Saturday, September 11, 2010

Do They Reassure or Disturb Patients?

By Joel Sherman MD

Chaperones are increasingly recommended for routine use in Western medicine.  There are semi official recommendations in both the UK and USA.   The AMA has long had this policy.   

The rationale for using chaperones is twofold.  In theory their primary purpose is to protect, comfort and assist the patient.  In reality though, the usual purpose is to protect the physician against claims of sexual assault or harassment.
Preferably chaperones should be real professionals, ideally nurses, female or male.  They should function as a patient advocate and their presence should reassure and comfort the patient.  Medical assistants are far less able to do this and should never be used without them being given special training.  Unfortunately, many offices use anyone who’s available at the moment.  This could be secretaries or clerks.  They could be experienced at their jobs or young girls just out of high school.  I have never seen data delineating just what type of personnel each office uses as chaperones and how they are trained.  This information is sorely needed to evaluate the topic.  It is also not clear what percentage of these chaperones are introduced as such.  It is probably more common to pass them off as ‘assistants.’

There is no doubt that male physicians feel that they need to offer chaperones when doing pelvic exams on women.  Over 80-90% use them in the US. (Ehrenthal et al, Chaperone Use By Residents J GEN INTERN MED 2000;15:573–576) and Rockwell, DO et al,  Chaperone Use by Family Physicians During the Collection of a Pap Smear Annals of Family Medicine 1:218-220 (2003).  For other intimate exams, ie breast, male genitalia and rectal, the percentage drops off.    Not surprisingly male physicians use chaperones at a much higher rate than women do for opposite gender patients.   Women physicians plan on using chaperones for male genital exams no more than 20% of the time.  The use of chaperones by male physicians is driven by legal concerns.  This is not as evident for women physicians (Ehrenthal, ibid).   They more often site patient comfort and their need for assistance with the exam.  In truth what is the real legal risk for women physicians?  Suits and complaints against male physicians are common enough.  State medical boards deal with them every year.  However complaints against female physicians are nearly unheard of.  Their risk is so low that the presence of chaperones cannot be justified to protect the physician in my opinion.  Some women may use them not to protect themselves against suits, but to ease their own discomfort with the patient.

It’s clear however that many patients aren’t comfortable with the presence of chaperones for a variety of reasons.  Surprisingly nearly 50% of women don’t want chaperones present even when male physicians do a pelvic exam.  For men, the figure is 80 to over 90% refuse chaperones when given a choice in most studies.  That is hardly surprising when you consider that almost all chaperones are women.  Men are almost never hired as medical assistants in an office setting.  In part, that’s because they won’t accept the low pay scale, but many offices won’t hire men because they can’t readily be used as chaperones for women patients whereas female assistants are generally used with both men and women.  Few men feel that the presence of extra female eyes is reassuring.  One statistic that is not readily available in the US is the percentage of physicians who actually ask their patients whether they want a chaperone present.  If the chaperone’s  presence is driven by legal concerns, many doctors don’t ask  as they plan on using them anyway.  Some women physicians may use them because they feel at risk of inappropriate behavior from their male patients.  Patients turn down chaperones for many reasons.  The presence of extra people watching intimate exams increases the embarrassment factor for many patients.  There is also a loss of privacy that patients may resent.  It is harder to discuss intimate problems when strangers are present. Factors such as the familiarity of the patient and physician come into play here.  New patients are less comfortable in these situations.   In short, it must not be assumed that patients want chaperones present.

Adolescents are a special case as they are more prone to embarrassment than adults.  Boys are particularly subject to embarrassment when the physician (male or female) brings in a women chaperone to watch.  And the chaperones are almost always women.  Doctors do this again for legal reasons as they are concerned about charges of assault.  At least one state, Delaware now mandates the presence of chaperones during intimate exams given by pediatricians.  This law was passed after an egregious case of a pedophile pediatrician who assaulted many children over the years.  The case is not unique; Connecticut had a similar case and I’m sure there are others.  Delaware’s law is unusual in that it does state that same gender chaperones should be used ‘when practicable.’  However in the average office, it is never practicable.  Pediatricians’ offices almost never have any male employees.   I believe the law is an overreaction to a rare problem; bad cases make for bad law.   This law forces the presence of women as observers to watch the exams of older adolescent boys, many of whom would be severely embarrassed.  Using a parent, usually a mother, would not be much better in many families.  In short this law substitutes inflexible provisions for common sense. 

In my opinion, sensible provisions for chaperone usage should include:

1.)     Chaperones should be offered to all patients for intimate exams.
2.)    They should always be voluntary.  The AMA regulations above make no mention of this allowing physicians to use them against the patients’ wishes.  This is wrong.  If the physician is worried about liability, he/she can have the patient sign a waiver or refer them elsewhere.
3.)    Chaperones should be professionals.  The use of secretaries and clerks is not acceptable.  Medical assistants, i.e. unlicensed ‘professionals’ need to be specially trained.
4.)    Chaperones should not be present during history taking segments of the visit, only during the intimate exam.
5.)    Chaperones should be introduced as such, not labeled as assistants when none are needed otherwise.
6.)    Chaperones should be same gender as the patient.   This always happens for female patients and almost never for men.  Any exceptions should be made clear ahead of time with the patient given the option to refuse.

In summary I believe that the large majority of chaperones are used solely to protect the physician without the patients’ wishes being taken into account.  They are a hindrance to patient privacy and betray an underlying lack of trust on either the physicians’ or the patients’ side.  I believe they are greatly over used in our litigious society.

Further references on chaperones can be found in the thread on my discussion blog.   They are embedded throughout the near 250 comments.

This article has been chosen for publication on KevinMD, a widely read medical blog. 

Addendum  4/26/11  I note with pleasure a just released set of chaperone guidelines from the American Academy of Pediatrics which does allow both  for patient choice and same gender chaperones.


Anonymous said...

Very good summary. It's nice to learn these facts in advance so we can prepare ourselves for when it might happen. I think it's easier to plan out in advance what we'll say and do in such a situation. The first time I encountered a situation like that I was so shocked that I almost relented and let her stay. Almost. That was with a male examiner.

I'm actually not too concerned about the need for a chaperone myself because I will never accept a female doctor or nurse for intimate exams or procedures. For a male doctor to bring in a female "assistant" is completely unacceptable, but even a male assistant is uncalled for unless his assistance is absolutely necessary. For me the more is NOT the merrier.

I also think that any man or boy that feels more comfortable with two sets of female eyes than one has some kind of ulterior motive. I can't see any reason other than exhibitionism that a man would want another woman "assisting". It's still difficult for me to believe that a female doctor would actually use another woman as a chaperone for a male patient. They must think we're pretty stupid if they think a second woman would make us more comfortable, and is for OUR benefit. Who would believe that?


Joel Sherman MD said...

Only a small percentage of men want a chaperone present when they are examined by either a male or female percentage. You're probably right that any man who desires two women to watch his exam is probably an exhibitionist, or has a fetish. It's not a rarity though.

Anonymous said...

What I don't get is how anybody, including our legal system can believe that an employee that's paid by the doctor to "chaperone" is automatically considered to be beyond reproach. If a doctor is untrustworthy and a liar who's to say his employee isn't as well? And why are females always considered more honest and trustworthy than men?

No matter what the reason is to be sent to trial if a female "chaperone" testifies against a male patient the guy has no chance.

I don't really see any reason to have a chaperone present to "protect the patient" unless the patient knows the chaperone can be trusted. To a patient an unknown employee of the doctor as a chaperone will be just another set of eyes that can't be trusted. In the case of a female chaperone with a male patient I see nothing but more humiliation for the patient.

Can't doctors come up with any lie better than "it's for your benefit"?

Joel Sherman MD said...

