She used WHAT as a dildo??!!

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I no longer practice medicine, but I sometimes miss it.

One of the reasons is that the amazing thing about practicing medicine is that every time you think you’ve finally seen everything, you see something new. Not just something that you’ve never seen before, either, but something that you could not have even imagined.

Consider a case that came to my attention when I was an attending physician. A young woman came to the evening urgent care clinic at our health center one evening complaining of severe genital pain; so severe, in fact that she could only walk with her legs widely spaced a part.

That walk is a classic sign of a Bartholin’s gland abscess, a fairly common infection of the glands at the outer edge of the vagina. Bacteria can take up residence in the gland and cause an abscess. Even though the abscess is small, it is extremely painful. The wide stance walk is almost a guarantee of the diagnosis. The triage nurse explained the likely diagnosis to the patient and the fact that the abscess could be easily treated. Rather than looking relieved, the patient appeared embarrassed.

She was right. I couldn’t believe it.

A physician’s assistant (PA) saw the patient, took the history, which was unremarkable, and started the exam, which was very remarkable. The patient did not have an abscess; she had what appeared to be shallow, but extensive burns around and extending into her vagina. The physician’s assistant was so flustered that she excused herself to call me.

I could not leave the hospital to go to the clinic, because I had a patient in labor who would deliver soon, so I had to rely on the PA’s description. The description certainly fit with that of burns, but I had never seen burns of that kind in any area. Yes, I had seen chemical irritations of various kinds, but it didn’t seem like an injury of this sort was likely to be caused by a new bath soap or detergent.

The PA insisted that the patient’s history was unremarkable, and I insisted that she had not gotten the complete history. It wasn’t her fault; the patient simply didn’t want to reveal what happened. I suggested to the PA that she question the patient about domestic violence, since I had certainly seen vaginal injuries related to violence in the past. I also pointed out that it was important to explain to the patient that we needed to know what happened in order to treat her appropriately.

I was dreading the return phone call, and I imagined all sorts of horrible things that might have happened, but I failed to imagine what really did happen. When the PA called again, she was laughing.

“You’re not going to believe this,” she said, “but the patient accidentally did this to herself with a dildo.”

She was right. I couldn’t believe it. What could the patient have used? I’d heard of all sorts of things in the past: fruit, candles (unlit), and glass bottles, among others, but nothing that could cause burns.

“She used a deodorant stick!”

The patient had used the actual stick of deodorant, which she had pried out of the container (for who knows what reason) and the burns she had were serious chemical burns. We treated her by washing the area to remove any trace of the chemicals and applying the salve typically used for treating burns from gynecologic laser surgery. Oh, and lot’s of pain medication, too, for obvious reasons.

Her treatment plan included her medications, an appointment for follow up, and a recommendation: should she feel the need to use a dildo in the future, she should avoid deodorant, or at least leave it in the container with the cap still on.

  • Anion

    A patient in my mom’s ER one night came in because of similar extreme pain. This woman had decided that she must have a vaginal infection of some sort because she “smelled bad,” so had given herself a douche to fix the problem.

    She’d used bleach.

    And tangerine juice. (Presumably for the nice smell.)

    I swear that is a true story.

  • Leah

    I definitely thought that the object was going to turn out to be a curling iron.

    • Ardea

      I did too!

  • Nick Sanders

    Reminds me of this thread over on SDN: http://forums.studentdoctor.net/threads/things-i-learn-from-my-patients.257985/
    I’d estimate a good fifth of the stories are “things retrieved from hoo-has/rectums”.

  • fiftyfifty1

    This type of case report for amusement sake has always made me uncomfortable. Sometimes in medical school professors would end a lecture with a “funny” slide show of Xrays from the ER of rectal or vaginal foreign bodies. It reflects on us poorly as doctors. What is the point of it? Clearly the only point is to make fun of our patients.

    If you are a doctor (especially in ER, OB/GYN or family medicine) you will encounter your share of retained foreign bodies whether they are dildos or tampons or what not. Grow up and move on.

    • DelphiniumFalcon

      Is it okay if the patient thought it was funny? Seriously, some of them come in giggling and just blurt it out. It’s hard to keep your composure and just not end up staring when they just blurt out something like “Cue ball in my bum” and continue giggling when you ask what they’re checking in for.

      • fiftyfifty1

        No problem. But I still don’t run out and post it on the internet for the amusement of others.

        • Sue

          I tend to agree, but I do wonder how Dr Amy comes up with a different topic every day. It must be hard on slow news days, or short breaks in radical-NCB disasters.

