Intimate Examinations Research Articles

The shadowy boundaries of obstetric violence

Obstetric violence is a term that has sparked considerable debate. It represents a range of harmful practices around unwanted intimate examinations. This article explores the contested boundaries of obstetric violence, examining both overtly abusive actions and more routine, yet potentially harmful, medical practices during childbirth and beyond. By delving into the underlying patriarchal and misogynistic structures within healthcare, the article challenges traditional understandings of care in childbirth. It argues for a broader, more nuanced recognition of obstetric violence, emphasising its connection to gender-based violence and the need for a more context-sensitive approach in both legal and medical frameworks. The aim is to expand the discourse on obstetric violence to include often overlooked and normalised practices that contribute to the mistreatment and dehumanisation of women, birthing people, and transgender people receiving gender-affirming care.

Chaperone in breast examination: a comprehensive systematic review of patient and clinician perspectives, and documentation.

The General Medical Council (GMC) has made it mandatory to have a chaperone present during intimate examinations, including breast exams, highlighting the importance of medicolegal protection for both patients and clinicians. The use of chaperones during breast examinations is logical, especially in an increasingly litigious society. This review aims to summarize current information regarding patients' and clinicians' perspectives on chaperone use in breast examination. A PRISMA-compliant search was conducted in electronic databases from inception until April 2023 for qualitative literature on patients' and clinicians' perspectives on chaperone use in breast examination. The inclusion criteria focused on studies related to breast examinations, excluding other intimate examinations. An inductive thematic analysis was performed in three domains: physician-associated factors, patient-associated factors, and chaperone documentation. Ten studies were included after screening 939 articles. For breast examination, the presence of male and older surgeons, nurse availability, rural settings, and patients' psychiatric comorbidities increased the likelihood of chaperone use during consultations. Medico-legal concerns were prominent for male physicians, while female physicians highlighted the need for technical support. Logistical issues were a common hindrance. The gender of physicians was important for patients, but there was conflicting evidence regarding patient preferences for chaperones and their purpose. Poor documentation was generally observed despite quality improvement projects. This study emphasizes the vital role of chaperones in clinical practice, urging a precise definition and targeted resolution for implementation challenges. Patient preferences highlight the need for a personalized approach, and increased awareness among healthcare professionals is essential.

Learning of Intimate Area Examination Amongst Pakistani Medical Students: Knowledge, Attitudes, and Practices Study

Background: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their effects on students’ learning. Methods: This cross-sectional study, based on a self-designed questionnaire, was conducted at two Pakistani medical colleges, which included final year students and postgraduate trainees. Results: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum, and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning, more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative effect on IAE learning. A high percentage of respondents reports that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed. Conclusion: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

Impact of body mass index and examination type on utilization of screening programs: A big data study

ObjectiveTo investigate the relationship between Body Mass Index (BMI) and adherence to recommended screening tests, addressing gaps in previous literature by utilizing a large cohort, while considering longitudinal changes in weight and the type of screening. MethodsData from Clalit Health Services in Israel were retrospectively analyzed, including participants aged 50 and above from 2002 to 2021. BMI measurements and various screening test records were examined. Generalized Estimating Equations were employed for analysis, adjusting for potential confounding variables, including age, gender, geographic location, and socioeconomic status. ResultsThe study included 634,879 participants with 4,630,030 BMI measurements and 56,453,659 test records. Participants were categorized into BMI cohorts at the time of the test, with overweight and obese individuals showing lower odds of undergoing intimate examination-based screening tests (mammography, PAPS, and skin examination), as opposed to higher odds of several non-intimate tests (e.g., diabetes and eye disorder screenings). DiscussionOur findings suggest that individuals with overweight and obesity are less likely to undergo screenings involving intimate physical examinations, potentially due to weight stigma and discomfort. This avoidance behavior may contribute to increased morbidity rates in these populations. Interventions addressing weight stigma, improving access to care, and enhancing patient engagement are warranted.

Patient Perceptions of Medical Students' Involvement in Clinical Classes: A Cross-Sectional Survey.

