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How to be a considerate ER physician

Spending time on off-service rotations gives you a good view of the ER from the outside. Here's something that I used to know in my head, and that I now know in every organ of my body:

If an ER doc calls a trauma consult for a patient with abdominal pain from trauma eight hours after the patient first came to the ER, that doc should have done a rectal exam already. It's just considerate, not to mention good patient care.

I'll try to remember this when I'm back in the ER.

Comments

Eh. I've been doing this for ten years now and I have never once seen a trauma case in which the rectal exam yielded new or clinically unsuspected information. (Spinal cord injuries being the exception) Agreed that you should probably do it in a training environment so you don't piss off your consultants, but don't be deluded by ATLS into thinking it an important part of the exam.

Fair enough.

My point is only that when the ER doc knows that a rectal needs to be done for whatever reason -- patient care or placating the seniors/attending on the trauma service -- the considerate thing is to do the rectal and document the results in the 8 hours before calling the consult.

When I'm in the ER, I'm not going to leave a rectal exam for my consultant unless I know he's going to have to repeat it anyway. It's like pelvic exams -- do it yourself unless you know the ob/gyn is going to have to do one anyway. (No sense subjecting the patient to two exams when one will suffice.)

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