it’s difficult to establish the kinds of relationships that are necessary mutual trust and a chance for that to flourish.” “By placing more and more security requirements. “I don’t blame doctors for this but I think they’re being put into a defensive mode that’s really not appropriate,” Glouberman says. Yet physicians have been accused of impropriety “during the course of what otherwise would not be an exam where you would think an attendant would be necessary” such as “examining a musculoskeletal injury.”īecause of that, medico-legal experts and the Canadian Medical Protective Association have urged more routine use of chaperones and detailed documentation of sensitive examinations and discussions of intimate problems ( Can Fam Physician 2001 47:1732–1734).īut some patient advocates worry that the emphasis on protecting doctors from liability undermines the goal of putting patients at ease. “We’ve tended to see the benefit of the attendant as a function of the kind of examination that’s being done,” he adds. “Being the same gender doesn’t offer as much protection as one might think it’s not always about sex,” he says. Ed Schollenberg, registrar for the College of Physicians and Surgeons of New Brunswick, concurs, citing a recent case in which a woman complained about a female physician because she felt unnecessarily exposed during an intimate exam. Therein may lie a “false sense of security,” considering both male and female patients have leveled accusations against physicians, in some cases, regardless of the level of intimacy of the procedure performed, Upshur says.ĭr. Similarly, male physicians are less likely to have chaperones present when they’re doing intimate examinations on men.” “Female physicians are less likely to have a chaperone present while doing intimate examinations on female patients. Chaperones are more commonly used with female patients, while male doctors are about 40 times more likely to use a chaperone, he explains. Ross Upshur, Canada Research Chair in Primary Care and professor of family and community medicine at the University of Toronto in Ontario. Many physicians forego the use of a chaperone depending on the procedure or the gender of a patient, says Dr. Others contend this intuitive approach may be exposing physicians to increased risk of allegations from patients who, for whatever reason, don’t set off those internal alarm bells. it’s a good idea to have someone else in the room until a long-term relationship is established.” “If you’re with a brand new patient you don’t know and your ‘spidey senses’ go off. Janet Wright, assistant registrar for the College of Physicians and Surgeons of Alberta. “What we say is weigh it all out,” says Dr. A chaperone’s presence may be necessary “if the patient is mentally handicapped, subject to delusions or paranoia, exhibits seductive behaviour, exhibits anxiety about a proposed examination … is a survivor of abuse, or has other emotional or cognitive challenges which may lead to misperception or misinterpretation” ( But for the most part, physicians are left to rely on their own intuition. Medical regulatory authorities, however, do offer some advice.įor example, the College of Physicians and Surgeons of Ontario leaves it for physicians to decide whether to offer patients the option of having a third party present ( The College of Physicians and Surgeons of Prince Edward Island places an onus on patients to ask for chaperones ( while the College of Physicians and Surgeons of New Brunswick says either patients or physicians can insist on a witness in situations that make them feel uncomfortable ( The College of Physicians and Surgeons of British Columbia provides perhaps the most comprehensive guidelines. “If all of this is based on the growing trend towards less trust and less connection between patients and practitioners, then it makes the relationship even harder and makes the situation more unpleasant and more intrusive.”Ĭhaperone use is not mandated by any regulatory body in Canada, except in cases where it is a condition of an individual physician license. Undergoing an intimate examination shouldn’t feel “like being searched at the airport,” says Sholom Glouberman, president of the Patients’ Association of Canada. What’s more, there’s growing concern among patient advocates about who chaperone policies actually serve, particularly as there’s been increasing call in recent years by medico-legal societies for more routine use of such attendants to protect physicians from allegations of impropriety. Medical regulators have long recommended the use of “chaperones” to make patients feel more comfortable during sensitive examinations.īut standards of practice vary considerably across Canada and guidelines about when to use a chaperone and whether patient consent is required are somewhat hazy and often left to physician interpretation.
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