          • FrequentFlyer

            Maybe she needed to take a break from the dead and brain damaged babies and thought her readers would like one too.

      • Gatita

        Cue ball reminds me of this story: Man shows up in ER with cue ball up his rear. The attending lines up the residents and med students and says, okay, who has the smallest hands? The poor person who got picked was a tiny Japanese American woman who’d been a concert pianist before going to med school. I’m sure she never imagined the day she’d be elbow deep in someone’s rear. And in the end (ar ar) she couldn’t grab it so the poor guy had to have surgery.

        • DelphiniumFalcon

          That poor girl. XD if I were the person with the stuck Cue ball I would have just asked for the surgery first! I don’t want to be that well acquainted with a resident!

      • Kristine Rowland

        “It’s hard to keep your composure and just not end up staring when they
        just blurt out something like “Cue ball in my bum” and continue giggling
        when you ask what they’re checking in for. ”

        *eyeballs the table*

        “8-ball in the corner pocket”

        *eyes bulge*

        Oh SHIT!

    • Megan

      To be honest this was my first reaction too. I was surprised a whole blog post was devoted to it. I love this blog but as a physician, it made me uncomfortable also.

    • Who?

      I once saw an xray of a dog with a rubber duck in its tummy. Which was a big deal for the vet-and the dog, presumably.

      Perhaps it isn’t about making fun of patients but alerting students to the wide range of ‘normal’ they are about to encounter. Most of the young med students in my world come from fairly sheltered backgrounds-the humour could be a way to in talk about this stuff.

      • fiftyfifty1

        But it’s never presented as a wide range of normal, it’s presented as this idiot/pervert did WHAT?!!

        • The Bofa on the Sofa

          But when people do silly things, we laugh at them. Because it’s silly.

          How is this any different from laughing at someone who tried riding a canoe down the roof of the house into a wading pool and ended up in the ER? I’d say, “That idiot did what?”, too.

          Stupid things happen all the time, yes, but that doesn’t make them not stupid.

          • Megan

            I think the distinction is that patients come to us expecting a certain amount of confidentiality. They often tell us things they would not tell anyone else, not even their partners or family, and they count on us to keep those things between us as a physician and them as our patient. This is especially true when it involves things of a sexual nature. Someone may be willing to tell their friends all about their antics while drinking Friday night (or about riding a canoe off the roof) but be very uncomfortable telling their friends what they do for sexual pleasure if it is outside the “norm.” If they do want to tell their friends, good for them, but it seems inappropriate as a professional to put it on the Internet when we are expected to maintain a certain level of confidentiality. If this patient gave Dr Amy explicit permission to publish this, fine. And before you say it, I realize she did not violate HIPAA because no names were used but it’s unique enough a case that if I saw it, as the patient, I would be embarrassed and upset my care provider shared it. I feel like patients expect a certain amount of decorum from us.

          • Dr Sarah

            Yes, this absolutely. I don’t know the law or guidelines regarding confidentiality in the US, but wheRE I work as a doctor, in the UK, this story would be considered to have breached confidentiality because the *patient* could identify herself from it if she reads it. It’s very unprofessional, and I’m disappointed in Dr Amy for posting it. I hope she takes it down.

          • fiftyfity1

            Sure, we can think they are stupid. But that doesn’t mean we post about our patients on the internet to amuse ourselves at their expense.
            And this type of post is more than just an isolated example of a single stupid story. It belongs to basically a genre of medical storytelling that revolves around sex. It often has homophobic, misogynistic and sometimes racial overtones that make it even less professional. Those guys were sticking WHAT up their asses?! That nasty tampon made me puke!!! OMG her boyfriend gave both her AND her 5 year old daughter gonorrhea!!! It’s unprofessional, it’s unkind, and it certainly serves no useful purpose. Patients fear that they are being judged and mocked….and it turns out they aren’t wrong.

      • Azuran

        Ah yes, the famous rubber duck (actually, as far as I know, the record is 5 rubber ducks removed from one dog at the same time) We have a x-ray contest about foreign body each years.
        Still, showing off medical cases is usually about:
        -medical interest: when you have something special (we love those crazy medical stories/horrible injuries),
        -Education
        And most importantly: Coping.
        No matter what is going on, you still have a job to do. Lost a baby during a delivery? got a toddler who accidentally shot himself in the head? Told someone her boyfriend sexually abused her 5 years old daughter? (or in my case, putting down an animal because the owner doesn’t have money to treat it, while at the same time having the owner telling their kids in front of me that I’m killing their pets because I’m a heartless thief who doesn’t care about animals and won’t treat it for free) Well, though luck, your next appointment is here and you need to by smiling and supportive.
        It’s hard. You need a way to cope. For many people, it will be secretly laughing at weird and actually funny things we see. Although those should be done in the back room. not in front of patients.
        But as long as doctors are humans, it will happen.

