Wednesday, April 16, 2008

Chaperones

I've always been opposed to the idea of having a "female attendant" in the room while I perform a physical examination on a woman. In medical school you always had to have a chaperone in the room when you performed a pelvic or breast exam on a woman and I always thought that doing so made a potentially uncomfortable situation even more awkward. Sends a message to the patient that either you don't trust her or she ought not to trust you. Gave me the creeps. Besides, contrary to popular thought (with the ubiquity of CT scans), physical exam is still a big part of what we do as doctors. I give my female patients a special gown and only expose what is necessary for a thorough exam. It's not a big deal. I can't remember the last time it was ever awkward; usually there's a steady stream of banter to keep things light and then I leave the room so they can dress.

But then I came across this horrible story of a GI doc who was falsely accused of "sodomy" during a colonoscopy. The guy basically lost everything before finally being exonerated years after the intial verdict. Sure, the lady had some serious red flags, but you'd never expect a patient to make up something so outlandish. Read the link if you have time.... it even won a Pulitzer Prize.

14 comments:

rlbates said...

Very scary!

Devorrah said...

I agree--it makes me nervous to have some nurse I don't know in the room. I'm more comfortable with my doctor.

UnsinkableMB said...

That story definitely made a case for having female chaperones present. Scary!

Anonymous said...

why should a chaperone have to be the same gender. i mean, i get it from a patient comfort perspective, but shouldn't another professional be enough? sheesh

platensimycin said...

There is an avoidable element in this case before it resulted in such unfortunate end for Dr. Griffin. Namely, there’s a personality mismatch between the patient and the well-mannered internist. It’s not entirely unlikely that over the course of time, Ms. Jeffreys perceives Dr. Griffin’s altruism and good manner as something she can take advantage of. A clinician can certainly protect him/herself by having a third witness around during the procedure (whether he/she be a med student to whom you can explain the procedure while demonstrating it, or a CMA who can observe and attend to patient’s need while recording clinical findings for you during the procedure). Back in China the court (without jury) also tends to favor the patient rather than the physician or institution being accused. We had our share of pain when brilliant colleagues (for us, often as a result of lack of adequate communication skills) were brought down by litigations. If the differential perception (of the plaintiff, the doctor and of the jury) is the key here, perhaps a third party from the healthcare team can protect an internist in private practice from unwarranted lawsuit. Be that as it may, it is probably quite different for surgical colleagues in a sizable hospital.

Anonymous said...

I know my family doctor is completely unhappy with the female body. he has made me very self conscience on several occasions. if he walks in the room and you even have that 'gown" on he will immediately exit the room and not enter it again until a nurse is with him. I had a rash on my back and the nurse had me get into a gown for him to check it. nope, he wont even come in the room by himself if you have a gown on, even though you may still have on your bra and all your clothes from the waist down. I think he is a little silly although I may not know all the reasons he acts this way.

Guy said...

sounds like your family doctor has heard of cases like this. I won't walk into the room of a patient undressed either.

Anonymous said...

Dorothy Rabinowitz is my heroine. She restores my faith in journalism.

I've been showing that story to doctors since it came out in the WSJ. It is remarkable how many doctors dismiss the story out-of-hand. It's the doctor's fault because he "didn't have a chaperone".

In fact, what he had was a nurse who floated from patient to patient, assisting procedures, checking on recovering patients, getting the next patient ready, etc.

So to believe the doctor did all this sodomy, etc., means he had to be engaged in the act, but could stop and clean up when the nurse pops in unexpectedly.

But that's why medicine is in the shape it's in. We're so quick to condemn each other.

Anonymous said...

this overzealous (almost CRIMINAL) prosecutor should be jailed - she essentially ripped apart a young family that had inordinate potential for serious greatness & contribution to society.

But while Dr. Griffin is divorced, stripped of his kids & medical license, she's still practicing law:

http://attorneys.riverhead.ypeek.com/results.htm?pid=p102&sub=riverhead&what=Attorneys&where=Riverhead%2C+NY&id=624214158

platensimycin said...

which is frustrating to say the least. i wonder how Dr. Griffin is doing nowadays....

Anonymous said...

I coudl not even read all this story. i got as far as all thos eother women calling that 800 number to complain about moronic things like waking up in a room different than the one the procedure was done in. I have EGDs and colonoscopies every 2 years and I have never woke up in the procedure room. These women are idiots.

Her motive is plain as can be. She was pissed at him for not testifying at her trial against her landlord. What a bitch!

Teresa said...

Wow, that is incredibly scary. It kind of reminds me of all the fake daycare center sex scandals that swept the nation a few decades ago.

In medical school you always had to have a chaperone in the room when you performed a pelvic or breast exam on a woman and I always thought that doing so made a potentially uncomfortable situation even more awkward. Sends a message to the patient that either you don't trust her or she ought not to trust you. --Buckeye Surgeon

I could not agree with you more. As a patient, the number of people I would prefer to have in the room for a gynecological exam, ordered from best to worse:

1. Zero people
2. Just me
3. Just me and the doctor
4. Me, the doctor, and 1 assistant
5. You get the idea--I don't need an audience.

But at the end of the day, whether or not I am comfortable with the situation will not affect the quality of the exam as much as if the doctor has the right number of people in the room. The doctor needs to be comfortable, whether that means a chaperone/assistant or not.

I count myself as being very fortunate that I finally have a primary care doctor who does not make me undress just so he can listen to my heart and lungs. He listens to them at every visit, but I am able to retain a modicum of dignity because he allows me to leave all of my clothes on. It also allows me to walk out of the room when he does, which is also helpful psychologically in a way I can't quite find words for.

Oh, and the doctors backing out of the room when they see you undressed--ugh. You feel vulnerable enough, and to have that happen would give me a lot of angst. Doesn't he KNOW whether you are dressed or not before he comes in? My gynecologist always talks to me first, then gives me a gown, along with instructions on how many clothes to take off (all but my socks) and which way to put on the gown (opens in front). Doesn't your doctor know why you are there, and whether that will involve you being undressed or not? Sheesh.

Anonymous said...

This is shameful proof of what people will do for MONEY! Desperation and financial troubles will lead people to lie, cheat and steal to get what they want/need to survive, or in this case, "Get Rich" Unfortunately we have become a "Cover Your Ass" society. (no pun intended).
I am a male seeing a female physician. I'm very comfortable with this, and so far no chaperon needed. But, if she were to insist on a chaperon, I would fully understand.

platensimycin said...

Greed & fear, from Wall Street to the ghetto indeed.