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 am a male and I prefer a female provider. I do not prefer to have a third party in the room.
Name: 
Patrick
Email: 
aol@aol.com
Yes the patient must be "out spoken" with modesty issues but it is not always that way, especially for those who are new to being an adult in a hospital, or clinic, situation. Here, is it the doctor's requirement, listed in the "Patient's Bill if Rights, to inform the patient of the option that is available for the patient to be seen by a same-sex, as the patient sex, medical provider?
Name: 
Olaniyan Adefumi
Email: 
oadefumi@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
Most female physicians really only want female patients anyway so they could care less. And since most females want female doctors it's not like they will gave a lack of oatients.
Name: 
mark
Email: 
gonepostal2@charter.net
While I would prefer, as John stated, that the "use of any chaperones must always be left solely to the discretion of the patient," it is unreasonable to expect any doctor regardless of their sex or the sex of their patient to refrain from using chaperones. The use of a chaperone may be required by their medical malpractice insurer. Furthermore, as noted in this article, "female nurses outnumbered male nurses by more than 9-to-1." So chances are that even if a male patient did as Jesse Stone suggested and went to only male doctors, there's a good chance that for certain procedures the doctor may need a nurse in the room, and perhaps a scribe, too - and they're very likely to be female. (But there seems to be very little outrage directed against male doctors in such cases, only at female doctors.) Some men do not care about the sex of their doctor. But others, like me, prefer female physicians - especially for intimate care. Yes, it's embarrassing having a second and sometimes even a third woman in the room while fully exposed. But if that's what the doctor decides for whatever her reasoning or assistance needs, I'm willing to accept that just as I'd be willing to drive further to see a preferred physician. Like MB pointed out, the "ambush" can be quite embarrassing. Been there, too. Common courtesy would be for the doctor to at least warn the patient that another woman will be coming into the room. But it's not a deal-breaker for me. I suspect most of these complaints about female chaperones and with even third females being in the room are from men who didn't choose their doctor to begin with and ended up seeing a female doctor because of a sudden health crisis. Completely understandable why they don't like the situation.
Name: 
PV
Email: 
phillip.virgencito@mail.com
My "ambush" came courtesy of a female doc I'd been seeing regularly for several years. I thought we had a good working relationship, so I had no qualms about making an appointment for a testicular complaint. Then she made the classic move - stepped outside to let me undress, then reappeared with a (female) nurse in tow. Not a word of explanation or warning, and no opportunity to say yea or nay. Just pulled the drape off me and let the nurse stand there staring at my crotch for the entire exam. I never went back and told the practice director why.
Name: 
rg
Email: 
guthfamily1@hotmail.com
I don't care if the Doctor is a male or female, but I don't want any 3rd party in the room. If anyone is going to be guard me it will be me, and the moment I feel something not normal has taken place I assure anyone reading this I have very little flight when it comes to fight or flight psychology. But would I would not want is a 3rd party just standing around watching, that would make the embarrassing procedure more embarrassing. No thank you, regretfully as it is now I've never agreed to a DRE and when one doctor told me it was required for employment I told him he's welcome to write it down my refusal but he was not going to do that. Honestly to me the practice of a DRE on a 36 year old male seems redundant and as I now reach 38 I still refuse the DRE, and plan to for many years. Until someone can prove to me why or how it's helpful I just don't see it as required and at this point in time we have to have something more reliable than a finger and KY jelly. And if the day comes and they need to do it because i'm pissing blood all over the place, then they better do it with me under some sort of drug because I just don't ever seeing anything bad enough including death that would get me to consent to that while awake or aware.
Name: 
Hunter Burchett
Email: 
hburchett@gmail.com
Male, prefer female doctors and nurses, they just seem more gentle/understanding. Even when nudity is involved, I still prefer female. Never had anything inappropriate happen, although once while at dermatologist, I had a paper towel covering my genitals and the doctor was examining my ears, and my ears are really sensitive, and I got an erection that moved the paper towel off my lap, leaving me completely exposed! The nurse didn't say anything, the doctor went from one ear to the next, before noticing. I explained that my ears were really sensitive, and we all had a little laugh. But it was all very professional. She ended up explaining that you can get skin cancer anywhere, not just on skin that is exposed to sun, and that dermatologists should be examining everywhere. And she did. Later in exam, she examined my genitals and even my anus! It doesn't get much more private/intimate/exposed than that - but I was glad it wasn't a male doctor, I would have felt even more awkward.
Name: 
mark
Email: 
whatever@comcast.net
This has all been interesting reading. I have been with my current doctor (male) for over 25 years and we have a great relationship. I have often seen his PA who is a delightful young lady of mid 30’s whom I trust completely. My PCP got involved with a hospital undergoing a complete renovation and he was out 85% of the time. Because of the all too many health issues I have, I felt a little lost. So on my next visit with the PA I expressed my concern and asked if she would be able to take me on full time. Since she knew all of my history she seemed very pleased and excited and yes thrilled to work with me full time. That was over three years and many visits including three annual physicals that coveres ALL issues. Any and all issues are wide open including the annual DRE exam. Looking back at the first one, I realize that at the time I had no compunction whatsoever about her finishing the exam. with the obligatory DRE nor did she! That’s what was next and then it was finished. I don’t believe either one of us thought about it for two seconds. Looking back, I am so happy she did not ask directly or indirectly ask if I wanted some else in the room for the final bit of the exam, I kind of think I would have been upset if she had and would certainly have answered NO. To be fair, I worked for four years in a large “teaching” hospital in the Mid-West first as an Orderly then on a CV surgical team. You do not have much modesty left after a stint like that. I feel somewhat saddened to read that so many men are reluctant to work with the superior side of our species! Their loss.... My regular PCP is back full time and is certainly there for me, but I’m very content to stay with my incredible, brainy, funny, cute and loving PA. I told her if she ever left that office that she better call me and give me the address to my new office!!
Name: 
Scot Howard
Email: 
driver335@verizon.net
Your all a bunch of babies. This did happen to me with my female urologist. She brought in a female nurse when she did a digital exam etc. I was embarresed but got over it. After that it just was excepted as a rule. I prefer a female nurse because that is what I am used to. Grow up and except the fact that women are doctors also. Two of the posts here. Sound sick to me.
Name: 
Henry
Email: 
Pet5654@embarqmail.com
Let us call them what they really are: voyeurs.
Name: 
Archie B
Email: 
madmanbanterings@gmail.com

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Chaperones in the exam room — who gets to decide?