Are chaperones really necessary for pelvic exams?

[prolene60]

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I was always told throughout residency to always have a chaperone for pelvics because you could be falsely accused of sexual assault and not have a witness. What I don't understand is technically a woman can falsely accuse you of sexual assault at anytime. I mean if you walk in a room to see a female patient alone for eye pain, she could always say that "he started to touch me sexually." It seems like you would need a chaperone for every encounter. Also I don't usually see chaperones for male GU exams. A guy could say the same thing for a male or female doctor. "He or she sexually assaulted me when I needed an exam for my penile discharge ( or my eye pain)." It's usually a pain for me trying to locate my nurse to get this done and for the nursing staff if they're really busy to stop and do this. If a male or female obviously needs a GU exam and you document why and document your findings in the chart I can't possibly see any physician being successfully sued and/or criminally charged for assault. The whole thing sounds kind of silly.

 

[JediZero]

I was always told throughout residency to always have a chaperone for pelvics because you could be falsely accused of sexual assault and not have a witness. What I don't understand is technically a woman can falsely accuse you of sexual assault at anytime. I mean if you walk in a room to see a female patient alone for eye pain, she could always say that "he started to touch me sexually." It seems like you would need a chaperone for every encounter. Also I don't usually see chaperones for male GU exams. A guy could say the same thing for a male or female doctor. "He or she sexually assaulted me when I needed an exam for my penile discharge ( or my eye pain)." It's usually a pain for me trying to locate my nurse to get this done and for the nursing staff if they're really busy to stop and do this. If a male or female obviously needs a GU exam and you document why and document your findings in the chart I can't possibly see any physician being successfully sued and/or criminally charged for assault. The whole thing sounds kind of silly.

Yeah, it's always a possibility. You're basically just adding an extra layer of protection in high-risk scenarios such as genital exams. I had a patient with a CC of an abscess, and when I came into the room she told me it was in her groin. I immediately left and came back with a chaperone. When my attending saw her, he did the exact same thing. And yes, nurses are busy, but they're usually happy to help when I ask.

Personally, I try to always have a chaperone when seeing female psych patients, as they have a near 100% rate of sexual abuse history...

 

[Arcan57]

I was always told throughout residency to always have a chaperone for pelvics because you could be falsely accused of sexual assault and not have a witness. What I don't understand is technically a woman can falsely accuse you of sexual assault at anytime. I mean if you walk in a room to see a female patient alone for eye pain, she could always say that "he started to touch me sexually." It seems like you would need a chaperone for every encounter. Also I don't usually see chaperones for male GU exams. A guy could say the same thing for a male or female doctor. "He or she sexually assaulted me when I needed an exam for my penile discharge ( or my eye pain)." It's usually a pain for me trying to locate my nurse to get this done and for the nursing staff if they're really busy to stop and do this. If a male or female obviously needs a GU exam and you document why and document your findings in the chart I can't possibly see any physician being successfully sued and/or criminally charged for assault. The whole thing sounds kind of silly.

Dear God. Yes, you need a chaperone. While you can be falsely accused at any time, going without a chaperone is unusual enough to be worrisome and many women are going to be uncomfortable with being examined alone by a man. This combined with potential unhappiness regarding findings on pelvic, the bill received, etc. makes it much more likely for a complaint to be filed. It's not defensible.

 

[Rendar5]

resident at my old program got suspended for several months for an accusation related to this. Criminal charges were pending, Luckily after some investigation police turned up similar charges by the same woman against multiple doctors in other states in the past. If they hadn't looked at other states, the guy would be in jail with nohope of completing residency or obtaining licensure.

 

[deleted547339]

Yes. Trying to convince yourself or others otherwise is simply insanity. We work in a world filled with a disproportionate number of crazy people and those interested in secondary gain.

Just yes.

 

[The White Coat Investor]

Yeah, it's always a possibility. You're basically just adding an extra layer of protection in high-risk scenarios such as genital exams. I had a patient with a CC of an abscess, and when I came into the room she told me it was in her groin. I immediately left and came back with a chaperone. When my attending saw her, he did the exact same thing. And yes, nurses are busy, but they're usually happy to help when I ask.

