A lot of hoopla regarding the construction worker from Brooklyn who is suing the trauma unit who performed an "unauthorized" rectal exam during his initial evaluation. I hate to be a "doctor apologist" but when you find yourself being rolled into a Trauma Bay, your "inalienable rights of man" are temporarily suspended. I'm sorry, but that's just the way it is. The approach to trauma resuscitation is completely protocol driven. Everyone gets essentially the same work-up every time, all the time, in every level I trauma unit across America. The reason is, evidence suggests outcomes and 30 day survival numbers to be superior in centers that employ an algorithmic, protocol based approach. First you do ABC's. Then mental status exam/glasgow coma score, then a brief history, and finally a complete head to toe, back and front physical exam. So many of these patients roll in with severe head injuries or compromised by drugs/alcohol on board that you can't trust anything they say, initially. You can't afford to. Removing a c-collar too early, or skipping a rectal exam can be disastrous. The Brooklyn guy supposedly fell and sustained a head injury at the construction site. What if they found blood at the anal verge? Is it just hemorrhoids? Or maybe a shard of lumber that lacerated his rectum as he fell back unconscious? You don't know, but your interest is piqued and further work-up is warranted.
The problem in this area is one of proper triage. If I walk into my PCP's office and decline a rectal exam, it would certainly be assault if I were held down and forcibly rectalized. Trauma is a different animal. It's like when you were a little kid and had to be cajoled and bossed around by your parents. You didn't have a choice in brushing your teeth because it was "good for you." Same thing in trauma. The cost of missed traumatic injury far outweighs the momentary loss of dignity of having somebody put a finger in your anus for 1.5 seconds. Obviously this guy probably didn't need to be sent to trauma bay; he sounded completely alert and oriented and without obvious physical injury. But that's where he ended up. And we're much safer, in the long run, knowing that the guy got his inevitable rectal exam.