Chaperone or not during exam

[masstudent]

I know I am probably going to get a lot of heat about this question but I am going to ask it. I am a prenursing student and work ata local free clinic as a volunteer manager. I am having an argument with the nurse who oversees the volunteers that when a male doctor performs a pelvic/breast exam that a female chaperone should be in the room. The male nurse's opinion is that it is a medical procedure and there is no reason he shouldn't be allowed in to help the doctor. My concern is for the comfort of the patient. Not all pateints feel comfortable speaking up about having 2 males they don't know in the exam room. I have been used as a chaperone before bout one of the patients became upset because she had seen me working the desk that night something I only do when we are short staffed.

I have convinced our only ob-gyn to always use a female and he now works with his wife who is a nurse so it is not a concern for him anymore. Actually when I mentioned the situation to him, he said it never crossed his mind since all of his nurses at the regular hospital are female.

So my questions are are doctors required to have a chaperone of the opposite sex in the room during a pelvic exam? A question that the clinic nurse has asked me is why isit okay for a female doctor/nurse to do a rectal on a guy without supervision? My response was that the guy can't get pregnant.

Have any guys who work ob/gyn had a lot of problems and how do you/they handle it?

[mhull]

Now....my personal opinion is that if there is family in the room (which there almost always is) why would anyone (male or female) need a chaperone....wouldn't the family member work? Just curious if anyone else felt the same way.

I don't think I would use the family as a chaperone. It will make them, patient, and me uncomfortable. What if the family claimed something inappropriate and they was the only witness? I see that being a really touchy subject. It is best to just have a staff member chaperone.

[CEG]

I have always found it creepy to have an extra person hanging around the room during a pelvic exam... But after one horrificly bad experience I only see females for my care so it's not an issue anymore. If a female provider offered a chaperone I would decline unless she was uncomfortable with it.

[MS._Jen_RN, ASN, RN]

I think it should go both ways. If a female wants another female in the room when having that kind of exam, it should be available. If a male wants another male in the room, that should also be available. Not saying it always goes this way in either case, but I think that is how it SHOULD be.

I would agree. Because it is for the safety and comfort of the patient, they should choose. If the patient just wants someone, reguardles of their gender, that's OK too.

Just to play devils advocate:angryfire , what if the female MD preforming the exam is a lesbian? What if the male MD were gay? Would women feel that they needed a chaparone? (assuming the patient knows - I know)

~Jen

[diamondmeadows, BSN, RN]

Just to play devils advocate:angryfire , what if the female MD preforming the exam is a lesbian? What if the male MD were gay? Would women feel that they needed a chaparone? (assuming the patient knows - I know)

the physician i used to go to (i switched for a different reason) was a lesbian, and i am female. she always had a female chaperone in the room. my current physician (whose sexuality i don't know or care about) does the same thing, and i never asked either of them to do so.

honestly, i have never even imagined that my physican might do something inappropriate. i think it's just a good idea to have someone else present for many reasons, and i have never felt too awkward about the other person being there because she and the physician are always chatting and relaxed.

i also think the form with the box checking is a good idea. or at the very least, if it has to be handled verbally, the question could be phrased something like "there will be a staff member in the room to assist. would you prefer a female or a male?" instead of "is (opposite sex) okay?"

[nursedude1]

As a man who has worked in OB/GYN, and may someday again work in OB/GYN, I find a lot of interesting commentary here... I have run into the issue of chaperoning before. My heart's desire coming out of nursing school was to work in L&D. I took a job on an antepartum/GYN unit and was glad that I did, due to many of the issues raised here.

The thread most troubling to me here is the insinuation that any man performing an intimate procedure with a female patient must be a sexual predator. Yes, we do live in a litigous (sp?) society, and we must constantly be vigilant to protect our licenses. In two-plus years of OB/GYN nursing, though, I have only had ONE patient to make any kind of accusation against me, and it had nothing to do with any intimate procedure. The patient had a psych history - she claimed that I had 'accidentally-on-purpose' "caressed her breast" while reaching for the blood pressure cuff. Of course my unit manager and her manager took it no more seriously than they had to and the matter was soon over. I guess what I'm trying to say is that any reasonable person is capable of speaking up if they are uncomfortable with a situation (patient or staff member). If you notice that a patient seems to be uncomfortable with a certain aspect of their care, you should then graciously ask if there is any way you might be able to accomodate that patient's sensibilities.

I have never performed an invasive exam on a female, but I have on innumerable occasions had to work 'down there' without incident. We might (and then again, we might not) be avoiding a few lawsuits, but what we are also doing, unwittingly, is to undermine the bonds of trust that we try to build with each of our patients. No one in their right mind would deny a chaperone to a patient that requested one, but to require one for each and every encounter only sends the message that we as professionals are not trustworthy. What's next? Video monitors at the bedside to record every move that we make?

[clemmm78, RN]

as a woman, I have never had a chaperone in the examination room. Ever. I've had three differnt male gyns and one female. I couldn't stand the female and have been wtih my currect gyn since before my 19 yr old was even conceived.