Personally, I try to always have a chaperone when seeing female psych patients, as they have a near 100% rate of sexual abuse history...

I had a complaint once in residency because I did not get a chaperone to drain an upper thigh abscess.

I wouldn't even think of doing a pelvic or breast exam without one, although I admit I will do testicular/rectals on men without one. Probably not a good move either.

 

[ccfccp]

I always get one for either male or female exams. It just doesn't seem worth the risk.

 

[Apollyon]

At my first job, one guy there had a patient that he was unfortunate enough to see more than any other doctor. This lady was (I don't know if she is still alive) just crazy, but not there for overt psych issues. My colleague saw her in a room with a chaperone (because of history) for a non-gyn complaint, and left the room. The patient then called 911 from the room, and stated the doc had raped her. That's why he had the chaperone.

The reason for males needing a chaperone for females is due to historical associations and statistic prevalence of males as sexual predators on females. However, I also know of many female colleagues that also would have a chaperone, just for an added layer of protection.

 

[dotcb]

In a word - yes. Though I don't usually get chaperones for male or female rectal exams.

 

[VentJockey]

resident at my old program got suspended for several months for an accusation related to this. Criminal charges were pending, Luckily after some investigation police turned up similar charges by the same woman against multiple doctors in other states in the past. If they hadn't looked at other states, the guy would be in jail with nohope of completing residency or obtaining licensure.

I hope he sued that woman for every dime she is worth....and that they banned her from that hospital. How horrible

 

[docB]

I hope he sued that woman for every dime she is worth....and that they banned her from that hospital. How horrible

Sue the patient? Very unlikely and usually a waste of money.

Banned from the hospital? Due to EMTALA it is almost impossible to really bar someone from a hospital with an ER. Lots of people talk about it like it's possible but the reality is that if they manage to show up in the waiting room or by ambulance you are stuck with them. It's kind of like getting someone charged with "911 abuse." It sounds good but it's usually not real.

 

[DeadCactus]

Anyone can accuse you of anything at any time. It's still a hell of a lot easier to convince the police, your administration, and a jury that she was taken advantage of in a situation where she was sexually exposed and undergoing what she thought was a medical exam until X happened.

It doesn't even have to be some crazy woman making insane accusations. I guarantee someone has launched an investigation because they mistook the rectal exam during a trauma as a sexual assault or their pre-operative Foley placement as molestation.

 

[Siggy]

Sue the patient? Very unlikely and usually a waste of money.

Banned from the hospital? Due to EMTALA it is almost impossible to really bar someone from a hospital with an ER. Lots of people talk about it like it's possible but the reality is that if they manage to show up in the waiting room or by ambulance you are stuck with them. It's kind of like getting someone charged with "911 abuse." It sounds good but it's usually not real.

At orientation for my current hospital, they mentioned that there's two individuals in the community that the hospital has a restraining order against and essentially the only way they're getting into the hospital is through the ED. However all of the county clinics and other services? Nope.

 

[EM_Rebuilder]

YES!

I don't get near 'the area' unless I have a nurse present. I am male, I will exam a male sometimes without a nurse, but usually I have one present.

Imagine being accused in a case and being on trial. Your a 35 year old male doctor, and the 20 year old college female simply says you brushed your hand awkwardly on a part of the body that was sexual in nature while she was in stirrups naked. Good luck trying to explain yourself out of that one to a 'jury of your peers'.

Sure, a clothed patient can say you did the same thing. But I think its much harder for them to convince a jury, versus in a genital exam when multiple readjustments of a speculum *could* be taken wrong...

All of our job is risk stratification and this is one place where its much better to have a second person on your side.

 

[JediZero]

Sue the patient? Very unlikely and usually a waste of money.

Banned from the hospital? Due to EMTALA it is almost impossible to really bar someone from a hospital with an ER. Lots of people talk about it like it's possible but the reality is that if they manage to show up in the waiting room or by ambulance you are stuck with them. It's kind of like getting someone charged with "911 abuse." It sounds good but it's usually not real.