Not sure I fully understand you, Anon. As I've said, over 90% of chaperones are used to protect the doctor from unwarranted accusations. If a doctor brings one in, they don't have an assault in mind. The mere presence of a chaperone stops nearly all accusations. Don't think it has anything to do with who's more believable, a man or a woman. Certainly though a man bringing in a male chaperone with a female patient could raise a question of motives. But of course the opposite happens all the time, 2 women with a male patient, and no one thinks of questioning their motives. (A forthcoming article will explore this more.)
There is no need in my opinion to have a chaperone present to 'protect' the patient. A physician who offers a chaperone does not have an assault in mind. I'd be more concerned about the physician who doesn't offer chaperones when appropriate. But a minority of patients feel reassured by a chaperones presence. Ideally the chaperone can explain what's going to happen next and allay the patients’ fears.

Anonymous said...

To anonymous from Nov.17,2010 at
5:15 pm.

There was an abortion Doctor
who had molested over 50 of his
patients here in Arizona a few
years ago. After a lengthy trial
he was as my memory serves me
sentenced to life in prison.
In each case he had a chaperone
with him and on some occasions the
chaperone was his wife.
Personally,I have mixed feelings about the use of chaperones in that in some cases
I think they are beneficial. The
issue that I do have is that they
generally are only used with
physicians (male). Is there the
assumption that female providers,
ie,nurses and physicians don't ever
need chaperones with male patients because they would never behave unprofessionally?
All part of the double standard
against male patients.


Anonymous said...

Dr. Sherman, I believe that a previous post made a good point. If a chaperone is under the employ of a doctor, then is that chaperone likely to be viewed as impartial, should that person be called upon to make a statement to the authorities? If not, then does this person truly protect the doctor?

I would extend this, by stating that the qualifications of the chaperone could also be a factor in determining his or her credibility as a witness. If, as the article states, a secretary, or recent high school graduate is used, will that person's opinion as to the appropriateness of the examination have any merit? He or she has no medical training, so what good is this person as a witness?

Since 99.9% of patients will never file suit against their doctor, and since none of the chaperones can be considered impartial witnesses, it would seem that nearly all patients examined in the presence of a chaperone have their privacy violated for no gain to either party.

Of course, this only considers the legal aspects of the situation. This does not consider the comfort that a voluntary chaperone would offer.

Joel Sherman MD said...

Anon, a chaperone is not absolute protection for a doctor, but short of filming every encounter it's the best that can be done. As stated, the mere presence of another person would prevent 99% of false accusations. But no it would not prevent the rare real accusation where the chaperone was in collusion with the doctor or had no idea what the physician actually did.

Joel Sherman MD said...

The American Academy of Physicians Assistants has published online guidelines for the use of chaperones. My article on this is specifically mentioned in the context of giving a male patient's point of view.
On the whole the article is well thought out and researched. The author recognizes that chaperones should be agreed to by the patient and be voluntary. That is a big improvement over the AMA guidelines for example. The author recognizes that nearly all men prefer not to have them. She says the discussion should be gender neutral. I'm not sure what she means by this, probably just that chaperones should be offered to all patients irregardless of the genders involved. My only major disagreement with her views is that she states that chaperones should be introduced as assistants, not chaperones. That to my mind is misleading to the point of being unethical. Patients understand an assistant is needed for medical reasons, not legal reasons.
She also states that patients should be offered a 'trained' chaperone but doesn't define what she means by this. Does a secretary qualify? What training would make her appropriate for use as a chaperone? The problems are always in the details.

Doug Capra said...

"The gender of either patient or provider should not influence the discussion."
I'm not sure what that means, either, but it is a remarkable statement. How does gender not influence discussion in some way? All kinds of factors influence discussions, and gender is one factor.
"Do patients and providers want chaperones? How does chaperoning work? Whose interests are protected?"
At least the right questions are being asked, but they seem to be asked as if...Wow!...all of a sudden they're relevant.
"Instinct is the number one reason that providers summon a chaperone to the examining room"
I question that. I would say "policy" and/or "custom" and/or just plan "habit" is the number one reason. It's done because it's been done and continues to be done because that's the way it is. I question how much thought goes into it in many cases.
"... using the term assistant in place of chaperone may defuse anxiety."
Well, of course. Note that the author isn't making a moral or ethical statement, just that doing something, ethical or not, may defuse anxiety. Lying can almost always defuse anxiety if you lie the creatively. This is blatant dishonesty -- but it's part of some medical culture -- the attitude that the patient doesn't always need the truth, that we know what's best for the patient, and that a lie like this is okay because we know what's best, not the patient. What they don't know, won't hurt them.
"The patient should never be made to feel at fault for requesting a chaperone."
I think requesting a chaperone is more routine that refusing a chaperone. Note there's no mention that a patient should enver be made to feel at fault for declining a chaperone.
"All patients should be offered a trained chaperone for intimate exams in advance of the consultation."
This idea of a "trained" chaperone is simply a way to save money, a way to allow other less expensive employees (less expensive that medical trained personnel) to do the job. Who would these other people be? Secretaries? Receptionists? Volunteers? What are the odds of these "trained" chaperones being males? Slim, I would suggest.
Having said all this -- there are great suggestions in this piece -- like making the whole chaperone police known ahead of time to the patient. Put it on the website, in the advertising.
Okay, Joel. Go at me. Am I being too harsh in my analysis?

Joel Sherman MD said...

I think your points are all valid considerations, Doug.
Just remember that no one uses chaperones to harass or embarrass patients. Male providers really do need the protection in most circumstance when seeing women. My point is that women providers only rarely need a chaperone for protection, and if they feel they do, it would be better to send the patient to someone else.
With the exceptions noted, the article is a pretty fair rendering of the subject.

Doug Capra said...

I agree, Joel. And I'm glad to see it in print, and glad that our blog, your article in particular, had important influence here. It shows we're making progress.

Anonymous said...

Using a female chaperone for a male patient is absolutely obscene and degrading. It borders on nothing more than a peep show. To use a secretary or clerk should have a medical professional stricken off. What ever happened to basic privacy rights for men - did they get lost in all this feminism?

Joel Sherman MD said...

Lauren Vogel, a reporter for the Canadian Medical Association interviewed me for these articles.
She wrote a balanced article on the subject of chaperones in two parts which can be found online: Part 1 and Part 2.

Joel Sherman MD said...

I note with interest that Uptodate, a bible of current information in medicine has this sentence in a section under the heading the pediatric exam, the perineum:

The use of a chaperone for the examination of the anorectal and genital areas of adolescent patients should be a shared decision between the patient and the clinician after the clinician has explained the reason for the examination and described how the examination will proceed. The sex of the chaperone should be determined by the patient’s wishes and comfort (if possible). If a patient is offered the use of a chaperone and declines, this should be documented in the chart.

I suspect this is new, but don't know when it was amended.

Doug Capra said...

We may never know -- but I think your article had something to do with the change. We can make a difference on this blog.

Anonymous said...

I recommend you take a look at this article ( The conclusion states, "When designing an office policy, or reviewing an existing policy, physicians should consider adding provisions for physician discretion to use a chaperone without asking the patient in certain circumstances to avoid potential harassment of the physician."


Anonymous said...

You can look at it like this: If you ask someone to dinner. It wouldnt be polite for them to bring a friend along without asking you first. Its dinner, not an "all you can eat buffet" Not to compare a medicine with food. It is all about respect for the person's body and feelings

Anonymous said...