    • It also reminds us to take nothing for granted when it comes to humans and the human body.

  • toni

    omgosh ouch. I think I had something similar once when I used my friend’s ‘Nair’ down there because I didn’t have what I needed to make my sugaring paste. I was in a rush and applied it without due care (i.e. all over the shop) even to the places where there isn’t any hair and five minutes later felt like my pee hole was aflame – all the sitz baths in the world couldn’t cool it. Hurt for a week.. felt too silly to see the gyn though haha.

  • Mattie

    OT: Have people seen the new picture of Prince George, released for his birthday tomorrow, taken at Princess Charlotte’s baptism. He’s so cute, I just want to snuggle him 😀 https://twitter.com/KensingtonRoyal/status/623480900282675201

    • Who?

      Nice to see him smiling, he is usually a very serious little boy. He looks like his late grandmother.

      • Looks like a mix of his mum, dad, and grandma.

    • Nice looking kid, but not as nice as my grandson
      I’m not in the least prejudiced….

      • demodocus

        I prefer this 2013 baby for some reason 😉

  • Megan

    Isn’t there an entire series on TLC devoted to strange sex injuries? I seem to remember an episode with burns involving a giant melted gummy bear…

    • FrequentFlyer

      Sex Sent Me To The ER. I’ve watched it a few times. If sex ever sends me to the ER I will not tell the world about it.

      • I will not tell *anyone*about it! My friends think we’re freaks as it is.

    • Liz Leyden

      More evidence that TLC should change its name to The Freak Show Network.

      • DelphiniumFalcon

        I remember when they used to have Mystery Diagnosis and those kinds of shows. Still sometimes a freak show, but I need my fix after House started getting more and more out there with symptoms not matching the diagnosis.

        • Kq

          I honestly miss the “freak show” shows. There was one about unusual bodies – one featured the twins who were conjoined at the head. Lori and George Schappell. I had the chance to meet them years after that (being a street performer on Hollyood blvd has odd perks) ams they were such nice and interesting people!

          Also, my family carries a birth defect made famous in the “freak show” circuit – ectrodactyly, made famous by “Lobster Boy” Grady Stiles. So although my manifestation of the defect is unnoticeably mild, I feel a certain defensive pride on the topic…

          • DelphiniumFalcon

            They just need that dedicated health channel back that became OWN. I’m freaking addicted to medical shows and there’s nothing good on lately!

      • Megan

        Oh absolutely agree! I saw it on the guide and thought, “For real? Isn’t this supposed to be a family network? And it’s in at 3 in the afternoon??” I watched maybe 5 minutes of it and changed the station.

      • Mattie

        Although they have cancelled 19 kids and counting, and they have a show about a trans girl and the challenges and happiness that goes with coming out at a younger age, it’s got good reviews from the trans community.

    • DelphiniumFalcon

      This was on Untold Stories of the ER, but did you see the one where a man got a vibrator lost up his rectum? And the batteries were still good and it kept going off at random?

      • Sue

        I’ve worked in ED for more than thirty years, including in inner city locations, and have seen thousands of patients, but less than a handful (so to speak) of this sort of injury.

        People just don’t circulate stories of the old lady they saw with heart failure or pneumonia.

        • DelphiniumFalcon

          I do like to talk about the 109 year old lady I met in the ER that was more lucid than most of the people I went to high school with. She took a bad fall on the ice and they just wanted to check her out to make sure she didn’t have any catastrophic breaks. Kind of made me feel better about ever living to be that old and I wouldn’t unavoidably be a lump in a chair waiting to die.

          • I had the LOL in NAD who arrived in a taxi when I was covering ER (ICU was closed: 4 hardwire beds, 2 telemetry, so sometimes we didn’t have patients). Usually the supervisor covered ER. She didn’t feel well, so we did labs. Her glucose was 2000. We started an insulin drip and I had to go open the ICU.

        • Mishimoo

          Speaking of pneumonia, it looks like I’m about to lose a 3rd grandparent to that nasty infection. At least he seems comfortable and is unconscious, which is much better than my paternal granddad who was randomly thrashing about and moaning because no position was comfortable for long.

