scenario and I would certainly take that tact tack if I were the hospital's attorneys in that situation, but, I wouldn't bet more than lunch on it.

Rob,

It does seem a bit unfair, but when did fair have anything to do with being right or just. ;) Thus going back to Anna's original point, the hospital is caught between Scylla and Charybdis. Rob, enjoy the long weekend, and to everyone on SM, I hope you don't find yourself in a hospital with a finger up...

If you have off, enjoy MLK day.

As a doctor who has worked in the ER for some time, I can gather from the brief (alert and oriented x 3)that this fella will win the case hands down in any court in the UK.(Should in the US as well)
He is competent. He is an adult. I have actually seen a Jehova's witness being allowed to bleed to death after a car accident because she had set up an advance directive not to be transfused under any circumstances.And many times I've had patients refuse P.R (per rectal)examination after minor head injuries. If they are competent, meticulous documentation, preferably witnessed by another health care worker is all that is required.
In the cases of mentally incompetent patients, and minors the rule is to act in their best interest. It sometimes requires the services of a psychiatrist and the hospital lawyer to declare patients incompetent to make independent decisions.

Harlem Sun,

Respectfully, I would disagree. Let's take an extreme situation, he ends up in a wheelchair unable to move any of his body parts and all that would have been needed to prevent that result was a simple finger test, you don't think the sympathies of a judge and jury would weigh in favor of the plaintiff as opposed to the big, bad hospital with deep pockets. If this is his injury, a review of jury verdict reporters (especially in the bronx and brooklyn), you'll find multi-million dollar awards against the hospital where its found that the hospital failed to follow protocol which resulted in spinal injury. Honestly, what's the value of this battery? The price of his ego and mental anguish, a few thousand maybe, a little more, okay, not millions of dollars. Seriously, take a look at jury verdicts in some of the counties, I think you'd be stunned.

BTW, your hypothesis is based on the premise that he was competent at the time he gave consent. Isn't it possible an expert would argue that the hospital should not have taken the chance the plaintiff was competent to give consent simply based on his aggression. The psych eval. doesn't do anything to determine if there's a latent spinal cord injury. Thus leading back to the dueling experts. As I mentioned with Rob, I don't disagree that the scenario he posited would have a chance of success, I just don't see it as being as conservative and protecting the hospital as well. (like the finger test the hospital actually performed).

I guess that's what makes for good horse races and lawyers in court litigating cases. ;) Speaking of which, I have been a dilettante this week, so I must get back at it. I'm glad both Rob and you are aboard, always like to see how other people process information and what results the come to, especially when they are lawyers. (You may have been around before and I never noticed, my apologies if that's the case).

I heart our newest commenters. Great batch, this Winter '08. ;)

I don't know if anyone's posted a link to the Family Guy episode with Peter's rectal exam yet but it's soooo relevant I'm going to risk being redundant!

60 · Vanya said

I don't know if anyone's posted a link to the Family Guy episode with Peter's rectal exam yet but it's soooo relevant I'm going to risk being redundant!

I don't think they have and I love FG, so thank you kindly for the phunny.

This may sound insensitive, but does "incapacitated by post-traumatic stress disorder" seem a bit overblown? This kind of thing is what gives plaintiffs with substantive medical malpractice damage claims a bad name. If I were Persaud, I might be afraid of someday karmically reaping a colostomy after being admitted for gallstone removal.

How hard must a hit on the head be before my my friend's doctor is forced to do a rectal exam? My 'friend' McSleazy wants to know.

Oh, and that reminds me of a recent case in my ward where a bed bound old lady with impaired swallowing came in with an aspiration pneumonia (due to her impaired swallowing, she was choking on the food, causing the pneumonia).
We treated the pneumonia which in itself has a high mortality rate in her patient subgroup, but then she refused all forms of assisted feeding. We tried talking, cajoling, pleading. The family did likewise. She remained adamant that she didn't want either a naso gastric tube or a PEG.We called in the psycho gerries (psycho geriatricians) who concurred that she was of a sound mind. She gradually became weaker and weaker and died in a few days. Nothing much we could do except document and observe.

I have a few things to say.

First, let this be a lesson to all of you that hindsight can sometimes cause a stink.
Second, Mr. Persaud, sorry if you feel like you are a butt of my jokes right now.
And, turd, I am sure I will be the one feeling like an ass when you come victorious out the other end of your lawsuit.

(P.S: Anal-yze this was me.)

anna, yes i think the doc would be negligent if he/she did not perform the exam. As physicians, we're taught in any trauma case, to "check all holes,"

Call me a cynical realist, but I have never believed in glove at first smite.

everybody is allowed to be stupid. Lots of patients leave without getting what is necessary to evaluate them properly. I usually make sure they understand what they are refusing and what is likely to be missed. quite frequently, if the time is taken to talk to the patient, they will change their mind. The rest of them continue on their inexorable march towards a Darwin award. Thats okay too. Everyone cant live to be a hundred. I dont wring my hands too much over the 80-90+ year old who made an informed decision to not be tube fed intubated and mechanically ventilated and then undergo bone crushing CPR by a 200 lb tech. I try to make their passing easier in whatever way possible. THAT also is a crucial role that doctors forget about.

If anyone is interested, go to Gruntdoc.com. He is a residency mate and a great doc-he sums it up pretty well.

i can sympathize with persaud and hope he wins.
if he said no - doesnt this get characterized as an assault - especially if they forcibly did the procedure out of anger for his havign struck the doc.

It is sad when you care more about the patient and her baby then she does.

I think that sounds incredibly sanctimonious... many pregnant women have read and researched their options and know that every intervention increases their chance of having to get a c-section and risks to their unborn child.