9 hjdarkaI would like to thank Ed for posting the link to the Women in Medicine article regarding chaperones. (
Since this group is a subsidiary of the Massachusetts Medical Society, I believe the article provides us with some interesting insights regarding the attitudes of at least a certain numbers of female physicians toward their male patients.
Some conclusions that can be drawn from the article include:
1. The protection of female physicians from sexual harassment far outweighs the modesty and privacy rights of male patients.
2. Male patients will, in most cases, have to accept that a chaperone will be a female. The article does grant that “Whenever possible a healthcare professional should serve as the chaperone”. Of course we know that the “whenever possible” escape clause means that a receptionist or even the college student who is working part time to help computerize the office records system may be used as well.
3. Female physicians should use compliance techniques to intimidate males into accepting chaperones. The article states that rather than asking a male patient if they want a chaperone or not; the questions should be phrased as follows, “It is office policy to have my assistant present during the exam, are you comfortable with that?”, thus implying to the patient that he has little choice but to comply.
The articles states that the rationale for requiring chaperones is at least in part related to a study in the New England Journal of Medicine that found that 75 percent of female physicians had been sexually harassed by a patient during their career. Of course, no reasonable person would agree that this is acceptable. However, we can disagree how to best protect female MD’s from such violations. (Continued in next post)
takingq 14

Anonymous said...

Earlier post continued!

The first group includes those who have by their own choice selected a female MD. While it is true that some in this group may have unsavory motives for their choice it is highly doubtful that most do. Yet the article states that because of a few offenders, all male patients should be compelled to accept the presence of a chaperone. If this is a females MD’s policy than I believe she has an obligation to make available the option of a male chaperone for those who prefer one. Undoubtedly, some physicians would argue that this would impose an added expense on their practice, but the fact remains that if the bottom line is more important than their male patient’s modesty and dignity, perhaps a career change is in order.
The second group consists of males who find themselves coerced into being examined by a female physician despite the fact they are extremely uncomfortable with such an exam. This would include those required to undergo physical exams as a condition of employment, in order to participate in organized sports, and those in the military, to name a few.
In my opinion, if a female physician chooses to contract with a company to perform pre-employment physicals, or with a high school or college to perform sports physicals for male teams, she would be naïve not to realize that a certain number of these males would be very uncomfortable with the intimate portion of the exam and could react by talking or acting in a way that might constitute sexual harassment. While I would certainly not justify such behaviors, I believe they are caused by the very nature of the situation which could easily make some males feel that if they are going to be humiliated and embarrassed against their wishes that they will retaliate by attempting to humiliate and embarrass the examining physician.
The obvious solution here is to simply avoid coercing anyone into accepting an opposite gender intimate exam by providing patients a choice regarding their practitioner’s gender.
If for some reason this is impossible, the presence of a same gender chaperone could serve the dual purpose of providing the female physician with protection against sexual harassment while at the same time minimizing the embarrassment and discomfort of the patient.

Doug Capra said...

This attitude represent, as I've been saying on Dr. Bernstein's blog, some of the more repressive and negative aspects of the medical culture. As the writer above has suggested, the medical profession knows about the issue under discussion here. They are fully aware of gender considerations.
But I've become convinced that the old maxim is true in this case: If you don't want the answer, don't ask the question. In many cases, they know the answer will be no as far as gender choice goes. In fact, I've been given this truth as a response from some higher ups in the medical field. Even if providers agree with the gender choice issue as an ideal -- they know it's most often not possible to grant that request. So -- why ask if you know you'll have to refuse. In other cases, the "fairness" to their staff trumps the dignity of their patients, i.e. they want to give all their staff equal opportunity to do varied work and deal with both genders. That value is more important to them than is granting gender requests of patients. Another issue is the CYA one. What the lawyers tell them to do trumps what may be best for the patient is some regards.
Has anone here ever read a "patient privacy" pamphlet produced by most hospitals? It's a document written by lawyers primarily for the protection of the hospital and its staff. It's not written by lawyers for patients; it's a document written by lawyers to protect institutions.
Frankly, I thought the lawyers article about chaperones was pretty well balanced up until the very last -- when she says essentially that's okay to intimidate and/or plain lie to the patient. And this idea that anyone in the office can stand in as a chaperone is pure nonsense. It's just another example of what I call the current "deprofessionalization" of the medicine. More and more doctors consider their assistants, receptions, and assistants to the assistants to be on the patient's "medical team," just as professional as the doctor or nurse. I reject that, as do, I think, many patients. That attitude waters down the whole definition of professional in medical terms.

Joel Sherman MD said...

Thanks for bringing that article to my attention Ed & 9 hjdarkaI. I had not seen it before. Please note that two of the references the article gives is to this article of mine above. So it's not surprising that I agree with Doug that the article was pretty fair until the end when she suggests that it's OK to surreptitiously use a chaperone.

Attorneys working for physicians, even for prestigious societies such as the Mass. Med. Society, are undoubtedly being used to primarily protect physicians. So her primary concern is to protect physicians, in this case women physicians. But that does not excuse the subterfuge she suggests at the end. I would agree that a chaperone is occasionally needed for a woman provider's protection. If a patient refuses a chaperone, the provider always has the option of referring the patient elsewhere if she is not comfortable continuing.

I have never put great reliance on legal opinions when it comes to chaperones. Lawyers don't want to take even a miniscule chance that a doctor may be sued. I've even seen legal recommendations that a physician use chaperones for all encounters, no exceptions. A doctor in practice must balance their personal risk against patient needs. For women providers the risk of their being sued is miniscule. How frequently they are harassed by male patients is less clear to me, but as physical assaults in this setting are essentially unheard of, the problem can be solved by referring the patient elsewhere or just refusing to see them again.

Doug Capra said...

Anonymous brings up a point that is important and intereting and a situation I have found referenced in a few medical articles. Anonymous writes
"The second group consists of males who find themselves coerced into being examined by a female physician despite the fact they are extremely uncomfortable with such an exam. This would include those required to undergo physical exams as a condition of employment, in order to participate in organized sports, and those in the military, to name a few.
In my opinion, if a female physician chooses to contract with a company to perform pre-employment physicals, or with a high school or college to perform sports physicals for male teams, she would be naïve not to realize that a certain number of these males would be very uncomfortable with the intimate portion of the exam and could react by talking or acting in a way that might constitute sexual harassment. While I would certainly not justify such behaviors, I believe they are caused by the very nature of the situation which could easily make some males feel that if they are going to be humiliated and embarrassed against their wishes that they will retaliate by attempting to humiliate and embarrass the examining physician. "
Some men respond to this lack of control and embarrassment by trying to take control, and one way to do that is to put the provider in her place, so to speak. Like anonymous, I don't condone that behavior, but that's the psychological reality. Some men, and women, don't get to chose the gender of their provider, and if they challenge the policy, they may not get their job or play sports. This is indeed coercion, an intimidating situation, and if the provider takes advantage of that they
are being unprofessional. As anonymous said, the way to avoid this is to give people a choice of provider gender for intimate care and a clear choice of whether to have a chaperone or not.

Anonymous said...

From the website, "About the Massachusetts Medical Society."

"The Massachusetts Medical Society is the statewide professional association for physicians and medical students. We are dedicated to educating and advocating for the patients and physicians of Massachusetts.

The MMS publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 12 specialties.

The MMS is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals."

I think its reprehensible that a society that claims to "advocate" for patients can support a policy that encourages physicians to mislead or lie to patients.

And we're expected to bare our bodies and souls to these same physicians (and staff) simply because of the initials at the end of their name; not any more.


StayingFit said...

