When I was in residency, sexual assault exams were part of our training.  We spent a lot of time learning how to ask the right questions, how to be gentle and empathetic, how to gather evidence appropriately and thoroughly.

While many hospitals now have SANE programs (Sexual Assault Nurse Examiner), I have never enjoyed the privilege of working with one of them.  I have, for two decades, performed sexual assault exams on my own.

In 21 years of practice, I have been in court (as far as I can recall) no more than three times to testify in a sexual assault case.  That suggests to me that one of two things may have happened in the cases that involved me.  First, the case was never prosecuted for any number of reasons (the alleged victim recanted, law enforcement felt the case was too weak, the story was good but the evidence was inadequate, procedural problems, etc.).  Second, the case was prosecuted, and the evidence was so damning that my testimony (separate from the evidence gathered) was irrelevant.  Third, the case indeed went to court but the story and evidence were so poor that no prosecution resulted, and it was deemed unnecessary to involve me.  I am not of a particularly legal mind, so excuse me if I have missed other reasons.

I was recently thinking back to a patient I saw some years ago, who alleged that she had been sexually assaulted.  And then I thought back to residency.  And I remembered something that always troubled me.  In residency, I recall being told not to comment, in my chart, on whether or not the alleged victim had been using alcohol or drugs.  I seem to recall (and I may be wrong on this point) being discouraged from obtaining blood alcohol levels or urine drug screens.  (In like manner I was told to note in the chart whether I saw live sperm in samples, but not to remark on their absence.)

Back to the case at hand: The patient I saw had been drinking copious amounts of alcohol and was clearly very intoxicated.  While I saw her, and law enforcement officers spoke to her, her story changed wildly from assault by multiple men to assault by no men.

Now, I ask you wide and gentle reader, was her alcohol use relevant to the situation?  When asked, “Who assaulted you and describe what happened,” would her recollections be trustworthy?  Would they be sufficiently lucid to possibly put a man, or several men, or a woman for that matter, in prison for years for what could have been consensual sex? And before you accuse me of sexism, remember that in an era of equality, both men and women are capable of sexual adventure as well as being capable of deceit and vindictiveness.

I believe that an alcohol level and drug screen was relevant.  Not in order to punish someone for substance use, not to “slut-shame,” but because like sexual assault, arrest, and prison are serious, life altering things.  And because one’s ability to recollect what happens clearly can be influenced by drugs.

If I were intoxicated and said that I had seen young man commit a crime, and if my story varied wildly with each telling, it would be evident to all that my impairment was an issue in terms of the validity of my testimony.  I don’t see how it can be any less in sexual assault.

Sexual assault is a problem.  False accusations of sexual assault are also a very real problem. But covering up reality to attain a particular end, however gilded our intentions, is never the right thing to do.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test and Life in Emergistan.