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.
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.
34 comments:
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?
GR
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.
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"?
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.
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.
PT
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.
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.
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.
"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?
Doug/MER
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.
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.
Doug
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?
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.
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.
Joel:
We may never know -- but I think your article had something to do with the change. We can make a difference on this blog.
I recommend you take a look at this article (http://www.piam.com/WIM_bulletin/chaperone0411.html) 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."
Ed
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
9 hjdarkaI would like to thank Ed for posting the link to the Women in Medicine article regarding chaperones. (http://www.piam.com/WIM_bulletin/chaperone0411.html)
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
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.
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.
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.
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.
From the www.massmed.org 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.
Ed
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.
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.
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.
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.
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.
Recommend you read "Use of chaperones in the urology outpatient setting: a patient’s choice in a “patient-centred” service" located at "http://pmj.bmj.com/content/83/975/64.abstract".
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.
Ed
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.
And this study is from Australia dated Dec 2007:
http://journals.lww.com/stdjournal/Fulltext/2007/12000/The_Differing_Views_of_Male_and_Female_Patients.13.aspx
Ed
From my last post:
60% of patients who desired a patient
Meant 60% of patients who desired a chaperone.
Another article about chaperons by a physician.
http://www.hemodoc.com/2010/12/do-doctors-need-chaperons.html?cid=6a0133f61818b7970b0147e0965c97970b#comment-6a0133f61818b7970b0147e0965c97970b
Ed
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.
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