Patient privacy and pelvic exams

[cphillipslpn]

Okay, so I'm a nursing student about to start externship in a physicians office. I recently was a patient at my gynecologist's office, my doctor was female, and they are required to have a chaperon. This particular nurse likes to stand between my legs right next to the doctor and watch the whole procedure. The second time I was there a different nurse stood opposite the doctor to where she could not see what was going on. So my question is; do you have to watch what is going on during a pelvic exam as the nurse? Because it made me very uncomfortable to have so many people down there and I don't want to have to make my patients feel uncomfortable. Where do you all stand during an exam?

[Altra, BSN, RN]

I do not work in a physician office, so my setting is different, but I do assist with pelvic exams. Sometimes I'm in view, sometimes not. The first consideration is the reason for the exam. If the patient is being seen for STI symptoms, abscess, or injuries ... I would rather assess visually at the same time as the physician, so that the patient is uncovered only once, not twice. However if the patient's presentation means that the exam is likely to be painful, it might be more important that I support her emotionally. It just depends.

I also work in a teaching hospital, and sometimes newer resident physicians need some coaching on equipment, specimen collection, and with technique. I also learn a great deal from more experienced physicians, so I may "watch" in order to learn. I'm sure you do the same as a student, no?

Hope you have a productive, successful externship experience. :)

[Rocknurse, MSN, APRN, NP]

I have been trained to do pelvic exams and PAPs as part of my APRN program and we were always taught to ask the patient if it was ok before we did anything and to explain everyone's role in the room and ask if it was ok that they were there. They should be asking your permission before doing that. Quite insensitive.

[cherryelle07]

My OBGYN is male and I've never had a nurse present for a pelvic exam. I believe there was one there to assist with the placing of my IUD, but that was it. My exam was just me and my physician.

[Horseshoe, BSN, RN]

Every male OB/gyn I've gone to has called in the nurse when it's time for the exam. When he's doing a pap smear, she appears to be helping him with it, but I suspect that some of this is to protect the doc from being accused of doing anything inappropriate. And whether or not it's the intent, the presence of the nurse also serves to protect that patient.

[cherryelle07]

Every male OB/gyn I've gone to has called in the nurse when it's time for the exam. When he's doing a pap smear, she appears to be helping him with it, but I suspect that some of this is to protect the doc from being accused of doing anything inappropriate. And whether or not it's the intent, the presence of the nurse also serves to protect that patient.

Mine didn't. He offered, but I declined and said I would be fine. Everything went pretty smoothly. He was very professional and I have no complaints. An nurse was there for the very beginning, but she left when he came in.

[mysonsmama]

Usually it's medical assistants working in these types of roles in doctors offices. And if they are chaperoning the provider (Doctor, NP, PA) then they are 1. Providing assistance with supplies and 2. Being a second set of professional eyes in case there is an accusation of inappropriate conduct. If the MA stands where she can't visualize what the provider is doing she can't very well give an accurate statement that the provider did no wrong during the exam, after all, they didn't witness it.

Just a side note: since when do nursing programs do externships at doctors offices? This sounds more like a MA program.

Just my 2 cents.

[sailornurse]

In many offices it is standard to have chaperone during genital exams both male & female patients. In this litigious society, one has to be careful. I worked at one clinic where it was policy to have chaperone in the exam room and yes they need to be able to see the exam. Consider the possibility that of a patient saying they had been "groped" when actually it is the bi-manual exam that is part of the pelvic exam. I also have chaperone when doing sports physicals which require checking the groin for hernias. I won't do a pelvic without a chaperone.

[OCNRN63, RN]

I don't think it's necessary to stand at the foot of the bed and gawk. Your presence in the room should be sufficient.

[OCNRN63, RN]

Usually it's medical assistants working in these types of roles in doctors offices. And if they are chaperoning the provider (Doctor, NP, PA) then they are 1. Providing assistance with supplies and 2. Being a second set of professional eyes in case there is an accusation of inappropriate conduct. If the MA stands where she can't visualize what the provider is doing she can't very well give an accurate statement that the provider did no wrong during the exam, after all, they didn't witness it.

Just a side note: since when do nursing programs do externships at doctors offices? This sounds more like a MA program.

Just my 2 cents.

We had a 2 day clinical at an OB/GYN office as part of our OB/GYN rotation. That was over 30 years ago.

[CrunchRN, ADN, RN]

I always stood where it was the easiest to assist the doctor and reassure the patient. Usually a little back from both and unobtrusive, but ready to assist.

[bugya90, ASN, BSN, LVN, RN]

I'm a nurse in a physicians office. There has to be a chaperone during genital exams for both females and males. I normally stand about waist level with the patient. I'm close enough to hand the provider supplies and am able to tell what they are doing in case of any litigations, but am far enough away that I'm not staring straight at the area or making the patient uncomfortable.