I agree completely with the comments made by Anon on October 19, 2012. I also agree with Doug and Dr. Sherman, that, overall, the article was fair and appropriate.
I am, however, bothered by the following statement, as much as I was with the author's admonition that it is acceptable practice for doctors to trick their patients into accepting a chaperone :
“The presence of an additional person during an intimate exam may make some patients feel more comfortable, but it may exacerbate the embarrassment factor for others. This may be particularly true for a genital or other intimate examination of a male patient where the chaperone is most often another female. Having a chaperone present may make it more difficult for male patients to discuss intimate problems with the physician. Given that the goal of any chaperone policy is both to protect physicians, and make patients feel more comfortable, it becomes very challenging for female physicians to balance these objectives when so many men prefer to reject the offer of a chaperone. Nonetheless, there are few other options to protect against sexual harassment by a patient against a physician. “
That is pure nonsense. First, because guarding against this is somehow deemed more important than the embarrassment caused to all, or nearly all, male patients, and the chilling effect that the presence of another woman can have on the willingness of men to discuss important issues with their physicians.
Second, because the term “sexual harassment” is so nebulous. How does one define it? I suggest that at least some of those incidents that led to the “75%” figure, mentioned elsewhere in that same article, were committed by men who would not regard their behavior as inappropriate.
Third, because most definitions of the term include things such as inappropriate remarks, which hardly present a threat to the well-being of the physician. As Dr. Sherman states, the best way to handle this is for the woman to refuse to see the patient again. I would add that, she could also stop the examination, if at any time she is made to feel uncomfortable.
I would also like to comment on the last line of the quote that I pasted, above. I contend that the presence of another party would exacerbate the embarrassment of the patient, thus making men who make these remarks, in order to gain control of the situation, more likely to do so, not less.
Further, those men who, being nervous or unaware, make an unfortunate comment or joke, will not be less likely to do so, simply because there are witnesses. If they are nervous, an audience will make it worse. If they are unaware that their behavior is inappropriate, an audience will have no effect.

StayingFit said...

Here is a situation that illustrates the points that I raised in my previous post.

Last year, I attended a prostate cancer awareness event, which included a DRE and PSA for certain patients. A line of men was being herded toward a series of doctors, where they would receive their examination. The people collecting histories and filling out forms, drawing blood, and directing these men were, almost universally, women. (I question this, and other aspects of the event, but that is a topic for another post). While waiting, some of these men were bantering with the women who were guiding them to the various doctors. Probably due to the anxiety over the exam, and embarrassment over the fact that the women with whom they were speaking were well aware of the exam that they were about to receive, some of these men made jokes that were entirely inappropriate. One going so far as to suggest that he would prefer that these ladies perform the exam, instead of the doctor.
Did the presence of several dozen other male patients, along with at least a dozen staff members, deter this remark? Not at all. I submit that these ladies would have been within their rights to take offense. Instead, they acted like it didn't bother them, they re-directed the conversation, and no further harm occurred. I might also add that at least one of the doctors performing these examinations was female. From what I could tell, she did not use a chaperone, and, apparently, never felt threatened by a stupid comment.
As Dr. Sherman states, there is very little likelihood that a female physician will be assaulted during an examination. I would add that, if there is a reasonable chance that this could occur, that patient should not been seen by a woman. Further, if I was that doctor, I would want a burly, male chaperone, preferably one who is an ex-marine, since he would actually be acting as a security guard, and not as a chaperone. I would definitely NOT want a petite, 20-something file clerk.
It seems to me that a female physician should have the confidence and social skills necessary to handle most any case of sexual harassment, by a patient, that is likely to occur. If she does not, then no chaperone will be sufficient to prevent this. She, and her patients, would be best served if she restricted her practice to include only women.

Joel Sherman MD said...

StayingFit, I agree with your points. I too have wondered what is meant when women physicians feel they are harassed by men. The original article does give a reference to an old NEJM article which came up with the 75% figure of women being harassed. I intend to obtain that article next week and report on it.

Joel Sherman MD said...

I have indeed read thru the article that studied harassment of women physicians by patients (NEJM, 1993, V 329, p 1936).
There were many points worth commenting on. This was a study of 422 women physicians, all general practitioners, in Ontario who returned a questionnaire. Some later got together in focus groups and more details were obtained. To my surprise, the article only states that a 'majority' of the harassment was done by male patients. I would have guessed beforehand that nearly all was, but that was apparently not the case. One has to wonder why such an important and basic statistic was not given. One doctor reported that a female patient having an orgasm was harassment!
Needless to say that some women complained that the occurrence of a male patient's erection was harassment. In my opinion, any woman who thinks that an involuntary erection is harassment has so little understanding of male physiology that she should restrict her practice to women. Not surprisingly, the most common setting for harassment by percentage was in the ER, not the office. This usually occurred with very inebriated or very ill patients. -Hardly a surprise. Male physicians also get harassed in that situation all the time.
But in the end only 22% of the doctors thought that any of the harassment was serious. In other words, they were perfectly able to deal with it. Some women indeed realized that they may have misinterpreted the patient's actions or indeed became too familiar with the patient before it happened. To be sure some clear and serious infractions did occur including one attempted rape, but the setting is not given.
Doctors do get assaulted in the ER, especially in urban jungle areas.
This study is now 19 years old. I hope that today's generation of women physicians feel more comfortable treating men or alternatively limit their practice to women.

Anonymous said...

Dr. Sherman,
Thank you for taking the time to research the study regarding the “harassment” of female physicians. I was particularly struck by the fact that some women MD’s complained that the occurrence of a male patient's erection was a form of harassment.
The fact that these women chose to enter a field where they knew they would be performing intimate exams on males and then portray themselves as victims when something they find unpleasant occurs is the height of hypocrisy. I think there is a strong comparison here with women sportswriters who insist on entering male locker rooms but if an “incident” occurs the male is immediately blamed while the female who invaded his privacy is considered blameless because she was “just doing her job”. As Harry Truman said, “If you can’t stand the heat, stay out of the kitchen.

Anonymous said...

Recommend you read "Use of chaperones in the urology outpatient setting: a patient’s choice in a “patient-centred” service" located at "".

I believe its from the British Medical Journal and a relatively recent study completed in 2006. Clear majority of both genders did not want a chaperone for outpatient urology visits.


Joel Sherman MD said...

Thanks for the reference Ed. I had not seen it before.
The article was a questionnaire sent to 709 patients who responded, 78% of them male, asking them their chaperone preferences for GU exams in the clinic. All physicians were male.
The results: 20% of males preferred a chaperone presence and 42% of women. Overall 75% did not want a chaperone. 60% of patients who desired a patient preferred a family member. Thus only 15% of all patients preferred a staff member of the clinic to chaperone.
The message couldn't be clearer, chaperones are overwhelmingly not desired by patients.

Anonymous said...

And this study is from Australia dated Dec 2007:


Joel Sherman MD said...

From my last post:
60% of patients who desired a patient

Meant 60% of patients who desired a chaperone.

Anonymous said...

Another article about chaperons by a physician.


Joel Sherman MD said...

Thanks Ed. That article is based on a NY Times blog article which I had not seen before either. My article above actually precedes them all though not always credited. The questioning of chaperones is being raised more and more. It is a hopeful sign.

Joel Sherman MD said...

Here's a Canadian article from an assistant who was trained to be a chaperone. She only mentions being used for women's exams. Her description of her training is interesting. In her area a formal course is available which is rare in the US.

Doug said...

I agree with the author. His suggestions make total sense. If I lived in Delaware when I was a teen I would probably ask my parents to take me to another state for my sports physicals. I would be too embarrassed having my neighbor lady, who was my doctors assistant, see my naked and the next day I'm mowing her lawn. Too weird!

Anonymous said...

Should a female housekeeper (cleaning staff) at a hospital be asked by the employer to stand in as a chaperone for the male ultra sound technician when a transvaginal probe exam is being given? Especially when the cleaning staff feel truly uncomfortable doing this?

Joel Sherman MD said...

