we don't get consent, either, and i rarely mention why i need urine.
[color=#483d8b]i have noticed, however, that some patients automatically assume that any requested urine is for a tox screen. i had one kid (in his 20's) tell me last week "i can't give you any urine. i'm dirty!!!" he was also quite drunk
. i just looked at him and said, "it's ok. who do you think we're going to tell??"
[color=#483d8b]i think it is important to realize that the drug screens we usually do in the er (at least where i work) arn't valid for forensic purposes. mostly because we treat it like a routine ua: have the patient pee in a cup, label it, and tube it to the lab. no quality control, no chain of custody papers, nothing. there is even a little disclaimer on the results that state they are only good for medical purposes. if we have an workman's comp patient where the employeer has requested a drug screen, then someone from the lab has to come over and run the test, with all the appropriate forms signed and hoops jumped through.
[color=#483d8b]by the way, not all states require consent for an hiv test. the one i currently work in does not. if you get stuck with a dirty needle, a needle stick panel is ordered on the patient. no need to wait for a doc to come up and "counsel" a patient about getting the test, and then gettin their permission. not the case in the last state i worked in, where a needle stick panel couldn't be run until the patient consented.