I wonder about this sometimes. It seems like number of ED visits per month is inversely proportional to likelihood of serious pathology. There's no way to deal with this currently, but what if there were some sort of 'boy who cried wolf' law? Where >10 visits for malingering in a year gets you a prison sentence (a fine would be more appropriate, but none of them seem to have a dime to their names).

Of course, that would last for exactly as long as it takes for some chronic drug seeker to have an MI or bowel obstruction... maybe a month, tops.

 

[VentJockey]

I wonder about this sometimes. It seems like number of ED visits per month is inversely proportional to likelihood of serious pathology. There's no way to deal with this currently, but what if there were some sort of 'boy who cried wolf' law? Where >10 visits for malingering in a year gets you a prison sentence (a fine would be more appropriate, but none of them seem to have a dime to their names).

Of course, that would last for exactly as long as it takes for some chronic drug seeker to have an MI or bowel obstruction... maybe a month, tops.

I think you would find broad support for criminal sanctions for abuse of ED services among physicians....and close to no support for it from the general public. It is soul sucking :-(

 

[docB]

I think you would find broad support for criminal sanctions for abuse of ED services among physicians....and close to no support for it from the general public. It is soul sucking :-(

Nail on the head here.

The general public is totally and blissfully ignorant of the abuses inherent in the system. For example, when I explain that Medicaid patients are incentivized to call an ambulance for sore throats and hang nails (Medicaid+Ambulance=free by law, bus ticket=cost) they really just don't believe me. These are usually the same people who have lots of opinions about the homeless but have never spoken to a homeless person.

That said we have to be careful. Historically when the public does become aware of how the system is abused they don't cut off our obligation to see the patients (which would require changes to EMTALA at the federal level). They have always tried to cut our pay for seeing these inappropriate patients (which can be done at the state level). Look at the recent problems in WA.

 

[gro2001]

I was always told throughout residency to always have a chaperone for pelvics because you could be falsely accused of sexual assault and not have a witness. What I don't understand is technically a woman can falsely accuse you of sexual assault at anytime. I mean if you walk in a room to see a female patient alone for eye pain, she could always say that "he started to touch me sexually." It seems like you would need a chaperone for every encounter. Also I don't usually see chaperones for male GU exams. A guy could say the same thing for a male or female doctor. "He or she sexually assaulted me when I needed an exam for my penile discharge ( or my eye pain)." It's usually a pain for me trying to locate my nurse to get this done and for the nursing staff if they're really busy to stop and do this. If a male or female obviously needs a GU exam and you document why and document your findings in the chart I can't possibly see any physician being successfully sued and/or criminally charged for assault. The whole thing sounds kind of silly.

Many lay people still have misconceptions about things like pelvic exams and have difficulty understanding how clinically NON sexual it all is. Have you ever heard a member of the lay public voice the perception that male gynecologists went into gynecology to see more vaginas? Those are the people you are going to have to explain yourself to (not just if this goes to trial and you are facing a jury of lay people, but at almost every step of the process: the hospital administrators, the police, etc). Combined with the fact that the current standard practice is to use chaperones, this is going to be very difficult to explain. Also don't think that it will impact you negatively only if the allegations are proven to any degree. Just the mere shadow of the accusation is going to color your career for a long time.

 

[abolt18]

Many lay people still have misconceptions about things like pelvic exams and have difficulty understanding how clinically NON sexual it all is. Have you ever heard a member of the lay public voice the perception that male gynecologists went into gynecology to see more vaginas? Those are the people you are going to have to explain yourself to (not just if this goes to trial and you are facing a jury of lay people, but at almost every step of the process: the hospital administrators, the police, etc). Combined with the fact that the current standard practice is to use chaperones, this is going to be very difficult to explain. Also don't think that it will impact you negatively only if the allegations are proven to any degree. Just the mere shadow of the accusation is going to color your career for a long time.

Haha I used to think exactly that! Now OB/GYN along with EM are my top interests. Funny how perception changes things.

