Saturday, October 2, 2010


More on Chaperones

In the first part of this series, I noted some strategies mentioned in the study, Not Just Bodies, that doctors use to help “desexualize” physical exams. One of those strategies is using chaperones -- a topic that Dr. Sherman covered well in the last post. I’ll add a few more observations about chaperones from the study.

In all but one of the interviews with doctors using chaperones, only female chaperones were used. “Many doctors believe,” the study says, “that the mere presence of a woman’s body in the examination room is comforting to patients.” This belief is articulated in The woman in the surgeon’s body (1998) by J. Cassell, who writes that patients' reactions to a woman’s body are “below the level of words,” and that these reactions are:

Shaped during the infant’s earliest interactions
with mother…A woman’s body comforts and holds;
a man’s body acts. A baby learns these distinctions
very early; a young child anticipates different behavior
from women’s bodies than from men’s; an adult is
impelled by the same embodied knowledge.

This belief may explain many of the gender attitudes and stereotypes, patients encounter in hospitals, -- why it’s just assumed that all or most men prefer female nurses. With few male nurses and chaperones available anyway, it could also be a rationalization for the status quo. This use of the word “impelled” in the above quote is revealing. Apparently, we have no control over this “feeling,” this “urge.” It has been imprinted upon us from birth. Following this reasoning, it would make sense for a doctor, male or female, to use a female chaperone when examining a male.

On the other side, the study quotes a female doctor who refuses to have any chaperone in a room when examining a male patient. “I can’t have a women in the room with me,” she says, “Plus I think it would be worse to have another guy in there…I just think it’s embarrassing enough for him already…” Even though she has male chaperones available, she believes it would be embarrassing for the male chaperone, too. I believe this response to be closer to the truth than most others because it supports a number of studies that say men just don’t want chaperones.

“Thus, female patients are protected by chaperones,” the study notes, “but men must be protected from chaperones.” Even J. Cassell (quoted above) argues that these feelings of childish dependency of mother, though acceptable for females may be emasculating for men. Any chaperone for a man, male or female, “could exacerbate his feelings of powerlessness.”

Why would the doctor quoted above think it worse for a man to have another man as a chaperone? This may be a power issue. Isn’t a man supposed to be able to protect himself? As the study points out, women are more often defined as victims than are men. Our culture sees women as in more need of chaperones. But men? A chaperone could be considered an affront to his masculinity.

A significant number, if not the majority of doctors and nurses, use chaperones primarily for their protection. Participants in this study gave three ways that chaperones protect them. First is the protection from false accusations of sexual misconduct. One male doctor called chaperones “cheap insurance.” It was generally agreed by those interviewed that “sexual allegations usually come from women.”

Are women doctors and nurses afraid of false accusations from their lesbian patients? The study didn’t show this to be a major concern, although one nurse said a complaint against a female doctor at her teaching hospital caused some others to use chaperones with their female patients.

A second reason for chaperone use, according to the study, is to protect doctors from sexual advances from patients. A female urologist said that many men (especially her Hispanic patients), are embarrassed because she is a women, and that they are “really macho” and uncomfortable with women in a “position of authority.” She was asked directly if she had ever had sexual incidents with male patients. She answered that she always had a chaperone in the room with either men or women. “I have a male chaperone with men, and a female with women.” To those interviewing her, it was clear that the purpose for the chaperones was for her “physical protection from sexual harassment or assault.”

The study noted that most doctors and nurses interviewed didn’t use chaperones for this purpose, but rather practiced other strategies. I’ll comment on these strategies as I go through this study later in the series.

A third reason respondents said they used chaperones was protection from their own sexual feelings. One male doctor talked about a female patient of his who he considered “gorgeous.” He had a difficult time examining her. “…I needed to use a chaperone." he admitted. "A chaperone not for her comfort but for mine.”

Although some female caregivers admitted that they sometimes “experience unwanted sexual feelings when examining an attractive man,” they said they didn’t use chaperones. They seemed more concerned with controlling the patient’s sexual desire. Interestingly, several believed that “men are expected to act on their sexual desires and women are not.” One nurse commented:

“Younger teenage girls, I would rather just female
nurses take care of them. I think we kind of discourage
male nurses from taking care of teenage girls. You don’t
want anybody to get the wrong idea. Teenage boys are
very comfortable with me, so I try to distract them, talk
with them, try to make them more comfortable.”

