I hope they file a complaint with the medical board. I find that complaining to medical boards can be very tedious, but that is the only way to get to this MD...who will claim she didn't want to treat the girl until she was seen by the "official rape crisis team." that will be her out...
I like to think I am the kind of person that hates no one, then I hear a story like this and...I realize I lie..
any reason why I keep getting the posting error: I'm posting too fast...when uhm, well, I'm not..
"I'm going to let my ridiculous personal beliefs get in the way of doing my job" is a perfectly reasonable attitude for the physician to have even if it compounds the pain and trauma of the victim.
Listen again. I think we do not have the whole story.
1. One of the pieces is this. Rape exams have become so specialized for legal reasons (preservation of evidence, etc) and medical reasons (strong social opinions on proper counseling) that it has become a specialized service-- completely paid for by the hospitals, not the insurance company and hardly ever the patients. The hospitals in this area apparently have a system where a specialist is available in the community all of the time but not at all hospitals all of the time.
2. It sounds like the doctor told them she was not the specialist and the specialist was at that time available at Baptist Integra.
3. Now we speculate. Did the mother and daughter try to induce the doctor to do just part of the service, like "we just want the contraception". The doctor of course is damned either way at that point, because if she does part of it she will be held to the same standard of care as the specialist. If she refuses to do just the parts they want, they can call her a heartless bitch, as they are doing. I have no idea what the three of them said to each other and neither do any of you.
4. So this is one more story that is simply a rorschach test about your opinion of ER doctors, because the facts we are told are potentially congruent with all the fault at either end or somewhere in the middle.
"It sounds like the doctor told them she was not the specialist and the specialist was at that time available at Baptist Integra"
The mother of the victim said the doctor refused treatment because she said "it was against my beliefs". If that's true then this has nothing to do with rape specialists or following protocol. If what she said is true then this is about a doctor letting her personal beliefs interfere with patient care.
However, I agree there is probably more to the story than we are being told.
This whole "personal belief" shit really should never be acceptable if you went into a job knowing full well what you'd be doing. There's no reason that poor girl should have suffered even more =(
something doesnt seem right here. I think there's a bit we're missing. Mom is more upset about the treatment than the 'fact' her daughter was raped. She also states her daughter just wanted treatment and then go home ... no police report? Raped early sunday morning, at an apartment complex ... mom picks her up to take her to the hospital, where's the cops?
so it doesn't bother you that the ER doc specifically told the mother and her daughter that she is not going to give them emergency contraception because of her religious belief?
Can't someone get fired here? Do we have to record these (supposedly protected) doctor/patient conversations in order to figure out if proper treatment is being given? Is this some Oklahoma arrogance from some jerk doctor? So many questions, but as usual, media doesn't answer any of them.
There is a need for outrageous behavior on blog posts because an equivocal situation doesnt allow the righteous indignation, does it? And what else is as satisfying? However, intelligent people should pause at a really outrageous story and wonder if it includes all the relevant facts.
One of the apparent facts here is that the hospitals in the community have attempted to provide (at likely their own cost) a full-service specialist available to provide what is likely more sympathetic and more expert -- from both a medical and legal standpoint-- service. The doctor referred them to this service. I can think of lots of reasons why that are way more compelling and probable than that she did it because of her own religious beliefs.
Rape visits tie up emergency rooms. Whoever deals with it is suddenly removed from availability to any other patients for half a shift or more. Rape victimes require an uncommon combination of expertise: ability to do a pelvic exam, STD knowledge and prevention, counseling skills for an upset victim, legal understanding of chain of evidence rules, ability to counsel accurately about legal rights, etc. Prescribing a morning after pill is the simplest part of it .The likelihood that a random ER docs can do all this to the satisfaction of victims and their advocates is as small as the likelihood that a random ER doc can operate on a subdural hemorrhage. They stabilize life-threatening problems and refer to a specialist. The US government has mandated that "ERs are the free walk in clinics of this country.
So the community hospitals pay for a specialist service and rotate it among the hospitals or base it at the hospital with the highest demand. The ER doc seems to have determined there was no life-threatening emergency and sent her where she could get the best care.
Most of us are assuming that the patient asked for the morning-after pill and she refused because she equates it with abortion. And was self-righteous enough to give them that reason. ER docs may be all kinds of things you dont like, but few of them are stupid enough to say something that they know will get them in trouble when there are a dozen valid and legitimate reasons for doing the same thing.
I can guess lots of reasons why the woman and her mother did not like being referred--- inconvenience, another ER wait, fear that the someone would ask uncomfortable questions or involve the police, and many others. But those are not newsworthy complaints, are they?
So in judging the relative probability that (1) the ER doc gave a patient a non-allowed reason for a legitimate referral, or (2) the patient's mother exaggerated or distorted what was said, I think (2) is more probable. But WE DONT KNOW, do we?
Tyler gets it. joemac insists on that rush of self-righteousness. Even though the ER doctor had not put herself in a job in which she needed to prescribe an abortifacient, and even though she referred the patient to where she could get one (along with superior, specilalized care), joemac thinks having a patient accuse her of expressing her opinion on it should be a firing offense.
Interestingly enough, there was another recent case in NJ of a doctor letting their beliefs get in the way of patient care... this time in allegedly denying HIV medications to a gay man (as well as apparently having some rather... choice... words for the man's primary care physician when they spoke over the phone).
1. News stories about doctors are one sided because doctors will not publicly discuss patients even in their own defense. Any of you ever been attacked for a distorted version of what YOU allegedly said?
2. Religion was not mentioned as the source of the ER doc's “personal belief”. Distinguishing ethics and religion should be easy for readers here. Might doctors refuse to treat a patient on nonreligious ethical grounds? Are there limits to what we are entitled to demand doctors do if they think it morally wrong? Should all doctors be required to do abortions on demand? It would be easy to compile a long list of things that a doctor and patient might differ about on ethical grounds.
E.g. A little girl falls. Cuts her face across the lip. Taken to clinic where she sees pediatrician who says, "to minimize the scar this should be stitched by a plastic surgeon, who is on call for the ER at St Elsewhere". Guessing this will likely take all day, the presumptive father (who isnt paying for it) presses the pediatrician to do it himself. The doc refuses, thinks the father a selfish fool. Father complains. Real case, not ethically much different. A doctor may realize she is not the best doctor for that patient's problem. Or will refer to another doctor willing to do what the patient wants.
3. The NJ case of a psych ward refusing to give a man his own HIV meds is indefensible ethically and legally--- if the facts are correct. It would be like denying someone with diabetes his insulin. Psych facilities sometimes refuse to admit diabetic patients because they do not want the trouble and responsibility for the medical disease. But if they have admitted someone with diabetes, they will not refuse to order the insulin.
4. From a medical ethics perspective two key differences between the two cases are (1) a life-sustaining medication and (2) availability of the requested service by a reasonably accessible alternate provider.
