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?

[masstudent]

"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?"

The problem with only supplying a chaperone when a patient asks for one is when the patient feels uncomfortable asking for one. Many patients feel vulnerable during a pelvic/breast exam be it done by a male or female. I had a patient complain that she didn't like being examined without a female present after the fact. If my clinic had a standing rule to provide a female chaperone we could have easily made her happy. Many patients don't speak up and as nurses we need to advocate for all of them, especially those who don't have a voice. In the clinic I work at we have many females from other countries and their english is limited. I am sure they would like to have a female in the room but won't speak up. I also went to college with a lot of Muslim students and my roommate who was Muslim wouldn't even think about getting a breast/pelvic exam from a female doctor even though it could possibly save her life.

[nursedude1]

You're probably right as far as the patients not able/comfortable speaking up for themselves. There are always three sides to every story, each one usually not without merit...

I happily advocate for the comfort, safety, and privacy of each of my patients. I only worry about the message that this sends to our patients and to the public with regards to men working in nursing. We have a hard enough time recruiting men to this profession to begin with. Now we present with the perception that men in nursing are not trustworthy (while women are). It doesn't matter if that's not the true meaning behind all of this. The general public doesn't care about details, only perception. We male nurses, as a minority, should be trying to change the public's perception about us, not apologizing for being here.

I know that this probably qualifies as a rant, so let me just summarize by saying that while there certainly many people out there who have different values than our own, I also think that the public perception of men in nursing is influenced by our own attitudes and behaviors. In my 2.5 years (a plethora of experience, to be sure) of OB/GYN nursing, I have found very few patients (even those from more modest cultures) that I have not been able to 'win over'. Even the most reluctant ones, in the end, would admit that my determination and sensitivity changed their minds about having a man "take care of them".

[58flyer]

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'

My opinion...as a male, I would definitely want a male chaperone if the caregiver is female and is performing an intimate exam/procedure. However, having had some bad experiences with female medical personnel (nurses and docs), I would most likely not accept such care from females at all.

[diamondmeadows, BSN, RN]

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'

you're right. i am not a man, and i'm not even going to pretend that i have some special insight into the male perspective. :wink2:

i suppose i was just thinking that it might make some men more comfortable in the way that it makes some women more comfortable, but that could just be my naivete. i was also thinking about the lawsuit opportunity: "well, they were both women, and they were working together to sexually abuse me." i don't know if this has ever happened before; i just always tend to think of the worst case scenario. based on my very limited knowledge, i think that ultimately it should be whatever makes the patient most comfortable and the health provider most secure, within the limits of practicality.

[58flyer]

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.

Sorry to read that you had a bad experience. You are not alone. Would you like to share it with us? That's how we learn. Of course if you don't want to, I respect that.

[JaneyW]

As a nursing student a few years ago, I chaperoned a doc doing a pelvic on a woman in her 70s on a med/surg floor. I forget exactly why she was there, but the male doc was someone that had been called in to consult. What I will remember forever about that incident was that the patient was very uncomfortable about having an unknown male touch her--appropriately--and was just mortified by the whole thing. After he was gone, she was tearful and when I hugged her she thanked me for being there and for supporting her and listening. He was a polite, good doc who did nothing wrong, it was just the situation that was disturbing for her. For her, I needed to be there and be female. It was one of those 'art of nursing' moments that keep me in this profession.

Don't get me wrong, nurses of the male gender are also great practitioners of the 'art of nursing'. I just think that, as many others have already posted, we need to keep the needs of our patients foremost in our minds and be advocates for them--not ourselves and our own need to feel like we can do it all regardless of what the patient may feel. Maybe it is a left-over remnant of the "mom-love" thing in us that makes us comfortable with females? I don't know. I am not anti-male--don't flame me. I have three sons!

[CEG]

Sorry to read that you had a bad experience. You are not alone. Would you like to share it with us? That's how we learn. Of course if you don't want to, I respect that.

First off, I am 27 years old and have 2 children so I have had a lot of different people "down there" and have never been close to the experience I had with this man. First I was told that I had scheduled the exam at the wrong point in my cycle (I believe it was about 4 days before ovulation- cervix should have been pretty open). Then he began the exam without the standard "You'll feel me touch" which is a little disconcerting. At that point he realized there was no chaperone in the room, opened the door, yelled at someone to come in and we waited, me in stirrups, him sitting at my bottom end. The door opened again and a woman came in (I say woman and not nurse because I had no idea who she was). He proceded with the exam, pronounce my cervix "weird", muttered that he needed a large speculum, got it, put it in painfully, moved it around to visualize my (I have since learned) posterior cervix. That exam hurt worse than having membranes stripped, water broken, any pap I have ever had, etc (not worse than pushing out a 9 lb baby though :) ). I bled following this exam for quite a while and I was sore for several days.

My feeling is that this was a particulary unskilled provider- no one has ever had to fight to see my cervix or use a larger speculum. It was painful, degrading, and unnecessary. He was disrepectful to me. I am sure the only reason he had any patients was that he was a military provider and no one had any choice.

Using the word horrific was probably a little much, but this was not a good experience and has made me stressed for every exam I have had since then. I have never had a similar experience since. I always chose female providers and when I have risked having an on-call male doctor it worked out that I had a female midwife.

On a side note, a friend on mine had an on-call doc she didn't know for her son's birth. Each time he examined her he would throw back the sheets, check her cervix, say she would probably need a c-section, and leave with her butt out in the air and her trying to reach down to cover herself with the sheet. She found it quite degrading. A good teaching point for all providers, male or female.

