personal concern about boundaries

[rkaz]

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[asmallchild]

Umm, even if that was an appropriate physical exam manuever, it still warrants some explanation to the patient. Undressing a patient is a no-no as well (although admittedly that is something probably taught in medical school but not actively practiced in "real" medicine)

 

[P Diddy]

Hi there. I am not sure if it is appropriate or not to post personal situations on this forum, but I thought I'd at least ask in case that's okay. If not, then if a moderator wants to remove this, I understand.

Around that time, I was sitting on the exam table, and he pulls out his stethoscope, unhooks my bra, pushes it aside, and then places his forearm between my breasts (he wasn't fondling me as his hand was on the stethoscope)... I mean, does removing a patient's bra help one to get a clearer sound of her heart? And even if so, wouldn't you ask the person first before doing that??

The short answer is that removing the bra does lead to better auscultation of the heart, as there is less extraneous material between the stethoscope and the heart. However, the cardiologist (or any physician) should ask before removing clothing, and let the patient know what he/she is doing. This physician erred by not giving you the opportunity to remove your own clothing/wear a gown, but that wouldn't be sexual abuse, instead unprofessional behavior

One aspect of your description confuses me. You say he put his forearm between your breasts. Do you mean his hand was on the stethoscope listenening to your heart and his forerarm was resting on your skin between your breasts? That would be irregular; even if I am listening to a woman wearing a gown, my hand/arm never contacts the skin unless I am lifting the breast to feel for the apical impulse. So I wonder if you could give a better description of this physician's exam.

My take is that he's probably trained in an era when patient autonomy and comfort were not a priority; this modus would be highly irregular for a recently US trained physician.

p diddy

 

[dragonfly99]

The short answer is that removing the bra does lead to better auscultation of the heart, as there is less extraneous material between the stethoscope and the heart. However, the cardiologist (or any physician) should ask before removing clothing, and let the patient know what he/she is doing. This physician erred by not giving you the opportunity to remove your own clothing/wear a gown, but that wouldn't be sexual abuse, instead unprofessional behavior

One aspect of your description confuses me. You say he put his forearm between your breasts. Do you mean his hand was on the stethoscope listenening to your heart and his forerarm was resting on your skin between your breasts? That would be irregular; even if I am listening to a woman wearing a gown, my hand/arm never contacts the skin unless I am lifting the breast to feel for the apical impulse. So I wonder if you could give a better description of this physician's exam.

My take is that he's probably trained in an era when patient autonomy and comfort were not a priority; this modus would be highly irregular for a recently US trained physician.

p diddy

I think I know what she means. The answer is yes, it's actually appropriate to listen to a female patient's heart with the bra off, and inappropriate to try to do the exam with it on (because it gets in the way of being able to hear the heart well). I have seen physicians listen in this way...I mean with the arm between the breasts...not sure what the maneuver is but I've seen people try to listen from that angle/position. I agree with p diddy. It sounds like that rather than trying to assault you, he was being insensitive and thoughtless. He should have asked to have you undress from the waist up, but have on a hospital gown, and then when he did the exam he should have told you that he is going to listen to your heart now, needs to uncover part of your chest, whatever...before he touched you at all.

This case shows how medicine has changed in recent years...male docs used to examine patients without a chaperone and physicians used to just not respect patient's privacy to the degree that we are taught to do so now. I could totally see a lot of old doctors examining a patient this way...he was being a clod but probably didn't know he was being a clod. I'll be $1000 he totally does not remember this incident at all. If you still feel uncomfortable about it, you might want to bring it up and tell him that it made you feel uncomfortable, and maybe he needs to consider warning the patient before he touches the patient, etc. He probably doesn't realize that what he did was invading your privacy. He did need to do the exam, though, and with the bra on is the totally wrong way to do a cardiac exam.

This case shows how male physicians probably should not examine any patients without a chaperone present. Actually, female docs (like me) are supposed to have chaperones too. A lot of older docs are just not used to using one, as it takes an extra staff member in the room and they just did not need one in bygone days.

I think it is better to go see doctors who you don't know personally...makes it easier for you and them to both be honest, and avoids general weirdness.

 

[rkaz]

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[dragonfly99]

rkaz,
with all due respect,
I am not sure why you thought you would go to the doctor and there would be no physical exam. I guess it just shows how we (as patients) have gotten to expect improper care from medical providers because of the rush that a lot of them are in, and the lack of physical exam abilities of a lot of younger doctors (I am one, by the way). The primary doctors who examined you with bra and probably clothes on were not really doing a proper physical exam. However, I think this is super common now in primary care, especially with well patients (i.e. teenagers and young adults) because the doctor is in a hurry and doesn't think it is necessary to do a proper physical exam. But you came to that doctor for a cardiac exam and I actually think he was probably just trying to do his job, and to his credit he was being thorough by actually doing an exam instead of laying the stethoscope on the chest over/through the clothing and then pretending that he could do a cardiac exam that way (you really cannot).

I think a lot of old doctors act like that one...they were not trained in an era of high medical liability, nor one in which there was a lot of patient autonomy. They were taught to be thorough, do their best, and that the patient would respect them and not question them a lot, and would probably follow their recommendations. Boy, are things different now. Sometimes in a good way, and sometimes in a bad way.

 

[Hernandez]

I'm starting med school myself this year, and I've had several insensitive physician experiences over the years - so hopefully I've learned something from it and won't make the same mistakes myself on patients.

You will be quickly surprised by how your physical boundaries change once you become a physician. I had a 10 foot personal space in college, now I have to remind myself to tell the pt what I'm doing (when they're not gorked out or demented) I sounds like you took a little too much offense and he was insensitive and should have told you what he was doing.

 

[RxnMan]

You will be quickly surprised by how your physical boundaries change once you become a physician. I had a 10 foot personal space in college, now I have to remind myself to tell the pt what I'm doing (when they're not gorked out or demented) I sounds like you took a little too much offense and he was insensitive and should have told you what he was doing.

On new patients, I can usually tell how big their PMHx will be based on how compliant they are with the PE.

 

[dragonfly99]

hernandez is right about the physical boundaries.
After you have seen 999 naked patients and 199 on the bedside commode, none of it affects you any more. But we (docs) need to constantly remind ourselves that to patients this is not old hat and they might need reassurance and some warning about what we are going to do in terms of the exam.