The sexual abuse scandals of the past decades and the current #MeToo movement have exposed unthinkable acts of abuse at the hands of our most trusted professionals and public figures. The sheer volume of these cases and the wake of destruction caused by even a single “bad actor” woke the public to the uncomfortable truth that sexual harassment/abuse is pervasive and tends to flourish where there is a distinct power differential between the perpetrator and the victim: employer-employee, professor-student, coach-player, clergy-parishioner, physician-patient.
And yes, now the spotlight is on medicine. Recent accusations of sexual acts against physicians have alerted the public to the need for increased vigilance. Patients are now empowered to speak up and are inclined to complain to law enforcement and medical licensing boards when they feel that boundaries have been breached, rights have been violated, or whenever something just doesn’t feel quite right.
The physician-patient relationship is strengthened when physicians respect the patient’s need for modesty and privacy, when they care enough to educate the patient on the nature of sensitive procedures before performing them, and by using chaperones when conducting intimate physical exams.
Tips on Promoting Privacy and Using Chaperones in Your Practice
- A chaperone is encouraged for all exams of an intimate nature including genital, rectal, breast, and full-body skin exams.
- Chaperones exist for the mutual protection and comfort of the physician and the patient.
- Family and friends should not serve as chaperones nor should physicians assume that patients wish to have a family member present during a sensitive physical exam. While family may remain in the room per patient request, an additional chaperone who is not a family member should also be present.
- Be sensitive to the patient’s need for modesty by allowing the patient to disrobe and dress in private. Provide gowns and drapes for comfort. Knock and request permission before entering the exam room.
- Consider that the details of a pelvic or breast exam may be completely unfamiliar to your patient. Explain what it is you plan to do, why you’re doing it, and what the patient is likely to feel before you begin! This shows respect for the patient and helps prevent shock or surprise.
- Refrain from making any comment that could be construed as sexually provocative. This includes complimenting the patient on his or her physical appearance, discussing intimate subjects such as dating or relationship status, or using epithets or terms of endearment such as “honey,” “sweetie,” or “darling,” etc.
- Examinations of pediatric patients may require additional education, discussions, awareness, and sensitivity.
- Physicians should be sensitive to their patients’ need for confidential communication. The presence of a chaperone should be limited to the duration of the physical exam to allow time for private discussion.
- Document the name of the chaperone and anyone else in attendance and indicate that he or she was present throughout the entire exam.
- Be aware of your own feelings. Physicians who develop romantic feelings for a patient should consult the AMA or medical licensing board guidelines for discontinuing the physician-patient relationship.
- A romantic relationship with a patient is a breach of professional ethics even when the relationship is consensual.
- Develop an office policy for the use of chaperones including situations where chaperones are required, accommodation of the patient’s request for a chaperone, and documentation requirements. The policy should apply to both male and female physicians.
- When patients first visit your office, inform them of the use of chaperones and chaperoned exams.
While a “few bad apples” certainly won’t erode the respect and trust we place in our healthcare providers, medical professionals are well-advised to exercise sensitivity and caution when conducting intimate physical exams and are encouraged to observe the basic rules of etiquette and professionalism when interacting with patients.
Catherine Miller is a Senior Risk Management Specialist for CAPAssurance. Questions or comments about this article may be sent to cmiller@CAPphysicians.com.