by If you bump your head and are taken to the emergency room for eight stitches — would you expect a rectal exam to be part of the diagnosis process?
What do you make of the case Brian Persaud — a 38-year-old construction worker — is making in court as he sues the hospital that treated him for a head injury and then forced a rectal exam against his consent:
Mr. Persaud was taken to the emergency room at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, where he received eight stitches to his head. According to a lawsuit he later filed, Mr. Persaud was then told that he needed an immediate rectal examination to determine whether he had a spinal-cord injury.
He adamantly objected to the procedure, he said, but was held down as he begged, “Please don’t do that.” As Mr. Persaud resisted, he freed one of his hands and struck a doctor, according to the suit. Then he was sedated, the suit says, with a breathing tube inserted through his mouth.
After Mr. Persaud regained consciousness, he was arrested, then taken — still in his hospital gown — to be booked on a misdemeanor assault charge.
Was the hospital right to require a rectal exam?
Was Mr. Persaud in the correct frame of mind to cogently deny the rectal exam?
Where is the line drawn between a necessary emergency medical procedure and a patient’s right to deny treatment?
When men reach a certain age — The Rectal Exam — becomes a big and looming and necessarily ordinary part of their lives as an ongoing check for prostate trouble.
Some gynecologists require rectal exams as part of a routine pelvic exam — and some doctors will even do a “rectovaginal exam” where a finger is inserted in the vagina and another finger in the rectum at the same time — and please be warned this video is a graphic, but professional, demonstration of that exam. Do not click to watch if you are not old enough, or mature enough, to handle the matter.
I’m sorry I couldn’t find a similarly professional prostate exam video. I think it’s sad and telling that YouTube is filled with so many unfunny “funny” prostate exams. How do you feel about getting poked and prodded?
Have you ever felt violated by your doctor?
Did you say anything?
Do we feel more violated when entered rectally than through the mouth or urethra?
Is there more of a cultural taboo when it comes to bending over than when we spread our legs?
Can we ever overcome the involuntary tightening when asked to relax our sphincter?
I think it’s highly likely that Mr. Persaud’s refusal was down to some level of homophobia on his part. For some unknown reason a huge number of men seem to equate having a rectal/prostate examination with a sexual act.
I had one recently when I went into hospital for abdominal pains (turned out to be gallstones). I’m pretty sure the doctor didn’t do it for his own enjoyment (certainly not for mine, although it wasn’t as painful as I was expecting)
It would be nice to raise the issue above the level of schoolyard humour and childish innuendo – and it might save some lives in the process!
urbanspaceman —
I agree with you Mr. Persaud has some sort of fear of a finger up his bum — and at age 35 he’d better get used to if he hopes to stay in good health.
I think the hospital was perfectly reasonable to do the exam and even though Mr. Persaud refused and fought them and he had to be sedated — the hospital did the right thing in checking him out so thoroughly because he was behaving irrationally and the smash on the head may have no only affected his thinking, but other parts of his body as well.
I find some MDs are not eager to do a digital exam. You sometimes have to demand one if you have a history of prostate trouble in your family.
I agree we need to raise this discussion beyond the idea of violation and “homosexual desire” and into the realm of dealing with serious concerns to life and well-being.
The YouTube video indicates women have greater access to a serious preparation for this sort of exam than men.
I suspect he would have also sued them IF not having the rectal exam HAD missed a spinal injury.
Will ask a couple of medics I know about the procedures in the UK .
Nicola!
Now that is EXACTLY right, isn’t it? He wants to have it both ways — no exam, but I sue you if you miss my injury ; poke me with without my consent, and I sue you for violating me.
That really bears down on the consequence of modern living: You can’t win if you try or if you beg off… you’ll have it taken to you no matter what — so the only thing you can do is to do the right thing as best you know it.
I’m glad the hospital is going to court to fight the matter instead of paying him off to shut him up — which I’m sure is easier for them and probably what he wants in the end. They must fight because he called into question their very method for being in medicine.
an amazing video David. The patient was brave. I coulnd not have done it.
Some people just spend their lives looking for trouble. This guy seems like that sort of person.
That’s a pain in the ass and I don’t mean the guy. Got man hurt looking at picture. Video couldn’t handle even if I had the parts.
Anne!
How right you are. The video is beautiful. I’m with you on the patient/performer… I would not have been able to do it, either. She did a great service to us all.
The video makes that sort of examination “okay” and public and it offers the opportunity to heal and talk about these things out loud together.
Gordon —
You make a good point. The hospital was trying to give him a complete and whole examination and, because of his insecurities — or the gash on his head — became irrational and cruel. Now he wants to get paid his bad behavior! Shameful.