5. But she felt treated with contempt! No ideal patient deserves to be treated with contempt by an ideal doctor. But doctors sometimes feel contempt for contemptible behavior—for the father who could not be troubled to spend a few hours to save the girl from a disfiguring scar, ---but usually keep feelings of contempt from affecting treatment, or even showing.
We don’t know why that ER doctor behaved with contempt to the Oklahoma girl if she did. I can imagine scenarios where you too might feel contempt for the patient or mother: parent with priorities other than daughter's health, suspicion of false accusation for face-saving, transparently lying about relevant facts, talking about lawsuit, asking for oxycontin, displaying naked racism, arriving in an ambulance because it was cheaper to them than a taxi… Or maybe the doctor was an evil bible-thumper who thinks any woman who suffers sexual harm must have deserved it. You know, ‘cause that’s such a common attitude among women doctors.
At this point, I'm not even surprised. There was that story John Smith just mention about the NJ man refused HIV medication for close to a week (though that story is still fresh so the standard level of waiting for all the facts to come in should be expected). And of course that great one from a few years back when a private doctor refused to treat a young girl's ear infection because her mother had a tattoo and that was ruining the positive Christian environment he was trying to maintain. Because, you know, that's what really matters, not saving lives or some tiny detail like that.
ER docs may be all kinds of things you dont like, but few of them are stupid enough to say something that they know will get them in trouble when there are a dozen valid and legitimate reasons for doing the same thing.
Religious motivation is one factor where I would be unsurprised to see an otherwise intelligent person do something like this. A religious zealot would probably be more motivated to honestly express why they were doing it rather than using an excuse. Religious zealotry is one of those things where it's not just important to do something stupid and nonsensical - it's important to be seen doing it.
If you join, for instance, the military, you sign on the line agreeing to hold your personal beliefs at bay if you are ordered to do a mission you disagree with.
If you are a firefighter, and a house is on fire, you put out the fire even if it is the house of someone you don't like (gay person, non-christian, etc)
If you are a public defence lawyer, ethical standards require you to represent the best legal interests of your client, putting your own beliefs and prejudices in check.
Ok, you nitpickers out there are going to find gray areas and disagree with me; whatever, my point is this...
There are certain professions out there, including being a doctor on call at an emergency room (where the public is, by law, entitled to service), where you had better be prepared to put your personal (including religious) prejudices on hold to serve your duty. If you are doctor on call, or a firefighter on call, or a military servicemember on call, you don't get to choose.
You agreed to give up that right when you signed up for this job of special public responsibility. Somehow, some doctors, pharmacists, nurses, etc, feel OK weaseling out of this duty. (Hint: it has to do with mythical beliefs)
John Smith: You sir need to reflect on your words-- rape does NOT "tie up" emergency room services. That's like saying, trauma ties up operating rooms. Or coughs-and-colds tie up pediatric clinics. Hello... that's one of the reasons they exist.
Does twitter tie up the internet? Do Toyotas tie up the interstate highways? Does Delta tie up the air traffic control system?
Look man you may be a nice smart guy but you might not have any idea how inflammatory a thing it was, that you said.
Rape treatment is resource intensive, but why don't you compare that to the hospital resources required to deal with, say, an unrestrained high-speed motor vehicle accident. Or a homeless, mentally-ill, chronic ED visitor. If that's how you look at a rape victim, then you are one person I hope I never have to work with in my ED. Please think long and hard about what you said about rape victims.
"Most of us are assuming that the patient asked for the morning-after pill and she refused because she equates it with abortion. And was self-righteous enough to give them that reason. ER docs may be all kinds of things you dont like, but few of them are stupid enough to say something that they know will get them in trouble when there are a dozen valid and legitimate reasons for doing the same thing."
"So in judging the relative probability that (1) the ER doc gave a patient a non-allowed reason for a legitimate referral, or (2) the patient’s mother exaggerated or distorted what was said, I think (2) is more probable. But WE DONT KNOW, do we?"
My experience tells me (2) usually doesn't happen unless (1) happens. You don't see the giant stick in your eye, do you?
To Mac: I hate to break it to you, but most of your "facts" are wrong. Your arguments show ignorance in nearly every sentence.
1. Not every doctor is obligated by law to have every expertise. Not every doctor is obligated by law to do anything a patient asks for. Not every hospital ER is obligated to have a specialist of every type sitting there waiting for every type of problem.
2. Rape care has become a specialized service for EXACTLY the reason that you objected to use of the term "tying up the ER". Rape is a social emergency, a psychological emergency, a legal emergency, but not usually a medical emergency in the sense that immediate care is needed to save life or reverse injury. Not all doctors who work in ERs have the combination of social, psychological, medical, and legal skills to do it right, as this doctor demonstrated. Victims sure dont expect to pay for it, do they? And it offends you that an ER doctor might not welcome a perfectly healthy woman who comes because she was raped? That is EXACTLY why the hospitals set up an expert rape service--- because women DO deserve to have a rape handled right in all respects.
3. Assume much? I dont recall a single mention of religion in that new story. The dissatisfied mother claims the doctor refused to do what they wanted because of her "beliefs". You clearly are imagning that the doctor must have refused to do part of the care because of her "mythical" beliefs, yet ethical beliefs may be completely independent of "mythical beliefs", there were a dozen ways to put the story together based on the facts of the news report that are more probable than the doctor being a "bible-thumper who thinks any woman who suffers sexual harm must have deserved it." Some people can read and appreciate different ways to understand a story. Some clearly cannot.
JKR, there is no "stick in my eye". If you could read my posts you saw that I offered dozens of scenarios for the story. You too are quite naive if you think people dont exaggerate facts to fit their feelings.
When someone, like the young woman's mother quotes verbatim what the doctor told them, I usually find that it's in our best interest to first take the allegation seriously and do a full investigation into what exactly occurred.
I do understand you choose to give the benefit of doubt to the doctor, but those are precisely the reasons for the unbiased investigations, and I'd note that you are not arguing for an unbiased point of view. You have argued extensively from the viewpoint that the mother and the young women have a lot of reasons to exaggerate facts.
I'd hardly call your position neutral and convincing.
As for Mac, I agree with much of his/her comments. Being professional in one's occupation means exactly what Mac has written. If what is alleged turns out to be true, the doctor has exhibited an unprofessional conduct that merits a serious investigation and a possible sanction and dismissal from her job.
Your #1 is a completely bizarre and irrelevant response. Where did I say ever Doc has to have perfectly broad expertise? You are reading into my response your own assumption that this is about some doctor refusing to treat a person because you presume they are exercising their discretion not to treat a case outside their expertise. I do not share your assumption that this doc is merely exercising discretion due to lack of appropriate training. Emergency docs specifically should have rape-specific training. The woman's story, as told one-sidedly, is very different. And regardless, there is a certain level of care, consideration, and BEDSIDE MANNER that the doctor is ethically require to provide.