Commonly abbreviated in notes as A&Ox3 [alerted and oriented, 3 ways] refers to awareness of self and the surrounding environment with respect to any three of person, place, time and event, i.e., one has the functional ability to know and understand (cognize) who she is, where she is, when it is and what has happened to her. Typically only the first three (3) parameters are assessed by simple conversation with the health care professional (or designate) leading to the A&OX3 assignation. If the patient is oriented to only two (2) of the parameters, he would be notated as being A&Ox2. Thus, "person, place and time" is quite right. It is hard to recall the date (and thus downgrade the orientation level of the patient) because the lights in the ER are always on and we just know when it is time to go home :)

Oh, and that reminds me of a recent case in my ward where a bed bound old lady with impaired swallowing came in with an aspiration pneumonia (due to her impaired swallowing, she was choking on the food, causing the pneumonia). We treated the pneumonia which in itself has a high mortality rate in her patient subgroup, but then she refused all forms of assisted feeding. We tried talking, cajoling, pleading. The family did likewise. She remained adamant that she didn't want either a naso gastric tube or a PEG.We called in the psycho gerries (psycho geriatricians) who concurred that she was of a sound mind. She gradually became weaker and weaker and died in a few days. Nothing much we could do except document and observe.

My Dadi (grandmother on my mother's side) refused all treatment for blood pressure when she was in her 60s. She died peacefully.

Ammi (grandmother on my father's side) was basically alive due to the miracle of modern medicine. She died at the grand old age of 85. However, last 5 years of her life, she couldn;t walk, couldn;t talk, couldn't see, and didn't recognize people.

We used to think that Dadi lost her mind, but after seeing Ammi, I'm not so sure anymore

69 · khoofia said

i can sympathize with persaud and hope he wins.
if he said no - doesnt this get characterized as an assault - especially if they forcibly did the procedure out of anger for his havign struck the doc.

Khoofia, i agree

I am a gastroenterologist, and Every day, I have to do colonoscopies, I have been taught that a rectal exam or a colonoscopy without consent is assault and can be prosecuted as such. Now in this case, the xam was needed, but forcible sedation and intubation, without a psychiatric opinion diagnosing the patient as incompetent is another problem for the doctor and hospital.

Both are
S-C-R-E-W-E-D

You managed to insert a kundi joke in there Anna !! touche'

Watching the Australian Open between Mirza and Venus Williams. Looks like India has its share of useless lawsuits too. Some asshole lawyer filed a lawsuit because Mirza's feet were near the indian flag in some picture. If cnvicted, she could have faced jail time. What kind of useless law is this?

Back to this case, I wonder if the same lawyer who is representing Persaud would be the first to file a case against the doctor if they did not check his ass.

>Persaud is claiming that due to the rectal exam, he is now incapacitated by PTSD; he is seeking unspecified damages.

Revenge of the Sooth, perhaps?

P.J = Poor Joke?? That sounds a little classical. I wonder...I would better stick to the abbreviation I know... Pakau joke :)

am i the only one who feels a little bad for this guy? i don't know how other desi men would handle that...

am i the only one who feels a little bad for this guy? i don't know how other desi men would handle that...

Allopathic medicine is Western and the insertion of digits could be viewed as a form of imperialist violence against the East. desi progressives & reactionaries may agree that this is an outrage, but for altogether different reasons

Allopathic medicine is Western and the insertion of digits could be viewed as a form of imperialist violence against the East. desi progressives & reactionaries may agree that this is an outrage, but for altogether different reasons

Also, the introduction of said digits could possibly stimulate the prostate, leading to pleasurable sensations. This would be a direct affront to the long and venerable tradition of asceticism among reactionaries.

akak, you are right that most women at least know what a c-section involves and have done some reading or have taken a class that provides a nice overview of the procedure. However, there are non-medical folks out there (like doulas, etc.) who make women feel like failures for choosing an epidural or for needing a cesarean delivery.

Watching the Australian Open between Mirza and Venus Williams. Looks like India has its share of useless lawsuits too. Some asshole lawyer filed a lawsuit because Mirza's feet were near the indian flag in some picture. If cnvicted, she could have faced jail time. What kind of useless law is this?

There is a reasonably high number of frivolous lawsuits in India, because of the concept of PILs. PILs do make access to justice easier, but it also lowers the bar for easily offended nut jobs to cause significant annoyance. If I recall correctly, this flag offense issue has led to lawsuits against Narayana Murthy for cutting a cake with an Indian flag on it, some actress for wearing a saree with the flag on it, and so on. There was a discussion about this on SM a few months ago, and here's a rediff article on the phenomenon (which I haven't read).

Rahul, that reminds me of the same sort of ridiculous American-flag lawsuits over the years.

Anyone who values a symbol above common-sense, their own resources, or human life is a certifiable idiot, no matter what country they hail from.

Anyone who values a symbol above common-sense, their own resources, or human life is a certifiable idiot, no matter what country they hail from.

Yes, and the constant stupid political grandstanding between Dems and Republicans about flag burning, or the innuendo about Obama not putting his hand over his heart during the pledge, are evidence of that. I wasn't implying that Americans don't fall prey to this nonsense, but the bar for prickly idiots to become nuisances does seem lower in India, since the judicial doctrine allows them to file suit even if they have no horse in the race (as compared to the onerous requirement of standing in the US, which the "constructionists" (aka rich white men, and I include Clarence Thomas in that list) on the Supreme Court keep tightening in an effort to prevent people from filing lawsuits).

hahaha... kundi hymen... hahahaha

anna, you just made my monday.