Assist during pelvic exam

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I've never had an issue setting up for a pelvic exam, then assisting by handing our docs speculum, swabs, cultures etc. Obviously am there as a chaperone then too. But there is one young doc who is frankly is a jerk, and I don't know whether it's because he's nervous conducting the exam on young ladies but he adopts this strange, bossy attitude with me, making little weird cracks like I work for him and all but snapping his fingers at me to get a move on with handing him swabs etc. It's happened more than once and is really strange. Frankly I don't care what the psychology is behind it at this point, I'm just done with it.

My question is, I believe my role is to set up for the exam and be there as a chaperone but as it's not a sterile exam am I obligated to assist? He can open his own swabs and lube up his speculum just like I can. I've been doing it because it's helpful but if it's not appreciated then I'll just stand to the side. The next time a pelvic comes up I plan on taking him aside beforehand so we don't have an awkward conversation in front of the patient and let him know that I'll stay as chaperone but plan to allow him to manage his own exam.

Thoughts?

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I would decide how to approach it by taking into account how he conducts himself in other encounters you have with him. He should be over it by now, but it's possible that he does feel very anxious while sitting there and has simply made some poor choices about how to fill the awkward silences. Maybe he thinks he's demonstrating to the patient that he's trying to hurry so that she isn't in this position very long. I put my money on a combination of these two things - not that it's okay.

But your "physician intervention" would not work for me. I think once patients' legs are in the stirrups they deserve to have things go as quickly and smoothly as possible.

I would simply ask him if he realizes that he's making all these little comments when he is doing exams. Ask him if the situation makes him nervous or there is some other explanation for it. Once he has his say, let him know you are happy to help him but that those aren't helpful or appropriate comments. Remind him of your role: "I'm there for two reasons: to be YOUR witness (not "chaperone"), and to help things go smoothly for the patient by handing you things so you don't have to fumble around."

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JKL33 I think you make some excellent points, particularly that ultimately what's best for the patient is to be finished as quickly as possible. I will take your advice and approach him the way you've suggested. Thank you!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Having done pelvic exams both as an ED RN in the assisting role and also primary as a SANE, it is very helpful to have someone open swabs and hand them to the person performing the exam. Makes it go faster for the patient, which is best — few patients enjoy prolonged pelvic exams.

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I guess I don't understand your comment. You ARE working for him and the patient, at that moment.

Anything you can do to expedite the pelvic exam is a win, win!

He may be making comments to distract the patient.

Be completely set up, swabs open, speculum lubricated..(2 sizes of speculums handy if needed)

You are there to chaperone... AND ASSIST. Why would you not?

If he is impatient, are you too slow getting him what he needs when he needs it.

Everything he needs is set up 'behind' him/her. Why would you not assist and give him what he needs,

because if you are 'witnessing', you know what he'll need next.

Sounds like much ado about nothing ...or I missed the salient point of your question??

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No it is not okay for a provider to snap his fingers and make cracks about the nurse while performing an exam on a patient, that is the salient point. I assume he is trying to lighten the awkwardness of the situation at the nurse's expense, and even that is giving him the benefit of the doubt. If there IS a problem with the nurse's organization or speed, that would be something dealt with privately - just as she now plans to address her own concern privately.

I think it's perfectly fine to come here and run these thoughts past others in order to get some ideas about one's proposed handling of the situation. Seems to me like she already plans to make a more patient-centered choice than she originally intended. Win.

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I guess I don't understand your comment. You ARE working for him and the patient, at that moment...

No, I never work FOR the physician. I work WITH them. Huge difference.

I don't work for the patient either, but I am their advocate.

And no, snapping fingers and making comments is not acceptable. Could be nerves, but still not acceptable.

I would just try to causally bring it up what he is doing, he may not realize it. It is not a pleasant experience for anyone involved, and acting that way does not help. Maybe he just feels you are not fast enough for him or is used to where he used to work and how it was done there.

Or he may really just be a jerk.

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I just have to add that this behaviour is not OK! Also, from a pt perspective, if this were me and I observed a male doctor demeaning the nurse (I am assuming you are female because you are witnessing) and while performing this SPECIFIC exam to make matters worse, i might infer that the doctor does not respect women and frankly not care about women's health. I want my doctor to be thorough and accurate not speed through because he feels "uncomfortable". Like, get over it! It's a body part and you're a doctor!!

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