#2: rape IS a medical emergency. The emergency room is the customary place where it is evaluated in U.S. hospitals. There are certain management decisions that MUST be made in a time critical manner to allow for the best outcome. If you limit your definition of "medical emergency" to only that which is immediately life threatening, you are ignoring a sizeable fraction of cases.
#3 your points that there are many sides to this story, and that we only have one of them, is well-advised and I acknowledge it again. Personally, I glean several things from the description and if I take aspects of the news testimony at face value, it is very difficult for me to envision ethical or competent behavior on the part of the doctor. You must be a much more generous--or less cynical--person than me.
It is still no excuse for accusing rape victims from "tying up resources." If you were raped by billy-bob in Arkansas, and came to the ED with excrutiating rectal trauma, worried that you could get HIV, HPV, herpes, syphilis, etc etc etc, scared to ever walk out to your car again in the dark, let alone afraid that you could get pregnant (and what if you had a condition that made it life-threatening to get pregnant)... I hope NO ONE makes you feel like you are just a hassle, just a drain on the system that exists to handle "real emergencies," just "tying up resources" that are better spent handling broken bones, new cases of smoking-related cancer, severe alcohol withdrawal, obesity-related heart failure, or... lets see, how many other preventable, self-inflicted life threatening injuries can we name? We treat all of these people with the respect, care, and competency they deserve. And they all deserve it.
That does not mean we offer them deplorable bed-side manner and make them feel ignored because "the SANE nurse isn't available" immediately. A competent doctor, acting ethically, would not have allowed this situation to develop whether a SANE nurse was next door, next town over, or 10 states away.
To quote someone else from elsewhere, this is the "comment section" not the "write a fucking novel section," so I'm going to bow out unless someone has a truly credible reply...
JKR and Mac, you both have trouble with reading comprehension, as well as poor understanding of professional ethics and laws regarding American hospitals and doctors,
1. JKR, I did not claim to give a "neutral" analysis. I claimed the original story was inherently biased because we only had one side of the story, as we always do when a patient publicly criticizes a doctor or hospital. I understand how much you passionately want to see the doctor as a religious zealot who thinks sexually harmed women deserve scorn rather than help. I happen to think that viewpoint is shallow, caricatured, and improbable for the reasons I gave, but you are entitled to your opinion. But the FACT is that we have only one side of the story and i would assume that every reader of this blog understands how easy it is to make accusations of wrong motives and attitudes when only one side of a story is given.
2. Mac, I hate to break it to you but a young woman who says she was raped does not look like a medical emergency to most doctors who thought they were going into ER medicine to take care of trauma, heart attacks, appendicitis, etc. So you do not think you are demanding that every doctor in the hospital has every skill set? Regardless of what you think you are demanding, that is indeed what it would entail for you to demand that every ER doctor be able to stop what they are doing and be a rape specialist. Referring a patient to the designated specialist with the most expertise, training, resources, time, and compassion is NOT unethical, regardless of the perceived attitude with which it is done.
3. I deliberately used the term "tying up" the emergency room because I was trying to help you understand what an ER is like, what a rape without injury may look like to some of the doctors and nurses who work there. Rape is a social, emotional, and legal emergency but only occasionally a medical emergency with physical injury. in this country all kinds of social and emotional problems are brought to the ER to be dealt with-- a homeless person making a ruckus on a street corner, a drunk lying on a sidewalk, a dumped lover threatening suicide, children with colds, and over and over, people seeking their oxycontin or vicodin or drug of choice. So yes, ERs are where rapes are brought, along with all those other social emergencies. That does not make all of these problems a medical emergency in any other sense of the word. These people all need help and deserve compassion.
4. I did not defend a doctor treating a patient with contempt-- I was trying to help you understand it. I am sorry if you are still so young and naive that it shocks you that not all doctors in ERs welcome all the social problems they are asked to deal with. There is a specialized rape service in many communities, but there are few specialized services available for mental health problems or chronic pain problems.
Claiming someone who doesn't agree with you to have low reading comprehension skills as well as poor understanding of professional ethics and law, in addition to being "still so young and naive that it shocks you..."
Classy. You've taught me a lot john smith. I hope to see you around here more often.
You both asserted or implied i wrote things I did not, or responded as if i had claimed something else. Does that not justify my questioning your reading comprehension? I was trying to teach several of you the differences between a ER doctor's professional and ethical duties, and how unrelated they usually were to religion. I did realize that challenging the simple, shallow, and popular view that the doctor breached her professional view because she didnt share ethical values with her patient would elicit resistance, but the story and the initial responses seemed to so poorly understand what i suspect happened that it just seemed like it might be an interesting contribution to help people see that there were likely more sides to it.
It sounds like you, unlike Mac, grasp at least a little of this even if you dont like it. Real ER care is a lot different than television shows and Mac's fantasies. If every doctor whose patient accused them of not showing proper compassion and respect were fired the ERs would be closed. I am not exaggerating. No real doctor, no matter how conscientious, compassionate, or politically correct in his or her attitudes, has not had a patient complain about his or her attitude. If you dont see patients you will never offend anyone, but if you do, it is simply an occupational hazard. And it hardly ever has anything to do with religion.
Mr. Smith: You are bordering on some personal attacks here with comments like "poor reading comprehension... etc." Perhaps we are all guilty, but how about we all remind each other to keep it civil. We are clearly arguing past each other and operating on different assumptions about the situation.
Another AAFP article is reproduced at: http://www.aaets.org/article130.htm
And it specifically discusses ED management. (It's a little dated but not that much)
I would consider your opinion of the role of emergency departments to be excessively narrow, and not reflective of the actual demands society places upon the ED. If you happen to be a healthcare professional I urge you to expand your parameters for what is entitled to emergency department care. It may even help you offer more compassion and better care to your patients.
I maintain, narrowly, that "tying up resources" is an insensitive and unjust characterization of ED rape management, because rape requires a time sensitive examination, time sensitive treatment to prevent morbidity, and although mortality is uncommon, life-threatening injuries may need to be ruled out. (The role of the ED is not just to treat life threatening injuries. It is to rule them out, or direct their further management either in the ED or another appropriate hospital setting, as well as to provide time-sensitive treatment for non-life-threatening conditions i.e. urgent care.
I am certainly not saying every doctor needs the skills of a SANE nurse. I am not even saying every hospital needs a SANE nurse available all the time. I am not sure what you are saying any more, other than that rape victims don't belong in the ED. That is my only point of debate with you.
By your definition, I would take it that you think a broken leg need not be seen in the ED and should instead be managed by an appointment at an orthopedic clinic. Most people would agree that while most broken legs are not life threatening, nevertheless it is nevertheless generally regarded as an appropriate reason to visit the ED.