A crucial aspect of the education of prospective medical professionals is their interaction with patients. The study aimed to explore patients' perspectives on the interaction between medical students and themselves. It sought to understand how patients perceive this dynamic within clinical classes. The goal was to gather insights into the most favorable behavior and demeanor of medical students during these sessions, with the overarching objective of enhancing patient comfort. The authors collected a total of 403 surveys from patients of a teaching hospital, regarding their perception of students as healthcare providers. The participants ranged in age from 18 to 92. 53.83% of the participants were female, and 46.17% were male. The surveys were collected between April 8th, 2022, and August 10th, 2022. The results of the anonymous survey undergone statistical analyses using the Mann‒Whitney U-test for comparing two groups and the Kruskal‒Wallis test for comparing more than two groups, because the Shapiro‒Wilk test indicated that the data did not follow a normal distribution. The study delved into patients' assessments of students' external presentation, adherence to behavioral norms, empathetic qualities, consideration during intimate examinations, and preferences for the organization of clinical classes. Our research indicates notable differences in responses based on age. Specifically, the senior demographic prioritizes students' external presentation, communication and the utilization of courteous language more often than younger individuals (p<0.05). Attendees exhibit varying levels of interest in participating in educational sessions with students based on the ward. Significantly, individuals in the gynecology ward display the least enthusiasm for engagement (p<0.05). Notably, the majority of patients perceive their involvement in the education of future healthcare professionals to be essential (83.38%). The study found that generally, patients voluntarily engage in educational classes with students. The relationship between patients and students is amicable, and the majority of students display a respectful demeanor toward patients. Nonetheless, preserving patient confidentiality and ensuring the proper management of classes remain persistent issues. This is particularly crucial, especially when the clinical classes pertain to intimate and personal health matters of a patient. Upholding and enriching the organization of such sessions, along with the attentiveness and knowledge of medical students regarding patient comfort, assumes heightened significance.

"The habit of keeping silent": An exploratory-descriptive qualitative study of the knowledge and attitudes of Kazakhstani gynecologists toward dyspareunia.

Dyspareunia (pain during sex) is a common condition that causes physical and emotional stress for many women. This condition can be caused by various factors, including physical, hormonal, inflammatory, viral, neoplastic, psychological, and traumatic events. Anatomical causes include pelvic floor muscular weakness, uterine retroversion, hymenal remnants, and pelvic organ prolapse. The etiology of this condition is complex, causing it to be often overlooked. The main aim of this study was to conduct a qualitative exploratory study and provide a comprehensive description of the knowledge and attitudes held by gynecologists in Kazakhstan on the medical validity, diagnosis, and treatment of dyspareunia. This is an exploratory-descriptive qualitative study. Semi-structured online interviews were conducted with 10 physicians. They were identified as obstetrics and gynecology specialists, gynecologic oncologists, and outpatient gynecologists. The average number of years spent practicing their specialty is 15.7, with the shortest being 4 years and the longest being 35 years. All the participants are female. Braun and Clarke's six-stage, step-by-step methodology was used for the thematic analysis. Findings suggest that gynecologists in Kazakhstan have knowledge of the most common causes of dyspareunia, although they still often attribute women's distress to psychological rather than physical factors. It was found that due to stigma and mutual embarrassment open dialogue about sexual health was lacking between patients and physicians. In addition, gynecologists describe difficulties discussing symptoms and performing intimate examinations due to time constraints and a lack of privacy at state facilities. To knowledgeably diagnose and treat patients with dyspareunia, gynecologists recommend further training to acquire the requisite evidence-based knowledge and competencies.

Learning of Intimate Area Examination Amongst Pakistani Medical Students: KAP Study

BACKGROUND: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their impacts on students’ learning. METHODS: This cross-sectional study, based on a self-designed questionnaire was conducted at two Pakistani medical colleges which included final year students, and post graduate trainees. RESULTS: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative impact on IAE learning. A high percentage of respondents reported that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed. CONCLUSION: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

‘I Did No Harm’

