Getting Permission for Physical Exam of Opposite Gender Patients

May 2, 2012
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What are the best ways to ask for permission prior to performing a chest or genital physical exam on patients of the opposite sex? Namely, would it be better to put the request plainly to avoid being accused of assault or using 'softer' words to avoid sounding preverse? I believe a chaperone in either case is essential but even so how do you prefer to ask patients without using jargon like palpation?
 

Stagg737

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Just be straightforward and professional. As long as you do that and actually ask permission there shouldn't be an issue...
 
OP
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Thanks but can you give me an example of how you would ask it, for example:

"Can I feel along your chest for vibrations..."

"Can I push your chest to feel for vibrations..."

Would both be acceptable for permission to assess for thrills or is there a better way. I want to avoid not saying exactly what I will do since then I did not really get permission for the exam.
 

Stagg737

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Thanks but can you give me an example of how you would ask it, for example:

"Can I feel along your chest for vibrations..."

"Can I push your chest to feel for vibrations..."

Would both be acceptable for permission to assess for thrills or is there a better way. I want to avoid not saying exactly what I will do since then I did not really get permission for the exam.
Just say where you'll be touching them. Both your examples are fine if that's what you're doing. If you're going to be working in a more sensitive area, you can always elaborate on how you'll be touching them and why. I've found that if you explain to patients why you're performing the procedure or touching them that way, they're typically more comfortable with the situation. If they're not, they'll tell you.
 

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"I would like to place my hand below your left chest to see if your heart is enlarged, okayyy? Thank you."
 

bashwell

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In addition to the good advice above, act professionally and confidently, like a "real" doctor. That goes a long way.
 

Dave89

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If by "chest exam" you mean a heart and lung exam, there's no need to ask permission.

If you mean a breast exam, then you do need to ask permission (just as for a genital exam). Instead of "palpation", you can say that you'd like to "feel for lumps."
 

Siggy

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Lovely lady lumps?
Check them out...


Ok, on a serious manner.

Regular physical exam (heart/lungs/abdomen, etc) then I normally just do a quick, "Ok, let me take a listen" while pulling out my stethoscope.

If it's a genital/breast exam, then it depends. Hospital or clinic.

Clinic: I need to do a ____ exam because ____. (On first pre-partum visits, we do a pelvic exam and pap smear. Ok? Here's the drape. I'm going to go out and get everything set up and one of the nurses to chaperon and I need you to take off your pants and underwear. Any questions? I'll be back in a few minutes.")

Hospital: Gather supplies, get chaperon, then go see patient.

Two things:
1. These exams are not "teaching" exams in the sense that they're done without any specific indication (i.e. no one is going to really object to a neuro exam on a pneumonia patient).
2. As such, I would leave out the, "Would you mind if a medical student does ___ exam?"
 

NontradCA

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I need to check your cooter.

Seriously, don't you have standardized PT labs to practice this?
 
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redpanda

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For all patients, I ask permission before I start doing a physical exam. Before moving any clothing out of the way or asking for it to be moved, I tell the patient what I'd like to examine. When it comes to genital exams (haven't had to do any pelvics on inpatient yet), I tell the patient why I would like to do the exam, tell them about how I'd like them to disrobe and where to drape and if I'm bringing in a helper, step out to let them undress in peace, return and do the exam. Also, after all interactions with the patients, the rule is "leave it as you found it", i.e. all body parts exposed in the exam are now re-covered and suitable tissue or whatever is provided if they'd like to remove any lubricating jelly used, blankets and pillows rearranged to their liking, TV remote and call button in hand, meal tray in reach.
 
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Psai

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I pretty much always ask for permission before I start any physical exam.

Not anything formal, but generally before I make physical contact with someone I find it good to let them know what I'm about to do.

e.g. "is it okay if I take a look at you?" or "do you mind if I take a look at your belly?"
i like it when they raise their gown to help you look
it really makes me feel like they trust me
 
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OP are you what year are you? If M1/M2 still being observed by preceptors, you might want to say things like "examine" rather than "take a look". Maybe I'm in the minority, but I had a couple of preceptors tell me not to say "take a look" because it sounded unprofessional. If M3 and no longer being observed (and working with real patients) you can say whatever you want as long as it's respectful. Typically I just say "do you mind if I take a listen?". They always say yes. After they say yes, then you ask them to lower or raise their gown. Then they do it, then you proceed. Obvi it would be different if I was going to do something like a pelvic/rectal/breast exam, but for the general exam it's fine.

I'm assuming you're a guy and are nervous about navigating around breasts. I've found it's best be confident and act like it's a regular thing (because it is) and not a big deal (because it isn't). Most adults have been to the doctor before and you won't be the first person for whom they've elevated their breast for auscultation. Ever had a sports physical? Who would you rather have asking you to cough. The guy who asks "do you mind if I place my hand under your testicles to feel for movement?" or the guy who asks "do you mind undressing for this part of the exam?".

Also, you don't have to tell pts every single thing you're going to do (i.e. don't have to say "feel your chest for vibrations). Furthermore, if you start narrating your entire exam you're never going to finish because pts are going to constantly be asking you questions like "what vibrations? Is that bad? does everyone have vibrations? No one has ever mentioned vibrations before".
 

Etorphine

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What are the best ways to ask for permission prior to performing a chest or genital physical exam on patients of the opposite sex? Namely, would it be better to put the request plainly to avoid being accused of assault or using 'softer' words to avoid sounding preverse? I believe a chaperone in either case is essential but even so how do you prefer to ask patients without using jargon like palpation?
Just be professional and don't be weird. As a medical professional this is just another part of the job. Don't overcomplicate it. "Now it's time for the prostate exam.." Don't move clothes yourself, just tell them what they need to do, and if they drop trou they're implicitly giving you permission
 
Feb 22, 2015
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What are the best ways to ask for permission prior to performing a chest or genital physical exam on patients of the opposite sex? Namely, would it be better to put the request plainly to avoid being accused of assault or using 'softer' words to avoid sounding preverse? I believe a chaperone in either case is essential but even so how do you prefer to ask patients without using jargon like palpation?
I'm super confused why you ask how to not use jargon like "palpation" with women, but you find it okay to use with men. The whole game is to assume each patient has a fourth grade education level; you shouldn't be using the word palpation with any of your patients.
 

Siggy

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I'm super confused why you ask how to not use jargon like "palpation" with women, but you find it okay to use with men. The whole game is to assume each patient has a fourth grade education level; you shouldn't be using the word palpation with any of your patients.
I imagine even most educated people outside of medicine don't know what "palpation" means.
 

tantacles

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I pretty much always ask for permission before I start any physical exam.

Not anything formal, but generally before I make physical contact with someone I find it good to let them know what I'm about to do.

e.g. "is it okay if I take a look at you?" or "do you mind if I take a look at your belly?"
The second one is one I use all the time. "Do you mind if" and "take a look at" go together very nicely.
 
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Kaustikos

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I pretty much always ask for permission before I start any physical exam.

Not anything formal, but generally before I make physical contact with someone I find it good to let them know what I'm about to do.

e.g. "is it okay if I take a look at you?" or "do you mind if I take a look at your belly?"
Also add that I tell them what I'm doing beforehand.
Ie: if I'm listening to the heart on a female I say "I'm gonna need to listen to your heart" and then ask them to move their breast if need be.
I've found that as long as you tell them what you're doing beforehand, things are okay.
Peds patients... Nother story.
Though there was a pelvic exam I did with a speculum and the patient managed to eject the speculum out of her vagina while I was doing it. The nurse and I were both stunned. I didn't know how to tell her to stop contracting....