Finally, frankly speaking... it is incredible, baffling, breathtaking, and yes, offensive, to me that anyone would suggest a rape victim not go to the ED. That flies in the face of professional recommendations, doctors' opinions, advocates' opinions, public perception, and rational inspection. If you are aware of any professional recommendations against this use of ED resources, I would welcome references. Otherwise, good day, sir.
My other comment disappeared, I'll keep this briefer.
Mr. Smith-- your condescending manner is inappropriate and not appreciated. I have no disagreement with much of what you said, but I maintain that it is offensive and wrong to characterize rape as "tying up resources."
For ANYONE who is raped, and wonders where to go, please be assured that the emergency department is the appropriate place. You will not be "tying things up," as it has been crudely and unfairly put.
I have tried to post URLs to references, but maybe the spam filter doesn't like that. Instead here are some citations for clinical perspectives that clearly endorse the use of the emergency department for management of rape:
Petter and Whitehill. Management of Female Sexual Assault. Am Fam Physician. 1998 Sep 15;58(4):920-926.
What to Do if You're Raped. Am Fam Physician. 1998 Sep 15;58(4):929-930.
Beebe K. Emergency Management of the Adult Female Rape Victim. Am Fam Physician 1991 June
NIH online recommendations are consistent with this, sorry no link.
I also recommend the UpToDate article, "Evaluation and management of adult sexual assault victims." This article specifically addresses indications for referral to a trained provider/examiner.
Finally, the emergency department, in general, is not just for the "life threatening" medical emergencies. It is for urgent care, triage, and ruling out life-threatening conditions as well.
If someone went into EM only because they love acute abdomens and trauma, and don't want to deal with other things, well... Don't apply for a job around here.
If misogyny is now classified as a religious belief that cannot be interfered with because of the First Amendment, does hatred of bigots get the same deference?
Again, mac, you ignore what i wrote to accuse me of opinions i do not hold. Women who have been raped deserve not just treatment of physical injuries, but sensitive and informed emotional, social, medical and legal support . Optimal performance of all of these is beyond the competence of most ER docs-- regardless of your wishes and television fantasies.. Performance of all of those things can take several hours. Raped women often come to emergency departments for this care. THEREFORE, many hospitals have developed special resources, programs, people, and/or locations to provide this better care and to continue to have ER physicians available for other patients in a busy ER.. I still do not understand why this concept seems so difficult or offensive for you.
None of us were present for the conversation between these three people. I think it far more likely that the physician referred her to the rape specilalist for all the good reasons described above rather than from religious zealotry, and far more likely that the mother was mainly unhappy at the incovenience of the referral rather than the motivation. But several of you are making it clear how unacceptable that opinion is here. Fine.
I agree with you, referral to an appropriate center is not just fine-- IF it's available in a timely manner, it is absolutely preferred! That has never been a point of contention among any of us, as far as I can tell. And I certainly don't think that's an unacceptable opinion for you or anyone else to hold.
You give the doctor more benefit of the doubt than I would, but I'm not even debating that. And I'm sure you'd agree that it would be unacceptable for a doctor to refuse to treat, AND simultaneously refuse to refer to someone else. (Although my fear is that the doctor in question, at best, refused a specific referral and instead gave a general one, a la "go somewhere else, I don't treat this")
I don't think your defensiveness on these points has been necessary. I don't think you've understood my concern, I haven't understood the context of your replies.
So, let me try to clarify my issue another way. My beef is that the term "tying up resources" is derogatory towards victims, and discourages them from seeking help in the first place. If a person is raped, and scared, and wondering what to do, they may be afraid of further embarassment by going somewhere where they'd feel as if they were inconveniencing others, or improperly utilize resources. Instead, they might go home, shower, douche, and try to forget about it.
"Resource intensive?" yes. "Tying things up?" no. My issue has always been purely semantic and not procedural. (Sound quibbling? Read the end)
I hope that is a bit more clearly put.
You know, you could have called me out, "Hey Mac you said some pretty offensive things about religion in your first comment. So what, if I'm not PC? Neither are you." And I'd reply, "point taken." I just happen to be more sensitive about offending rape victims than I am about the faithful.
Why? Someone close to me is a victim's advocate. And I have friends who have been assaulted. Not all of them knew what to do at the time. Some victims are victimized again, by misleading information, police mis-training, or healthcare workers' prejudices. Even today it still happens so frequently, many people would be surprised. Every comment counts.
Doctors working in a hospital may be called upon to do a sexual assault examination even if they have not had specific training. The American College Emergency Physicians publishes a handbook of guidelines.
The National Resource Center on Domestic Violence published a 2011 white paper, "The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs," that highlights others' research on some of the challenges rape victims face once they arrive at the emergency room, for any who are curious. Lack of training and staff attitudes are still significant challenge areas.
Carrie Tibbles, a Boston emergency physician, presented at a 2009 ACEP conference that in Massachussetts, only 50% of sexual assault exams were done by a SANE nurse. Massachusetts is one of the most medically progressive states in the country. This emphasizes that despite improvements in victim care, and adaptations by emergency services to the demands of society, optimally trained personnel are only available in a limited fashion.
OK, maybe we disagree less than initially apparent. Obviously I no longer have to convince you that a rape victim needs specialized treatment. But have I still not convinced you that the ER doc is not likely to feel kindly toward a rape victim's mother who insists on having a less qualified ER doctor without the resources, time, and (likely) training, do just part of the care? When the hospital has helped set up exactly the service the patient needs? Tying up the ER" would be a mild and charitable perception to a likely shift-ruining, unreasonable, PITA patient. The doctor at that point knew she couldnt win, and the mother went on to confirm it.
And while we may differ on what we might guess about some unspecified aspects of the encounter or the physician's attitude, it seems pretty clear that someone at the first ER was trying to persuade them to go to the second ER where the specialist was. If you really dont want to believe the doctor tried to turf her there ASAP, then you are just looking for a reason to make the doctor a bad guy.
If you are all looking for an example of a doctor to hate for breaching professional duty on the grounds of her own religious belief, this isnt a very good candidate case. It kind of tells us more about the prejudices with which many of the folks here interpret a very incomplete and one sided story than it does about a specific doctor.
According to the mother, the doctor said he/she wasn't going to treat the young woman because of his/her "beliefs" (I'm going with religious at this point). There is no evidence to suggest that the doctor or the ER was too busy or didn't have the appropriate resources to address this traumatic event.
Jeff, of course you are going to go with the assumption she is a religious villain. It is far easier and more satisfying than understanding what ER medicine is really like and how wrong news stories can be. It's ok, your prejudices are in the safe majority here.
Where's the post I can cuss in?
I hope they file a complaint with the medical board. I find that complaining to medical boards can be very tedious, but that is the only way to get to this MD...who will claim she didn't want to treat the girl until she was seen by the "official rape crisis team." that will be her out...
I like to think I am the kind of person that hates no one, then I hear a story like this and...I realize I lie..
any reason why I keep getting the posting error: I'm posting too fast...when uhm, well, I'm not..