Objective: To assess the performance of our urology team against GMC guidelines for using chaperone during intimate clinical examination. Background data: intimate physical examination is an integral part of our urological practice. There is a paucity of literature regarding the use of chaperones among urologists. Given the importance of this topic for both patient safety and providing support for the urologist, we decided to assess our performance as per the GMC guidelines for good medical practice. Methods: We completed an audit loop to evaluate the performance of 12 members in our urology team as regards compliance with GMC guidance for the documentation of chaperone use in urology clinic. Based on our scoring system, we objectively assessed both overall team performance as well as individual scores for documenting chaperone use. Results: There was a significant improvement in the overall documentation rate in both clinical notes (+9.85%) and clinic letters (+36.65%). Raising awareness among team members managed to increase the individual performance scores as well. Conclusion: This is the first report using a scoring system for objective assessment of a pertinent topic such as the use of chaperone and its documentation. This managed to achieve a significant improvement in our practice.

871 Audit on Compliance and Documentation of GMC Guidelines Regarding the Use of Chaperone During the Intimate Examination

Abstract Aim To assess the compliance of GMC guidelines with respect to chaperones during intimate examination and their appropriate documentation. Method Analysis of patient notes documented by members of the general surgery department in the surgical assessment unit, or ED, for the month of October 2022. We checked the patient notes for the following dataset: Chaperone - offered/not offered, name and position of chaperone and signature of chaperone.Area examined – Perineum, Abdomen, Breast or perineum and abdomenGender of patient, doctor and chaperone.Time of the day and place of examination The data was analyzed (results below). As part of the audit cycle, the results were shared with the department, and education on the seriousness of this issue was discussed. Stickers for chaperones with their name, position, and gender will be attached to the patient notes. Results 168 patients were reviewed totally. 9/168 (5.3%) – documentation present, 1/9 (11%) had complete documentation. 23 patients had perianal examination – 1 (4.3%) had documentation 141 patients had abdomen examination – 8 (5.6%) had documentation 9/9 (100%) documentation done by male doctors for female patients Conclusions We found a lack of adequate documentation for chaperone presence during the examination. It was agreed that chaperone presence was always adhered to, but documentation was lacking. Necessary changes have been initiated, and we are collecting prospective data after the intervention.

A specialist service evaluation: a cross-sectional survey approach.

To evaluate the overall patient experience and the degree to which individual needs were being met, and make improvements to service delivery. A cross-sectional survey questionnaire was sent to a random sample of women (n=350) who were registered on the electronic patient record system from January to June 2020. Two items on the questionnaire related specifically to communication with patients during the first COVID-19 lockdown in March 2020. Routine service data were collected and included in descriptive statistical analysis. Qualitative themes were thematically analysed. The response rate was 39% (n=137). More than 90% of respondents felt listened to during consultations with nursing and medical personnel, and had trust and confidence in their clinical expertise, felt involved with decisions about care and felt comfortable with intimate examinations. Negative responses related to poor communication with administration and rescheduling appointments. Findings resulted in a departmental review of admin processes, which resulted in improvements to administrative systems, staff training, communication and information giving, and directly benefited patients.