 

[deuist]

I guarantee someone has launched an investigation because they mistook the rectal exam during a trauma as a sexual assault or their pre-operative Foley placement as molestation.

A doc in NYC was sued for "assault" after he performed a rectal exam on an altered, combative, trauma patient. The doc won the lawsuit, but it was still a terrible experience for him.

 

[DrDrummer]

Personally, I try to always have a chaperone when seeing female psych patients, as they have a near 100% rate of sexual abuse history...

Have a source for that statistic? Seems like a somewhat broad generalization.

 

[spyderdoc]

I always use a chaperone for female exams, including rectals on elderly females.

If I walk into a patient's room and get a weird psycho vibe, I turn around, walk out and get a female chaperone. I also document on my chart that "all time spent with patient was in the presence of a chaperone".

Having scribes is also great in that their presence gives an automatic chaperone.....

 

[Spinach Dip]

A doc in NYC was sued for "assault" after he performed a rectal exam on an altered, combative, trauma patient. The doc won the lawsuit, but it was still a terrible experience for him.

In other news...newly graduated lawyers are having difficulty finding good-paying jobs, and some are willing to take on any case whatsoever.

 

[JediZero]

Have a source for that statistic? Seems like a somewhat broad generalization.

Just my (admittedly limited) personal experience, but seriously. I can't remember a single female psych patient who denied a history of sexual abuse, and it seems like half the SA patients that come in just don't want to live with their PTSD anymore. Don't know what the cause-effect relationship is here (it's likely two-way), and it's certainly possible that some of it is factitious/delusional, but I don't think anyone on here would deny that it's rampant.

EDIT: Okay, a quick Google search shows:

51% of female state psychiatric hospital patients were found to have a history of childhood or adolescent sexual abuse (1988, Hosp Community Psychiatry; n = 105)
http://www.ncbi.nlm.nih.gov/pubmed/3356438

Meta-analysis of 37 case-control and cohort studies showed that sexual abuse history was related to an increased risk of anxiety disorders (OR 3.09), depression (OR 2.66), eating disorders (OR 2.72), PTSD (OR 2.34), sleep disorders (OR 16.17) (!!!), and suicide attempts (OR 4.14). There was no statistically significant increase in risk of schizophrenia or somatoform disorders. They didn't find good data on bipolar disorder or OCD. (2010, Mayo Clinic Proceedings; n = 3M+)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894717/

We're dealing more with what I'd call "para-psychiatric" disorders, but the same people did a meta-analysis of 23 case-control and cohort studies showed that sexual abuse history was related to an increased risk of IBS (OR 2.34), nonspecific chronic pain (OR 2.20), psychogenic seizures (OR 2.96), and chronic pelvic pain (OR 2.73), with no association found with fibromyalgia, obesity, or headaches, with insufficient data on syncope. (2009, Mayo Clinic Proceedings; n = 4640)
http://www.ncbi.nlm.nih.gov/pubmed/19654389/


The data on schizophrenia are interesting, in that there doesn't seem to be a consistent link between childhood sexual abuse and schizophrenia, but I guess you might expect that given that schizophrenia is more 'biochemical' while many of the others listed are more 'psychological' (and to any Psych people out there, please don't flame me for the oversimplification!). However, while an association between sexual abuse and the later development of schizophrenia is debatable, there does seem to be a clear association between schizophrenic patients who then become victims of sexual abuse. It's a broad topic, but I'll link to this study and this article as examples.

Basically, no, maybe it's not 100%, but given the problems with sexual abuse studies (i.e. underreporting), it's probably safe to assume that a female psych patient should be approached with extreme sensitivity and caution when it comes to genital, rectal and breast exams.

 

[deleted547339]

Have we all been super-trolled?

 

[vengaaqui]

I'm a female resident. Male or female, if you're getting a rectal or genital exam, I'm getting a chaperone. We have enough weird patients.

 

[Groove]

Ok, this is the most idiotic troll post ever, or someone suffering the largest theft of common sense yet witnessed on a medical forum.