PLAY Exam Reports and Abnormal Findings

Doctors, do you write a report about the play exam? Do you use any forms for that?

Patients, do you want your doctor to write a report about the play exam?

Yes, I always write a very complete report as soon after an exam as possible. My report is written freehand (not using a form), but always follows the same format:

Signalment: (age, gender, ht, wt, notes on overall condition at presentation, etc.)

Reason for visit:

Past Medical History:

Exam:

Findings:

Results:

Follow-up recommendations:

and, if the patient so desires (and they usually do), the date and time of any recommended follow-up appointments.

This all goes into the "chart" with any other documentation, which can include notes on previous conversations determining what's going to be included in the exam, etc.

As you can see, I keep pretty complete records on my patients, but the effort is well worth it. Patients can always see my notes on their case.

Play On!

LadyDoc

PS - as a patient, I would like my doctor to write notes on my exam as well. (Yes, honey, that's a hint 😁)

I have a form i use that documents any abnormalities i find and gives detailed instructions on how to follow up or what to do

I have a form i use that documents any abnormalities i find and gives detailed instructions on how to follow up or what to do

You may wish to ask the advice of a lawyer before you do that. Unless you are a licensed physician maintaining any documentation may be construed as business records and used as evidence to support criminal charges of practicing medicine without a license. Further, if you do find any abnormalities your ONLY response to the patient should be to seek the advice of a real physician. Offering any diagnosis or suggested treatment truly is practicing medicine without a license and is neither in the patient's or PlayDoc's best interests. For your own protection the safest bet is that if you do create an exam report for the sake of realism, destroy it immediately after the exam session has ended.

DrJ58-

You brought up some really good points that I hadn't thought of. Even tho' all this is done for the sake of realism and in role-play situation, there is no telling how the "civilian" authorities would interpret it. I try to keep this in mind as I live in a state where law-enforcement is not known for intelligence or common-sense. Thanks for the reminder!

Now, where do I plug in the paper-shredder?

Play On!

LadyDoc

Pleased to offer the advice. I likely would not have given it much consideration myself had one of my patients not been a lawyer. Based on her advice I now use a legal release with my patients which acknowledges we are adults role playing upon mutual consent and no form of medical advice or treatment is being offered, and that both parties hold the other harmless from any legal recourse in the future. If required an additional clause for mutual non-disclosure may be added, which legally binds both parties to secrecy unless compelled to testify by a court order. It is signed in the presence of a third party witness in duplicate, one copy for the patient and one for the doctor.

I too have used a release similar to that described by DrJ58. I claim no special merit for it but thought that it might be of some interest. Suggestions for improvements will be welcomed!

"We, XXXXX, of [place of residence], and YYYYY, [place of residence], hereby declare that we are meeting together between [date] and [date], and may meet again at future times, for the purpose of enacting role play between us as 'doctor' and 'patient'. This role play involves no actual medical practice and no diagnosis or treatment will be offered by either of us. Anything that takes place between us is for our mutual enjoyment and for no other purpose.

"We declare that we are both of the full age of majority in the jurisdictions in which we respectively reside, and fully consent to whatever takes place between us. Should either of us object to any part or proposed part of our role play, we undertake to discontinue it immediately.

Signed at [place], [date]."

______________________________

XXXXX

_____________________________

YYYYY

A suggestion for improvement would be to add Exclusions and Limitations. By defining this in advance both agree to the same conditions so that there is no misunderstanding during the session. It is not necessary to list the things you will do, but more importantly those you won't. Some examples may be:

Injections limited to intramuscular and subcutaneous. No intravenous injections or access will be performed.

No photography, video or audio recording will be permitted.

Anything either person will specifically not allow....

We write medical reports like the real doctors and we keep them in a patient's file, just like the real doctor does.

Medfedcouple - wife

This is really maybe one of the more important ethical rules of the playdoctor. In a presence of an "abnormal finding" and having the play doctor the whatever knowledge level this is really the only thing to do. I allways follow with great attention all the advices and posts of DrJ58, he's maybe the most experienced and wiser of all of us. Karma point (I can not give him every time he comes out with a brilliant and important post, which is constant...

Thank you Amaral, that was a very nice compliment which is sincerely appreciated. Karma to you too. 😉

I totally agree with Amaral. Thank you for adding so much great information and useful knowledge and experience to the board, DrJ58. I would love to meet you sometime!

