In general, the rule is to have a "chaperon" present to protect patients against possible sexual misconduct, and to make them feel more secure during intimate examinations. The official AMA guidelines state, "From the standpoint of ethics and prudence, the protocol of having chaperons available on a consistent basis for patient examinations is recommended."
In fact, most institutions mandate that chaperons be present for rectal, pelvic and breast exams. Whether this actually happens is another story.
In practice, adherence to these rules varies widely. Often the issue is not having extra staff available, or not having enough time to track someone down. Most male doctors are assiduous about having a chaperon when performing a breast or pelvic exam on a female patient, though many do not use chaperons for male patients.
But female doctors, as a group, rarely use chaperons for either male or female patients during genital exams. In some studies, the number was as low as 10 percent.
When I asked various female doctors whether they use chaperons, most responded that they knew they were supposed to but that it was just too hard to manage in a busy clinic day. Others commented that bringing a chaperon into the exam room felt awkward to them, especially with patients they knew well. They felt that it inserted a sense of mistrust into their relationship with the patient And some confessed that it just didn't feel necessary; sexual misconduct by doctors always seemed to involve the male half of the profession, they said.
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.
Personally, I've always disliked the word "chaperon," even though it is the accepted terminology. There is the assumption that the physician cannot be trusted, and that like a teenager at a prom, he or she must be sharply watched for expected misbehavior. On the other hand, I am aware that the patient is acutely vulnerable — psychologically and physically — during the physical exam.
What probably makes the most sense is for male and female doctors to ask all patients whether they'd like another person present during an intimate exam. It's critical, though, that the question be posed in a neutral way, not implying a preference — or a hassle — with either choice. Our goal is to engender trust and to make our patients as comfortable as possible.
http://well.blogs.nytimes.com/2010/12/02/do-patients-need-a-chaperone/
