Sunday, January 20, 2008
A Little Bit of Sole
The other day I really stuck my foot in my mouth, although it was kind of necessary to counter future embarassment.
I had picked up a new chart, and went to go find my new patient. When I went to claim my patient on the whiteboard (unfortunately we are soon switching to a computerized tracking program), I noticed that the patient was actually in a different room than the one listed on the chart. Patients often get relocated if the room isn't quite clean yet, so I went to the room listed on the whiteboard. Instead of finding a middle-aged male, I walked in on a topless female. I apologized and ducked out.
My second attempt was in the room originally listed on the chart. Nope, that was an octogenarian male, and clearly the wrong room as well. At this point, I threw up my hands and consulted the charge nurse. He had no idea where this patient was, so he called up the triage nurse, who also walks the patients back to their rooms.
"Didn't you see my stickey?" he asked.
So, the triage nurse flips around through chart and finds a small 2x2" yellow Post-It note. It reads: Patient wants to be called [insert female sounding version of a male name here].
"Um, ok, so what does that mean?" I ask.
The triage nurse just rolls his eyes at me and mouths the words "he looks like a girl."
This isn't helping matters. The patient's chief complaint is hematuria, or blood in the urine, so it makes a big differnce whether or not they have male or female anatomy. I have already observed what are obviously augmented breasts, so there's no getting around asking what other sort of surgeries the patient has had.
Finally, I develop a game plan. I go into the room, and act like I think registration has made an error and marked the patient as a male instead of a female. He says no, and after a lengthy discussion, he explains that other than breast augmentation, he hasn't had any sex change surgeries. Although I think I may have alarmed him at first, I think he probably found me to be concerned and attentive in the end.
I was explaining my technique to the charge nurse later and he said, "I can't believe you did that." When I asked him how he would have handled it, he said he would have asked the patient when their last menstrual period was. Maybe I'm wrong, but that seems a lot less diplomatic way to bring up the issue.
While nobody likes to be asked what sex they are, sometimes you just can't tell. I think it's better to be direct rather than to end up with a male in the stirrups or asking all sorts of unnecessary questions. And in medicine, gender totally matters. Workups revolve around it, so there's no excuse for ending up in court saying, "Well, I didn't get a pregnancy test because I thought she was a dude."