Lady Teddy

This thread brings up something that I've been wondering about for a long while. That is, has anyone, while partaking in a play exam ever encountered a situation where something abnormal was uncovered, and because of it then got a professional opinion that proved that finding of great importance?

For instance, I suppose it would be very possible that a play-doc might encounter something that feels abnormal to him/her during a play breast exam - and then having it turn out that that finding was the reason for the patient then getting a real diagnosis of breast cancer in its earliest, most curable, stage.

For male play patients, this could also be a recommendation to the patient to get his prostate checked out because the play-doc encountered something that seemed abnormal.

And for both males and females, I think it could very well be possible that a play doc might detect an irregularity in his/her patient's heartbeat that warrants checking out by real medical professionals.

So, what I'd like to hear from either play docs or play patients is if any of you have ever been in a situation where a play exam was instrumental in there being an early identification of a real medical problem.

Lady Teddy, I graciously and humbly thank you for your compliments as well. I also hope that we shall meet in the not too distant future. 😉

Addie, ethically no PlayDoc should be divulging any specific details of their patients so it is hard to fully answer that question. To avoid or reduce the possibility of "accidentally" finding something I have a strict policy with my patients that unless they are under regular care with their real doctor, they must have had a complete physical exam and pap smear within three to six months of our play session. Fortunately all of my patients are very healthy however there have been a couple of instances where I have recommended they see a doctor for further advice but they were not potentially life threatening conditions. I have however contributed trained lifesaving skills in emergency situations outside of the playroom which I have found to be highly rewarding.

I had an incident not too long ago when I was taking a medical history from a "patient" on-line. Several of the symptoms he reported, when put together with some of his family history, rang several alarm bells for me. I strongly advised him to see his GP and have some bloodwork run, specifically to check for elevated blood glucose.

As it turns out, he was diagnosed as being "pre-diabetic" and is now receiving treatment. Just a lucky catch on my part, but perhaps really lucky for him.

Play On!

LadyDoc

DrJ58, I understand why you have the policy you describe, and agree with you that it is an intelligent and practical way to go about play-exams. After all, not many of us here are trained medical professionals. But, to clarify, I am in no way suggesting that a play exam is an adequate substitute for a real medical examination. My query has to do with a play doc coming across a warning sign that his/her patient is unaware of, and as a result, directing that patient to have the symptom checked out by a qualified professional medical provider.

For instance, with something like a breast lump, it is quite possible that, if it has been developing slowly, that the patient has taken no notice of it. But when that person is in a play exam situation, the play doc might notice it as something abnormal, and call it to the attention of his/her patient. The next step would be to inform the patient, and strongly suggest the patient have it checked out as soon as possible.

I have read of several accounts of abnormal breast lumps having been uncovered this way by a so-called "vanilla" sex partner.

Ladydocsin's experience with a pre-diabetic play patient is a very good example of what I am talking about, also. That is, there is an observance that is encountered during a play exam which turns out to be an important sign that the patient needs to have assessed by a medical professional. The play doc does not presume to act as a real physician, but directs the patient to have the symptom professionally looked into.

Addie, I believe the potential for a PlayDoc finding something abnormal is proportionately linked to their knowledge and experience. In many cases MedFet play may be an occasional diversion based strictly on role-playing and as a result the doctor does not require nor acquire any advanced level of knowledge. If this is the case, the PlayDoc may find something quite obvious but otherwise unless they know what they are looking for, they could never be expected to find it. The more educated and experienced any real or play doctor becomes, the greater their diagnostic yield becomes.

Another factor that must be considered is that sometimes play goes places real has not. A patient may submit to procedures with a PlayDoc that they would not with a real doctor unless they had a serious issue which absolutely required it. In these instances the PlayDoc may go places and see things that no one else has done before. An experienced PlayDoc will usually take more time and be more thorough than most real doctors as well. Obviously the potential to discover something unexpected is far higher in these circumstances.

Real or play, the more experienced the doctor, the more likely they will find something others may miss. All PlayDocs must be prepared for the ethical issues and responsibilities which go with that as if they were a real doctor. Not the least concern is that short of something obvious which the patient may have discovered by themselves such as breast lump, how do they explain it to a real doctor. The greatest concern, above all else, is the emotional impact you may have on the patient. It is crucial that if you do find anything of concern you do not alarm the patient during the exam. Only after the exam has ended and you have further researched your findings to the best of your ability should you then present it to the patient.