"I'm going to let my ridiculous personal beliefs get in the way of doing my job" is a perfectly reasonable attitude for the physician to have even if it compounds the pain and trauma of the victim.
Frankly I don't see what the fuss is all about...
How appalling - I am outraged!
Listen again. I think we do not have the whole story.
1. One of the pieces is this. Rape exams have become so specialized for legal reasons (preservation of evidence, etc) and medical reasons (strong social opinions on proper counseling) that it has become a specialized service-- completely paid for by the hospitals, not the insurance company and hardly ever the patients. The hospitals in this area apparently have a system where a specialist is available in the community all of the time but not at all hospitals all of the time.
2. It sounds like the doctor told them she was not the specialist and the specialist was at that time available at Baptist Integra.
3. Now we speculate. Did the mother and daughter try to induce the doctor to do just part of the service, like "we just want the contraception". The doctor of course is damned either way at that point, because if she does part of it she will be held to the same standard of care as the specialist. If she refuses to do just the parts they want, they can call her a heartless bitch, as they are doing. I have no idea what the three of them said to each other and neither do any of you.
4. So this is one more story that is simply a rorschach test about your opinion of ER doctors, because the facts we are told are potentially congruent with all the fault at either end or somewhere in the middle.
Am I the only one here who absolutely cannot parse the response from Integris?
Never mind. I take back my previous comment. I was getting the two hospitals confused. After watching the video again, the comments make sense.
"It sounds like the doctor told them she was not the specialist and the specialist was at that time available at Baptist Integra"
The mother of the victim said the doctor refused treatment because she said "it was against my beliefs". If that's true then this has nothing to do with rape specialists or following protocol. If what she said is true then this is about a doctor letting her personal beliefs interfere with patient care.
However, I agree there is probably more to the story than we are being told.
This whole "personal belief" shit really should never be acceptable if you went into a job knowing full well what you'd be doing. There's no reason that poor girl should have suffered even more =(
something doesnt seem right here. I think there's a bit we're missing. Mom is more upset about the treatment than the 'fact' her daughter was raped. She also states her daughter just wanted treatment and then go home ... no police report? Raped early sunday morning, at an apartment complex ... mom picks her up to take her to the hospital, where's the cops?
This just doesn't make sense.
john smith,
so it doesn't bother you that the ER doc specifically told the mother and her daughter that she is not going to give them emergency contraception because of her religious belief?
Can't someone get fired here? Do we have to record these (supposedly protected) doctor/patient conversations in order to figure out if proper treatment is being given? Is this some Oklahoma arrogance from some jerk doctor? So many questions, but as usual, media doesn't answer any of them.
There is a need for outrageous behavior on blog posts because an equivocal situation doesnt allow the righteous indignation, does it? And what else is as satisfying? However, intelligent people should pause at a really outrageous story and wonder if it includes all the relevant facts.
One of the apparent facts here is that the hospitals in the community have attempted to provide (at likely their own cost) a full-service specialist available to provide what is likely more sympathetic and more expert -- from both a medical and legal standpoint-- service. The doctor referred them to this service. I can think of lots of reasons why that are way more compelling and probable than that she did it because of her own religious beliefs.
Rape visits tie up emergency rooms. Whoever deals with it is suddenly removed from availability to any other patients for half a shift or more. Rape victimes require an uncommon combination of expertise: ability to do a pelvic exam, STD knowledge and prevention, counseling skills for an upset victim, legal understanding of chain of evidence rules, ability to counsel accurately about legal rights, etc. Prescribing a morning after pill is the simplest part of it .The likelihood that a random ER docs can do all this to the satisfaction of victims and their advocates is as small as the likelihood that a random ER doc can operate on a subdural hemorrhage. They stabilize life-threatening problems and refer to a specialist. The US government has mandated that "ERs are the free walk in clinics of this country.
So the community hospitals pay for a specialist service and rotate it among the hospitals or base it at the hospital with the highest demand. The ER doc seems to have determined there was no life-threatening emergency and sent her where she could get the best care.
Most of us are assuming that the patient asked for the morning-after pill and she refused because she equates it with abortion. And was self-righteous enough to give them that reason. ER docs may be all kinds of things you dont like, but few of them are stupid enough to say something that they know will get them in trouble when there are a dozen valid and legitimate reasons for doing the same thing.
I can guess lots of reasons why the woman and her mother did not like being referred--- inconvenience, another ER wait, fear that the someone would ask uncomfortable questions or involve the police, and many others. But those are not newsworthy complaints, are they?
So in judging the relative probability that (1) the ER doc gave a patient a non-allowed reason for a legitimate referral, or (2) the patient's mother exaggerated or distorted what was said, I think (2) is more probable. But WE DONT KNOW, do we?
Tyler gets it. joemac insists on that rush of self-righteousness. Even though the ER doctor had not put herself in a job in which she needed to prescribe an abortifacient, and even though she referred the patient to where she could get one (along with superior, specilalized care), joemac thinks having a patient accuse her of expressing her opinion on it should be a firing offense.
Tyler-
There was a police report filed. Do things make more sense now?
Interestingly enough, there was another recent case in NJ of a doctor letting their beliefs get in the way of patient care... this time in allegedly denying HIV medications to a gay man (as well as apparently having some rather... choice... words for the man's primary care physician when they spoke over the phone).
http://www.courthousenews.com/2012/06/01/47019.htm
1. News stories about doctors are one sided because doctors will not publicly discuss patients even in their own defense. Any of you ever been attacked for a distorted version of what YOU allegedly said?
2. Religion was not mentioned as the source of the ER doc's “personal belief”. Distinguishing ethics and religion should be easy for readers here. Might doctors refuse to treat a patient on nonreligious ethical grounds? Are there limits to what we are entitled to demand doctors do if they think it morally wrong? Should all doctors be required to do abortions on demand? It would be easy to compile a long list of things that a doctor and patient might differ about on ethical grounds.
E.g. A little girl falls. Cuts her face across the lip. Taken to clinic where she sees pediatrician who says, "to minimize the scar this should be stitched by a plastic surgeon, who is on call for the ER at St Elsewhere". Guessing this will likely take all day, the presumptive father (who isnt paying for it) presses the pediatrician to do it himself. The doc refuses, thinks the father a selfish fool. Father complains. Real case, not ethically much different. A doctor may realize she is not the best doctor for that patient's problem. Or will refer to another doctor willing to do what the patient wants.
3. The NJ case of a psych ward refusing to give a man his own HIV meds is indefensible ethically and legally--- if the facts are correct. It would be like denying someone with diabetes his insulin. Psych facilities sometimes refuse to admit diabetic patients because they do not want the trouble and responsibility for the medical disease. But if they have admitted someone with diabetes, they will not refuse to order the insulin.
4. From a medical ethics perspective two key differences between the two cases are (1) a life-sustaining medication and (2) availability of the requested service by a reasonably accessible alternate provider.