          • momofone

            I’m sorry.

          • Mishimoo

            Thanks! He’s alert today, so hopefully the antibiotics are working and he might come good.

          • demodocus

            Sorry to hear it

          • Mishimoo

            Thanks, I’m hoping that the antibiotics are kicking in since he has been conscious and talking today. Apparently he’s aspirating saliva though, so yeah :/

  • Medwife

    I know of a case where a flashlight got stuck, turned on. It was in the rectum though. The burned tissue was bowel 🙁

    Looking at that sentence, the frowney face is inadequate.

  • PrimaryCareDoc

    I had a little old lady who used a banana as a dildo. It might not have been such a bad idea…except she peeled the banana first, which led to me having to maneuver half a banana out of her vagina.

    • Mattie

      One way to get your 5 a day…

    • Medwife

      I wish people would just go to sex shops and internet sites (babeland!) and get toys that are made not to hurt you or ruin your night. Stupid stigma.

      • goodvibes! They have stores that are respectable and not embarrassing to enter. Clean, well-lit, and well-organized.

  • Julia

    I’m mostly horrified that deodorant can give you an actual chemical burn.

    • Medwife

      Only if you put a whole bunch of it on delicate mucosa.

    • momofone

      I had a reaction to some brand (you’d think I’d remember which one, but I don’t) under my arms once. I was miserable for a couple weeks. I can’t imagine it in/around my vagina! Ouch!

      • Phascogale

        I had the same thing. Actually blistered my skin on my armpits and I hadn’t even shaved that day. Even now I have to use the ‘sensitive’ ones otherwise within a day or two of using a ‘normal’ one I get burning and itchiness and redness.

  • stenvenywrites

    For a minute there I thought you were about to say “curling iron.” Whew. And also, ew.

  • The Bofa on the Sofa

    Rule 34…

    • demodocus

      I’m guessing that’s some variation of “people will put *anything* where the sun don’t shine for kicks”

      • The Bofa on the Sofa

        No, it’s “…there’s porn of it”

        • demodocus

          Next logical step, I suppose.
          On the related note, ewwwwwwww

          • The Bofa on the Sofa

            That’s Rule 35: An addendum of the internet rules stating that if there is no porn of it, it will be made.

      • Alcharisi

        I think Rule 36 covers you here: “…it turns SOMEONE on.”

    • I keep thinking of the Evil Overlord rules. Rule 34: I will not turn into a snake. It never helps.

  • Paloma

    We actually had a similar case recently. This lady decided to use a spray deodorant instead (with the cap on) and when she pulled it out, the cap decided to stay a while longer. So she came over to the hospital and we took it out. Apparently she was very brave putting things in but not her fingers to do the opposite. Go figure…

  • DelphiniumFalcon

    And here I thought the Twilight vampire dildo you put in the freezer or just using an ice pop was the worst scenario I could think of when it comes to “normal” household items used as a dildo. You know, like tongue stuck to flag pole only not your tongue?

    I was so wrong and now I can’t stop laughing.

    This makes me miss working ER registration sometimes. We were always the first ones to hear that it was probably a foreign body in the vagina or rectum.

  • Rita Rippetoe

    Is there a possibility that the poor woman has been told that she smelled bad “down there” and thought that applying an underarm deodorant was appropriate? I mean there is so much in our culture about the need for “freshness” used to sell douches, feminine hygiene sprays (remember them), menstrual pads with deodorant embedded and so forth. I really can’t imagine trying to use a crumbly stick of solid deodorant for sexual pleasure.

    There is so much confusion and hypocrisy about the natural state of female bodies. I remember a book I read years ago, written by an immigrant doctor who could not go into regular practice until he updated his medical license. However he could work in a public VD clinic. He made several critical comments about women who were not clean; but when he examined a woman who did douche regularly (or at least recently) he assumed that she was a prostitute because only professionals keep their ‘equipment’ that clean. Sexist pig! OTOH he was critical of men who were diagnosed and treated by their private urologist but sent their girl friends to the public clinic. The book, in case anyone is interested, is Dark Fields of Venus.

    • DelphiniumFalcon

      I was just thinking about this since it’s summer where I am and we get 100 degree F days. People are going to sweat. But don’t you dare smell like sweat if you’re a woman! Use antibacterial soap, scrub an entire layer of skin off, apply deodorant multiple times a day despite what the label says, and then drown yourself in perfume. You are now just barely passable. What, the antibacterial soap makes you break out? You still must not be clean enough! That’s the only reason for acne! Get in the decon showers!