Don't know if the question is hypothetical or not. It is certainly very undesirable to use an untrained non medical person as a chaperone and most institutions would not consider doing it. But I know of no state that regulates the use of chaperones so legally they could use anyone.
Male ultrasound technicians doing vaginal ultrasounds is quite unusual as well and I'm sure that a man wouldn't perform one without a chaperone present.

Anonymous said...

The best chaperone policy I've seen and while not a hospital, clinic, or practice, it's obvious that there are some in healthcare that may actually get it!


Joel Sherman MD said...

That is indeed the most complete chaperone policy I have ever seen. But it's so long that few will ever read it.
However this seems to come from a company that provides services, not an actual doctor's office. I'm not sure. I wonder if any office actually uses it.

GaryM said...

I recently had umbilical hernia repair and had 10 days off to recover. Cross gender medical care was a topic that came up during my recovery period.

During my "research," the subject of chaperones came up.

As I scoured the Internet, I found some threads where female receptionists, presented as "assistants," were sharing how their chaperoning duties were "the best part of the job." In fact, in one thread a female that went by the name of "Susan" gave several, very graphic descriptions of her experiences as a chaperone. She treated a male's exam like it was fodder for the junior high girls locker room.

She shared how she was "embarrassed and excited" when she first started chaperoning. In fact, another staffer told her before her first time to “enjoy yourself.” Hardly professional, eh? It was obvious by her remarks that she took full advantage of the male exams and "enjoyed the show" as a chaperone. By her own admission, she is not even a medical assistant; she's a receptionist.

If this “Susan” spoke like she did in that thread out on the streets, we would call her a
pervert. And she would have had to subscribe to a magazine to see what she described (using graphic language) in the examination room.

Is this what males have to look forward to when a female doctor makes the presence of an "assistant" a requirement for the exam? And the sad part is all of the male patients have no idea that this is going on. If they did, they would feel exploited.

Does “Susan” represent the majority of "chaperons" out there? No way to tell. There is no formal training or requirements for them. They could be receptionists, office clerks, medical assistants, the janitor... who knows! As long as they wear scrubs and are labeled “assistants” they're qualified! They are one step above a stranger on the street being asked to come in to witness the exam.

A female GP has the depth and breadth of medical training so as to handle male nudity properly within a clinical context. From what I've seen, most “assistants/chaperones” do not.

I think most men do not have a problem being treated by a female medical professional provided said caregiver is necessary and actively involved in their care. On the other hand, an "assistant," who contributes absolutely nothing to your medical care, is allowed to watch the most intimate and invasive parts of the exam. This may protect the female doctor's license but it comes at the expense of the male's privacy. Besides, when a female “chaperone” is introduced into the equation, not only is privacy invaded but the communication between the female doctor and the male patient breaks down.

I've thought about if I were placed in a situation such as this, would I comply? I'd like to say that, as a man, it would not bother me... yet, at the same time, why should a young female receptionist--possibly a young lady just out of high school--whom the female doctor has "knighted" as "assistant" be allowed to sit there and watch as I get the most invasive and intimate part of my physical exam?

And after some of the threads where female staffers with little-to-no medical training state that this is the "best part of the job," how do we know that these assistants/chaperones will keep matters confidential after you have left the examination room? It's bad enough having a stranger witness the exam; it is worse to not know what will happen after you leave.

The requiring of female chaperones in a male patient's exam--no matter what the reason--is of benefit only to the female doctor and it comes at the expense of the patient's privacy, dignity, and modesty concerns.

At least this is what I've found to be true.

Joel Sherman MD said...

Thanks GaryM. Could you post the links to the assistants discussions online?

GaryM said...

Joel Sherman MD

I'd like to bring up another aspect to this topic of female chaperones with male patients.

We know this happens at local medical facilities and we know that the staff in these places are mostly all females—I have never seen a make working at these places. But what happens when you leave these medical practices and venture out to specialists offices and such like?

One thread where this was being discussed by several men (I forget where) said that when he went for a dermatology appointment with a female dermatologist, she was accompanied by a female assistant who took notes during the whole exam. And it was a full body exam requiring the patient to be nude the whole time.

For the sake of consistency, how is this any different from the local medical practice where a chaperoned/assistant is present?

Then, in other anecdotes, males had ultrasounds of their groin by a female technician and no assistant/chaperone was present, nor did the male patient feel any discomfort. The technician was professional and put him at ease. So we know that not all medical situations requiring inmate procedures or exams require a chaperone.

So, what's a male to do?

It is far more convenient to just go with the flow and walk into every situation/exam and just let them do their procedure, I know. But at what point do you start to question the “who and how many?” of an appointment?

If we are to be consistent as men, we need to have some kind of principle(s) that, no matter the medical scenario, we can apply them for our own peace of mind and privacy.

My principle is this: to not be exposed any more than I have to be, for no longer than I have to be, in front of no more personnel than I have to be.

When I went for hernia repair a few weeks back, I never asked for an all male crew as that would not have been practicable and I did not mind the presence of female nurses (of which there were three in the OR). Reason being, I knew they would take care of me and they were qualified professionals.

So, the only way for us men to be totally confident in front of females would be either to accept the “professionalism” of the assistant, technician, or provider when they say they are necessary, or we would have to research their education and training at each exam.

Something that is not very practical. Without this info, males could possibly be the object of a “peep show” and never know it.

I believe that most female medical professionals are ethical and have the male's best interest at heart. But after discovering that some female personnel cannot or will not handle nudity properly and with respect, it is enough to send a warning that we have to keep a look out on our medical providers as we head into the future.

GaryM said...

One last thought...

I am just as concerned about the practice of using non-medical personnel as chaperones in male exams as the next guy. I believe that it does violate privacy to a large extent and represents a double standard.

However, a solution to this problem does not appear to be on the near horizon. Though I have yet to encounter this in a clinical setting, I might in the future.

So, how to behave? At the risk of sounding like I am contradicting myself, this is how I will handle it.

Since I do not know of any way to alleviate the current state of things, and since it would be unpractical to do background research on each and every possible person who may be used in my medical care, I would probably just go along with any clinical scenario—chaperone or otherwise—and let the chips fall where they may.

It's not that I do not have any concerns, but with my inability to change the environment on my own, I can either go through life worried about it or adapt within the confines of my conscience.

Here's another way to look at it:

Regardless of the maturity level of my female providers, if I bring my respect and my integrity to the medical exam and someone there (doctor or chaperone) is less than professional, why should I be embarrassed in a clinical setting just because they can't handle themselves professionally?

And if I didn't request a chaperone, and that chaperone can't handle male nudity in a mature and professional manner, why should I be concerned about it? I'm there to get my exam not impress the ladies. Besides, you'll never know if they talk or not so I guess you can't be concerned. (unless they release personally identifiable information... which means that you will be retiring early after the legal stuff is over!)

I feel this position is the most doable seeing that any other intervention is not practical at this time.

I mean, no males are going to be hired as front office staff in the near future at local medical centers, and females still make up roughly 94% of the nurse population.

The use of non-medical personnel for male exams, while unethical, won't be a hindrance to my medical care should I encounter such a situation in the future.

And worrying about what happens after you leave would be the same as trying to keep people from talking behind your back. Like Susan did in her post.

Is it wrong? Yes. Unethical? Yes Moral? No. But what can you do about it? Nothing. You can't worry about the things you can't control.

Deal with those you can and keep walking.

Until the situation can be changed the one thing medical clinics can do is to be upfront and honest about what they're doing when they bring in an “assistant.” In fact, I suggest the following letter or form be sent to all patients BEFORE their medical appointment...

Dear Mr John Smith,

Thank you for trusting ABC Healthcare with your health and medical needs.

This letter is to confirm your appointment with Dr Kathy Applebaum on Tuesday, April 5, 2014 at 1:30pm.