I would suggest a few points about this last comment. First, this is not an uncommon attitude today among a significant number of female caregivers. Indeed, how many male nurses steer clear of these encounters for their own professional safety? Secondly, how accurate is this nurses assessment of her male teenage patients -- “Teenage boys are very comfortable with me…” How does she know? Has she asked them if they would prefer a male nurse? Although homophobia, especially among boys, may be a factor -- a common assumption seems to be that most boys are homophobic and would prefer female nurses or doctors. Is this assumption backed up with any research? Certainly it makes it easier for the medical system to base their practice on this assumption, since they are unable to accommodate most men or boys who would prefer same gender intimate care.

But, as the study points out, the attitude of the nurse above is that, even if the teenage boy wanted a male nurse, a man replacing her may give people the “wrong idea.” Men, as this attitude suggests, are sexual beings not in control of their feelings. Females are more to be trusted. “Just as women are more likely to be cast in the role of ‘victim,’ the study states, “so are men likely to be seen as sexual aggressors. These beliefs are internalized by some health care providers and institutionalized in the patterns of chaperone use.”

The assumption, unstated, is quite clear. Men are not in control. They will act upon their sexual urges. Women are in control. They won’t. A female nurse, talking about catheterizing men, said: “If a male patient wants a male, that’s fine. Some male patients are hesitant about anyone catheterizing them.”

Isn’t it also true that “some” female patients are hesitant about anyone catheterizing them? I would suggest that most patients don't "want" to be catheterized. Another attitude that seems prevalent in health care is that men just don’t want anything done to them. Men just don’t want to be there and don’t really care about their health. I would suggest that most patients -- male and females -- are uncomfortable with people doing intimate procedures to them.

But back to chaperones. As the study points out, attitudes toward and practices regarding chaperone use are embedded in assumptions about men’s and women’s sexuality. “Men are powerful; women are sexually vulnerable. Women’s bodies are comforting and soothing, but they also elicit feelings of childish vulnerability.” This vulnerability is acceptable in women but not in men. Men should be strong, shouldn’t complain.

So -- what does all this mean to patients who may face the use of chaperones at a clinic or hospital? Here are a few points to consider:

-- Be aware of the various uses of chaperones. Be honest with yourself and with your caregiver about what’s comfortable for you. Unless your comfortable with it, never allow a chaperone to just be present without being “offered” to you. You do have a choice.
-- Be aware of note-takers and other “assistants” whose real purpose is that of chaperone. This is simply dishonest and needs to be challenged. Ask the medical reason for the extra person in the room.
-- Some caregivers will offer to place the chaperone behind a curtain or have them turned away. Consider the ridiculousness of this. Can you imagine a chaperone sitting on the witness stand in court being asked, “What did you see?” and answering “The wall.“ or “All I could see was a white sheet.”
-- Some practices are continued for no medical, legal or even logical reason. They’re done because that’s how it’s done. No one thinks anymore about why. Not too long ago, I had to have a pre-surgery EKG. The nurse took down some information, told me to take off my shirt and handed me a gown. It would be fine, she said, to keep my pants and boots on. “Do I need to put on the gown?” I asked. “It would be best,” she said. I went along out of curiosity. So there I was -- shirtless, with pants and boots and wearing a gown. The tech came in, a young female, and did the EKG. The only reason I could see for this inane gown request was for the possible protection of the female tech. Would she feel more comfortable with me in a gown? Would it help me control my sexual urges? As patients, we need to be alert to these behaviors. Don’t be afraid to ask questions and demand medical reasons for these behaviors. I let this slide because I often act as a participant-observer and, in this case, wanted to see where this was going.
-- Men need to be aware of how some female caregivers may view them -- the perceptions, assumptions, stereotypes. Remember, it’s not just about their comfort. It’s just as much about your comfort. Don’t hesitate to speak up.
-- If you agree to a chaperone, be very alert as to her status. Is she a nurse? A medical assistant? A nurse assistant? The receptionist? And, of course, don’t hesitate to request a chaperone whose gender you feel most comfortable with.
-- If you don’t want a chaperone, or are faced with one of the opposite gender, don’t feel forced into having one. Doctors who required chaperones need to place that requirement up front. It should be mentioned at the time you make your appointment; it should be placed on their web page. Don't be ambushed. Don’t be afraid to file a complaint, several complaints. Doctors in private practice have the right to run their business they way the want to. They don’t have the right to accept you as a patient without making clear their chaperone polices. Of course, you’ll find that most if not all doctors and hospital have no written polices for chaperones. Having nothing in writing makes it easier to just do things they way they do things. You’ll find that, nationwide, there are no standards for use of chaperones by the medical community.
Next in the series, we’ll look at what this study, NOT JUST BODIES, has to say about the strategy of “Objectifying the Patient,” and why, even though this may work for the caregiver, it may not work for the patient.
(c) Doug Capra 2010

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