This post will perhaps be most relevant to the men though female doctors are feeling the pressure to have chaperones in the room. The main topic of this post is whether a chaperone will legally protect you should there be a patient complaint against you.
I’m a guy so when I go in to see a female patient I always take a female chaperone in with me. I never let the chaperone leave the room until I’ve left it – especially not when I still have got a speculum in hand.
In order for the chaperone to be effective this requires you to explain to the nurse that you are taking her in because she is a woman and that you don’t want to be in the room alone with the female patient when they are gowned or in otherwise a vulnerable state – at any point.
Purpose of a Chaperone
Up until I attended the UCSD Professional Boundaries course I assumed the purpose of a chaperone was to protect me legally in case an accusation was made against me.
Unfortunately that’s not the purpose of a chaperone. We’ll get into why they cannot protect you in court. But let’s focus on their actual purpose.
Patient Infantilization and Victimization
It’s not news that the law and even our medical profession views the patient as a vulnerable entity which cannot think for itself. This person must be coddled and protected from the many evil doctors who are running around humping and molesting everything in sight.
It’s a far cry from the patient empowerment that I was taught in medical school but very little of what I learned in medical school relates to the real-world practice of medicine.
It’s important to have this concept in mind because the public’s view of your interaction with the patient will be based on this.
The Display of a Chaperone
When you have a female chaperone it sends a message to the patient that you are taking a step to assure their safety. If they go home that night and feel weird about something that took place in the exam room then they hopefully think about the chaperone and realize that if the male doctor had sinister intentions then he wouldn’t have a female chaperone.
A female chaperone can also assist your patient in getting dressed/undressed which you obviously cannot take any part in.
Filling in for Social Touch
Should your female patient be in any kind of discomfort during a procedure then you should never use ‘social touch’ to assure or soothe them. However, your female chaperone can do so.
Social touch is when we place our hands on the shoulder or thigh or forearm of a person in order to express empathy. However, it’s inadvisable for a male doctor to use social touch in the exam room which has ended up many male doctors in the UCSD PACE program.
The Chaperone on the Witness Stand
Let’s say that your female patient sues you for sexually molesting her during a pelvic exam or breast exam or when draining a pilonidal cyst. The case ends up in court in front of a jury.
The first thing the patient’s lawyer is going to do is put your chaperone on the stand and ask:
“Are you employed by the same medical group as the accused physician?”
“Is it in your best interest to speak in favor of the doctor or against him since your job could potentially be at risk?”
“Is this physician your superior and can they tell you what to do and what not to do?”
The lawyer already discredited the chaperone’s ability to be a worthwhile witness to the case. Whether it’s effective or no, this is what will take place.
Effectively Using a Chaperone
Not all chaperones are created the same. Some are far more effective and others can even get you into trouble. Since we established that they serve as a minimal way of protecting you legally, let’s focus on how to best use a chaperone to prevent us having to face an accuser in the first place.
I often use a bit of humor, not jokes, but humor to lighten the mood in the exam room. The chaperones I choose will maintain a poker face which is very helpful to create a safe environment for the patient.
Traits of a Good Chaperone
A competent chaperone will never crack jokes or start busting up laughing at something I say.
A good chaperone will be mostly attentive to the patient and watch my hands at all times.
It’s best to assure that the patient has a direct line of sight with the chaperone at all times.
The chaperone should be intelligent enough to know that I won’t want to be alone in the room with a patient – they will have the room prepped ahead of time.
Most importantly, they will instruct the patient how to get into the paper/cloth gowns and where to sit while waiting for me to enter.
One doctor that had to attend the UCSD Professional Boundaries course was there because a patient complained about him to the medical board for walking in exactly at the time she was taking off her blouse. There were no divider curtains in that particular exam room and his chaperone wasn’t adequately competent to make sure the patient was fully gowned before entering.
Chaperones for Exams
One of the doctors who was at my Professional Boundaries course was there because a patient felt uncomfortable for having her shoulder examined by this doctor even though she was fully gowned.
This doctor didn’t have a chaperone and she claimed that he touched her back inappropriately. He claimed that as a DO he was performing a manipulation technique on the shoulder which he was describing to the patient as he was doing it.
Such a situation is an ideal example of how a chaperone could be helpful. Maybe the doctor really was copping a feel – maybe he just came across as sleazy.
