Sexual assault and the ER

Is the ER the best place for an examination after a sexual assault? Scalpel argues no:

In my opinion, it is my job to stabilize and treat your emergency medical condition. Collection of evidence and detailed completion of medically-unnecessary forms (while sicker patients wait unseen) in order to support an often doubtful and frequently unpursued court case is something altogether different.
I think such examinations are best performed in specialized facilities….not the typical ER.

Comments

Evan
It’s very nice that Houston has such a facility, and in a town that has one I think that’s outstanding. For most places however, there is no such facility except the ER.
Anonymous
As Evan says most cities do not offer this. But, Scalpel also knows those women need to be checked for injuries, receive antibiotics, nerve medication and etc…Why in the world would you want to send someone in this condition all over town seeing multiple providers and having multiple providers touching them when they had just been raped?
by “more sick” is he implying the colds, flus, strained muscles, addicts and those sent to him because of a k of 3.3 are more sick and in more need of care? After all, aren’t those all things he also bitches and whines about? Incessantly! When did being in need of care become more about what the doctor wants, rather than what is best for the patients?
scalpel
Here’s where I would put them in line:
CPR in progress
Penetrating thoracic trauma
Acute neurologic deficit
Active chest pain
Abdominal pain
Facial or pediatric laceration
Sexual assault
Other simple lacerations
Cold or flu
Strained muscle
Potassium of 3.3
Anonymous 12:21
Anonymous
Thankfully “you” won’t be putting me any where. I am not even remotely close to Texas. BTW, that’s exactly where I would also put you.
MLO
This is an extension of the discussion started by the Well Timed Period around whether doctors have the right to refuse or refrain from telling female patients’ a given treatment due to their religious beliefs.
Let’s see? I did a stint working in the field of child abuse and neglect. Sexual assault victims are both physically and mentally in danger. So, you are going to allow the trauma to continue by making the woman go all around the city instead of helping her get her bearings back after a very traumatic event. Somehow, I don’t think that should be the standard of care.
Pax,
MLO
scalpel
If a child has been sexually abused, I assure you that they would be much better off being evaluated in the Children’s Assessment Center than in ANY emergency department anywhere. I would encourage every community to offer similar services for their most vulnerable citizens.
In the case of adults, why should we treat sexual assault differently than any other assault?
Anonymous
by “any other assault” I assume you mean the guy that gets his a** kicked in a bar fight? I say that because obviously you see alot of this type assault injuries. How can you even possibly see a comparison is what Im trying to figure out?
If your wife is attacked and raped, do you want her to be treated the same as the drunk in the bar fights?
Do you have any compassion whatsoever?
ERMurse
If your system has the ED MD or Resident doing the SART exams fitting them in around all the other patients then you dont have a system. I am suprised the DA in your community would tolerate such a system. Each facility or a designated facility (ER) within a community should have either an on-call SART examiner or someone on the staff such as a midlevel trained in the exams that is pulled off their other duties and dedicated to the exam. In some facilities I have worked it is the Fast Track Midlevel, others an on-call Nurse or Midlevel that can respond to the facility.
scalpel
“If your wife is attacked and raped, do you want her to be treated the same as the drunk in the bar fights?”
Are you suggesting we treat drunks in bar fights poorly? Why would that be? Because they are drunk? Because they were in a bar? So were many of the sexual assault victims.
Where is YOUR compassion?
You obviously know nothing about emergency medicine. We treat everybody the same; everyone is deserving of equal compassion.
But not every emergency department has SANEs on call 24 hours/day, thus the point of my post.
Anonymous
You know what Scalpel, that’s exactly what I am saying. Two grown men outside a bar fighting, is in no way comparable to a woman being raped.
Are you saying that all women who get raped ask for it? because that’s what it sounds like you are saying. You are comparing a sexual assault to a bar fight.
Do you not treat rape victims with any more compassion than you do a guy getting in a fight with another man?
You are without a doubt the most arrogant Doc. I’ve ever heard of.
Anonymous
In some areas, don’t they have specialized teams to do the exam?
The idea being, the exam was physically done in the ER, but a specialized group to do the forensic sexual exam.
Whatever other advantages there may be, you got the advantage the team could more easily be found for future court testimony.
ER docs may come and go, as contracts change, people finish training programs, etc. Can’t get testimony if you can’t find the doc or not easily available.
scalpel
“Are you saying that all women who get raped ask for it? because that’s what it sounds like you are saying. You are comparing a sexual assault to a bar fight.
Do you not treat rape victims with any more compassion than you do a guy getting in a fight with another man?”
Are you saying that everyone who gets attacked in a bar was asking for it? Because that’s what it sounds like you are saying.
Get a clue.
Anonymous
Let’s see scalpel:
1: You don’t want to take care of PCP’s pt’s and make fun of them when the pt is sent in for an eval.
2: You don’t want to take care of women after sexual assaults.
3: You talk about treating everyone equally with “compassion” in the ER. Then you go into tirades about drug users, idiots who don’t know the purpose of an ER, and losers who clutter your ER.
Just who the hell do you want to treat?
Something a very wise attending said to me back in the dark ages of medical school was:
What consitutes an appropriate visit to the ER?
A: Whatever a patient states it is until they have evaluated.
Personally I think you need a serious attitude adjustment. If that fails then go find another career.
scalpel
Anonymous medical school reject:
1) I am happy to take care of any patient, as I have said many times. I am sad when bottom-rung PCPs send their patients to the ER unnecessarily instead of being able to care for their patients in a competent manner. It’s sad when these patients have to wait for hours, get a huge bill, and be discharged with only a pat on the back by a more competent physician.
2) I am happy to treat women after sexual assaults. But I’m a doctor, not a detective. I take care of the medical issues, and the police can take care of the legal case. Like any other assault.
3) I have never called any of my patients losers or idiots on my blog or anywhere else. I would be happy to respond to specific examples (if you can find any), but this is not the proper forum for your little tirade. You are frothing at the mouth like Old Yeller. Perhaps you should settle down a little bit and take some deep breaths.
Anonymous
How much of an ER doc’s time is taken up with medicolegal testimony because of…….auto accidents, other trauma, workplace accidents, sexual assaults, for that matter assaults generally.
It’s enough of a hassle in primary care, I can imagine what it must be in emergency medicine.
Anonymous
Sorry it’s a hassle doing your civic duty. Stop being a doctor and become a hermit if it’s putting you out that much.
What’s the “medicolegal” system? You’re a witness, explaining what you saw/did. Get over yourself.

Sexual assault and the ER

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