5. But she felt treated with contempt! No ideal patient deserves to be treated with contempt by an ideal doctor. But doctors sometimes feel contempt for contemptible behavior—for the father who could not be troubled to spend a few hours to save the girl from a disfiguring scar, ---but usually keep feelings of contempt from affecting treatment, or even showing.
We don’t know why that ER doctor behaved with contempt to the Oklahoma girl if she did. I can imagine scenarios where you too might feel contempt for the patient or mother: parent with priorities other than daughter's health, suspicion of false accusation for face-saving, transparently lying about relevant facts, talking about lawsuit, asking for oxycontin, displaying naked racism, arriving in an ambulance because it was cheaper to them than a taxi… Or maybe the doctor was an evil bible-thumper who thinks any woman who suffers sexual harm must have deserved it. You know, ‘cause that’s such a common attitude among women doctors.
At this point, I'm not even surprised. There was that story John Smith just mention about the NJ man refused HIV medication for close to a week (though that story is still fresh so the standard level of waiting for all the facts to come in should be expected). And of course that great one from a few years back when a private doctor refused to treat a young girl's ear infection because her mother had a tattoo and that was ruining the positive Christian environment he was trying to maintain. Because, you know, that's what really matters, not saving lives or some tiny detail like that.
Religious motivation is one factor where I would be unsurprised to see an otherwise intelligent person do something like this. A religious zealot would probably be more motivated to honestly express why they were doing it rather than using an excuse. Religious zealotry is one of those things where it's not just important to do something stupid and nonsensical - it's important to be seen doing it.
If you join, for instance, the military, you sign on the line agreeing to hold your personal beliefs at bay if you are ordered to do a mission you disagree with.
If you are a firefighter, and a house is on fire, you put out the fire even if it is the house of someone you don't like (gay person, non-christian, etc)
If you are a public defence lawyer, ethical standards require you to represent the best legal interests of your client, putting your own beliefs and prejudices in check.
Ok, you nitpickers out there are going to find gray areas and disagree with me; whatever, my point is this...
There are certain professions out there, including being a doctor on call at an emergency room (where the public is, by law, entitled to service), where you had better be prepared to put your personal (including religious) prejudices on hold to serve your duty. If you are doctor on call, or a firefighter on call, or a military servicemember on call, you don't get to choose.
You agreed to give up that right when you signed up for this job of special public responsibility. Somehow, some doctors, pharmacists, nurses, etc, feel OK weaseling out of this duty. (Hint: it has to do with mythical beliefs)
John Smith: You sir need to reflect on your words-- rape does NOT "tie up" emergency room services. That's like saying, trauma ties up operating rooms. Or coughs-and-colds tie up pediatric clinics. Hello... that's one of the reasons they exist.
Does twitter tie up the internet? Do Toyotas tie up the interstate highways? Does Delta tie up the air traffic control system?
Look man you may be a nice smart guy but you might not have any idea how inflammatory a thing it was, that you said.
Rape treatment is resource intensive, but why don't you compare that to the hospital resources required to deal with, say, an unrestrained high-speed motor vehicle accident. Or a homeless, mentally-ill, chronic ED visitor. If that's how you look at a rape victim, then you are one person I hope I never have to work with in my ED. Please think long and hard about what you said about rape victims.
john smith says-
"Most of us are assuming that the patient asked for the morning-after pill and she refused because she equates it with abortion. And was self-righteous enough to give them that reason. ER docs may be all kinds of things you dont like, but few of them are stupid enough to say something that they know will get them in trouble when there are a dozen valid and legitimate reasons for doing the same thing."
"So in judging the relative probability that (1) the ER doc gave a patient a non-allowed reason for a legitimate referral, or (2) the patient’s mother exaggerated or distorted what was said, I think (2) is more probable. But WE DONT KNOW, do we?"
My experience tells me (2) usually doesn't happen unless (1) happens. You don't see the giant stick in your eye, do you?
To Mac: I hate to break it to you, but most of your "facts" are wrong. Your arguments show ignorance in nearly every sentence.
1. Not every doctor is obligated by law to have every expertise. Not every doctor is obligated by law to do anything a patient asks for. Not every hospital ER is obligated to have a specialist of every type sitting there waiting for every type of problem.
2. Rape care has become a specialized service for EXACTLY the reason that you objected to use of the term "tying up the ER". Rape is a social emergency, a psychological emergency, a legal emergency, but not usually a medical emergency in the sense that immediate care is needed to save life or reverse injury. Not all doctors who work in ERs have the combination of social, psychological, medical, and legal skills to do it right, as this doctor demonstrated. Victims sure dont expect to pay for it, do they? And it offends you that an ER doctor might not welcome a perfectly healthy woman who comes because she was raped? That is EXACTLY why the hospitals set up an expert rape service--- because women DO deserve to have a rape handled right in all respects.
3. Assume much? I dont recall a single mention of religion in that new story. The dissatisfied mother claims the doctor refused to do what they wanted because of her "beliefs". You clearly are imagning that the doctor must have refused to do part of the care because of her "mythical" beliefs, yet ethical beliefs may be completely independent of "mythical beliefs", there were a dozen ways to put the story together based on the facts of the news report that are more probable than the doctor being a "bible-thumper who thinks any woman who suffers sexual harm must have deserved it." Some people can read and appreciate different ways to understand a story. Some clearly cannot.
JKR, there is no "stick in my eye". If you could read my posts you saw that I offered dozens of scenarios for the story. You too are quite naive if you think people dont exaggerate facts to fit their feelings.
When someone, like the young woman's mother quotes verbatim what the doctor told them, I usually find that it's in our best interest to first take the allegation seriously and do a full investigation into what exactly occurred.
I do understand you choose to give the benefit of doubt to the doctor, but those are precisely the reasons for the unbiased investigations, and I'd note that you are not arguing for an unbiased point of view. You have argued extensively from the viewpoint that the mother and the young women have a lot of reasons to exaggerate facts.
I'd hardly call your position neutral and convincing.
As for Mac, I agree with much of his/her comments. Being professional in one's occupation means exactly what Mac has written. If what is alleged turns out to be true, the doctor has exhibited an unprofessional conduct that merits a serious investigation and a possible sanction and dismissal from her job.
Hi again Mr. Smith,
Your #1 is a completely bizarre and irrelevant response. Where did I say ever Doc has to have perfectly broad expertise? You are reading into my response your own assumption that this is about some doctor refusing to treat a person because you presume they are exercising their discretion not to treat a case outside their expertise. I do not share your assumption that this doc is merely exercising discretion due to lack of appropriate training. Emergency docs specifically should have rape-specific training. The woman's story, as told one-sidedly, is very different. And regardless, there is a certain level of care, consideration, and BEDSIDE MANNER that the doctor is ethically require to provide.
