Chaperone – That’ll fix it

Chaperones in the exam room have become a way of life in residency.  Ostensibly, a M.A. will protect me from a patient who either: 1.) is trying to come up with reasons to sue and hit the lottery, or 2.) might misinterpret a normal physical exam as sexual assault. 

The idea seems to be a good one.  Between emphasizing better communicating through the exam itself – “I’m not listening to your heart…I’m going to lift your shirt so I can listen to your lungs” and having a second pair of eyes in the room, it seems that misunderstandings and craven accusations will both be kept to a minimum.

Still, the addition of another, salaried, person in the room is yet another way that costs in medicine are rising due to litigation.  Litigation itself, obviously, is expensive.  But the secondary costs – like chaperones and a host of other additions in the medical field meant to protect us from law suits – are where the real money is being spent. 

The doctor in my area who was recently tried for sexual assault apparently did not have chaperones with him during most of the physical exams in question.  On the surface, one might gape in disbelief at this lapse in standard of care…especially considering that he came from my program where this practice is drilled into us.  But I’m tempted to forgo the chaperone almost every day I’m in clinic.  It’s a pain.  It slows things down.  Half the time I’m ready to do the exam and nobody is available.  A 3rd person in our small rooms makes things cramped.  My biggest problem with it, however, is the implicit message to my patient that “I don’t trust you, and you may not be able to trust me.”

And will chaperones really save us all in white coats?  I doubt it.  This latest doc in question is being charged by patients who he saw at a chemical dependency unit.  Places like that necessitate long histories prior to or following a physical exam.  It isn’t practical – or really even possible – to have someone sit through the entire meeting from start to finish.  So, a patient could easily just charge that the assault happened before or after the chaperone arrived.

Maybe more technology is the answer.  Maybe we could rig security cameras in every exam room.  The entire time the pt. is on the premises, s/he would be taped, with the patient’s knowledge before they even enter the room.  The entire meeting would be archived, with an index to the exact start time and date of the encounter for reference later if needed.  In every chart would then be a reference to where you could watch the entire visit.  All the data could be stored somewhere “safe” and cut from the hardlines that connect the clinic to the internet. 

I don’t mind chaperones in the room, especially when they hand me stuff and remind me to do everything involved with an initial pregnancy speculum exam.  Some procedures just need assistance.  But most don’t, especially in family medicine.  And in the end, a determined litigant will find a way around chaperones.  So will a determined predator.

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