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Medical Forum / General / General / March 2005Undressing for medical examinations:
Is there a resource where one can go to find out what are the appropriate protocols for times when a patient is required by circumstances to be disroped or naked for a medical procedure or exam? Robert W. > Is there a resource where one can go to find out what are the > appropriate protocols for times when a patient is required by > circumstances to be disroped or naked for a medical procedure or exam? Yes. The office staff member who is asking you to disrobe. You can even ask the office staff at the time you make the appointment. This person should be able to tell you exactly what you need to do to make the examination go smoothly. Jeff > Robert W. I made an appointment with my physician for what I thought was a possobile hernia. When I was called and taken to the exam room by a nurse, she told me to take off my pants and underwear and that she would be back shortly. When she returned she performed an inspection of my genital area and noticed the slight protrusion through the muscle wall with her finger, Next the doctor came in and performed the identical procedure, except that he pushed the bowel back in and had me do a couple of squats, which caused it to lower again. I was just wondering why was it necessary for the nurse to assess me first or for that matter at all? In retrospect, it seemed redundant and unnecessary to me. When the nurse takes me back to the exam room now, I feel like we have this secret between us, which neither of us talk about. Robert W > I made an appointment with my physician for what I thought was a > possobile hernia. When I was called and taken to the exam room by a [quoted text clipped - 11 lines] > > Robert W The modern Practice Nurse is a highly trained and very competent person. Whilst she may not always be able to make a full diagnosis she can often eliminate some possibilities and thus save the doctor much valuable time. If your situation had been slightly different, but with similar symptoms, she might have been able to completely rule out hernia, or alternatively to have been able to confirm it and the absolute need for surgery to correct it. As it was, she found a slight protrusion. It needed the doctor to make a final decision as to whether it might heal itself after being replaced by him, or if the condition might still need surgery. In short, a preliminary examination by the nurse can sometimes eliminate the need for a doctor's examination at all and in other cases direct his attention more rapidly to the real source of problems. >The modern Practice Nurse is a highly trained and very competent person. >Whilst she may not always be able to make a full diagnosis she can often [quoted text clipped - 13 lines] >the need for a doctor's examination at all and in other cases direct his >attention more rapidly to the real source of problems. As a practicing physician, I would have to disagree with you 100%. I would never under any circumstances omit a part of a physical exam because a nurse did it for me. In particular, I would not refer a patient to a surgeon for a hernia based only on a nurse's report, as I would certainly look foolish were she incorrect, nor would I conclude someone does not have a hernia based on a nurse's exam, as the potential problems associated with non-treatment of an undiagnosed hernia would be my liability. Again, I can not imagine any duly thorough physician would omit a necessary part of a physical exam because the rooming nurse had done it. An entirely different situation exists, however, with either advanced practice nurses, such as nurse practitioners, or physician assistants both of whom, unlike nurses, are qualified to make independent diagnoses and prescribe treatment. In this particular poster's case, he may have been at a clinic where an NP does indeed take the initial history and perform a physical exam, and perhaps the supervising physician prefers to do a cursory confirmatory examination himself, which would explain the serial similar examinations by two people. PF > >The modern Practice Nurse is a highly trained and very competent person. > >Whilst she may not always be able to make a full diagnosis she can often [quoted text clipped - 35 lines] > > PF PF, Thanks for your comment. It was very helpful. I agree with you and I'm sure my doctor would agree with you. I believe that since doctors are so busy--that some of them do make use of nurses to speed up the process and save time. For example, a nurse could ask certain questions and if the patient stated--"I have a mole that on my stomach that may be infected"--the nurse could take a quick look at the mole and make a comment on the chart. That would save the doctor some time but he or she would still look at the mole. Jason  SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. > Is there a resource where one can go to find out what are the > appropriate protocols for times when a patient is required by > circumstances to be disroped or naked for a medical procedure or exam? > > > Robert W. Robert, I understand your point of view. If you believed that you may have a strip throat and they make you remove your clothing--you would have a strong case that they screwed up. However, if your prostate gland needed to be checked --it would make perfect sense for them to order you to remove all or at least some clothing. I'm sure that beautiful women have all sorts of problems related to male nurses and male doctors requiring them to disrobe for medical procedures that might not require disrobing. Some male doctors require that a female nurse be present to prevent lawsuits or to have a witness in case there are future lawsuits. I think that this is a great practice. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. I don't have a problem with the modesty issue per se when getting medical attention if required. There have been other times that I had a condition that required me exposing my genitals to a nurse. Once in the hospital when I had a case of celulitis in my upper thigh very close to my crotch. Showing my private parts to medical professionals I don't expect to ever see again just feels different to me than showing them to someone I know and expect to see again. Anyway, it just felt a little awkward for me at the time, not that I was offended by her seeing me. Thanks for your input. Robert W. Robert, the thing that many patients forget when having an exam that is so personal to them is the job that people do in the health profession. I was a technician at a leading hospital and I saw nudity and was in contact with patients ALL THE TIME. Because health professionals are so accustomed to it, they really think nothing of it and the nurse may not even remember your exam or if she does it was "just another day at the office" for her. With an extremely beautiful woman and a male doctor it may be different and I have heard of abuses, like a patient being asked to strip for a sore throat but in general its still all in a days work. I'm a professional artist. In school we had figure drawing classes with nude live models. I never could understand the stir this caused among the other non-art students. It wasn't personal, it wasn't sexual, it was just part of our learning to render shape and form, light and shadow. It didn't have any meaning outside of the context in which it was set. > Robert, the thing that many patients forget when having an exam that is so > personal to them is the job that people do in the health profession. I was [quoted text clipped - 10 lines] > learning to render shape and form, light and shadow. It didn't have any > meaning outside of the context in which it was set. Nancy, I'm sure that you were honest in everything that you wrote. However, I'm sure that you are also aware of the fact that some people in the medical profession and art profession are not like you. There was recently a lawsuit--please don't ask for the source because I don't save newspapers or magazines. The lawsuit was filed by a lady that suspected that her dentist had sex with her while she was having a dental exam--she was sleeping during the exam. She called the police and they arranged a rape kit by a medical doctor. The exam revealed that the dentist did have sex with her and she settled out of court for a huge sum of money. I only wish that all people in the medical profession were more like you instead of the dentist mentioned above. You probably know some stories like the one above that never made it into the newspapers. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. My original post was a question as to whether there existed a protocol or guideline for who should see a patient in a state of undress or naked. I did not in any way feel abused by being seen, and actually, touched, by my nurse. My only question was if it was necessary for her to do so since the doctor had to see me in any event. My only discomfort from the experience comes from knowing the nurse in question. I am not offended by female nurses, doctors, or any other medical personnel seeing me naked if it is necessary. I suppose, if the person were very attractive, I might even enjoy it. Robert W > My original post was a question as to whether there existed a > protocol or guideline for who should see a patient in a state of [quoted text clipped - 7 lines] > > Robert W Robert, I understand your point of view. I had a strange experience related to this issue about 10 years ago. A medical doctor was conducting a complete physical exam on me. During the exam (while I was totally nude) the male doctor got down on his knees in front of me and spent about 3 minutes conducting what he called an exam to determine if I had testicular cancer. It was very stange and embarrassing to have a man on his knees in front of me touching my genitals. I was glad when he finally finished. I later asked his nurse (in private) whether or not the doctor was married and she said "No" and refused to respond or answer my question as to whether or not the doctor was a homosexual. I arranged to get a new doctor and have NEVER gone back that doctor. The following year--my new doctor did not even conduct an exam to determine whether or not I had testicular cancer. My newest doctor is a female. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. >> My original post was a question as to whether there existed a >> protocol or guideline for who should see a patient in a state of [quoted text clipped - 22 lines] > even conduct an exam to determine whether or not I had testicular cancer. > My newest doctor is a female. Your concern over this issue speaks volumes about your security in your own sexuality. It tells us nothing about your original doctor. I have little doubt that his exam played into some fantasy you may not even be consciously aware you harbor. HMc Dear HMc, Do you fantasize that you have the power to look into the soul of a man? Do you fantasize that you are all knowing? Robert W > Dear HMc, > > Do you fantasize that you have the power to look into the soul > of a man? Do you fantasize that you are all knowing? > > Robert W I only know what you've told us, and it speaks volumes... HMc Since myself, and the others who posted a comment on this topic here, must be unaware of the fraud that I have committed here, perhaps you could elaborate on the fantasy and what the rest of us has missed Dr Freud? Just give us a couple of the volumes you say it speaks, if you don't mind. Robert W > >> My original post was a question as to whether there existed a > >> protocol or guideline for who should see a patient in a state of [quoted text clipped - 29 lines] > > HMc HMc If you had a man (even if he was a doctor) on his knees in front of you touching your genitals for 3 minutes--would you return to that doctor the following year in order to go thru the same experience? If so, that says something about your sexuality. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. >Robert, >I understand your point of view. I had a strange experience related to >this issue about 10 years ago. A medical doctor was conducting a complete >physical exam on me. During the exam (while I was totally nude) the male >doctor got down on his knees in front of me and spent about 3 minutes >conducting what he called an exam to determine if I had testicular cancer. I sit on a stool and wear gloves, and the patient has his trousers and underwear pulled down to the knees, and he has his shirt on, which I have him lift up only as much as necessary, and the exam takes maybe 10 seconds. >The following year--my new doctor did not even conduct an exam to >determine whether or not I had testicular cancer. Well, that's not smart either. PF > >Robert, > >I understand your point of view. I had a strange experience related to [quoted text clipped - 14 lines] > > PF PF, I would not have any problems if the doctor that I mentioned had conducted the testicular exam the way that you conduct testicular exams. I discussed this issue with the doctor that failed to conduct a testicular exam. He told me that since I was only 38 years old (at the time) that it was a waste of time as a result of statistics. He said that he did not conduct the exam until his patients were 50 years old or older. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. >PF, >I would not have any problems if the doctor that I mentioned had conducted [quoted text clipped - 3 lines] >waste of time as a result of statistics. He said that he did not conduct >the exam until his patients were 50 years old or older. Well I certainly hope the he also conducts the exams in men under 30 because he will may miss a case of testicular cancer at least once in his career if he doesn't. PF >>PF, >>I would not have any problems if the doctor that I mentioned had conducted [quoted text clipped - 7 lines] >because he will may miss a case of testicular cancer at least once in >his career if he doesn't. IIRC, testicular cancer is the most common cancer, the most common cause of death from cancer, and one of the most common causes of death in men aged 20-40. It's sometimes recommended that men check their testicles periodically, just as women check their breasts, for suspicious lumps. You can get a booklet, or find info on the net, about how to do it. It seems to me that it should be part of the physical exam for young men. After all, it's not expensive nor invasive nor very time-consuming and as Dr.Riley says, could save a life. (I'm not a doctor.) I wonder if the physician who spent several minutes examining this poster's testicles may have been trying to determine whether what he felt was abnormal enough to follow up or not. A doctor doesn't want to needlessly alarm a patient, but this is a cancer that can be very successfully treated if caught early, but very hard to control once it spreads. >>>PF, >>>I would not have any problems if the doctor that I mentioned had conducted [quoted text clipped - 25 lines] > successfully treated if caught early, but very hard to control once > it spreads. I believe testicular cancer is the most common cancer cause of death in men under age 35, however, despite that, it is a relatively rare cancer, is usually curable, and is not one of the common causes of death in young men. There is no good evidence that yearly testicular exams by a physician or self testicular exams are of any benefit. The US Preventive Services Task Force recommends against such screening. I think the reason screening for testicular cancer became "popular" with pamphlets and the like was that people felt like there should be some male equivalent of screening for breast cancer. (Not that there's any evidence that self breast exams are of benefit, but at least it's a very common cancer in women.) SignatureDavid Rind drind@caregroup.harvard.edu > I believe testicular cancer is the most common cancer cause of death in > men under age 35, however, despite that, it is a relatively rare cancer, > is usually curable, and is not one of the common causes of death in > young men. I realized right after posting that the above may be wrong. Testicular cancer is the most common solid cancer (as opposed to hematologic cancer) in men under age 35, but I don't know whether it is the most common cause of cancer death in men that age. I don't have time to look up the statistics right now.... In any case, it is not a common cause of death in young men. SignatureDavid Rind drind@caregroup.harvard.edu >I believe testicular cancer is the most common cancer cause of death in >men under age 35, however, despite that, it is a relatively rare cancer, >is usually curable, and is not one of the common causes of death in >young men. Thanks for the no doubt more accurate information. >There is no good evidence that yearly testicular exams by a physician or >self testicular exams are of any benefit. The US Preventive Services [quoted text clipped - 4 lines] >breast exams are