You should have a chaperone with you anytime a patient needs to be gowned. And if you think you will be examining any of the “hot-spots”, the terms used during the UCSD Professional Boundaries course, then you should have a chaperone.
Here are some examples when I decided to bring in a chaperone or would have felt more comfortable having one:
- woman in a skirt complaining of knee issues
- shoulder pain on a woman
- back pains in a woman
- rib pain on a woman
- woman needing a full cardiac exam
- rash/abscess in any core-area of the body (trunk/flank/groin)
Lack of Female Chaperones
There was a humorous moment during the UCSD Professional Boundaries course when we were discussing the lack of available female chaperones.
We all cracked up in agreement because it’s not like there are female nurses who are just standing around looking for work. The nature of medicine is that everyone, especially the staff, is doing 12 things at the same time.
Furthermore, the ones who are competent are often even busier and impossible to find. You are more often left with someone who will get you into more trouble than help you.
I have my own tricks which I have developed over the years of practicing Family Medicine to deal with the lack of a chaperone. You may have to cut some corners and trade some patients around but unfortunately I view it as necessary so that you don’t increase your exposure to risk.
But decide today if you are going to practice medicine in the absolute best interest of the patient or if you are an employee at a job which pays you a living wage. If your income and your professional career is on the line then don’t end up in a situation where you might be doing something for the benefit of a patient or to help save the patient time and burn yourself instead.
I am sure that there is a way to satisfy my self-preservation instinct and meet the patient’s needs at the same time but I haven’t yet figured out that sweetspot.
Age Limits With Patients
You should have a chaperone for all ages – period. If it’s a woman then you should have a chaperone regardless of the age.
You might think that it would be impossible for a 95-year-old woman to file a sexual harassment complaint against you. But when if her granddaughter is an LPN and find a bruise on her breast when she helps her change at home, the last person she saw was you – are you protected?
What if you do the most benign shoulder exam and need to move the bra strap on a woman to examine her clavicle? Let’s say it all goes well but when she gets home she starts having some flashback to her childhood when some uncle touched her inappropriately – suddenly she thinks back to you touching her bra strap and you become suspect.
I’m not making these stories up,in case you have trouble believing such accusations. These are scenarios I am using from what was shared with me during the UCSD Professional Boundaries course.
I want to add here that it doesn’t matter what the outcome of an investigation will be. I would much rather avoid an investigation altogether and that’s what a chaperon can help you with.
The Flirtatious Patient
Some of you dudes reading this are looking like Fabio at work – I can only imagine that you are routinely flirted with. The rest of you are ugly as sin so you’re good – solid.
Most of the time it’s easy to get a flirtatious patient back on track, sometimes the female patient is resilient.
The best thing to do in such a situation is to excuse yourself for a moment and say that you’ll be right back. Then grab one of your female nurses, the meaner the better, and have them be present in the room.
Unfortunately everything in medicine these day s feels a bit awkward and though this too may feel weird, in practice it’s not all that bad and it will protect you.
The only reason that I hustle in the Urgent Care isn’t because I’m trying to get paid more but because I’m trying to help see patients faster so that they don’t have to wait longer than necessary.
Waiting is terrible – we’ve all been on the receiving end of it. A patient waits on the phone to get an appoint for which she has to wait a few weeks. She then has to wait in line to check in and wait in the waiting room to get called in. Then she has to wait in the exam room until I walk in.
The utter disrespect that we as a medical system have for patients when it comes to their time is shameful.
I don’t get paid more for seeing more patients and though there are some circumstances when it’s beneficial to be a faster Urgent Care provider, I have now learned that it puts me at a much bigger risk than I ever realized.
Take your time. Rushing from one patient to the next desperately trying to decrease their wait-time could hurt you. Every patient you clinically interact with is a patient who you own – forever.
The Big Picture
The big picture with this post isn’t to scare physicians though that’s going to be our first instinct. Being aware of what can get us in trouble and how we can mitigate such risk should instead make us feel more in control.
As men we probably don’t fully understand what it’s like to be a half-nekked woman sitting in the exam room alone with a dude doctor. It can’t hurt to have a chaperone and it will protect us, them, and hopefully decrease the chance of any friction.
Anytime you can decrease the risk of practicing medicine then you will earn the same hourly wage with higher chance of keeping more of the bottom line dollar.