Tuesday, March 28, 2017

Chaperone violation and resolution

How to resolve the issue 

by RG

Moderators note:  This post is anonymous at the request of the author.  However his actual identity is known to one of us. 
For more background on this topic refer to the article on chaperones and the article on privacy complaints.


I get my most of my health care from a large group practice in the town where I live; one of my two  primary care providers there was a female nurse-practitioner who I’d been seeing for 5-6 years and had a good professional relationship with. Last summer, I was taking a shower and noticed a large swelling on one of my testicles. Knowing this was not something I could put off, I immediately made an appointment with my NP, who fortunately was able to see me that same morning. I was a little self-conscious about being examined by her, but based on our prior history – and the fact that I’d had intimate exams from other female doctors over the years -- I figured I could get over myself.
Anyway, after talking with me briefly about the swelling I’d noticed, she got up and went to the sink to wash her hands. “When was the last time you had a testicular exam?” she asked. Not exactly an announcement of what she planned to do; on the other hand, I knew it was coming, so I wasn’t surprised. “This will be my first,” I said. She nodded, then instructed me to take my pants and underwear down to my ankles, lie down on the examining table, and cover myself with a large cloth. She left the room for a few minutes while I did so. But then, when she knocked and opened the door again, one of the intake nurses (also female) was right behind her. Without a word, they positioned themselves on either side of me, directly across from each other at my hips. Then the NP pulled the drape completely off me, exposing my genitals to both women. I was so shocked and embarrassed I literally couldn’t speak – the NP hadn’t said anything beforehand about bringing in a witness, and obviously hadn’t asked my permission for someone else to be in the room. Before this experience, I had never even heard of “chaperones,” and had never been undressed in a doctor’s office for anyone but that doctor. The other thing that bothered me was that the nurse literally did nothing the entire time but stand there staring at my exposed equipment. She did not say a word to me or make eye contact at any point, and wasn’t assisting the NP in any way. As soon as the exam was finished, she turned and left the room.
The swelling turned out to be a cyst, and I was referred to a (male) urologist who recommended surgery to remove it. That took up most of my attention for the next several weeks, during which time I noticed some glaring differences from my initial exam in terms of modesty acknowledgement. I’ll just give you two examples. First, a female ultrasound technician who not only didn’t demand a witness, but made sure to drape me in such a way that only my testicles were exposed and nothing else (not even my bare thighs), and only while she was actually examining me. When she had to stop for a few minutes to check her records, she readjusted the drape so that I was completely covered until she returned to resume the ultrasound.  Secondly, in the recovery room after my surgery, the nurse attending me asked if I would like her to change places with my wife when getting dressed to leave – an offer I gratefully accepted.  Gradually, as I pieced together my memories of the initial exam, I began to realize how seriously and unnecessarily my privacy had been violated. At that point, I sent a letter to the NP, asking why the nurse had been present and why I hadn’t been consulted about it. She replied in a 4-line email stating that it was her “policy” to have a witness present whenever patients were undressed, that it was “for your protection as well as mine,” and recommending that I see a different provider in future for intimate exams. I took her advice a bit further, and sent her another note terminating our relationship. I obtained a copy of her clinical note for the exam, which to my surprise did not list the name or credentials of the witness, just the phrase “Chaperone during exam: female present.”  I went back to the facility in person to get that information; the clerk I spoke with seemed surprised that I was asking, but obliged me.
Since the NP’s response was so unsatisfactory, I decided to follow Dr. Joel Sherman’s recommendations (see http://patientprivacyreview.blogspot.com/2010/10/privacy-complaints-what-to-do-about.html), and gradually worked my way up through their chain of command (threatening to file a complaint with the state medical board probably helped). Ultimately, I was invited to meet with their two top directors. I told them I preferred not to seek disciplinary action, but did require an acknowledgement that both their NP and their nurse had acted improperly, along with some meaningful protections that would keep me from being placed in that situation again. I pointed out the implicit double standard in allowing two female staff members to attend an undressed male patient; they agreed that the reverse situation would never be allowed to happen at their facility, but said that the small number of male nurses on their staff made that double standard difficult to avoid. I offered to sign an a priori waiver of legal liability in exchange for a universal exemption from “chaperones” in their practice, but they did not agree to it. Their position was that individual providers had a right to third-party witnesses if they desired. Instead, they told me they would post a note in my electronic chart so that any provider in their practice would know my wishes in advance; they also agreed to attach a letter from my therapist, stating that the presence of such third-party observers was emotionally harmful for me. Their thinking was that any provider seeing that information would be likely to respect my preference and not be worried that I was just looking for a way to trap them into a lawsuit.
At my request, they also gave me some advice for negotiating with any new providers: if circumstances permitted, I should arrange for an “establish care visit” in which the provider and I addressed my refusal of witnesses and came to some agreement in advance about how to proceed. In the event of an urgent situation, such as I’d had with my cyst, and the new provider was not willing to work without a “chaperone,” I could ask that provider to switch places with a colleague who would honor my wishes, so that I wouldn’t have to delay treatment by rescheduling.
In our meeting, the directors also announced that they were planning to train their entire staff in proper chaperoning protocols – something they admitted they had not done previously. I asked for, and subsequently received, a copy of the informational materials they developed for this training. To their credit, every one of my complaints is being addressed: providers know they have to announce their intention to have an observer beforehand and specifically ask for consent; “chaperones” themselves are explicitly instructed to be attentive to patients’ signs of vulnerability and embarrassment, and to provide reassurance -- verbally and by maintaining eye contact. The training materials also clearly state that opposite-sex witnessesc are equally inappropriate for male and female patients, thus apparently ending that double-standard at their institution. I sent a written reply, thanking them and commending them specifically for their progressive stance on male modesty.
In closing, I’d like to offer my thanks to Mr. Capra for hosting this site, and to everyone else who has posted here. Your thoughts and shared wisdom helped me learn how to advocate for myself, and to believe that change is possible if one is willing to help make it possible.