      I’ve always hated that double standard in particular. I don’t want to be smelly but holy crap men can smell like basically whatever they want but women have to smell like fresh rose petals including down there or she must be dirty and disgusting.

      And then coupled with the desire for a lot of American men to have women with no body hair, no scent from epocrine glands, and other forms of beauty that mimick prepubescent girls and you start wondering wtf is wrong with the world…

      • Roadstergal

        “forms of beauty that mimick prepubescent girls”

        Oh sigh, that’s turning into a sensitive spot for me (as it were). I simply prefer no body hair. I did my time at an all women’s college letting it all grow out because that’s what Real Empowered Feminists do, and I hated it – the feel, the smell, and gawd, the chafing. I finally just gave myself permission to shave, because it feels wonderful to me (especially on hot sticky days, and doing my favorite sweaty activities – running, biking, racing) and I love it. I prefer my men fully shaved, as well. If someone requires body hair to determine I’m past the age of consent, that’s someone whose genitals and brain I want nowhere near me.

        It’s just getting increasingly annoying to be told by people on Twitter and Facebook that I was brainwashed by the patriarchy, and/or that I’m out to reel in pedophiles. You don’t like to shave? Great, don’t, there are plenty of men and women out there who prefer body hair. Hairy pride is dandy, and can be promoted without denigrating those whose boats it just doesn’t float.
        I agree with you that double standards are bullshit, but to me, that means I want my partners as smooth and clean as I am when it gets down to business.

        • Mattie

          Yep same, for me it’s all about accepting different people for who they are. Whether they shave or not, as long as they are the one’s deciding, that’s all good with me.

        • Empliau

          It’s always complicated – I deal with young women at work, and there is a subset that doesn’t like waxing (think Brazilian) but are convinced that no one could ever love them with hair because Yeti. And it does seem that porn has something to do with their partners’ expectations. From your posts, I am absolutely confused that anyone could announce that Roadstergal has been brainwashed by the patriarchy. I think they cannot have been paying attention 😉

          • Roadstergal

            “but are convinced that no one could ever love them with hair because Yeti.”

            And yes, that’s why I think hairy pride is a good thing – to let people who prefer hairy know that they’re loveable and sexy. I just wish the hairy pride people would approach it with talking about their enjoyment of hair on partners and the ways it can be sexy, and not with “ugh, do you really want to be with those pedophiles? Do you want to look like a prepubescent girl?”

          • DelphiniumFalcon

            Yes the shaming is bad and I put it a bad way without thinking it through. It’s probably the area I’m in that influences what I said without thinking about how it came off. A lot of men around here are very controlling about their girlfriend or wife’s bodies and more often than not they keep going for that younger and younger to the point of creepy look. Like no evidence of hair what so ever. No bumps, razor burn, dark spots, nothing.

            Which let’s face it, if you’re a dark haired person unless you’re paying good money for higher end treatments that removes the hair from inside the follicle, there’s going to be evidence that hair grows there are some point or another. Hair has to be a certain length before you can wax it and all.

            Unless you’re my Hawaiian friend. All her hair was on her head and was gorgeous. We’re pretty comfortable with our bodies so we didn’t mind dressing in front of each other getting ready for dances and such. That’s the natural state of her body and she comfortable with it, as she should be. No one guilted her into looking like that.

          • Roadstergal

            I guess I just think in general, if the messages were more positive – I love to pet smooth skin, or I love to play with a girlfriend’s armpit hair, or the smell of sweat turns me on, etc etc, it would be more… productive, as it were? The Internet, for all its faults, has a lot of potential there. More – if you want to do this, great, here are resources (bumps, yeek, ingrown hairs, no fun); if you don’t, cast out a little and find someone who likes what you do. I know it’s WAY easier said than done, but I think men would be open to “Hey, have you considered the sexy aspects of women who don’t shave.” After all, bush was the sexy norm in the 70s.
            (The puritanical nature of the MPAA doesn’t help. If they were a little more relaxed about a glimpse of bush, that would help more body types get out there. I wonder if some of the drive towards shaving in the MSM is driven by the exact same glimpse of tantalizing skin being considered ‘genitals’ or not depending on whether there’s bush?)

        • DelphiniumFalcon

          The big thing that makes it okay in your post is that it was your choice to do so. As long as it’s your choice to shave or not, I’m fine with it. It’s when partners, men or women really with chest waxing and landscaping, are pressured into it. Especially if emotional manipulation saying they’re not attractive is used. Saying “Have you ever tried shaving/waxing?” is fine to me because it’s a suggestion and not “I won’t sleep with you anymore unless you get a Brazilian” because that’s no longer a choice.

