Who establishes the rules

1 I am completely new to this forum. Maybe a lot of you would think I don't belong here. I actually am currently studying to be a Medical Assistant but might eventually go on to become an RN.
However in the Medical Assisting program I am in, there were several nurses who needed to learn phlebotamy , and there was even one doctor from Russia who's Russian MD was somehow insufficient for the US and was studying to be an MA or phlebotamist.
I would have some stories to tell about my Medical Assistant training but I
just want to begin by saying that I was taught quite a bit about medical ethics and it left me with a lot more questions than I ever had. Of course my experience as a patient (whenever I had to go to a doctor or the hospital) already had left me with a lot of questions that my enrolling in Medical Assisting training hardly answered.
There is a "closed" forum on this site about how nurses ought to deal with female patients when applying EKG leads on them. At MA training I was taught that it is appropriate to touch the female's breast using the back of the hand because this is considered less intrusive and if you use your palm it can be considered "groping" thus sexual harassment or assault.
(By the way, I was also told that the same technique would apply when you are dealing with a man who has gynecomastia ; and this is not mentioned much).

What I wonder about is who established such a rule and had it become a "universal" technique to be taught to all nurses, or medical assistants or EKG technicians, ( etc)?

Anyone know?

This will be my first question on this forum. I will probably have more of different kinds.
I used to be an EKG tech many years ago and when it came to females with large breasts, I asked them to lift or move the breast themselves. Usually, that was sufficient to place the leads in the proper position. On the medium sized women, I would use my finger tips of my right hand to move the breast tissue out of the way and use my left hand to apply the leads. As long as you are professional, it shouldn't be an issue how you go about moving the breast.

We are taught in our program to inform the patient of our intent, then to use the back of our hand to move breast tissue. Alternatively, we may ask the patient to do so if appropriate.

One time I was attempting to place EKG leads on a lady with very large pendulous breasts. As I tried to find a polite way to move the mass of tissue she looked at me and said: "honey-do you want me to fling my tit out of the way?" Gave us both a laugh!

I don't apply EKG leads, but I am a lactation consultant which requires me to get up-close and personal with women's breasts on a regular basis. If I have to touch, lift or hold her breast, I simply say "Is it okay if I touch your breast?" and ask for their permission, then go about my business.

You can easily cover yourself (legally speaking) by stating your intent and asking permission before touching your patient. It's a habit now to do it for every patient, every time. Something as simple as assessing bowel sounds can feel invasive if you don't say what your intention is.

Hi all.I am the one who created this post. I have yet to fully learn how to utilize this forum. I appreciate the replies but none really answers the question, who made the "back of the hand" rule?It seems to be taught to every medical worker who will have to deal with the matter. Therefore, some "medical authority" must have thought it up and made it a standard to teach to all students of EKG or Medical Assisting ( etc). Was it the American Medical Association? ( It seems that they are very politically powerful and can make rules for a lot of medical personnel to follow). Thanks to anyone who can provide info. Maybe some of you can ask a teacher or professor whom had taught it to you.

Did you ask your instructor?I can say it certainly wasn't taught to us when I was in nursing school. I have never heard "back of the hand" until this thread.

I am almost done with dealing with the instructor who told me about the "rule." I may not get a chance to ask him. However I can also try to put two and two together.So, let me ask you "klone" how long ago were you in nursing school? Maybe it is some relatively new rule or standard that came about since the 1970s when society began to realize that sexual harassment happens regularly in common situations, such as in the workplace; and even when doctors deal with patients. Perhaps the "rule" did not exist anytime before the 1960s.

Quote from quizzicalSo, let me ask you "klone" how long ago were you in nursing school? Maybe it is some relatively new rule or standard that came about since the 1970s when society began to realize that sexual harassment happens regularly in common situations, such as in the workplace; and even when doctors deal with patients. Perhaps the "rule" did not exist anytime before the 1960s.

Quote from quizzicalHi all.I am the one who created this post. I have yet to fully learn how to utilize this forum. I appreciate the replies but none really answers the question, who made the "back of the hand" rule?It seems to be taught to every medical worker who will have to deal with the matter. Therefore, some "medical authority" must have thought it up and made it a standard to teach to all students of EKG or Medical Assisting ( etc). Was it the American Medical Association? ( It seems that they are very politically powerful and can make rules for a lot of medical personnel to follow). Thanks to anyone who can provide info. Maybe some of you can ask a teacher or professor whom had taught it to you.

I suspect you're looking for a reference to a "rule" established by some governing body, and there is none.Firstly, the American Medical Assn. is a professional association for physicians. It would not regulate the practice of clinicians who, for example, perform EKGs.The back of the hand technique you describe is commonly, but not universally, taught. If it works for you - great. If you develop an alternative way of working with patients' personal boundaries - that's great too.

Funny.I spent a very brief time teaching MA courses at a for-profit "college" until I realized admin was requiring me to pass students who were cheating and failing. I refused to send "healthcare providers" out into the world who were unknowledgeable and incapable. The concept was frightening and the idea that I was contributing to that horrified me.But, I digress. In the EKG lab that I taught, the textbook suggested the back of the hand method and I thought, "that's the first I've heard of that but, hey, it works." I also added on that the students should inform the patient of their intent. These are just general manners and not made up by a board of physicians who makes the end-all-be-all rules for patient care. My clinical instructors always made the point that we not call our patients endearing names like "honey" or "baby" so I've always passed this along in my own teaching. The patients are not in fact my "honey" or "baby." When I've been a patient I don't really like being called pet names, either.