Realities of the physical exam and patient modesty

[madchemist89]

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I recently began 3rd year, and for the last few days, I have been thinking about the performance of the cardio/pulmonary physical exam and patient privacy. If I were to perform these exams the "right" way (all 4 auscultation areas, stethoscope to skin, each lung lobe), then I would be required to expose a sensitive area of female patients, which would require a chaperone for every exam (probably impractical). How does one work around this issue while still performing as thorough an assessment as possible?

 

[Psai]

You just ask them to lift their boob a little and sneak your stethoscope underneath the bra. No big deal, just be an adult about it. There's a doctor-patient relationship and we are privileged to be granted access into the most personal areas of people's lives. I just explain what I'm doing as I go and if they aren't cool with it, that's fine.

 

[SouthernSurgeon]

You just ask them to lift their boob a little and sneak your stethoscope underneath the bra. No big deal, just be an adult about it. There's a doctor-patient relationship and we are privileged to be granted access into the most personal areas of people's lives. I just explain what I'm doing as I go and if they aren't cool with it, that's fine.

Yup.

Or you just casually use the back of your hand to elevate while auscultating.

This really is not a big deal.

 

[DermViser]

I recently began 3rd year, and for the last few days, I have been thinking about the performance of the cardio/pulmonary physical exam and patient privacy. If I were to perform these exams the "right" way (all 4 auscultation areas, stethoscope to skin, each lung lobe), then I would be required to expose a sensitive area of female patients, which would require a chaperone for every exam (probably impractical). How does one work around this issue while still performing as thorough an assessment as possible?

I'm really surprised med school Physical Diagnosis courses don't address this since we all see patients in MS-3. I guess when you use standardized patients...

 

[Brain Bucket]

I recently began 3rd year, and for the last few days, I have been thinking about the performance of the cardio/pulmonary physical exam and patient privacy. If I were to perform these exams the "right" way (all 4 auscultation areas, stethoscope to skin, each lung lobe), then I would be required to expose a sensitive area of female patients, which would require a chaperone for every exam (probably impractical). How does one work around this issue while still performing as thorough an assessment as possible?

If you don't act like it's a big deal, they won't see it as a big deal. Underboob is hardly 'sensitive area'. Also, women keep their bras on during a physical?

 

[madchemist89]

I think I was just worrying way too much.

 

[HooliganSnail]

On another but related note. If you come into the room, and the patient isn't in a gown, just ask them to put one on and come back in 5 minutes. It makes the exam go waaaaaay smoother, and after awhile you will realize that trying to fight with people's clothing is just a pain in the ass.

Set yourself up for success

 

[swoopyswoop]

just drape what you dont need to see and uncover in pieces. drape their pelvis when you do their abdominal exam. drape their breasts while you do the chest exam (you can work around it). and i do not think you need a chaperone just because you may have seen a patient's breast or genitals. just don't do an sensitive *exam* without someone supervising.

 

[Instatewaiter]

I recently began 3rd year, and for the last few days, I have been thinking about the performance of the cardio/pulmonary physical exam and patient privacy. If I were to perform these exams the "right" way (all 4 auscultation areas, stethoscope to skin, each lung lobe), then I would be required to expose a sensitive area of female patients, which would require a chaperone for every exam (probably impractical). How does one work around this issue while still performing as thorough an assessment as possible?

This BS is taught in med school to be super sensitive... don't be. Your goal is to get the required information. It is far more awkward if you pussyfoot around the subject. "Ma'am I need to listen to your heart. I will be listening underneath your left breast" is all you need to say. It takes 2 seconds to say it and they know what you're doing. Everyone is more comfortable. If you act like an adult, you won't need a chaperone.