          Personally I prefer smooth pits myself because I don’t like the feeling of hair there and it does get rank if you’re not careful.

          Basically, and I don’t think I communicated it well, it’s when the removal of all body hair, removal of all scent from glands that don’t function until puberty, along with a few other things all combined that makes me feel grossed out. If it’s not their choice.

          If they’re like that girl in the Netherlands that pretends to be a child doll, as long as it’s her choice more power to her. Not my cup of tea but she seems happy doing it. No one is forcing her into that prepubescent looks for their own sexual pleasure.

        • Kq

          Amen to that. My mother had a fit when the topic of waxing came up and refuses to consider some women just might prefer being hairless…

          • Gatita

            I think there’s a generational divide. Younger women seem to overwhelmingly prefer bare while women in their 40s and older recoil at the thought of a Brazilian.

          • Roadstergal

            I’ll be 39 in Sept… damn, I’m getting old. :p

          • You’re getting old? I’ll be 50 in Dec.! Rather looking forward to it.

        • Nick Sanders

          I tried shaving my chest once. Because I am a friggen’ Sasquatch, the first pass of the razor just took me from “thickly haired” to a single layer. It ended up take three strokes to get a spot down to “stubbly”. So I gave up. I hate my chest and back hair (at times it’s like wearing an unremovable undershirt), but since I can’t afford laser removal, it’s here to stay. I’m just glad I don’t have the bear pelt I saw on this one guy a long time ago.

          • Eater of Worlds

            I find a hairy chest sexy. I’m also ok with using an electric shaver on a partner’s back if they so wish.

          • Nick Sanders

            In my case, it’s not about the aesthetics, it’s the fact that it is hot and itchy.

  • Mattie

    Well that’s different, I wonder what her reasoning to herself was. There was an episode of Junior Doctors that aired in the UK where a young man had a toilet brush stuck up his bottom, he said he slipped in the bathroom…

    OT: What exactly is a physician’s assistant, what do they do? There’s talk of introducing them in the UK but not entirely sure what they actually do/how they are different from doctors.

    • Young CC Prof

      They work under the supervision of a doctor, but can treat patients. This PA took the patient because it was expected to be straightforward, then called the doctor by phone when he was baffled.

      Basically, someone who can do more than a nurse, less than a doctor, and whose job is to save time for the doctor.

      • Mattie

        Ok, so closer to a nurse practitioner? Or a level up? I thought saving the doctor time was what the junior doctors were for =P

        • Young CC Prof

          PA and NP are similar, but exact scope depends on the state.

          • Mattie

            Ok cool, thanks 🙂 doctors here are a little confused about why we suddenly need PAs but the current government is not being all that nice to HCPs and the NHS atm so it might be a bitterness from that.

          • Ash

            For the US, midlevel providers (anesthesiology assistants, physician assistants, nurse practitioners) allow for greater efficiency in the system. Some would argue that they do not (as in, perhaps midlevels do a greater amount of referrals/testing/sometimes are unable to diagnose something correctly). They are a huge part of the system in the US. The cardiothoractic service here has about 2 midlevel providers for every surgeon. The PAs assist during surgery, do followups for patients (either independently or in conjunction with the surgeon), and round on inpatients. The surgeons are all extremely busy and the midlevels work about 50 hours a week. If the midlevels disappeared, the surgeons could not keep up with the volume of patients they currently have.

          • Mattie

            Thank you, that makes it clear. I think those roles in the UK are currently filled with lower level doctors, and nurses. It will be interesting to see what happens if PAs are introduced.

          • Ash

            But doesn’t the UK have very few midlevels (NPs, PAs) in general? ALso it seems like some nurses in the UK have a more limited scope of practice in the UK. Forgive me if I’m incorrect, but it seems like some things that are core skills for nursing in the US are not core skills in the UK. Placing IV vannulas is a core skill for nurse midwives & registered nurses in the US. But i think here it was said in comments that a junior doc usually placed IVs?

            Heck, in the US some hospitals have venous access teams that have specially trained nurses for PICC lines and midline catheters.

          • Megan

            In my state (pennsylvania), NP’s can practice independently but PA’s must be supervised by a doctor. Not sure how the rules got to be that way though.

          • Megan

            Usually it’s because midlevel providers are cheaper and, at least in the US, the health system can still bill the same rate for a visit (and most practices these days are not owned by doctors, but by health systems). There has been talk here of allowing PA’s to also practice independently to help meet the increased patient demand, especially with the Affordable Care Act giving a lot more people access to insurance. It’s another way to pinch pennies.

