I have recently left an employer regarding this situation, and wanted a unbiased opinion on the topic:
I work(ed) in a pediatric unit, where a 5 year old patient presented with excessive vaginal discharge. My initial impression of the situation was that abuse was unlikely, but I wanted to provide a comprehensive workup, and decided to take an nuswab of the patient's discharge at the vaginal opening to rule out bacterial vaginosis, as well as screen for any potentially more malignant sources of discharge, such as GC/CT (even if I did not specifically suspect these things). My clinical administrator found this to be egregiously wrong, stating that it is a traumatizing experience for a child to go through, and that urine would be as powerful of a screening tool as a culture of the discharge itself. I questioned that if the procedure was traumatizing (This is not an endocervical sample, no speculum was used and the patient had no visible reaction to the swab being taken at the vaginal opening), and also questioned the clinical value of urine, with the belief that a urine culture is a less sensitive workup than a nu-swab would provide.
Since we have decided to part ways after this decision, my standard resources are unavailable to me, and I wanted to talk to meddit on this topic to insure my own clinical care is appropriate in the future. What do you think? Did I cross a line by using this tool? If I was to use urine, would a urine culture have the adaquete sensitivity to screen for pathogenic organisms? What would be best practice in this situation? I'm more interested in improving my patient care skills than I am receiving validation.
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