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

Adjust the Physical Environment

A space that is conducive to modesty fosters trust, says Dr Frampton. So make sure the examination table is not visible from the hallway when the door opens, that curtains in dressing rooms close properly, and that windows in the office have shades.

Keep the scale in the examination room rather than the hallway so that patients do not need to leave the room once they have undressed. Hanging a "do not disturb" sign on the door deters others from knocking or interrupting during an examination, which can feel invasive to the patient.

"When we undertook process improvement, we experimented with positioning the exam table," Dr Chou reports. "My nurse actually sat on the table as a way of understanding patients' experiences, and this informed some of our changes."

Dr Chou and his staff decided to cover the overhead fluorescent lights with an acrylic design of the sky with clouds and to hang posters of beach scenes on the wall to create an environment that would be relaxing during examinations.

Being cold can increase a patient's sense of vulnerability, not to mention physical discomfort. "We try to adjust the room to a comfortable temperature," he says.

Patient Modesty in Hospital Settings

Many large healthcare facilities are not conducive to patient modesty. Hospital policies, the patient's medical condition, available staff, and the often-frenetic pace mean that physicians cannot always adequately accommodate patients' concerns.

Your demeanor and affect are critical to putting patients at ease, especially when time is short and other means of patient support may be missing, Dr Frampton says. Courtesy, empathy, and explanation are as important in the hospital as they are in your office.

Many patients find open-at-the-back hospital gowns to be demeaning. Some hospitals are experimenting with innovative gowns, including wrap-around or kimono robes, or shorts to wear under the gown. And in many circumstances, patients can wear their own pajamas. Dr Padela urges physicians to accommodate patients' requests for more modest attire, even allowing the patients to wear their own clothing if not medically contraindicated.

And try to find a same-sex physician at your facility for patients who request it, he adds. As the concept of the "healthcare team" expands, it may be possible to ask a same-sex provider, such as a physician assistant or nurse practitioner, to examine the patient if no gender-concordant physician is available.

Conclusion

"When patients come to see us, they are uncomfortable and often ill," Dr Chou comments. "We as physicians need to make sure we do not create further unease and foster our patients' feeling comfortable." Honoring a patient's sense of modesty is key to creating an environment of trust, comfort, and safety.

Recommended Reading

Andrews CS. Modesty and healthcare for women: understanding cultural sensitivities. Community Oncology. 2006;3:443-446.

Galanti GA. Caring for Patients from Different Cultures. 5th ed. Philadelphia, Penn: University of Pennsylvania Press; 2014.

Padela AI, Punekar IR. Emergency medical practice: advancing cultural competence and reducing health care disparities. Acad Emerg Med. 2009;16:69-75.

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