#2: rape IS a medical emergency. The emergency room is the customary place where it is evaluated in U.S. hospitals. There are certain management decisions that MUST be made in a time critical manner to allow for the best outcome. If you limit your definition of "medical emergency" to only that which is immediately life threatening, you are ignoring a sizeable fraction of cases.
#3 your points that there are many sides to this story, and that we only have one of them, is well-advised and I acknowledge it again. Personally, I glean several things from the description and if I take aspects of the news testimony at face value, it is very difficult for me to envision ethical or competent behavior on the part of the doctor. You must be a much more generous--or less cynical--person than me.
It is still no excuse for accusing rape victims from "tying up resources." If you were raped by billy-bob in Arkansas, and came to the ED with excrutiating rectal trauma, worried that you could get HIV, HPV, herpes, syphilis, etc etc etc, scared to ever walk out to your car again in the dark, let alone afraid that you could get pregnant (and what if you had a condition that made it life-threatening to get pregnant)... I hope NO ONE makes you feel like you are just a hassle, just a drain on the system that exists to handle "real emergencies," just "tying up resources" that are better spent handling broken bones, new cases of smoking-related cancer, severe alcohol withdrawal, obesity-related heart failure, or... lets see, how many other preventable, self-inflicted life threatening injuries can we name? We treat all of these people with the respect, care, and competency they deserve. And they all deserve it.
That does not mean we offer them deplorable bed-side manner and make them feel ignored because "the SANE nurse isn't available" immediately. A competent doctor, acting ethically, would not have allowed this situation to develop whether a SANE nurse was next door, next town over, or 10 states away.
To quote someone else from elsewhere, this is the "comment section" not the "write a fucking novel section," so I'm going to bow out unless someone has a truly credible reply...
btw, my June 6, 9:00 pm post is in response to john smith's comments.
JKR and Mac, you both have trouble with reading comprehension, as well as poor understanding of professional ethics and laws regarding American hospitals and doctors,
1. JKR, I did not claim to give a "neutral" analysis. I claimed the original story was inherently biased because we only had one side of the story, as we always do when a patient publicly criticizes a doctor or hospital. I understand how much you passionately want to see the doctor as a religious zealot who thinks sexually harmed women deserve scorn rather than help. I happen to think that viewpoint is shallow, caricatured, and improbable for the reasons I gave, but you are entitled to your opinion. But the FACT is that we have only one side of the story and i would assume that every reader of this blog understands how easy it is to make accusations of wrong motives and attitudes when only one side of a story is given.
2. Mac, I hate to break it to you but a young woman who says she was raped does not look like a medical emergency to most doctors who thought they were going into ER medicine to take care of trauma, heart attacks, appendicitis, etc. So you do not think you are demanding that every doctor in the hospital has every skill set? Regardless of what you think you are demanding, that is indeed what it would entail for you to demand that every ER doctor be able to stop what they are doing and be a rape specialist. Referring a patient to the designated specialist with the most expertise, training, resources, time, and compassion is NOT unethical, regardless of the perceived attitude with which it is done.
3. I deliberately used the term "tying up" the emergency room because I was trying to help you understand what an ER is like, what a rape without injury may look like to some of the doctors and nurses who work there. Rape is a social, emotional, and legal emergency but only occasionally a medical emergency with physical injury. in this country all kinds of social and emotional problems are brought to the ER to be dealt with-- a homeless person making a ruckus on a street corner, a drunk lying on a sidewalk, a dumped lover threatening suicide, children with colds, and over and over, people seeking their oxycontin or vicodin or drug of choice. So yes, ERs are where rapes are brought, along with all those other social emergencies. That does not make all of these problems a medical emergency in any other sense of the word. These people all need help and deserve compassion.
4. I did not defend a doctor treating a patient with contempt-- I was trying to help you understand it. I am sorry if you are still so young and naive that it shocks you that not all doctors in ERs welcome all the social problems they are asked to deal with. There is a specialized rape service in many communities, but there are few specialized services available for mental health problems or chronic pain problems.
john smith,
Claiming someone who doesn't agree with you to have low reading comprehension skills as well as poor understanding of professional ethics and law, in addition to being "still so young and naive that it shocks you..."
Classy. You've taught me a lot john smith. I hope to see you around here more often.
You both asserted or implied i wrote things I did not, or responded as if i had claimed something else. Does that not justify my questioning your reading comprehension? I was trying to teach several of you the differences between a ER doctor's professional and ethical duties, and how unrelated they usually were to religion. I did realize that challenging the simple, shallow, and popular view that the doctor breached her professional view because she didnt share ethical values with her patient would elicit resistance, but the story and the initial responses seemed to so poorly understand what i suspect happened that it just seemed like it might be an interesting contribution to help people see that there were likely more sides to it.
It sounds like you, unlike Mac, grasp at least a little of this even if you dont like it. Real ER care is a lot different than television shows and Mac's fantasies. If every doctor whose patient accused them of not showing proper compassion and respect were fired the ERs would be closed. I am not exaggerating. No real doctor, no matter how conscientious, compassionate, or politically correct in his or her attitudes, has not had a patient complain about his or her attitude. If you dont see patients you will never offend anyone, but if you do, it is simply an occupational hazard. And it hardly ever has anything to do with religion.
Mr. Smith: You are bordering on some personal attacks here with comments like "poor reading comprehension... etc." Perhaps we are all guilty, but how about we all remind each other to keep it civil. We are clearly arguing past each other and operating on different assumptions about the situation.
If you feel that rape should not first present to the ED then you are at odds with many official recommendations.
for instance read:
http://www.nlm.nih.gov/medlineplus/ency/article/001955.htm
If you would like a brief clinical perspective on rape, I suggest you read:
www.aafp.org/afp/1998/0915/p920.html
as well as: http://www.aafp.org/afp/1998/0915/p929.html
(which specifically advises visiting a hospital emergency department)
Another AAFP article is reproduced at:
http://www.aaets.org/article130.htm
And it specifically discusses ED management. (It's a little dated but not that much)
I would consider your opinion of the role of emergency departments to be excessively narrow, and not reflective of the actual demands society places upon the ED. If you happen to be a healthcare professional I urge you to expand your parameters for what is entitled to emergency department care. It may even help you offer more compassion and better care to your patients.
I maintain, narrowly, that "tying up resources" is an insensitive and unjust characterization of ED rape management, because rape requires a time sensitive examination, time sensitive treatment to prevent morbidity, and although mortality is uncommon, life-threatening injuries may need to be ruled out. (The role of the ED is not just to treat life threatening injuries. It is to rule them out, or direct their further management either in the ED or another appropriate hospital setting, as well as to provide time-sensitive treatment for non-life-threatening conditions i.e. urgent care.
I am certainly not saying every doctor needs the skills of a SANE nurse. I am not even saying every hospital needs a SANE nurse available all the time. I am not sure what you are saying any more, other than that rape victims don't belong in the ED. That is my only point of debate with you.