Please arrive at our office 15 minutes before your scheduled exam. Be sure to bring any insurance cards, and a list of current medications with you to your appointment.

ABC Healthcare is concerned about you and your health. In accordance with American Medical Association guidelines, and to provide for the safety and comfort of our patients, we use chaperones/observers in all cross gender medical exams.

Due to our staffing, it is very likely that a female will function as your chaperone/observer during your exam.

If you have any questions about this policy please contact the office prior to your appointment at 555-555-5555 to discuss your concerns and to arrange alternate forms of treatment.

Thank you...

ABC Healthcare

Joel Sherman MD said...

Once again, thanks for your comments. If you are uncomfortable with a scribe or a non professional person present at your exam, you can always request that they leave. Most physicians should honor the request especially for intimate exams or sensitive history.
But scribes are a relatively new and still evolving phenomenon. I may do an article about them as their use certainly has consequences for medical privacy.

GaryM said...

Dr Sherman,

I know that the patient always has the right to make a request... but doesn't it depend on what a health facility's policy is as to whether or not it is honored?

If that doctor is determined to protect her license, she is going to have a chaperone/assistant/scribe present regardless of what your wishes are OR she will give you the option of discontinuing the exam and returning at a later date.

Unless there are laws which I am unaware of, this whole discussion revolves around balancing the need of the doctor to protect their license withrs the privacy of the patient. And from what we are seeing, many doctors would rather you suffer a little embarrassment then for them to take a chance and forego the chaperone.

By the way, what did you think of Susan's posts in that thread?

Joel Sherman MD said...

GaryM, a few institutions have policies requiring chaperones but by no means all. But as my article makes clear, women physicians, unlike men, are under no significant legal threat of suits if they don't use chaperones. Cases of sexual assault or harassment against women providers are very rare. Even if valid, most men are reluctant to make an incident public. In other words, if a woman provider insists on a chaperone, it is because she doesn't trust male patients or is uncomfortable with them. In either case, I'd rather go elsewhere. Even institutions that want chaperones for all exams will rarely insist upon it if the patient refuses.
So yes, you have a real choice to object.

GaryM said...

Thank you, Dr Sherman for your replies as they have been quite helpful.

In my job in sales, I get to talk to many different people in many different professions.

Tonight, I had a nurse stop in and I asked her her opinion about chaperones. I told her a little about what I had seen on the internet and she was appalled.

She said a few bad apples always spoil it for their profession.

Further, she felt that the poster (Susan) will get caught eventually and will be ousted. She said that chaperones such as Susan are rare. And that most are ethical and do not view their job in any other way except as professional--adding that they are used to what they see and are somewhat desensitized to it.

Needless to say, she endorsed the idea of chaperones and felt that even if a receptionist were used, they would be a trained observer and not a person looking for a "peep show."

Joel Sherman MD said...

GaryM, I looked at 'Susan's post. It's always hard to evaluate comments on forums like that as they attract so many trolls. But I have no doubt that similar situations occur.
When young non professional people are put in clinical settings like that they are bound to have difficulty dealing with it and some will find it sexually exciting. That's why I find it inappropriate for providers to use non professional personnel as chaperones. I would object in that situation but it's a personal decision.

GaryM said...

Dr Sherman,

If Susan's post is to be believed, the female doctors are as much to blame as she is. They seemed to foster the environment for this type of behavior to flourish in.

According to "Susan" the female doctors liked to exam the young boys, and men, and knew that the receptionists liked to watch as well. Susan stated in her post, "Afterwards the female doc winked at me and said "see, there are extra benefits to this job".

To your point, how would a patient know if a person dressed up in scrubs is a professional or a young person just waiting for the show to begin?

Obviously, a woman's age can be discerned from appearance to a certain extent; however, in a clinical setting, scrubs don't communicate what position someone holds all that well. We either grill them as to their qualifications or assume they are able to handle it.

An extra set of eyes may be awkward, but if the chaperone is a person of integrity and treats the exam with the same seriousness as the doctor does, then at least there is professional distance between the provider, chaperone and the patient.

If a chaperone must be used, this is the least we should be able to expect.

Dr Sherman. you said, "That's why I find it inappropriate for providers to use non professional personnel as chaperones."

I tend to agree. But...

We know that a RN's salary requirements usually means that clinics rely heavily on medical assistants and receptionists for staffing. They are all that's available.

But what kind of training would be necessary to get an assistant up to at least a level where they can handle the exam in a clinical--not sexual--context?

A nurse has spent hours in training, clinical practice, and has a certification which allows her to deal with these types of things in a professional manner.

With tight budgets, and time limits, somehow, I do not think they would be used as a resource for chaperoning... which leaves us with medical assistants and receptionists, etc.

Anonymous said...

Let's see if I've got this straight. We're expected to walk into an exam room with a total stranger, demonstrate the ultimate in trust and faith by barring our body and soul, and providers' repay that trust and faith by requiring a chaperon because they obviously don't trust the patient. Am I the only one that see's the problem with this?

Chaperon's are there solely for the provider's protection. Regardless of what actually happens in the exam room, what male patient would accuse a female provider of impropriety? The press would crucify him and the case would likely never end up in court. Moreover, if it did, what court is going to rule for a male patient against a female medical "professional"? Assuming that the female provider did act inappropriately with a male patient and a chaperon was present, what chaperon would ever testify against her employer? None! The concept is simultaneously ludicrous and depressing that male patients routinely suffer these indignities' while female patients are routinely afforded same gender care.

If not and they object, the medical system goes out of its way to comply with their request. We're not even asked; just expected to deal with it. Additionally, I've had a number of experiences with female providers who thought my healthcare was a spectator sport. Male nurses would likely have been fired for treating female patients in the same manner. You'll never see a female patient, male provider, and male chaperon in the same exam room. If you agree with that statement, why are we expected to submit to two females administering our exams?

Frankly, I could care less what they've seen, the procedures they've performed, or their claimed "professional" status. Comments like these are intended to shut down patient objections. I'm the patient and paying customer and how I feel and my personal comfort level are the only thing that matters. It is after all all about the patient isn't it! This double standard must change. We're all entitled to the same standard of care but in reality don't receive it.

Patients have the ethical and legal right to choose who and to what degree a provider (physician, PA, NP, nurse, medical assistant, student, CHAPERONE, and now a SCRIBE) participates in his or her healthcare! Most people are reluctant to question or object because they're sick and uncomfortable and/or in an unfamiliar environment where providers act and expect patients to be compliant, like inmates in the county jail! Be respectful but speak up and be insistent. To mitigate the situation in the first place, when making the appointment, insist on the gender you're comfortable with. Realistically in a female dominated profession, this is somewhat problematic for male patients. In that case, go somewhere else. If that's not an option, just say no. You're not refusing the exam, you're refusing an exam that that is illegal and unethical. This practice of always granting a female patient's preference while ignoring those of male patients is unethical, unprofessional, and illegal. The system will only change if patients insist on the same standard of care regardless of gender.

GaryM, you can rationalize this all you want but the bottom-line is it's your body, your healthcare, and your decision. Acquiescing to a chaperone, despite being clearly uncomfortable, perpetuates this despicable practice where males are treated as some lower life form.

Guys just need to grow a pair!


GaryM said...


I saw the same content in your post in another thread somewhere... interesting. No matter, I will answer it.

I agree with the gist of what you have written as I have already shared my thoughts about it.

But, this isn't about "growing a pair" as you have stated. It is about being consistent. Asking questions. Getting answers. Making decisions.

I have no problem speaking up if I feel the need to. I am the paying customer and deserve the right to be treated with the same courtesy as other patients including the females.

I may have appeared to "rationalize" this because a) I have never had this happen so it never occurred to me and b) I had to think through the ethics of such a practice.