[rhiannonwolf]

I am shocked and mortified that the clinic that you work in does not have a chaperone for their patients during gynecologic exams performed by male docs or nurses. I know that at my clinic and my hospital, it is MANDATORY that a female is present for all cervical checks and breast exams. If not, there is a huge liability for our institution. What about all of the patients who have been sexually abused? Is the doctor and male nurse that you work with sensitive to this dominating issue? The patient can always come back and slap a lawsuit against us if we do not do this. It is a violation of patients' rights and we as nurses or in your case a student nurse should be advocates for the people we care for. I am an OB nurse and I know firsthand that about 30% of all of our clientele have some past history of sexual abuse or domestic violence. I hope that you can go to a superior of your clinic and express your concerns. It just burns me up when I hear abou cases like this because, in your situation, if it is a free clinic, the patients are probably on the lower end of the socioeconomic ladder and this egomaniac doctor probably feels like they have no rights, they are just lucky to be recieving his services. Him and this male nurse need to be taken down a few notches. Just ranting!!

Rhiannon:angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

[mshultz]

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'

I do not have a history as a victim of abuse, and have never been concerned about inappropriate sexual contact from a healthcare worker (male or female). My concern around female healthcare workers is that I not do anything that might make them uncomfortable.

I received a digital rectal exam when I was in the ED in 2003 for a bad GI bleed. The male doctor was able to squeeze his hand between my thighs and under my genitals without me noticing until he touched my orifice (No one warned me in advance). It did not matter to me that three female nurses were present.

I do have a problem with urinating in public, but I believe I would have been given privacy even if I had not told the Critical Care nurse I needed to be alone.

[58flyer]

First off, I am 27 years old and have 2 children so I have had a lot of different people "down there" and have never been close to the experience I had with this man. First I was told that I had scheduled the exam at the wrong point in my cycle (I believe it was about 4 days before ovulation- cervix should have been pretty open). Then he began the exam without the standard "You'll feel me touch" which is a little disconcerting. At that point he realized there was no chaperone in the room, opened the door, yelled at someone to come in and we waited, me in stirrups, him sitting at my bottom end. The door opened again and a woman came in (I say woman and not nurse because I had no idea who she was). He proceded with the exam, pronounce my cervix "weird", muttered that he needed a large speculum, got it, put it in painfully, moved it around to visualize my (I have since learned) posterior cervix. That exam hurt worse than having membranes stripped, water broken, any pap I have ever had, etc (not worse than pushing out a 9 lb baby though :) ). I bled following this exam for quite a while and I was sore for several days.

My feeling is that this was a particulary unskilled provider- no one has ever had to fight to see my cervix or use a larger speculum. It was painful, degrading, and unnecessary. He was disrepectful to me. I am sure the only reason he had any patients was that he was a military provider and no one had any choice.

Using the word horrific was probably a little much, but this was not a good experience and has made me stressed for every exam I have had since then. I have never had a similar experience since. I always chose female providers and when I have risked having an on-call male doctor it worked out that I had a female midwife.

On a side note, a friend on mine had an on-call doc she didn't know for her son's birth. Each time he examined her he would throw back the sheets, check her cervix, say she would probably need a c-section, and leave with her butt out in the air and her trying to reach down to cover herself with the sheet. She found it quite degrading. A good teaching point for all providers, male or female.

CEG, thanks for posting that. A good example of how to NOT treat a patient. I cannot understand how anyone would want to subject a fellow human being to degrading and disrespectful treatment. I'm sure you didn't do anything to deserve it. All you did was give him your complete trust. Unfortunately there are some mean people in the world. Even though there may only be a few, they do a lot of harm for their small number. I know where you are coming from with the military provider and you not having a choice. It's also true in the civilian world when you deal with a public health agency. In my previous law enforcement career, our employment physicals were done at the health department. The guys were told to strip down to just underwear with no drapes or gowns provided. Of course when it got to the rectal exam, there you were with your skivvies around your knees, bent over the table, with absolutely nothing else to cover with. Talk about degrading! I was lucky enough to have a male doc, but I had to walk around him to shut the door to the room, he apparently didn't understand the concept of providing privacy. Several of my friends had to endure this exam at the hands of a female doc. The female officers were allowed to go to the OB doc of their choice, so at least they were spared. Since then, thanks to the police union, specific guidelines were devised telling the health dept precisely how the exams are to be conducted and with appropriate respect. In addition, candidates are allowed to choose their own doc at their own expense. Not all military docs are bad though. My current doc is ex-mil, and he is top notch.

CEG, may all your future care be done by compassionate professionals. Hugs to you......

[CEG]

. Not all military docs are bad though. My current doc is ex-mil, and he is top notch.

quote]

ITA- The military midwife who caught my two babies was wonderful! Sorry to hear about your experience, the military entrance exam is similar. Best wishes to you.

[RNfromMS]

"Then he began the exam without the standard "You'll feel me touch" which is a little disconcerting."

We have a resident at our hospital that is a 2nd year as of the first of July. I don't know how he made it through his internship (they spend that first year in triage) because he was so rought with the patients during exam and would even check them without KY. I know that most of the nurses who chaperoned him during that year called him on it several times. I was with him today when he examined a laboring patient and he was completely different. I think it is very important for the nurses to express their opinion for inappropriate treatment like that.

We have also had words with the few residents who, when a patient being checked screamed or pulled away, would make comments to them like "I don't know how you got pregnant acting like that." I have not had one act like that in a while.