Joel Sherman MD said...

This post is a testament to what an individual can do to alleviate and fix privacy violations. It takes determination and courage, especially for men who sometimes get mocked for their protests,
But the end result is generally worth the trouble. Medical providers are put on the defensive. It is difficult to defend privacy violations and they rarely try. One pursued complaint can fix or alleviate the problem.
RG is to be commended.

Doug Capra said...

I encouraged RG to write this because he represents someone who is actually doing something about this problem. The system will respond if enough people like RG approach this issue the way he did here. Refuse to be ignored. Present your case civilly and as objectively as possible. Use description. "This is what happened..." Don't be angry or insulting. Know your rights and insist they be respected.

Anonymous said...

Thank you both for hosting this site and for your insightful guidance on dealing with problems like this one. Your efforts made my own possible.

I did want to clarify that the practice administrators I dealt with regarding this issue were unfailingly polite and concerned; they seemed genuinely interested in learning from my experience and improving their practice. At no point did I encounter the dismissal and/or ridicule that others have reported. Being civil and respectful, as Mr. Capra points out, encourages a like response and a focus on solving problems.


Doug Capra said...

Thanks for your comments, RG. I'm a Stoic at heart, and I try to live by their words. Epictetus wrote:
“In life our first job is this, to divide and distinguish things into two categories: externals I cannot control, but the choices I make with regard to them I do control. Where will I find good and bad? In me, in my choices. Patients, both men and women, need to accept what they can't control, and change what they can. One thing they can control always is how they respond to any situation. Too many choose not to respond to situations they may have some control over. Patients need to understand that how they respond can begin to change individual behaviors and eventually the system. Your example should help them understand that they have more control over the system than they believe.

Doug Capra said...

Note -- on my last comment, close the quotation after "...in my choices."

Anonymous said...

Good evening Gentlemen:

Doug I agree with you, "Too many choose not to respond to situations they may have some control over. Patients need to understand that how they respond can begin to change individual behaviors and eventually the system."

That's especially true at the urologist office where they are doing more & more procedures these days.

Men are not told ahead of time that the procedure they are there for requires they be put into stirrups.

They're caught off guard and shamed into doing the procedure in the presence of at least one strange woman if not two.

They're too scared & humiliated at this point to stop everything and ask for same gender care of stop the proceedings and leave.

This issue must come out of cyberspace and into the real world.

Men have to know what kinda issues they will be facing as they get older and need healthcare assistance.

Many local hospitals listen to our pitches then it's business as usual.

We need more voices.

Can you tell us where we could call or write on a national level to someone with influence who can help us turn the tide?

Men everywhere have had their respect and dignity stolen from them by the healthcare industry long enough. Some gentlemen have gone as far as to call it rape.

Women over the years found their voice, then spoke up and demanded the system change and it did in their favor.

Men everywhere must decide now do you want protections put in place by the healthcare industry to protect your right to privacy & your dignity?

If you do, it's time to MAN UP and tell the medical community WE DEMAND CHANGE.

Four words that have a great deal of meaning to the healthcare profession.


Turns out they have a lot of meaning to the patient too.


Give ALL your patients (INCLUDING MEN),Choice without questioning why.

Protect their Privacy like you would protect your own.

In return, you will have earned your patients Respect and have their undying gratitude for a lifetime. What more can any healthcare worker ask for?

Choice Privacy Respect CPR three letters that can make a world of difference.

Do No Harm and CPR go hand in hand. You can’t have one without the other and successfully take care of the public you serve.