My posts simply showed that I was coming to grips with the issue and looking at it from several different angles. I'm guessing you've never done that.

One point of order is that there just may be a procedure in your future where you will interpret the situation as only needing one female when, in fact, there does need to be two for procedural/medical reasons. Then what would you do?

Do I think there is a double standard? You bet. Do I think a chaperone is for my benefit in these types of exams? Not at all. It only benefits the doctor.

But, with all this said, and though I have some issues about the practice, the methods that we use to deal with it may not always be practical. Calling ahead at every opportunity, always asking the why of a situation, constantly questioning, seems to be a great idea, but there is always that one time where you may be hit with something that is "policy" and that is required by the doctor's insurance company.

You either drive a long way home or consent, get the exam, and deal with it. It isn't the best thing to do but may be the most expedient.

On one hand, I agree with all of the things you have said about the use of chaperones, but on the other, if a situation arises where you have no choice, or declining one makes for greater problems, then you do what your conscience allows you to do.

Joel Sherman MD said...

GaryM said: there is always that one time where you may be hit with something that is "policy" and that is required by the doctor's insurance company

I agree with both of you in general. It is not always practical to take all of Ed's suggestions. The more urgent or serious your medical problems, the less most people would be willing to interject these issues into vital care. Avoiding or complaining about unwanted observers is most applicable to routine outpatient care. That doesn't mean that preferences can't be stated for urgent care, just that for most of us it then becomes a secondary issue.

But to clear up a common mistaken belief. I have never heard of insurance companies requiring physicians to use chaperones except when there has been a prior accusation or suit against a provider. If a provider tells you that their insurance requires the use of chaperones, it likely means that they have been previously sued for abuse, so maybe you want to go elsewhere anyway.

Anonymous said...

GaryM, the comments you saw elsewhere are mine; I simply cut and paste because they are relevant to this discussion.

With respect to coming to grips with the issue and looking at it from different angles, you guessed wrong.

For any gender specific health care, I've made sure my appointments were with male physicians to preclude this specific issue. My negative experiences, while not specifically chaperone related, occurred during appointments in a urologists private practice and a brief hospitalization.

The only possible scenario I see this occurring is with a female physician in the ER in which case we're no longer discussing chaperones but professional staff administering emergency medicine. If I'm that sick, I welcome whatever care they deem necessary.

While I may be wrong, your comments lead me to believe that you prefer female physicians. If so, you're likely to be confronted with this exact issue, in which case your options in dealing with it are limited.

When confronted with situations where their modesty, dignity, and privacy is threatened, male patients have nothing to lose and everything to gain by respectfully insisting their healthcare is administered in a acceptable manner. In my case, if the physician refuses, I'm simply walking out but only after informing the physician that I will file formal and informal complaints with my insurance, state medical boards, U.S. Department of Health and Human Services Office of Civil Rights, Yelp, Angies List, etc. Been there, done that!

If expediency is more important to you, than by all means submit and deal with it. My point about growing a pair is that the system will never change unless males are willing to stand up for their rights; nothing to lose and everything to gain.

There will never be a case where I have no choice!


GaryM said...


You are wrong about my having a preference for female doctors.

Look at my post again. I'll quote:

"I may have appeared to "rationalize" this because a) I have never had this happen so it never occurred to me and b) I had to think through the ethics of such a practice."

I have never had female medical providers, Ed. This is why the whole issue and the potential consequences of same are so new to me. What I was dealing with was how I would react in these situations. That's all. I explored different angles for my benefit--not yours...sorry.

And I thank Dr Sherman for the repartee which allowed me to discuss and address these issues from a male point of view. And with a medical professional.

As to modesty, ethics, privacy, dignity, etc., Ed, I hear what you are saying. Loud and clear. And I agree with most of what you say in this regard. I do think that an extra pair of eyes is a violation when that pair belongs to an attendant who is contributing zero to your medical needs. All I was saying was that there may be a time when those extra set of eyes are, indeed, a participant in your health care and are necessary.

I am as modest as they come...but, I am also realistic to the point that if I need more than one female medical provider, then so be it. If that is what is necessary.

Your experience at the urology office, while real, doesn't reflect every male's experience.

My father goes to a urology practice where the whole staff is composed of female nurses. They do catheters and cystoscopy procedures on male patients. And they do it with care and professionalism. He has never complained. However, he was in charge of EMS in Baltimore County, Md, and trained paramedics, so this never bothered him at all.

Ed, as to medical care, you do what you think is best and I will do what I think is best when it comes time for me to "deal with it."

I think we've covered enough ground for me to deal with future medical situations. And I would like to thank Dr Sherman once again for his comments and insight into this subject.

Have a great day...

Anonymous said...

about the "forced" exams (for work, sports or army) mentioned in the comments...

"The obvious solution here is to simply avoid coercing anyone into accepting an opposite gender intimate exam by providing patients a choice regarding their practitioner’s gender.
If for some reason this is impossible, the presence of a same gender chaperone could serve the dual purpose of providing the female physician with protection against sexual harassment while at the same time minimizing the embarrassment and discomfort of the patient."


"We're going to force you to let some strange lady you've never met fondle your genitals... maybe even shove a finger up your butt... but we'll also bring in some dude you've never met to stand there and watch her do it. THAT will minimize any embarrassment issues you might have, and help alleviate any discomfort you have with the whole process."


Jason K

StayingFit said...

I absolutely agree with you, Jason. I don't know of any guy who would find comfort in having an audience to such proceedings, be that audience male or female. Most guys don't want a chaperone. Period. The person's gender makes no difference.

For that matter, the person's qualifications don't much matter, either. What matters is that their presence has a purpose, and is acceptable to the patient.

I don't want anyone to be there only to watch, and, let's be honest, to guard against my "bad behavior". Especially if I have no choice in the matter. I don't care if that person is a receptionist, or the Dean of the Medical School.

I have let students attend some examinations, because I was asked first, I was given a right to refuse, and I understood their purpose. In such cases, I felt good about helping to train someone, but I understand that not everyone would feel comfortable with this.

My greatest issue with the use of ancillary personnel as chaperones is the disrespect that this shows to the patient. Such people have not demonstrated the temperament to be present during such examinations, and do not have any training that would give their presence any medical purpose. As others have stated, such people are little more than strangers pulled off of the street to attend my examination. I doubt that any doctor would happily allow such a person to witness their examination, and it is disrespectful to either force such a person to attend mine.

Or, worse, to misrepresent that person as an "assistant", when they are incapable of providing any medical assistance, and when their true purpose is not stated.

Freddy said...

Dr. Sherman, I am not a Physician but an Ultrasound Tech. I am a male who has been scanning over 20 yrs.
I was recently offered a job here in south central- east Pa.(Berks county) with the stipulation that I do transvaginal exams WITHOUT a chaperone unless the Pt. specifically requests it. I was told that that I was NOT to ask because if I did then every pt. would want one. I did not feel comfortable and reluctantly turned down the position.. As a medical professional, I would greatly appreciate if you can inform me of any rights I may have if any.
Thanks for insight and knowledge....

Anonymous said...

I believe that as the post states that having a chaperone present should always be voluntary and up to the patient. Today I went in for my first pelvic exam with a female gyno and wanting my privacy I ask that the other nurse/ chaperone not be in there. First off the gyno tried to lie to me by telling me it's the law for her to be in there then when I called her on her bluff she insisted it was her preference. Aren't you supposed to try and make the patient as comfortable as possible?! I wanted my privacy and she tried to bully me into doing it her way. I politely stayed once again stated that I would be much more comfortable if the nurse left. She then snapped at me that I should just cancel the appointment right then and there. I said ok and she stormed out. Most unprofessional physician I have ever dealt with

Anonymous said...