Delacroix et la nature éd. par Claire Bessède

Reviewed by: Delacroix et la nature éd. par Claire Bessède Karen Quandt BessÈde, Claire, éd. Delacroix et la nature. Musée du Louvre and Le Passage, 2022. ISBN 978-2-84742-482-9. Pp. 160. A product of the pandemic, it is fitting and even poignant that this exhibition extended a breath of fresh air to Delacroix's storied artworks. Country and urban gardens, studies and inventories of trees and flowers, and an array of animal sketches seem like a welcome refuge from the painter's dark and intimidating grand format scenes of massacres, animal combats, and brooding interiors. Yet, the point of Delacroix et la nature is not to position the painter as a nature artist. Instead, all of the letters, journal entries, sketches, curiosities, and paintings recently displayed at the Musée Eugène Delacroix in Paris worked together to embrace the dissonance exemplified by a leading studio artist who was nevertheless sensitive to nature's beauties and processes. The catalog opens with a brief preface by Laurence des Cars, a specialist of nineteenth-century art recently appointed Director of the Musée du Louvre, who applauds the curators' selection of local works that minimized the need for long distance transport. It continues in a "green" vein with three essays that examine how Delacroix "reinvented" nature into his own creations; how his animal paintings differed from conventional hunting scenes of the time period; and how gardens and botany developed his sensitivity to the natural world. The ensuing presentation of the exhibition's works, which are often accompanied by ample notes, helps synthesize an otherwise seemingly eclectic array as it underscores Delacroix's strong sensibilities for nature, his keen eye for flora and fauna, and the processes by which he refashioned his experiences of nature into studio paintings. Smartly interspersed amongst the impressive collection of Delacroix's oil paintings and drawings were several animal sculptures created by Antoine Louis Barye, a friend who often accompanied the painter to the Jardin des Plantes to study its animals and to attend animal dissections. The exhibition culminated in Delacroix's studio (the museum is located on the site of his last residence in Paris, which had the rather unusual distinction of having a garden), where signature colorful oil paintings à la Rubens were juxtaposed with taxidermized animals from the nearby Maison Deyrolle as well as with landscape watercolors by the young Delacroix's friends Theodore and Newton Fielding. Delacroix et la nature might not have the scope of a major retrospective or "blockbuster" exhibition, but it is nonetheless powerful in how it offers an incisive and unique look at an interesting cross-section of Delacroix's works. The catalog is an essential supplement to the exhibition, since it expounds on certain artworks and offers helpful historical and biographical details. Above all, the catalog lends a sense of cohesion to what exhibition viewers might have perceived to be loosely organized themes. Specialists of Delacroix and of nineteenth-century studies are sure to benefit the most from the scholarly expertise that buttresses the catalog, but the exhibition itself was surely a delight for all visitors who could experience the richness of Delacroix's dramatic compositions through his intimate examinations of the natural world. [End Page 204] Karen Quandt Wabash College (IN) Copyright © 2023 American Association of Teachers of French

O.12.3 - Bringing authenticity to teaching intimate examinations: Presenter(s): Karen Lobb-Rossini, St.Georges Medical School University of London, United Kingdom

O.12.3 - Bringing authenticity to teaching intimate examinations: Presenter(s): Karen Lobb-Rossini, St.Georges Medical School University of London, United Kingdom

What influences GPs' use of pelvic examination? A qualitative investigation in primary care.

Omission of pelvic examination (PE) has been associated with diagnostic delay in women diagnosed with gynaecological cancer. However, PEs are often not carried out by GPs. To determine the perceptions of GPs about the role of PEs, the barriers to and facilitators of PEs, and GPs' experience of PEs in practice. Qualitative semi-structured interview study conducted in one health board in Scotland (mixed urban and rural) with an approximate population of 500 000. Interviews were conducted face-to-face or by telephone between March and June 2019. Framework analysis used the COM-B behaviour change model concepts of capability, opportunity, and motivation. Data was compatible with all three domains of the COM-B framework. Capability related to training in and maintenance of skills. These went beyond carrying out the examination to interpreting it reliably. Opportunity related to the clinical environment and the provision of chaperones for intimate examination. Interviewees described a range of motivations towards or against PEs that were unrelated to either capability or opportunity. These all related to providing high-quality care, but this was defined in different ways: 'doing what is best for the individual', 'doctors examine', and 'GPs as pragmatists'. GPs' reasons for carrying out, or not carrying out, PEs in women with symptoms potentially indicating cancer are complex. The COM-B framework provides a way of understanding this complexity. Interventions to increase the use of PEs, and critics of its non-use, need to consider these multiple factors.

Young Australians' receptiveness to discussing sexual health with a general practitioner.

Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians' receptiveness to discussing sexual health with a general practitioner (GP). We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16-29years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression. Among 1915 participants, 69.3% were cisgender women, with a median age of 20years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health. Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP-patient relationships are key to promoting sexual health among young people.

