Chaperone for Cardiac Exam

[HelloGoodbye]

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I am just curious, on rotations when you do a full cardiac exam on female patients do you ask for a chaperone to be in the room?

I see many Attendings/residents/ students just auscultate the aortic and pulmonic and skip the pmi check, tricuspid, and mitral...


What is convention with this at your institution? I am just curious because, of the litigious nature of our society...

 

[Rendar5]

umm...I generally don't have to expose a female patient to auscultate. They're lying down, generally breast tissue falls enough to the side for me to auscultate.

 

[HelloGoodbye]

umm...I generally don't have to expose a female patient to auscultate. They're lying down, generally breast tissue falls enough to the side for me to auscultate.

Do you listen over the gown then?

I obviously don't "expose" the patient either!!! I try to keep them covered as much as possible!

I guess I was thinking about this because I read a paper that said male residents perform a more through cardiac exam on male pts than female pts! I just wanted to see if people had a chaperone or listened over the gown or slide gown out of way...

 

[joeDO2]

to have a chaperone for every time you listen to the heart you would need to employ someone just to shadow you everywhere. just keep as much covered as possible and have the patient lift her own breast if necessary.

 

[Bacchus]

You can tell the patient you're going to put your stethoscope under her gown. You can then move it around if you must. You can also ask the patient to lift her breast. With that said, I've never really seen someone look for the PMI unless it was an SP or a teaching moment.

 

[evilbooyaa]

You can tell the patient you're going to put your stethoscope under her gown. You can then move it around if you must. You can also ask the patient to lift her breast. With that said, I've never really seen someone look for the PMI unless it was an SP or a teaching moment.

Bolded for emphasis. OP, I imagine you are a MS2.

 

[HelloGoodbye]

I guess more my question is...

When you listen to tricuspid and mitral do you generally auscultate from the top opening of the gown or do you listen from going underneath the bottom part of the gown?

 

[PTPoeny]

Top. If you were listening from the bottom you would have to pull up the gown and you would be exposing the patient's genitals. Most stethoscopes are long enough you can listen from the top without exposing the breast.

If they are wearing a t shirt the answer may be different. But is is frequently still easier to listen from the top in case they have a second layer underneath that is tucked in.

 

[EM2013]

Who cares? 90% of the physical exam is bogus anyway.

 

[VisionaryTics]

You can tell the patient you're going to put your stethoscope under her gown. You can then move it around if you must. You can also ask the patient to lift her breast. With that said, I've never really seen someone look for the PMI unless it was an SP or a teaching moment.

I used to do it when I was on medicine at the VA. Male patients + no shame + everybody on the census has CHF = cardiac exam goldmine.