Chaperones in the exam room — who gets to decide?

  | November 30, 2017

A woman calls to schedule a Pap smear with her female ob-gyn, who is out on maternity leave. She arrives to discover that her procedure will be conducted by a male doctor and accepts the physician's offer to bring a third party — a chaperone — into the room.

A man schedules a prostate exam with a urologist and becomes visibly nervous when he finds out the doctor is female. She asks if he'd like her to bring a third party — a chaperone — into the room.

In both cases, the chaperone is a female nursing assistant who works in the office.

And therein lies the complication.

The practice of bringing chaperones into the doctor's office — as a way to protect both providers and patients during sensitive procedures — isn't new. Anecdotal evidence suggests that chaperones are most commonly offered in ob-gyn and urology practices.

Guidelines for their use, by such organizations as the London-based Medical Protection Society and the American Medical Association, have been around since at least the early 1990s. The AMA's Code of Medical Ethics says chaperones should be members of that clinic's care team, uphold professional standards, and be asked to leave the room if a patient wants to have a private conversation with the physician.

But as sexual assault allegations sit front and center in the public dialogue, the issue of chaperones feels more pressing — and the fuzzy standards around their use are apparent. 

Outnumbered

Every practice seems to handle the process differently. Some ask patients if they want chaperones, while others use them routinely when the patient and doctor are different genders. Some practices don't offer chaperones at all.

Adding to the complexity are the gender dynamics of the healthcare workforce.

Chaperones tend to be nurses, nursing assistants, and office workers, which means they're most likely to be female: In 2015, according to the Kaiser Family Foundation, female nurses outnumbered male nurses by more than 9-to-1.

Some male patients have complained that bringing a second woman into the room, without their consultation, makes them uncomfortable.

“Many of us have experienced the 'ambush,' where that trust is broken, when the female doctor brings in another female chaperone to be in the exam and sees 'everything' without asking the man whether the presence of another female would be acceptable," wrote one anonymous male, commenting on an athenaInsight article about gender and physician-patient dynamics.

“What started off as a great exam now turns into an embarrassing disaster," he continued. “Contrary to the belief assumed, men do value their modesty and are just as vulnerable in medical exams as women."

“Many female doctors need to re-examine their exam procedures, to ask and not assume her male patient will be comfortable with it," wrote another male commenter. “The message needs to get out to the medical community, to start giving men equal modesty."

Who's vulnerable, and when?

Those concerns — echoed by other male patients — upend some common assumptions about patient vulnerability. Because data shows that more women than men are sexually assaulted, both in medical situations and in everyday life, medical offices have traditionally been more attuned to women's concerns.

“Sexual assault numbers are high, so chances are high that some people are coming into the office with negative experiences and traumas," says Danielle Ofri, M.D., an internist at Bellevue Hospital Center in New York. “We need to treat every patient as if they might have some kind of trauma in their background. [For example] a pelvic exam could be re-traumatizing after a rape."

But men too can face discomfort in medical situations, such as during a digital rectal exam. And today, only about a third of practicing physicians are women — so older men, historically less used to seeing female physicians, may be less comfortable with them.

Data from the athenahealth network bears that out. A 2017 athenahealth/MedStatix study of 40,000 patients found that about 50 percent of patients returned to their doctor's office within 18 months of their first visit if they shared their physician's gender. And women returned to male doctors at about the same rate.

But only 40 percent of men returned to female doctors within that same time period.

Reading the room

Given the sensitivities, medical offices need to be attuned to patients' individual needs and frames of mind, professionals say.

“[When I was a chaperone], it was really about reading the room and doing what made sense based on what the patient needed," says Claire Biggs, a writer and editor who has worked as a chaperone in medical offices. “Some of [the patients] were nervous and wanted to talk. Others wanted to pretend I wasn't there. I took their cues."

Orfi suggests that doctors should leave the decision of whether to use a chaperone in the patient's hands — and always ask a patient's permission before bringing a chaperone into the room.

“A chaperone should be the expectation," she says. “Patients should know that — and if it doesn't come up, they should always know to ask for [a chaperone] if they want one."

And whether or not there's a third party in the room, Orfi says, doctors and nurses should treat intimate procedures with sensitivity.

“It's also about how you do the exam," she says. “Explain in advance, ask for permission, say 'this is what you'll feel.' When you do that, patient feel like they are in control. That is the most important thing."

Jenni Gritters is a writer based in Seattle.

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Doctors just don't care about patients modesty,decency or feelings,that takes time.
Name: 
Robert Haagen
Email: 
keybook6@gmail.com
Here where I live this chaperone nonsense isn't an issue. It's true that men are not treated with the dignity, respect, and modesty that women are in most cases. It's up to both genders to speak up and say what they will and will not put up with during an exam. Call ahead and demand the gender that you want. I hear terrible things from men on Web sites like this one where women health care providers act inappropriately like inviting females in the room during a male exam without asking permission. I blame the men also in part for not speaking up and telling them to get out. If a male doctor invited male nurses in the room during a female exam there would be hell to pay. Both genders need to be treated with the same dignity, respect, and modesty.
Name: 
Jesse Stone
Email: 
Jesse.stone307@yahoo.com
I forgot to mention, All of this inappropriate opposite gender chaperone nonsense could all be avoided if the patient would stop putting themselves in these positions to start with. What I mean by that is, stay with the health care provider that is your own gender and this chaperone nonsense will never be an issue. You as the patient have all of the say on what is going to take place in that room, you're paying the bill. Stop being intimidated and humiliated!!!!
Name: 
Jesse Stone
Email: 
Jesse.stone307@yahoo.com
I don’t argue the key points of the article but I will say that men almost universally do not like the presence of chaperones. The easiest way for a female doctor to lose male patients is to ambush them with a female chaperone for an intimate exam or procedure. While they might have been OK with you, bringing a 2nd woman into the room is a deal breaker for many men. They won’t tell you though. It is too embarrassing to do so. They just won’t be back.
Name: 
MB
Email: 
Bunderhill53@gmail.com
The main point for male patients is to stick with a male doctor and the inappropriate chaperone will never be a problem. A female doctor will always bring in another female as the chaperone, I don't see how that's supposed to be less humiliating for the male patient. Men need to stop putting themselves in these situations and speak up if they are ambushed. I can't see how it's embarrassing for a male patient to have a female that's inappropriately in the room to leave.
Name: 
Jesse Stone
Email: 
jesse.stone@yahoo.com
Too many doctors don't care if their patients come back because they know they have plenty of other patients.
Name: 
JF
Email: 
frylingjudy@gmai.com
The use of any chaperones must always be left solely to the discretion of the patient. If female physicians expect to grow their male patient base they need to figure out real fast that a man deserves the same level of respect given to their female patients. Woe to the female physician who springs a female chaperone on an unsuspecting male patient. Word of her indiscretion will spread like wildfire and she won't have any male patients. The media is having a heyday right now with all the high profile male indiscretions. Maybe it's time the media got wind of all the female indiscretions happening to male patients in the healthcare industry. They say what's good for the goose is good for the gander. Regards, John
Name: 
John
Email: 
raffie326@gmail.com

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Chaperones in the exam room — who gets to decide?