The acceptability of cervical electrical impedance spectroscopy within a multi-modal preterm birth screening package: a mixed methods study

BackgroundReducing the rate of preterm birth is a cornerstone of global efforts to address child mortality, however existing screening tests offer imperfect prediction. Cervical electrical impedance spectroscopy (EIS) is a novel technique to quantify the ripening changes which precede labour. Mid-trimester EIS measurements have been shown to accurately predict preterm birth in asymptomatic women. This study aimed to comprehensively evaluate the acceptability of cervical EIS to low and high-risk women as part of a package of screening tests performed during a larger prospective trial.MethodsIn this parallel convergent mixed methods study, 40 women completed questionnaires before and after screening tests (EIS, cervical length measurement and fetal fibronectin quantification). Quantitative outcomes were anxiety levels before and after screening (Spielberger State Trait Anxiety Inventory, STAI-6), pain (Short Form McGill Pain Questionnaire) and ratings of EIS device appearance and test acceptability (visual analogue scales). Twenty-one women (11 high-risk, 10 low-risk) also attended a semi-structured qualitative interview. Interviews were recorded and transcribed, then thematic analysis was performed. A convergence coding matrix was constructed to enable triangulation of quantitative and qualitative results.ResultsHigh risk women demonstrated a significant reduction in anxiety following screening (mean STAI-6 score 34.5 vs. 29.0, p = 0.002). A similar trend was observed among low-risk participants. Ratings of pain, EIS device appearance and procedural acceptability did not differ between groups. Mean pain ratings were low (visual analogue scale 0.97 and 1.01), comparing favourably to published evaluations of conventional screening tests. Qualitative analysis provided insight into both the physical consequences and emotional experiences of screening. Additional determinants of the screening experience included device design, pre-existing perspectives on intimate examination, attitudes to knowledge in pregnancy and interaction with clinical staff. Finally, a range of practical considerations regarding wider use of EIS were identified, with valuable complementary detail regarding acceptability for use in antenatal care.ConclusionsCervical EIS is well tolerated and acceptable to both low and high-risk women when performed as part of a multi-modal screening package. These results provide useful insights to inform the design of future study and screening protocols.

Improving the documentation of chaperones during intimate examinations in a surgical admissions unit: A four-stage approach.

The General Medical Council (GMC) states that all intimate examinations should have a chaperone offered. Documentation of chaperone identity, or patient's refusal, is essential. This project aimed to improve documentation of chaperones during intimate examination of patients based in a Surgical Admissions Unit (SAU) within a large tertiary hospital in the Southwest of the UK. A Plan-Do-Study-Act (PDSA) cycle structure was used. Initial data collection and planning occurred in December 2019. Intervention implementation and analysis occurred from January 2020 to March 2021. Intervention 1 involved presenting results at a clinical governance meeting. Intervention 2 was information posters in the SAU and intervention 3 involved training sessions for nursing staff. Intervention 4 was editing the surgical clerking proforma. Prior to interventions, chaperone identity or patient's refusal was correctly documented only 9.7% (N = 7 out of 72) of the time. Intervention 1 increased this to 34.6%. Following interventions 3 and 4, correct documentation was 25.0% and 28.6% respectively. After intervention 4 correct documentation was at 59.1%. Initial documentation of chaperones was poor. Interventions 1 to 3 were successful in educating clinicians how to document accurately, but engaging individuals in person was more successful than passive education through posters. Changing the proforma structure was the most successful intervention. This suggests a visual reminder for clinicians at the point of contact with the patient is the most effective way to encourage correct documentation of chaperones, improving patient care and clinical practice.

Association between Gender and Clinical examination frequency and confidence of Medical Students in Saudi Arabia: A Cross-Sectional Study

Objectives: Determine the student's confidence and capability in performing examinations by both gender on the same and opposite sex.Methods: A valid questionnaire has been distributed to College of Medicine students at Taiba University in Saudi Arabia. This questionnaire includes questions about the factors which may be related or affect the medical experience during general or intimate examination and questions about the frequency of examinations on the same and opposite sex. Comparison of males and females was done using Chi-square tests analysis using the SPSS version 23.Result: Out of 150 final year medical students, 108 male and female students (72%) have participated in this research. There were 82.8% of males and 62% of females that have agreed that cultural and religious traditions have impacted their clinical experience with the opposite sex. In regard of respiratory examination for patients of the opposite sex, only 1.7% of the males have performed respiratory examination for patients of the opposite sex more than (10) times, compared to 34% of females. Also 44.8% of males have performed male genitalia examination (1-5) times, compared to 12% of females. On the other hand, 1.7% of males have performed vaginal examination compared to 12% of females.Conclusion: This study showed that there is an association between gender and clinical experience in some aspects. Researchers emphasize minimizing the negative effects of gender nature on the clinical experience by using alternatives or encouraging the patients to allow students to complete their clinical examination while ensuring patients privacy and integrity.