Maybe it's where I live that it's different, but it wasn't until way after I had my kids did I even hear of women having a chaperone in the room.

[caroladybelle, BSN, RN]

To Nursedude:

I advocate for sensitive and competent men to work in all areas of nursing care.

We are not "assuming that all men are predators" when asking for a chaperone, anymore than a male provider who asks for a chaperone is assuming that all women will irrationally accuse them of molestation. It has to do the policies set for civility.

Often times, a patient may mistake innocuous movements and actions during many procedures for something that they are not. Often times patients (of both genders) will mistake certain interests/behaviors/language of the healthcare provider as something that they are not. Patients are also stressed/in pain/sedated/medicated, when in a facility and may mistake inoctuous things.

The other issue, is that most care is better rendered when the patient is relaxed and calm. A pelvic (especially if the patient is having pelvic distress) no exception. Just think how distressed some men get at the idea of a rectal or a prostate exam, even though it is less invasive and no one is using COLD instruments to do it.

I, for many years, refused male MDs because of some extremely poor and insensitive behavior on the part of several male MDs/PAs. I trust my current male MDs implicitly, though.

As an aside, healthcare providers, especially in the ER, show a great deal of suspicion about female patients and often do not believe them. As an ulcerative colitis patient and a female of childbearing years, VIRTUALLY EVERY TIME that I have presented to the ER/new MD with an abdominal issue, I am generally required by the ER/MD to have a pelvic, a pregnancy test, and in some cases, a STD check. When I have explained that there is ABSOLUTELY NO CHANCE that I am pregnant or STDs(cannot have the disease if not exposed...for monthes or at times, years), I am brushed aside with the "Well, we just have to MAKE SURE". It is often condescending and distrusting of me. Not to mention, an added unnecessary expense.

When the health system shows such distrust to its patients (with what it considers prudent reasons), it has no right to expect more trust be rendered it.

As far as a lesbian provider, as she has probably undergone a pelvic a few times, and dealt with some of the same questions (and cold instruments), one would suspect that she is more sensitive to making the procedure more comfortable. And since most MDs require some assistant there to prep slides, hand instruments, send specimens, she is not likely to be by herself, either.

[swatch007]

Health care industry is like any other business out there. We want to satisfy customers or clients. However, due to the nature of our business, we have to consider the gender-specific-approach. Whether we like it or not, it is futile to argue about the double standard involved with this business when it comes to the genders of health care provider to patient.

What is more important here is a patient should feel comfortable with the gender of her or his care provider, so we cater our services based on our clients' needs as long as we are allowed to do so within the legal limit of our professional practice. It's like being a chef in a big restaurant; the food the chef's cooks should not be too salty because others custumers don't like it for different reasons, so cook the food with light to moderate amount of salt and make a table salt available next the customers while dining --they can put more salt as they wish.

In our case, have female nurse available around the female patients in their most vulnerable times if it what it takes to make them feel comfortable. Hey, it's all business. Setting aside our feelings by meeting our clients' needs first is what makes us professionals.

[Gabie Baby]

The whole point of a chaperone for male doctors was, I thought, to protect the doctor from unfounded accusations that he did something untoward to the patient.

I never thought and never was taught that the patient's comfort was the issue. Reading it here, I do see the light now! Thank you. So, coming from that position, it seems completely counterproductive to subject a female patient to a male doctor AND a male nurse.

You're the boss. You make the rules. Get rid of anyone who won't follow them.

[Gabie Baby]

I would agree. Because it is for the safety and comfort of the patient, they should choose. If the patient just wants someone, reguardles of their gender, that's OK too.

Just to play devils advocate:angryfire , what if the female MD preforming the exam is a lesbian? What if the male MD were gay? Would women feel that they needed a chaparone? (assuming the patient knows - I know)

~Jen

I've wondered that, too, Jen. Life is so darned complex. Sigh

[gth]

Maybe to ensure all patients are able to express their wishes for a chaperone there should be some sort of check box on some form stating they would always like a chaperone or a female nurse or doctor. That way they don't have to ask or tell the doctor they feel uncomfortable, that in itself is not comforting.

Personally, I feel more comfortable with males, maybe because I was raised by my father? Who knows. I totally understand the second person in the room, but male or female, it's always seemed a little creepy to me because they are just standing there...watching...and watching:uhoh3: . For me that's more uncomfortable than being alone with the male.

I think your check box is a great idea. I am a male and go to female internist with no problem but I feel any time a person goes to new Dr. a nurse should be present. Personally would prefer female as never seen a male nurse in any office.

[Melina]

however, i disagree with your statement about the female care provider and the male patient. again, for the benefit of the patient and the care provider, i think a male chaperone would be preferable.

As a girl, I really don't have the expertise to have an opinion, but would a man really want another man in the room during an exam 'for support'? It seems that the fewer witnesses to a prostate exam, the better. Any men have an opinion? Would you want another man (or woman, for that matter) in with you during your exam?

~Mel'