Patient privacy and pelvic exams

RiskManager · Feb 20, 2016

For male providers, I recommend a chaperone whenever it is requested by the patient, but otherwise mandate it for all breast and genital exams of female patients. I have handled way too many cases in which a patient misinterpreted part of the examination and made a complaint to Administration or the disciplinary board. I also ensure that the chart note documents the presence of the chaperone. I like to have the chaperone do something useful, such as handoff instruments or specimen slides, or scribe the results of the exam as the provider dictates it.

I also provide a chaperone whenever a patient requests it, regardless of the type of exam being performed and the gender of the patient and provider.

Biker53 · Apr 10, 2016

Rocknurse, your saying that you explain what everyone in the room is there for and asking the patient if it is OK is like music to my ears. If only it were that way everywhere. Treating the patient with respect can make what would otherwise be an awkward situation comfortable. Patients sometimes feel like they have been ambushed when suddenly there are other people in the room that they did not know were going to be there. It is made worse when the doctor just says in a way that isn't really giving you a choice "I hope you don't mind". The other thing is that any additional people in the room should be accurately defined. For example, a medical scribe should never be inferred to be a medical professional. All trust will be lost with the patients if they figure out later that they were lied to.

Sailornurse, I don't know whether you are a male or female but I do understand your wanting a 2nd set of eyes when doing male sports physicals. Hopefully the chaperones you use are males. Teenage boys won't tell you how embarrassed they are when they are being exposed in that manner to two females, or even one. If for some strange reason it is impossible to find a male chaperone, the younger the female chaperone is the more embarrassing it is for the guys. Again, they won't tell you, but some guys don't do sports because of having to have such intimate exams by or in front of females.

bugya90, I applaud your efforts to not make the patients uncomfortable, but as I noted above most guys won't tell you if they are. Many instead avoid seeking healthcare to the extent they can. There aren't enough male nurses or techs for men to have same gender care in most settings and so the most modest guys don't go.

For me personally it is the process and communication that matters most, more than the gender of the provider. I have been catheterized dozens of times by female nurses and had other intimate care by the same. That's OK with me so long as good process and communication is followed, which it almost always is in my experience. That said I always choose male doctors which eliminates the whole chaperone thing that I don't really want to deal with. I'd be OK going to a female doctor but given the prospect of her maybe wanting to bring a chaperone into the room, I just make life simple and only go to male doctors. In private practice settings the chaperone is almost guaranteed to be a woman, maybe a nurse, maybe the receptionist but in all cases someone who is not directly treating me. One of the key aspects of using good process is to minimize patient intimate exposure. Nurses know to close the curtain or door, drape the patients etc so as to minimize exposure but adding chaperones into the room increases exposure. For most guys it is made worse if the chaperone is of the opposite gender. But they won't tell you.

sailornurse · Apr 10, 2016

For sports physicals for both male & female, I ask the parent to remain in the room. The chaperones at one clinic are all female medical assistants. However at this clinic, there are 2 male providers, the physician and a FNP. I am female as are the part time NPs and the other full time NPs. I also take the time to explain about TSE and testicular cancers. Most people are uncomfortable with pelvic/genital exams. However in this litigious society, it is necessary to have a chaperone in the room. The news recently had story about a physician accused of molesting 2 adult patients. Patients have the option of scheduling an appointment thereby have the choice of selecting the provider that will do the physical. Walk in patients do not have that option.

Anna Flaxis, BSN, RN · Apr 10, 2016

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?

I work in the ER. I do the pelvic set-up, which means I set up all the necessary equipment, i.e. speculum, lube, specimen swabs, get the stirrups ready, have the patient remove underwear, etc. Once the pelvic exam is underway, I stand at the patient's side, facing the physician, so that I may offer emotional support to the patient and hand and receive the specimen swabs to and from the physician.

Since I am not an advanced practice RN and have no desire to become a SANE nurse, I have no need to observe the physician's pelvic exam technique, and as an RN, it is not necessary to document a pelvic assessment - there are some assessments that are perfectly acceptable to defer to the physician.

Biker53 · Apr 10, 2016

Thanks for the explanation sailornurse, and I do understand why medical providers want chaperones for intimate exams. I'm fortunate that I've been able to avoid what I consider a privacy invasion from the patient's perspective but not everyone has that luxury. Interestingly all of my catheterizations (dozens of them for bladder cancer treatments and follow-up cystoscopies), a testicular ultrasound, and other intimate care all by women, none has ever tried to bring a chaperone in to the room. I would refuse the chaperone if they did and if they insisted then I would just leave and find another provider.

I did get a chuckle over the parent being asked to stay. Just what a teenage boy wants, a female NP, a female chaperone, AND Mom watching him get a hernia and testicular cancer check. When I was a teenager I'd of given up sports if that was the price I had to pay in order to play.

Dany102 · Apr 10, 2016

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?

I think you have already answered your own question, cphillipslpn. If it makes you uncomfortable has a patient to have someone standing that close, there's a pretty good chance that is also how patients feels about it. Consider being at their side, instead. Talk to them; make sure they understand why you are there. As opposed to contrive to make up a reason for appearances' sake.