Australian sonographers' perceptions of patient safety in ultrasound imaging: Part 1 - identifying the main safety concerns, a qualitative study.

Patient safety has been an undervalued component of quality healthcare but is a challenging area of research.Ultrasound is the most common imaging modality in the world. Research on patient safety in ultrasound is generally focused on bioeffects and safe operation of ultrasound equipment. However, other safety issues exist in practice that warrant consideration.This paper forms the first part of a PhD study exploring patient safety in medical diagnostic ultrasound, beyond the notion of bioeffects.The ultimate aim of the study is to inform the final phase of the research study which will consider the next steps in improving the quality and safety of healthcare experienced by patients. A qualitative study using semi-structured, one-on-one interviews. A thematic analysis categorised data into codes and generated final themes. A heterogeneous mix of 31 sonographers, who reflected the profile of the profession in Australia, were interviewed between September 2019 and January 2020. Seven themes emerged from the analysis. These were bioeffects, physical safety, workload, reporting, professionalism, intimate examinations and infection control. This study presents a comprehensive analysis of sonographers' perceptions of patient safety in ultrasound imaging, not previously available in the literature. Consistent with the literature, patient safety in ultrasound tends to be viewed in technical terms through the potential for bioeffects of tissue damage or physical harm to the patient. However, other patient safety issues have emerged, and while not as well recognised, have the potential to negatively impact on patient safety.

Confidence, consent and chaperones for pubertal staging examinations: a national survey

ObjectiveGeneral Medical Council (GMC) guidance describes an intimate examination as one that may be embarrassing for the patient, for example, breast or genitalia examination. Documentation of consent and use of...

Chaperones Utilization in Clinical Practice: Intimate and Sensitive Physical Examination Best Practice Strategies and Concepts in Modern Urological Medicine.

The intention of utilizing chaperones during sensitive physical exams is to show respect to the patient, while simultaneously providing protection to both the patient and the medical provider. Despite clinical practice recommendations to offer chaperones for sensitive urologic exams, there is no data regarding the consistency of chaperone utilization. Our aim was to summarize the patient and provider perspectives on the role of chaperones in urology as well as identify barriers to implement chaperone consistency. In the present investigation, we conducted a systematic review of prospective, case-control, and retrospective studies and followed the PRISMA 2020 guidelines for data reporting. Studies were identified from PubMed, MEDLINE, and PMC using the Medical Subject Headings (MeSH) terms "chaperones, patient", "chaperones, medical", and keywords "chaperones", and "urology". Studies were included if they addressed patient/provider perspectives on chaperone utilization in urology specifically and were excluded if they investigated perspectives on chaperone utilization in other specialties. Preliminary study identification yielded 702 studies, 9 of which were eligible for this review after applying the inclusion and exclusion criteria. Of these, 4 studies focused on the patient perspective and 5 focused on the provider perspective. The percentage of patients that did not have a chaperone present during their urologic exam ranged from 52.9-88.5%. A greater proportion of these patients were male. Patients (59%) prefer a family member compared to a staff member as a chaperone. Physicians (60%) prefer staff member chaperones compared to family members. One study reported that 25.6% of patients did not feel comfortable to ask for a chaperone if they were not offered one. Two studies reported the percentage of patients who believed chaperones should be offered to all urology patients, ranging from 73-88.4%. Three studies reported the use of chaperones in the clinic which ranged from 5-72.5%. Two studies reported chaperone utilization documentation, ranging between 16-21.3%. Two studies reported the likelihood of chaperone utilization depending on gender of the physician, showing that male physicians were more likely to utilize chaperones and were 3x more likely to offer chaperones to their patients compared to female physicians. Research suggests that there are differing perspectives between patients and physicians regarding the specific role and benefits chaperones offer during a sensitive urologic examination, as well as differences in preferences of who should perform the role of the chaperone. While more work needs to be done to bridge the divide between clinical practice and patient/physician preferences, the act of offering chaperones to urologic patients, regardless if they want to utilize a chaperone for their examination is respectful of patient privacy and decision making.