COMMENTARY

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

Batya Swift Yasgur, MA, LMSW

Disclosures

September 08, 2015

In This Article

Respecting Cultural and Religious Values

Many cultures, including Asian, Hispanic, Muslim, and Jewish, emphasize the importance of same-sex providers in intimate examinations. Familiarity with these parameters sensitizes you to your patients' needs.

In Islam and ultra-Orthodox Judaism, for example, certain female body parts may not be exposed in the presence of a man who is unrelated by blood or marriage. Unrelated men and women may not have physical contact. Studies of Chinese women have found that many avoided mammography or cervical screening until they were assured that a female technician would conduct the test.[1]

Every attempt should be made to accommodate cultural and religious sensitivities, emphasizes Dr Padela. This includes providing gender-concordant care when possible, and finding creative ways to honor requests regarding clothing and physical contact.

Although familiarity with cultural and religious mores is important, it is equally important to avoid making assumptions. Even within a given culture or religious tradition, there are individual variations, so always ask patients about their own needs and preferences.

Will Having a Chaperone Help Protect Patient Modesty?

Recommended by the American Medical Association and required by certain states,[2,3] chaperones ostensibly protect patients' dignity. But in reality, they may serve the needs of physicians rather than of patients, by protecting the physician from potential accusations of sexual impropriety, says Joel Sherman, MD, a retired Connecticut-based cardiologist, who blogs about modesty.

"The presence of an extra person at intimate exam can increase the patient's embarrassment. And it may be more difficult for patients to discuss sensitive issues with the physician if another person is in the room."

It should be the patient's choice whether to have a chaperone in the room, Dr Sherman states. The subject should be brought up in advance, so patients are not caught off guard.

And chaperones should be trained medical professionals of the same gender as the patient. If your facility or state requires a chaperone, explain this to the patient and assure the patient that the chaperone is not actually "watching" the exam. It may help if the chaperone stands or sits at a distance from the examination table.

It is advisable to ask a patient who refuses a chaperone to sign a waiver, and if you are uncomfortable without a chaperone present, you have the right to tell that patient that you cannot perform the exam, Dr Frampton says.

Some patients may prefer a family member or spouse to be present instead of a chaperone. This simple solution promotes patient comfort while protecting the physician.

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