of benefit, but at least it's a very common cancer in >women.) Well, when I suggested to my husband that he read the booklet and examine himself periodically, he told me that he'd let me do it. ;-) > >I believe testicular cancer is the most common cancer cause of death in > >men under age 35, however, despite that, it is a relatively rare cancer, [quoted text clipped - 14 lines] > Well, when I suggested to my husband that he read the booklet and examine > himself periodically, he told me that he'd let me do it. ;-) Thanks to all that responded. I learned from one of my doctors how to conduct an exam on myself related to testicular cancer. It's really easy. It's my guess that many doctors don't conduct the exam since they hate it. I believe that doctors or their nurses should give pamplets to all patients after yearly physical exams related to breast cancer (for women) and testicular cancer (for men). The pamplets should explain how to do self examinations. I should add that I am now 54 years old and during my last physical exam--my female doctor did NOT conduct an exam for testicular cancer or give me a pamplet about the subject. Is this common? I don't know. I did not care about it at the time since I know how to conduct my own exam related to this subject. Thanks again. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. >>>I believe testicular cancer is the most common cancer cause of death in >>>men under age 35, however, despite that, it is a relatively rare cancer, [quoted text clipped - 26 lines] > I don't know. I did not care about it at the time since I know how to > conduct my own exam related to this subject. Thanks again. Well, in my post that you quoted above, I pointed out that there is no good evidence to support doing such an exam or teaching patients to do a self exam and that the main US body on preventive services recommends against it. So your doctor who did not do such an exam and did not give you a pamphlet was following published recommendations. That said, even those people who advocate testicular exams usually don't recommend doing them in 54 year olds since testicular cancer would be extremely rare in a man that age. SignatureDavid Rind drind@caregroup.harvard.edu > >>>I believe testicular cancer is the most common cancer cause of death in > >>>men under age 35, however, despite that, it is a relatively rare cancer, [quoted text clipped - 38 lines] > recommend doing them in 54 year olds since testicular cancer would be > extremely rare in a man that age. David, Thanks for the information. It was great to learn that my present doctor was following current policy on this subject. I have a lot of respect for her. Jason SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. I had a somewhat similar experience, except the doctor in my case was female. This was OK by me, but my female partner who was present during this examination related to me later that she found the experience of watching somewhat 'stimulating'. David > Robert, > I understand your point of view. I had a strange experience related to [quoted text clipped - 15 lines] > We respect those subscribers that ask for advice or provide advice. > We do NOT respect the subscribers that enjoy criticizing people. David, I'm sure that if the doctor you mentioned was a man--it would have NOT been a stimulating experience for your female partner. In addition, I doubt if the experience would have OK by you. Am I correct? Jason > I had a somewhat similar experience, except the doctor in my case was > female. This was OK by me, but my female partner who was present during this [quoted text clipped - 22 lines] > > We respect those subscribers that ask for advice or provide advice. > > We do NOT respect the subscribers that enjoy criticizing people. SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. You are spot on there Jason - although I am not homophobic I don't let guys near my privates if a female is an option David > David, > I'm sure that if the doctor you mentioned was a man--it would have NOT [quoted text clipped - 6 lines] > > examination related to me later that she found the experience of watching > > somewhat 'stimulating'. Nancy, Have you ever had the occassion to exam a patient you know and to see that patient naked? If you have, did you see that person as just another patient or see them differently? If you have, when you next saw the person in a social setting did it not feel awkward in any way? Please tell me the truth. Robert W I'm a 49 yo male type 2 insulin dependant diabetic. Last year I had several (6) surgerys for diabetic foot problems. These were in the form of debredment and ultimately, amputation of 3 toes. It made me uncomfortable to have to remove my boxer shorts and go to surgery in just the hospital gown. After all, I was having surgery on my feet, not higher up. Everytime when I'd wake up in recovery my gown would be untied. I can't imagine what the heck the surgical team needed to get access to other than my feet, lower legs and an arm for the IV. The leads fot the heart monitor were put on while I was still awake so that couldn't have been it. I never made a big deal about it to the staff but still wonder why. I've been seeing the same primary care physician for my diabetes for well over a year now and still haven't been asked to undress for an office exam other than removing my shoes. I have been expecting a complete physical where I would be undressed but that hasn't happened yet. That would make me somewhat uncomfortable so I rather not do it anyway unless I just absolutely have to. And certainly not for the nurse. |
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