You must be prepared that should your information prove to be wrong, you may be subjecting them to a needless and possibly painful procedure. A 20 year old female with fibrocystic breasts does not need a mammogram, nor does a Nabothian cyst or cervical ectropion require a colposcopy or punch biopsy. (All are benign conditions which an inexperienced doctor may very easily misinterpret as being a serious abnormality.) If a patient presents it to a real doctor, the doctor would likely perform further tests to assure the patient all is normal. Always make sure you compile all the information carefully before making any suggestions as to the patient's condition.

LadyDoc made a good call. In modesty she said she made a lucky call. It was based on sound knowledge and good diagnostic skills, not luck Doctor. 😉

[quote author=DrJ58 link=topic=26600.msg257690#msg257690 date=1258819024]

LadyDoc made a good call. In modesty she said she made a lucky call. It was based on sound knowledge and good diagnostic skills, not luck Doctor. 😉

[/quote]

Definitely. She got an exceptionally well deserved karma point for that! 😃

Thank you so much for the lovely compliments (and the karma). While my diagnosis may have been made from knowledge as much as luck, no play-Doc wants to find something wrong with their patient. If they do, they should consider very carefully how to approach the patient. In my case, I waited until our med play conversation was over and then said, "You know, I'm seeing a pattern of symptoms emerge that cause me some concern. When was the last time you saw your GP?" The reply was that it had been several years. "I'd like to suggest that you make an appointment, and get some bloodwork done." I was very low-key and non-alarmist about the situation, but I let the patient know that I was concerned. I never did, and never would, offer a diagnosis. It's not my place to do so.

As a licensed veterinary surgical technician, I am frequently asked by my friends, "What do you think is wrong with Fluffy?" My reply is always the same, "I'm not a veterinarian, you should check with him (her) (them)." Even if I know darn well that Fluffy has a belly full of worms, it's not my job to diagnose, or to treat. It's my job to assist in alleving suffering and protecting the public health.

I take both parts of my life, the professional and the medfet, pretty seriously, as all play-docs should, particularly if they find something that is possibly not right.

Just my humble opinion!

Play On!

LadyDoc

I use to write and keep a file for every of my patients. Often the need to come in for "follow ups" and for my own I need to have something to refresh my memory with

My wife and I like to "play doctor" and during an exam, we found that she had a cervical polyp. After visiting the official doctor, it was removed promptly, and it wasn't a danger. If we hadn't been playing, it may have went until her next gyn appointment.

So if you think about it it's gonna happen, just a matter of time. Doing a play exam and actually finding something real : such as cervical changes, abnormal discharge, suspicious lump, etc. How many people have experienced this ? How often does it occur ?

I've given and received quite a few play exams but never discovered anything serious. If I did I would tell the patient though, just in case it's anything that should be investigated by a real medic.

A number of years ago, I was doing an exam on a guy in his early 20's, tall and trim, smooth body. As is my practice, I had had a pre examination meeting with him to get a general impression and to find out about his motivation for wanting a role play exam and to let him know what I planned to provide and my expectations of him. His motivation and interests matched up well with what I like. He found real exams embarrassing and difficult to go through, but found the experience to be sexually arousing once it was done. He was mainly focused on the genital examination as the most embarrassing portion of the process. He was agreeable to wearing white briefs for a full body exam and following all instructions to include exposure of all body parts including rectal examination. We met some time later for the exam session. I do a systematic full body examination with the man stripped completely except for white briefs in the following order of body parts: vital signs, eyes, ears, throat, neck, axillae, heart, lungs, reflexes and neurological, abdomen, pulses. Then the big finale--genitalia, hernia, and rectal. I have the examinee stand in his briefs and instruct him to lower the briefs to mid thigh. This particular man had a long and relatively thick uncircumcised penis. I told him to retract the foreskin for me. He took his penis in his hand and pulled back the skin only far enough for me to see the meatus inside of the foreskin. I told him to skin it back so that I could examine the head. He told me that it would not retract any further. I took his penis in my gloved hand and gently tried to retract it and saw that it was so tight that it would not go back any further. I finished the examination of the testes, did the hernia, and the rectal. I had a talk with him about seeing a doctor to see if he needed a circumcision because the skin should retract. He said no real doctor had ever examined the penis in that much detail. I ended up being in touch with him later and found out that he had been circumcised.

I have an epidydimal cyst on my right testicle. It's harmless and causes no discomfort. It looks like a third testicle. If anyone wants to examine it they're quite welcome. It's just a point of interest. Worth knowing about, though.

Maybe I should post a picture?