The Golden Rule is to treat people the way you want to be treated. Unfortunately many female doctors don't abide by this rule. That is to say, most female doctors would never allow themselves to have a male doctor give them a pelvic/breast exam with a male chaperone observing, but these same female doctors will have a female chaperone present when they are giving a male patient an intimate exam. This results in imposing an immoral double on their male patients, usually in the name of profit, that is, they can save money just hiring female nurses because societies norms say that it is okay to use a female chaperone a male patient. In other words, a male's modesty isn't as important as a female's. In the name of profit, too many female doctors will compromise the modesty/privacy of a male patient.

Ezekiel said...

I was abused by women. One was a doctor. I don't see women doctors anymore, for any reason. Not since I was 8. Chaperones still aren't a thing I like. Especially as a transmale. Let's at least make it even across the board. Women abuse just as often, they just get my with it. Males deserve better.

real said...

Doctor wanted the nurse to be in the room for a rectal exam,I said no I feel it's intrusive,He said if I refuse there will be no exam.Can I ask help from the Nj state medical board.Please respond.

Joel Sherman MD said...

You can certainly complain though I don't know if they'll take any action. I don't know enough about your situation to assess it.
If you're male and the chaperone was female you should request a male chaperone. And if you have any special problems such as prior relevant abuse, you should mention it as a reason.
In any event, no doctor is please to have any complaint filed and will certainly notice it.

Doug Capra said...

If you’re on Medicare, file a complaint with them. Remind them about the first item on their Patient’s Rights and Responsibility document. It deals with respect. If they say you were treated with respect, ask that they provide a definition of respect that applies ot all patients. Anyone else reading this who is on Medicare — if you run into a situation like this, remind the doctor or nurse about that Medicare document. Otherwise, if your doctor belongs to a FQHC, a Federal Qualifed Health Center, complain to the administrative agency in Washington, D.C. that governs those clinics. If it’s a hospital or other type of clinic, find out the names of the Board of Directors and send a complaint letter copied to each one. If it’s a private clinic, find out who the owners are and write to them. Don’t give up.

Joel Sherman MD said...

A nice article, worth reading:
Chaperones, Who Gets to Decide

PV1966 said...

Intimate exams can be embarrassing ... period.

But I think it's wrong to presume that just because a male prefers being treated by female doctors and or doesn't object to a female chaperone watching his intimate exams that it somehow denotes exhibitionism. One can feel embarrassed at being exposed in front of multiple females yet still feel more comfortable than having a male standing there watching him get a DRE from his female doctor. I doubt male nurses and techs are any less likely to be cracking jokes later than female nurses and techs.

Nurses and nurse practitioner are taking over more duties that in the past were done by doctors. It's of course about time and money, but that's just the way it is.

I both have (and prefer) a female doctor. She's is compassionate, detailed, never rushes when answering my questions, makes me feel comfortable and eases my embarrassment when I'm exposed. Her nurses and office staff, all women, are all great, too. Even though it's still embarrassing, I find it much less awkward being examined by a female medical provider. I'd rather feel a little embarrassed than feel quite awkward, uneasy and uncomfortable.

My colorectal surgeon is also female. On some visits, the female nurse practitioner has reviewed my symptoms and general health (vitals, etc.) before the doctor came in. On two occasions once I was undressed the nurse practitioner returned into the exam room with the doctor and stayed there observing and taking notes as I was examined. I wasn't exactly told that would happen. It's an embarrassing exam anyway no matter who is in the room. But I didn't mind the n.p. being there by necessity. It's not like she called in the female receptionist for a show and tell.

On the flip side, a prior surgeon (male) on my first visit sent one of his female office clerks into my exam room (after he stepped out to go treat other patients) to process my credit card payment for an expensive pain shot that he said wasn’t covered by my insurance plan. She wasn't in a nurse's uniform and worked at the front desk. I was laying there in bad pain, fully undressed, my pants and underwear briefs at my ankles and only partly covered at waist level by a small paper sheet. Needless to say, the sheet introduced itself to the floor when I struggled to reach my pants in a failed attempt to pull them up to knee level in order to reach my wallet. The young woman eventually had to reach into my pants pocket to get it. She clearly felt embarrassed for me and kept apologizing, as she had a difficult time processing my payment. She handed me my cell phone so I could call my credit card company. It turned out my available balance wasn't enough and she had to split my payment between two cards. She then retrieved the paper sheet from the other side of the exam table and laid it back across my genital area. I don't blame her for having a smirk on her face that day or later on subsequent visits when she assisted me at the front desk. I'm badly overweight and my small penis in a flaccid state nearly buried in pubic area fat no doubt made for a quite pathetic sight. But was my embarrassment the young woman's fault? Of course not. And I would have probably felt even more humiliated had the doctor sent in a male staffer.

There are a lot of men out there who feel embarrassed or awkward about women medical professionals treating them.

But by the same token, don't force us men who prefer and feel more comfortable with a female doctor or a female tech perform procedures that involve us being exposed to have to accept male nurses or male chaperones in the room.

Nor should it be assumed that a male patient should feel more comfortable with a male tech or male chaperone in the room than a female just because the doctor is female.

The best scenario would have the patient (male or female) be told what options are available and then be asked to specify their preference (one that would be accommodated).

PV1966 said...

My initial comment was too long to include this.

In the area of virtual examinations (something that we're all likely to be pushed towards in the name of cost-saving), why on earth is there any need for a chaperone whatsoever?

real said...

The female who came into the exam office was completely wrong and should have been reported to your state medical board,or hipaa.And they would have asked the doctor about the situation.And doctors don't like that.

PV1966 said...

I’m not the type to complain about someone who was just doing her job. The young woman clearly was surprised at the state of my undress when she walked into the exam room. She apologized for having been sent in to get a payment. She apologized at seeing me fully exposed (needless to say, I apologized as well). But I got the distinct impression that was a normal procedure at that office. I presume this is because of payment issues with patients.

(Naturally, the pain shot that would last for “several days” wasn’t covered by insurance while the one that would last for only “several hours” was. So much for Obamacare.)

I was far more upset later at how unprepared the doctor had me for the eventual surgery than that a young woman had a smirk on her face because she saw me fully exposed for several minutes. But I wasn't upset with her. Just red-faced and quite embarrassed.

After she left the room, the doctor returned I guess five or ten minutes later and I got the pain shot and got dressed. There was also far more talk with the doctor and mostly with his office staff about my health insurance, co-pays in advance, etc., than there was about post-op recovery and what to expect from the surgery. I found out later the practice has a financial stake in the surgical center I was sent to. (Nothing necessarily wrong with that, but I was only informed of that on the morning of the surgery.)

I’m sure I needed the surgery, but he made it seem like I’d be back to work in a couple days. Instead, a day later I was in so much pain I had to go to the ER (at a hospital; unaffiliated with the surgical center or that surgeon).

I also had been unable to urinate for nearly a day and a half after the surgery. After they got my pain under control in the ER, the nurse who had attended to me when I first arrived (along with another young woman, a nursing assistant who cleaned me up as I had soiled myself on the way there) gave me a urinary catheter and said my inability to urinate was likely the result of the anesthesia I was given prior to the surgery. She said the surgical center was wrong to have let me leave without making sure I could urinate.

I was still in intense pain several days later and had to go back to ER. I was treated again by the same female doctor and the same nurse. The doctor admitted me overnight to make sure my pain was under control and I was discharged the next day.

I was disappointed with the literally couple minute follow-up visits with the surgeon over the next several months. I think I spent more time waiting for an elevator in his building. I don’t doubt the surgeon’s capabilities and he is well regarded.

But when the time came for an annual follow-up I switched to the female surgeon who I have now. Wished I had found her to begin with. She has spent more time with me on each visit than the first surgeon probably did in five visits combined.