Karvain —
Ha! “Man hurt” — as in that queasy feeling with get in our groin when we ride a roller coaster of see something that makes us dizzy, RIght? I get where you’re coming from… and I know that uncomfortable ache…
The video is great and I’m thrilled it’s on YouTube so those too shy to ask about the procedure here or with their friends or MDs can at least understand what’s being done and why. I wish we had a good male video for the prostate exam.
Having checked with my *personal* A&E expert ( consultant) – the head injury would have to have been in a very specific area – ie back of the base of the head to require a rectal examination of that nature in the UK. Not only would there have been a chance of spinal damage but of nerve damage as well. It would be a very unusual and very specific injury.
It would also depend on what other symptoms he was exhibiting at the time and any other pain he was complaining of – or bruising .
Thus spoke my A&E expert.
The video is excellent and needs to be shown to a few of the Doctors I have seen over the years!
Thanks for that report, Nicola. I just can’t imagine any MD or nurse or hospital emergency room would waste an ounce of effort or a minute they don’t really have in the crush of the job to do a rectal exam on a guy if they didn’t feel it was, in some way, a medical necessity to make sure he was okay.
Perhaps if the circumstances were different: A private practice, previous sexual innuendo, turned-down advances… or something like that… you might be able to make a case for an unwanted violation that wasn’t medically necessary.
I agree that video will help save lives. I’m sure it could never be shown in any public school in the USA without total condemnation, firings, and feigned outrage at the “overt sexuality” of the rectovaginal exam.
I can’t sympathise with the guy. The cultural taboo’s associated with going in via the back door are not as important as proper diagnosis, and as others have said, he would have sued if they hadn’t done the examination and something had cropped up at a later date.
Rectal exams have been pretty standard practice for decades. There’s no requirement to enjoy it, but it has to be done.
That’s a good point, ruzkin, about the procedure being necessary and you don’t have to like it even if you must accept it.
Those doctors had no right to do a rectal exam on that man without permission or concent. What happen to patience rights, I wouldn’t let a doctor do that to me or I won’t go to the doctors anymore.
Also, the doctor is suppose to ask and if a person says no, it’s no. I won’t even let my OB/GYN do that to me when I go for a pelvic exam. I made it clear that I never want to have that done and she respected me when I said no. I’m sorry I don’t find it necessary and I’m totally against it. I’m sorry that’s my opinion.
The doctors were required to do a rectal exam. He had a head injury and was an emergency patient.
If you refuse to let your MD do a rectal exam — when and how do you have your rectum examined?
What is your rationale for refusing to allow an MD to do a proper, rigorous examination?
It doesn’t matter WHY he refused the exam. It doesn’t matter if he was polite, or if it was logical. No one should be penetrated against their will. How is this something that still needs to be said??? As a rape survivor with PTSD and chronic pelvic pain, I struggle to force myself to find medical care. I cannot handle a regular external physical exam, and need to be sedated for dental work etc. Sometimes I am in so much pain that I cannot walk. Sometimes I black out and throw up. My biggest fear is that something like this will happen to me. I would rather die. Please think about the fact that this man will have to live the rest of his life with the trauma of what those doctors did to him. You cannot imagine how horrible it is to go through the recovery process after something like this. You can’t fathom the pain and long term suffering. You cannot justify this- patients are people with rights that don’t dissolve when they walk into a hospital.
I was rear-ended (sorry for the pun) by a drunk driver as I waited for light to change. I got mangled and was taken to the hospital wih undetermined injuries. The doc on duty was a nice woman who quickly had my clothes cut off; she told me that she needed to do a quick rectal exam s part of the workup. Shekept asking me if it was “ok” to proceed and I told her that I consented. No issues since she ASKED first.
Thanks for the comment, gareth, but if you’d been unconscious and unable to consent, the rectal exam would’ve happened anyway. It is necessary in some accidents and the MD would be negligent NOT doing a rectal exam.
this is a response to an old post……..interestingly, I just had a follow-up check at the same hospital where i was seenin the ER. The nice woman doc who treated me actually remembered me (I guess that it was because I had my uniform on-airline pilot)..we joked about her asking my consent for the rectal exam; I asked her what she would have done if I said no..she would NOT have done the exam…my wife (an MD) said that in a trauma situation that getting poked and prodded is normal, but rectal exams are useless unless a patient has obvious spinal trauma….th eER doc and my wife had a good laugh..my point: just ask a conscious patient if it’s o.k and most will agree….don’t ask and youwill probably get hit