        • Medwife

          Lemme say right now before anything starts that PAs and NPs are different but nobody’s better, PAs can be great or suck, NPs can be great or suck, physicians can be great or suck but have way more training and education than either. WHEW.

      • Ash

        Some states allow physician assistants to be primary care providers.

    • Sarah

      I always just think, if you’ve got something lodged up your arse and you need medical assistance to remove it, don’t insult them with some bullshit lies. Just brazen it out. Go in and say right doc, I’ve got a toilet brush up my bottom. We both know how it got there. I’d be most obliged if you could get it out again.

      • KeeperOfTheBooks

        This made me howl with laughter. I can so see Rowan Atkinson doing a sketch like this, can’t you?

        • Sarah

          He can have the idea for free, if he’s reading.

      • The Bofa on the Sofa

        Go in and say right doc, I’ve got a toilet brush up my bottom. We both know how it got there.

        Actually, I’d add the fact that it doesn’t matter how it got there, so there is no reason for the doctor to even ask.

        It’s not like the doctor needs to tell the patient, “In the future, try to avoid shoving a toilet brush up your bottom”

        • Roadstergal

          http://www.thestranger.com/seattle/SavageLove?oid=15505018

          “I am sharing your letter, CC, in the hopes that doctors all over the world read it and promptly incorporate your “flared-base” advice into their practice. If they don’t, well, then we will just have to conclude that flared-base advice isn’t given to patients by doctors—ER or otherwise—because doctors secretly enjoy digging various foreign objects out of the variable rectums of various gentlemen.”

        • DelphiniumFalcon

          Unfortunately, at least for our registration system, if an accident or injury is involved we have to collect the date and time, where you were at, how it happened, and what was injured in case of insurance inquires. You get to know some patients and their hobbies reeeeaaaally well in ER registration. So don’t say it got up there by accident or they may ask for accident details! If it happened on someone else’s property, your insurance will want to know if third party liability is involved!

          Seriously, your insurance wants to know eeeeeverrryyything. And our jobs can be on the line if we don’t collect all that information and a patient loses out on some kind of insurance payout. So please excuse our invasive questions. We just want you to get your payout and to keep our jobs lol.

          • Young CC Prof

            I once got a letter from my health insurer demanding to know exactly how I’d been injured. They were checking for someone to sue so they wouldn’t have to pay to take care of my ankle. It’s called subrogation.

    • KeeperOfTheBooks

      In my teen years, I volunteered in the local trauma center ER. After a month or two, it became highly apparent that no sane person would ever guess the number of otherwise normal activities our patients got up to while naked, and how unlucky they were when they engaged in them. Painting. Woodworking. (I don’t care what you stick on the end of a drill bit, that’s still a Bad Idea.) Housecleaning. Etc. Somehow, they’d always slip and either get a foreign body where it shouldn’t be, or, in some men’s case, end up with a very important part of themselves stuck inside a foreign body. *sigh*
      On the other hand, as the person who wrote the initial reason for admission into the log, it did teach me how to keep a straight face no matter how insane or stupid the story I was listening to, a skill I found invaluable when I later ended up in business and had to deal with mid-level management on a regular basis.

      • Liz Leyden

        I, too, am a former ER volunteer. You know those ED medication warnings about erections that last longer than 4 hours? We got a lot of those.

        • momofone

          I’ve always been fascinated by the men who would wait four hours to decide there’s a problem. I have to think I’d become concerned a good bit earlier than the four-hour mark.

          • An Actual Attorney

            They fall asleep?

          • Roadstergal

            The ads all say “If your erection lasts longer than four hours…” I imagine that they’re anxiously staring at the clock after about the forty-minute mark.

            I remember a Prescott Pharmeceuticals disclaimer – “If your erection lasts longer than four hours, you’re welcome.”

          • Nick Sanders

            According to wikipedia, four hours is the current diagnosis threshold for priapism.

    • Amy

      Dr. Amy can probably give a better explanation, but PAs are something like certified nurse-midwives, only for general/primary practice. They have to have post-graduate certification, and at least in my geographical area, the programs are quite competitive themselves. Once licensed, they’re allowed to diagnose patients and prescribe medication, but not perform surgery, and they must work under an MD’s supervision. We all see a group family practice in our household, and when our primary care doctor is unavailable, we’ll often make appointments with the PA. (The one thing I have noticed is that for general physicals and well-care, we always see our primary care doctor– not sure if that’s an actual restriction on the PA license or just the way they do it at our office.)

