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Using Chaperones During Pap Smears

Most Male Doctors Use Chaperones During Exam, but There Are Regional Differences
WebMD Health News

Nov. 25, 2003 -- Male family doctors in the South are more likely than family doctors in other regions to have a chaperone in the room when they perform Pap smears, according to a new survey assessing chaperone practices during intimate exams.

The survey of almost 3,000 general practitioners shows that three out of four used chaperones when giving pelvic exams. But there are few guidelines regarding the practice, and the survey made it clear that there is a wide variation in customs from doctor to doctor.

"The variation may reflect different regional or local norms, efficiency or resource issues in high volume clinical settings or other interpersonal factors," researcher Pamela Rockwell, DO, and colleagues write. "These issues need to be explored in more depth."

Most Male Doctors Use Chaperones

Not surprisingly, gender was the biggest predictor of whether a doctor used a chaperone during Pap smear collection. Eighty four percent of male doctors reported having a nurse or assistant present vs. only 31% of female doctors. Male doctors were 15 times more likely to use a chaperone. Those reporting routine use of a chaperone were significantly younger and did fewer Pap smears per month than those who did not have an assistant in the room.

Just under 90% of doctors practicing in the South reported using chaperones routinely, compared with 72% in the West, 71% in the Northeast, and 66% in the Midwest. The findings are to be published in an upcoming issue of the journal Annals of Family Medicine.

"I would think that if you polled just male physicians in the South, the number would be closer to 100%," Selmer, Tenn., family doctor Jim King, MD, tells WebMD. "I was taught in medical school that you always have one for pelvic exams. It is not so much because of the fear of being accused of doing something inappropriate. It is more to help put the patient at ease."

Patient Preferences Unclear

The survey was sent to members of the American Academy of Family Physicians, which has no formal guidelines regarding chaperone use during pelvic exams. The American College of Obstetrics and Gynecology (ACOG) does address the issue in its guidelines for women's health care, but does not tell its members they must use chaperones.

"Local practices and expectations differ with regard to the use of chaperones, but the presence of a third person in the room during the physical examination can confer benefits for both the patient and the clinician, regardless of the gender of the chaperone," the ACOG guidelines read.

The ACOG statement addresses a potential downside to chaperone use -- that having a third party in the room may make a patient less willing to talk openly with her doctor. It noted that if a chaperone is present, the doctor should provide a separate opportunity for a private conversation.

The newly reported survey helps clarify doctors' feelings about the use of chaperones, but study co-author Terrence E. Steyer, MD, says it is not clear how patients feel about the practice.

"As primary care physicians, we should be asking our patients what they want, and if they prefer not to have a chaperone present there should be a discussion about that," he tells WebMD. "This study did not address patient preferences, and to my knowledge no study has. I think it is an important issue to examine."

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