Consider also that some patients will never be comfortable with this, no matter how it is presented to them.

Dany

Biker53 · Apr 14, 2016

Sailornurse, you hadn't commented further and I'm thinking maybe you really are serious that you would do a sports physical including a genital exam on a teenage boy with a female chaperone and Mom there watching. I was thinking you'd come back and say Mom would be asked to leave the room and that the boy would be shielded from the chaperone seeing his genitalia. It isn't his fault that his family perhaps can't afford to go to their own doctor or that his parents choose not to do so, or that Mom is so clueless that she doesn't speak up on his behalf. He is likely so terrified when he realizes what is about to happen that he won't speak up. Men are from Mars, women are from Venus. Silence is often how embarrassed/humiliated males react in this kind of situation. It is singular events like this that cause some men to subsequently avoid health care when they become adults. They may act macho with the "I don't need to go to the doctor" routine but the reality is often that they are afraid doing so will be a repeat of some prior event in which they were needlessly embarrassed and treated as if their modesty didn't matter.

BuckyBadgerRN, ASN, RN · Apr 14, 2016

As a patient I've NEVER looked down to see how many people are all up in my business. I look up or close my eyes! I couldn't even guess where the MA is standing. On her head for all I know or care

Biker53 · Apr 16, 2016

As a patient I've NEVER looked down to see how many people are all up in my business. I look up or close my eyes! I couldn't even guess where the MA is standing. On her head for all I know or care

No doubt that is how many patients, male and female, handle it when they are being needlessly exposed to people who are not part of directly providing healthcare and for whom the patient was not asked permission for them to be there. Obviously a pelvic exam is as about as exposed as it gets.

Personally I am agreeable to allowing students in the room being I understand it is a necessary part of how healthcare workers and professionals learn. I do expect to be asked first however and told exactly what they are (there is big range going from high school kids shadowing on up to residents) , and most importantly that I not have more exposure than is required. For example, students observing my colonoscopy do not need to have a view of my front side, and so I am OK with them being there so long as my front side is covered up. When I had bladder cancer surgery there were 5 medical students present (4 female, one male) and obviously it was my front side that was exposed. That was necessary exposure and so I agreed to them being there. There is a huge difference between being exposed in that manner than being unnecessarily exposed for what amounts to a spectator sport. The "we're all professionals here" mantra means nothing to me when I'm the only naked one in the room.

Chaperones and scribes are another matter in that they are not there as part of their training but rather for the convenience & protection of the doctor. I fully understand why the doctor wants them there but it is within the doctor's purview as to whether they bring in male or female chaperones and scribes. Just as women generally want female chaperones and scribes during intimate exams and procedures, I expect the same courtesy with them being male. If the doctor won't do that, then I won't agree to their presence. I'm not the one who decided to only hire women in that practice.

Having been necessarily exposed far more than most (dozens of catheterizations for example), I am not overly modest anymore. My issue is that I expect to be treated with respect and that means no more exposure than is needed or than I agree to (student presence). And I similarly fully support women who want privacy during pelvic exams or any other intimate exposure.

BuckyBadgerRN, ASN, RN · Apr 16, 2016

Are you a nurse, Vermont biker?

Biker53 · Apr 16, 2016

No, I am not a nurse but I have been in dozens of intimate care scenarios with nursing staff, enough so as to know the difference between being treated respectfully with no unnecessary exposure and on the other extreme having been treated so badly for it to have been a humiliating experience. Over the past 10 years or so I have seen great progress towards treating male patients with respect and am encouraged by that.

I saw a reference on another blog about allnurses.com and came over to get a look see. I have learned a lot by reading some of the threads here and now better understand some of the realities nurses must contend with. I've also been encouraged by comments from nurses that do their best to protect patient physical privacy and on occasion been dismayed to see some nurses still don't get it. All I can do is offer an occasional patient perspective for those who are interested in how patients see things. Please accept my apologies for not having properly introduced myself earlier.

BuckyBadgerRN, ASN, RN · Apr 16, 2016

Nurses are patients as well. Turns out we have a perspective of wearing different shoes. Why a non-nurse would join a forum not meant for them and post long diatribes like you have done is beyond me. Sorry, I'm a firm believers that non-nursing persons do not belong here.

No, I am not a nurse but I have been in dozens of intimate care scenarios with nursing staff, enough so as to know the difference between being treated respectfully with no unnecessary exposure and on the other extreme having been treated so badly for it to have been a humiliating experience. Over the past 10 years or so I have seen great progress towards treating male patients with respect and am encouraged by that.
I saw a reference on another blog about allnurses.com and came over to get a look see. I have learned a lot by reading some of the threads here and now better understand some of the realities nurses must contend with. I've also been encouraged by comments from nurses that do their best to protect patient physical privacy and on occasion been dismayed to see some nurses still don't get it. All I can do is offer an occasional patient perspective for those who are interested in how patients see things. Please accept my apologies for not having properly introduced myself earlier.