      • Fallow

        My husband sees a PA for his dermatology appointments, so they can at least perform skin biopsies and do stitches.

  • namaste863

    Omg, please PLEASE send that to the Darwin Awards website! I guarantee it will net at least an honorable mention.

  • Cobalt

    We have got to get better about sex education.

    • Roadstergal

      Safe masturbation. Ah, Joycelyn Elders, you dared to just hint at the idea, and look where that lead…

      I cannot recommend Babeland highly enough. Their stores are bright, clean, women-friendly, the employees are great, and they have classes. I miss it – there’s no Babeland in SF, and I don’t like Good Vibrations as much.
      http://www.babeland.com/

      • Cobalt

        Non creepy toy stores are something that really needs to catch on! We have 3 adult stores within a reasonable distance, and 2 I won’t visit because the atmosphere is like a bad parody of sleazy porn. The one that acknowledges that sometimes actual normal mature adults are customers has inconvenient hours, and that makes me sad.

        • Roadstergal

          Yeah, places that look like Normal Friendly Shops do a few things – they ‘normalize’ masturbation and differing sexual tastes (now I’m realizing what a complicated word that is!), and they make teenage/YA girls in particular feel better about popping in (for condoms and lube as well as toys – you can buy them singly near the front, and they stock a variety of brands so you’re not stuck with rubbery cheapos for the condoms, and can try out different little sachets of lube).

          • DelphiniumFalcon

            They have a very nice one in Seattle. Or did in 2006. Very well lit. I know for a fact because I accidentally walked in thinking it was a nice costume shop. The associated that greeted me was very nice but I was nineteen and very clueless sexually so I stammered something and left. Their wigs did look to be extremely nice quality though. And a very wide assortment of dildoes and butt plugs in styles I haven’t seen since.

          • Roadstergal

            Was it two blocks from Broadway, at the south end of Capitol Hill, across from the big BMW dealership? That was Babeland…

          • DelphiniumFalcon

            I don’t think it was across from the Ford dealership. It’s been sooooo long since I’ve been in Seattle and I don’t even remember which part of town I was in.

            I really need to visit Seattle again. Show my husband around. Maybe we’ll go for Sakuracon some year and really need it up.

            And find that store and actually take advantage of the services this time lol. It looked very clean!

          • Bombshellrisa

            707 E Pike, it’s close to lots of good restaurants and it’s just a great area to visit.

          • Bombshellrisa

            Still there, still nice people working there.

        • Kazia

          There are two adult stores in my area that I know of. One has no windows and I get the creeps just walking by. The other is full of light and is owned by a psychologist. Guess which one I like?

        • SporkParade

          In Israel (or at least in the Tel Aviv area) we have both creepy and non-creepy toy stores. The problem is that they all have incredibly limited selections. Like, I might as well just buy vibrators at the pharmacy.

    • demodocus

      With the current preferences in a lot of areas for abstinence only sex ed, that’s going to be a difficult sell.
      Don’t put things in that might need to get fished out. Icky, icky, icky, icky.

      • Gatita

        In theory, abstinence is perfectly compatible with using a dildo. Of course, that’s not what it’s really about, is it?

        • demodocus

          lol, I wouldn’t know. The assorted right-wingers would probably be just as upset either way, though

    • Alcharisi

      I’m only halfway joking when I say we ought to discretely distribute decent, inexpensive vibrators to all teens–along, clearly, with some literature about what NOT to put in, on, or around your junk. (I once heard an anecdote about a blowjob gone quite wrong. The culprit? Chile pepper honey. OW.)

      • Kq

        There may or may not have been an incident I may or may not have experienced that may or may not have involved an unlit candle with a surprisingly low melting temperature.

        • Gatita

          Ahhhhhh!!!!

        • Alcharisi

          Oy gevalt.

      • Gatita

        Lemme tell you about the time my husband chopped jalapenos for dinner and didn’t thoroughly wash his hands…

        • Alcharisi

          Based on the time that I chopped jalepenos for dinner and didn’t thoroughly wash my hands, and then used the restroom, I am so sorry.

    • Mattie

      There are some amazing young people using youtube for just that, good comprehensive sex positive sex ed, aimed at teens and young adults. My two favourite people are Laci Green and Sexplanations. Sexplanations in particular is awesome, it’s presented by a clinical sexologist and covers everything from health, to play to sexual and gender identity 🙂