Patients and Doctors are Cautious about Unwitnessed Physical Exams.
Disgraced former USA gymnast doctor, Larry Nassar, will spend his entire life in prison for his sexual assault activity. Without question, his crimes have ultimately damaged the implicit trust between patient and physician. As emergency physicians, we now are facing an environment of increased skepticism regarding the intentions of aspects of the physical exam.
The basic nature of our profession requires examining and palpating the bodies of our patients. If you search social media and open patient forums you will discover how truly confused and mistaken patients are by what is considered customary “appropriate touch” during a physical examination. Patients are left attempting to determine if any components of the physical exam may have constituted sexual misconduct. They typically ask each other’s opinions regarding possibly questionable practices, such as if a stethoscope touching the breast constitutes sexual misconduct or even if the proximity of the physician’s face during an ophthalmoscope exam suggests sexual inappropriateness.
As the public attempts to comprehend how a renowned physician sexually abused over 250 women and girls, the medical community should respond in the form of expanded chaperone use. Chaperones should be used by physicians for any “sensitive area” exam. For patients who may be anxious about the physical examination in general, or who have a history of sexual abuse, a chaperone may be advisable during all interactions with the patient — both history and physical.
Often patients aren’t familiar with the concept of a chaperone. It is important to explain the policy to the patient and communicate that a chaperone’s role is to make the patient feel more comfortable. Consequently, any doubt that a particular element of the physical exam was morally questionable will be diminished.
I polled our physician group in a recent meeting with the ED leadership regarding their utilization of a chaperone during the physical examination.
In a Post Larry Nassar era, it is important to review your chaperone policy. Unfortunately, physicians such as Nassar have exploited the privilege of the physical examination. ED physicians need to consider the more liberal use of chaperones in order to maintain trust and provide a sense of safety and comfort to our patients.
Patients are concerned about what constitutes an appropriate physical examination and a chaperone will add an increased degree of protection to the physician in the event that he or she is wrongly accused of a misinterpreted physical exam.
In summary, it is recommended that both male and female practitioners have a chaperone for all “sensitive area” exams. If resources permit and the situation calls for it, the presence of a chaperone should be considered for the entirety of the physical exam, and in some cases the interview as well.