The question: During my most recent interaction with a physician, I was not given a patient gown to change into but instead was asked to lift my top so that the doctor could listen to my heart. A former family doctor of mine also practised this way. Is this becoming more commonplace because of costs and time demands placed on physicians?
The answer: You are a female patient and your doctor is male. While going under your top is quicker than having you change into a robe – a medical shortcut of sorts – it could be misinterpreted. Most patients may be indifferent to the practice, while others may feel uneasy.
Examining patients with their clothes on is typically done to ensure time spent with the doctor is as efficient as possible, according to Rob Wedel, a family physician at the Associate Medical Centre located in Taber, Alta., a town east of Lethbridge. That’s because a physician who steps out of the room while a patient changes into a robe could be interrupted several times by office staff, further delaying the examination and causing the doctor to lose focus.
“In most situations, it is a completely benign process that just is in the best interests of making sure the interaction is not interrupted and that the information that’s needed is gathered,” Dr. Wedel said in a telephone interview.
That isn’t the case all of the time. If you make an appointment for a chest cold, office staff will likely have you ready and waiting in a gown for the doctor. Having to lift up your top is typically for a situation in which listening to heart sounds was not anticipated as part of the visit.
While examining patients with their clothes on is commonplace, Dr. Wedel thinks the practice is on the wane, adding: “Increasingly, we’re recognizing it’s important not to have this misinterpreted.”
He teaches medical students to ask permission of patients before listening to their hearts – robed or clothed – as patients should never be taken by surprise with a stethoscope suddenly on their chest.
Samantha Kelleher, deputy registrar of the College of Physicians and Surgeons of British Columbia, also thinks having patients shift clothing so doctors can listen to their hearts is done fairly frequently, though she is critical of the practice.
“With a gown, there’s not a whole lot of misunderstanding,” said Dr. Kelleher, who is responsible for complaints regarding serious boundary violations.
Doing an exam in which patients are lifting and shifting clothing can be misunderstood as being sexualized in nature. Patients could also see it as an invasion of privacy, she said.
“To compromise patient care for time efficiency,” she says, “is not best practice, is not in the patient’s best interest and not in the physician’s best interest.”
In answer to your question, it may be commonplace but it probably shouldn’t be.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.
