Hey Doc, No Hands: Part 2

You don’t get patients who refuse examination very often. There are those who do fall in this category, but most of them see reason when counseled and get examined. The second patient of the adamant variety I saw was a staff nurse. I was a Registrar (senior resident) then. She came to me in the outpatient clinic and told me that she was two months pregnant, had vaginal bleeding, and the lecturer had asked me to admit her. SO I admitted her in the antenatal ward. After the outpatient clinic, I went to see the newly admitted patients. She was there. I took her history, and then asked to go to the examination room for getting examined. “No, I don’t want an examination” she said. “But it is not possible for me to make a diagnosis about your condition without an examination” I said. “You may have a threatened abortion, inevitable abortion, and I hope not, but even a missed abortion or an ectopic pregnancy. The treatment for each of these conditions is different.” She should have known all this, because she was a staff nurse. In those days ultrasonography was not easily available. Nowadays, it is easily available, and often patients present with an ultrasonographic diagnosis, making a clinical examination superfluous. “I have had an abortion before, and if you examine me internally, I will have an abortion again” she said. “That is not correct” I said “a clinical examination does not cause an abortion.” “Whatever you say, I will not be examined” she said. She was an employee of our hospital, and the Matron was her boss. This situation was better than that of an outside patient. So I called the matron and explained the situation to her. She promptly arrived along with a couple of senior nurses. Together they counseled this patient. Finally they told her that she had to undergo an examination and informed me she was ready for an examination. “But if I develop and abortion, I will hold him responsible” the staff nurse said. I was experienced in the psychology of such patients who wanted to put the blame on the doctor for whatever went wrong with them. So I told them that I would do only a speculum examination first, so that only the vagina would be touched. If she was found to be aborting, I would not make a palpatory examination and would be free of any blame from the patient. I also asked the matron and the two nurses to remain present as a chaperon cum my witness. They agreed. I put in a speculum gently and found that her cervix was wide open and the products of conception were bulging out. She was aborting. I showed that to the chaperons cum witnesses, declared the same to the staff nurse and without touching her in any way took out the speculum. She got off the table. Before she could walk away to her bed, the products fell out. I heard she did claim to other nurses later that she had aborted because of me, but I had the matron and two senior nurses as my witnesses. I was glad I had examined her, because I felt she was quite capable of saying she aborted because I had not examined her properly and given appropriate treatment.