06 December 2007

Low Standards

One of the things in the ER is that we do the same thing over and over, and what is routine to us is very abnormal to patients. Certain things predictably draw comments from patients, and as a result, there are some conversations I seem to have over and over again. One predictable one goes like this:

The setting: seeing a normal, healthy female patient between the age of 20-40, for an acute complaint such as chest pain. As part of the physical exam, I need to look at the lower legs, shins and calves, to evaluate for edema or signs of a blood clot. I lift the sheet and if necessary pull up the hem of the pants legs to expose the skin.

Patient: Oh my God, I'm so embarassed. I didn't shave today!
Me: (reassuring tone) Don't worry about it, I'm just checking for fluid retention.
Patient: (increasingly mortified) I just never thought you would need to go there...
Me: It's OK, I'm not easily offended.
Patient: Oh, no, I'm so embarassed.
Me: (firmly) Listen, honey, this is the ER. 'Round here, if you've bathed at all in the last week you're ahead of the crowd. You really don't need to be embarassed.

It never fails to elicit a laugh, and to defuse the tension. But it's also true -- it seems that the hygenic standard for ER patients is ... somewhat lower than in my social circles. Sadly, I also have basically the same conversation doing pelvic exams.


  1. You mean women are embarassed about not having had a brazilian wax done before going to the ER?

    That is sad.

  2. shadow:
    as a woman ED doc, I never get that comment about unshaved legs.

  3. House Whisperer12/06/2007 10:31 AM

    I have that conversation twice a week. And this one:

    "Doc, I really can't stand needles. I mean, I hate needles."

    I used to do the ol' "Well, that's normal and we'd think you a little strange if you really liked them." But I've gotten so tired of this conversation that it's all I can do to just smile and say, "Is that so?"

  4. I don't think I would call them "honey" :)

  5. classic. you got my first chuckle of the day.

  6. I had a 23-year-old woman in the GYN area c/o pelvic pain and bleeding. One of our residents (male) came in to examine her while I chaperoned. He explained that he was going to do a pelvic exam, and she said, "Can't SHE do it?" (referring to me.) We told her no, and the MD asked if she would prefer a female doctor. She said yes, and he went out to find a colleague.

    The girl turned to me after he was out of the room and said, "He's so CUTE! I can't have him looking at me down there while I'm bleeding!"

  7. My grandmother (78yrs) had the same thing happen to her in the ER when she had a 'funny turn' (she has LBBB).
    She told the (young male) doctor she was so embarrased, she hadn't shaved her legs in a week and a half. He replied that it was quite alright, neither had he!
    It was the perfect answer and managed to raise a smile, despite how dreadful she was feeling at the time.


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