Do Doctors Need a Chaperon? (HemoDoc, From Doctor to Patient)

By Peter Laird, MD

I read an article in New York Times titled: Do Patients need a Chaperon? which brought me back to one of the important aspects of my own practice in medicine. I trained at an Army Medical Center where one of my colleagues in surgery residency was accused of improprieties simply for conducting an abdominal exam on a young female in the ER with symptoms suggestive of appendicitis. The difficulty attendant for any physician is that once a complaint of this nature is placed, there is truly no defence for that physician since it becomes the patient's word against yours. In most cases, the doctor is held guilty with no recourse of defense.

To answer this issue, the commanding general of our medical center imposed mandatory chaperons for all female exams including history and physical exams not involving pelvic exams, perhaps a little overboard, but then again, the physician in the surgery residency carried that accusation against him the rest of his career.

As a male physician, I have utilized this for all of my patients needing pelvic or breast exams. I supervised several nurse practitioners over the years who I also advised to utilize chaperons even though they were female practitioners with female patients. The wisdom of this came to roost when one of those nurse practitioners had a complaint lodged against her from doing a routine pap smear. Pap smears as all women know are intrusive and quite personal events outside of their ordinary daily activities. It consists of both a speculum exam and what is referred to as a bi-manual exam where the uterus is palpated between a hand on the abdomen, and one internally. That is the standard of care for such an exam.

The New York Times article took a unique twist I had not expected by calling the presence of the chaperon themselves intrusive. I hadn't expected that outlook given the intrusive nature of the examination itself.

DO Patients Need a Chaperon?

What’s more, it is not clear that having a chaperon in the room actually makes patients feel more comfortable, either.

Studies tend to show remarkably similar results: most female patients want a chaperon present during an intimate exam by a male physician. But if the doctor is a woman, that number is extremely low. In fact, many female patients distinctly do not want a chaperon present when they are being examined by a woman.

This attitude is mirrored by male patients, who overwhelmingly do not want any third party in the room, regardless of the sex of the doctor. For many patients, it turns out, a chaperon can make them feel uncomfortable.

So then we have to wonder whether chaperon policies are protecting the patient or protecting the doctor. If it is harming some of our patients by making an awkward situation even more uncomfortable, then we need to rethink blanket rules that mandate chaperons. On the other hand, we need to ensure our patients feel secure during these more sensitive areas of the physical exam.

The article asks an interesting question - are chaperon policies protecting the patient or protecting the doctor? The answer is unfortunately both. There are too many well documented cases of sexual misconduct by physicians whereby the patients do indeed need this protection from a small number of practitioners. Likewise, there are a small number of litigious patients that make false allegations against physicians that without a chaperon to document the interaction leave the physician completely defenseless against that accusation.

Unfortunately, some patients don't understand the nature of the legal requirements of these examinations and misinterpret the actual procedure done purely on medical standards of care, believing incorrectly that something untoward just happened when in reality it was the standard and required examination. The article thus takes only a one sided argument on the patient's side of this issue without at all considering the devastating effects on a physician of even one sexual impropriety accusation ending an otherwise promising and rewarding career. My response is to give the other side of the issue from a doctor's perspective that was not represented at all in the NYT article.

Nevertheless, I underwent a cystoscopy as part of my evaluation for renal transplant several years ago since my underlying renal disease sheds blood cells from the kidney itself. I have known the urologist professionally for several years, but I didn't expect him to have a female nurse assistant for the procedure. The indignity of having the exam before his female assistant bothered me more than the invasive examination itself.

Many men and women avoid much of this issue by simply selecting male physicians for male exams and female physicians for female exams. Perhaps that can't always be arranged, but that is the best solution in my opinion for many patients and physicians. But the issue of the medical legal nature of these sort of exams shall not diminish at all the need for chaperons in the exam rooms for certain procedures and tests. It is simply a sign of the times we live in today and the risk of losing a career over one patient complaint is a reality of practicing medicine today as too many physicians found out too late. Chaperons, love them or hate them are a medical-legal reality not soon to depart for the protection of BOTH the doctor and the patient.