By your definition, I would take it that you think a broken leg need not be seen in the ED and should instead be managed by an appointment at an orthopedic clinic. Most people would agree that while most broken legs are not life threatening, nevertheless it is nevertheless generally regarded as an appropriate reason to visit the ED.
Finally, frankly speaking... it is incredible, baffling, breathtaking, and yes, offensive, to me that anyone would suggest a rape victim not go to the ED. That flies in the face of professional recommendations, doctors' opinions, advocates' opinions, public perception, and rational inspection. If you are aware of any professional recommendations against this use of ED resources, I would welcome references. Otherwise, good day, sir.
My other comment disappeared, I'll keep this briefer.
Mr. Smith-- your condescending manner is inappropriate and not appreciated. I have no disagreement with much of what you said, but I maintain that it is offensive and wrong to characterize rape as "tying up resources."
For ANYONE who is raped, and wonders where to go, please be assured that the emergency department is the appropriate place. You will not be "tying things up," as it has been crudely and unfairly put.
I have tried to post URLs to references, but maybe the spam filter doesn't like that. Instead here are some citations for clinical perspectives that clearly endorse the use of the emergency department for management of rape:
Petter and Whitehill. Management of Female Sexual Assault. Am Fam Physician. 1998 Sep 15;58(4):920-926.
What to Do if You're Raped. Am Fam Physician. 1998 Sep 15;58(4):929-930.
Beebe K. Emergency Management of the Adult Female Rape Victim. Am Fam Physician 1991 June
NIH online recommendations are consistent with this, sorry no link.
I also recommend the UpToDate article, "Evaluation and management of adult sexual assault victims." This article specifically addresses indications for referral to a trained provider/examiner.
Finally, the emergency department, in general, is not just for the "life threatening" medical emergencies. It is for urgent care, triage, and ruling out life-threatening conditions as well.
If someone went into EM only because they love acute abdomens and trauma, and don't want to deal with other things, well... Don't apply for a job around here.
If misogyny is now classified as a religious belief that cannot be interfered with because of the First Amendment, does hatred of bigots get the same deference?
Again, mac, you ignore what i wrote to accuse me of opinions i do not hold. Women who have been raped deserve not just treatment of physical injuries, but sensitive and informed emotional, social, medical and legal support . Optimal performance of all of these is beyond the competence of most ER docs-- regardless of your wishes and television fantasies.. Performance of all of those things can take several hours. Raped women often come to emergency departments for this care. THEREFORE, many hospitals have developed special resources, programs, people, and/or locations to provide this better care and to continue to have ER physicians available for other patients in a busy ER.. I still do not understand why this concept seems so difficult or offensive for you.
None of us were present for the conversation between these three people. I think it far more likely that the physician referred her to the rape specilalist for all the good reasons described above rather than from religious zealotry, and far more likely that the mother was mainly unhappy at the incovenience of the referral rather than the motivation. But several of you are making it clear how unacceptable that opinion is here. Fine.
Mr. Smith--
I agree with you, referral to an appropriate center is not just fine-- IF it's available in a timely manner, it is absolutely preferred! That has never been a point of contention among any of us, as far as I can tell. And I certainly don't think that's an unacceptable opinion for you or anyone else to hold.
You give the doctor more benefit of the doubt than I would, but I'm not even debating that. And I'm sure you'd agree that it would be unacceptable for a doctor to refuse to treat, AND simultaneously refuse to refer to someone else. (Although my fear is that the doctor in question, at best, refused a specific referral and instead gave a general one, a la "go somewhere else, I don't treat this")
I don't think your defensiveness on these points has been necessary. I don't think you've understood my concern, I haven't understood the context of your replies.
So, let me try to clarify my issue another way. My beef is that the term "tying up resources" is derogatory towards victims, and discourages them from seeking help in the first place. If a person is raped, and scared, and wondering what to do, they may be afraid of further embarassment by going somewhere where they'd feel as if they were inconveniencing others, or improperly utilize resources. Instead, they might go home, shower, douche, and try to forget about it.
"Resource intensive?" yes. "Tying things up?" no. My issue has always been purely semantic and not procedural. (Sound quibbling? Read the end)
I hope that is a bit more clearly put.
You know, you could have called me out, "Hey Mac you said some pretty offensive things about religion in your first comment. So what, if I'm not PC? Neither are you." And I'd reply, "point taken." I just happen to be more sensitive about offending rape victims than I am about the faithful.
Why? Someone close to me is a victim's advocate. And I have friends who have been assaulted. Not all of them knew what to do at the time. Some victims are victimized again, by misleading information, police mis-training, or healthcare workers' prejudices. Even today it still happens so frequently, many people would be surprised. Every comment counts.
Doctors working in a hospital may be called upon to do a sexual assault examination even if they have not had specific training. The American College Emergency Physicians publishes a handbook of guidelines.
The National Resource Center on Domestic Violence published a 2011 white paper, "The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs," that highlights others' research on some of the challenges rape victims face once they arrive at the emergency room, for any who are curious. Lack of training and staff attitudes are still significant challenge areas.
Carrie Tibbles, a Boston emergency physician, presented at a 2009 ACEP conference that in Massachussetts, only 50% of sexual assault exams were done by a SANE nurse. Massachusetts is one of the most medically progressive states in the country. This emphasizes that despite improvements in victim care, and adaptations by emergency services to the demands of society, optimally trained personnel are only available in a limited fashion.
Correction: 2004 article by Campbell & Diegel, not 2011
OK, maybe we disagree less than initially apparent. Obviously I no longer have to convince you that a rape victim needs specialized treatment. But have I still not convinced you that the ER doc is not likely to feel kindly toward a rape victim's mother who insists on having a less qualified ER doctor without the resources, time, and (likely) training, do just part of the care? When the hospital has helped set up exactly the service the patient needs? Tying up the ER" would be a mild and charitable perception to a likely shift-ruining, unreasonable, PITA patient. The doctor at that point knew she couldnt win, and the mother went on to confirm it.
And while we may differ on what we might guess about some unspecified aspects of the encounter or the physician's attitude, it seems pretty clear that someone at the first ER was trying to persuade them to go to the second ER where the specialist was. If you really dont want to believe the doctor tried to turf her there ASAP, then you are just looking for a reason to make the doctor a bad guy.
If you are all looking for an example of a doctor to hate for breaching professional duty on the grounds of her own religious belief, this isnt a very good candidate case. It kind of tells us more about the prejudices with which many of the folks here interpret a very incomplete and one sided story than it does about a specific doctor.
According to the mother, the doctor said he/she wasn't going to treat the young woman because of his/her "beliefs" (I'm going with religious at this point). There is no evidence to suggest that the doctor or the ER was too busy or didn't have the appropriate resources to address this traumatic event.
Jeff, of course you are going to go with the assumption she is a religious villain. It is far easier and more satisfying than understanding what ER medicine is really like and how wrong news stories can be. It's ok, your prejudices are in the safe majority here.