What if Your Patients Don't Want to Take Their Clothes Off?

Getting Undressed at the Doctor's Office

Most patients understand that going to a physician involves a physical examination that may require removal of some or all of their clothing. And although they may not like being undressed in front of a stranger, they accept it as a necessary inconvenience of medical care. But some patients are particularly uncomfortable.

Responding to patient concerns about modesty is important not only for the patient's sake but also for the physician's, "especially in today's healthcare environment, with its emphasis on patient-centered care, process improvement, and quality," says Jack Chou, MD, director of the American Academy of Family Physicians and a family physician in Baldwin Park, California.

"We as physicians need to be sensitive to their discomforts and responsive to our patients' needs," says Dr Chou. "Through surveys and other means, we need to ask patients what they want."

Understand Your Patient's Modesty

Patients have many reasons for their sense of modesty, says Caryn Andrews, PhD, CRNP, Faculty of Medicine, Hebrew University School of Nursing, Jerusalem.

Dr Andrews, an oncology nurse formerly associated with the Alvin and Lois Lapidus Cancer Institute, Northwest Hospital Center, Randallstown, Maryland, has extensively studied reasons for patient modesty. Her research has identified cultural and religious concerns; a sense of personal vulnerability, often stemming from previous trauma; and embarrassment about body appearance, such as aging or being overweight. Understanding the reason for your patient's discomforts enables you to provide more targeted reassurance, she says.

Patients who appear unusually anxious may need the visit to be conducted in stages, says Dr Andrews. "I saw a patient who was shaking and nervous. I told her we would use today to get to know each other and conduct the examination another time. After two or three visits, she revealed that she had been raped. After discussing this, she was more comfortable being examined."

Maura Quinlan, MD, MPH, section chair of the Illinois chapter of the American College of Obstetricians and Gynecologists and academic director of the Department of Obstetrics and Gynecology at MacNeal Hospital, Berwyn, Illinois, adds that reassuring patients about their physical appearance is important. "Some women going through the menopausal transition feel uncomfortable about their aging bodies. Teenagers often feel their genitalia to be 'flawed' or 'disgusting' and need education and reassurance."

Some physicians want their patients to wear gowns because gowns provide rapid access to the entire body. But that degree of access is not always necessary, says Dr Chou.

"Patients coming in for a common cold don't need to disrobe and put on a gown. A patient with diabetes may need to take off shoes and socks. But a physical may necessitate breast, pelvic, or rectal exams, so the patient should be wearing a gown. The amount of disrobing is disease-specific."

It may be appropriate to allow patients who are extremely uncomfortable with a gown to wear their ordinary clothes, removing what is necessary as the exam progresses, adds Aasim I. Padela, MD, assistant professor of medicine in the Sections of Emergency Medicine and General Internal Medicine, University of Chicago. Although this is not ideal, the willingness to accommodate cultural or personal sensitivities is an important component of building trust and respect.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.