Sunday, November 23, 2008

Exam room etiquette

I'm currently reading Pursued by the Bear, a book by 70-something year old psychologist about his 8 year journey through the medical world in pursuit of treatment for 3 different kinds of cancer. Dr. Singer's book is both hilarious and insightful; I highly recommend it to you. A lot of the book explores the relationship between patients and doctors. Here's his take on exam room etiquette, and one of his only observations with which I take issue:

[The doctor] tells me to get dressed [and] leaves the room (you have noticed I am sure that doctors seem unable to tolerate you in the process of dressing or undressing? They don't have problems with you naked or very scantily clad, but the act of removing or putting on clothing seems to be too personal or obscene to be allowed in their presence. It's the action itself that seems off-putting to them. My theory is that in the act of dressing or undressing, your personhood, your humanity cannot be denied--you are someone doing something--I move, therefore I am. Naked you can be an object)...

I always meet my patients while they are dressed, invariably leave the room while they are undressing, attempt to examine them in a way that reveals only that part which I am currently inspecting, and always leave the room while they dress. While we are both dressed, I feel our 'equal partnership' status is intact. When they are undressed, I am very aware that this is an unusual and privileged interaction between two people, doctor and patient. While disrobing or re-robing, however, I feel like I have no business in the room, that, as Dr. Singer writes, the act is indeed 'too personal' though certainly not 'off-putting', and that to stay there would overstep the boundaries of our professional relationship. Once my patient is dressed, we once again enter our partnership agreement where I offer my knowledge and observations and ask my patient to consider with me the options for care.

Are you offended when your doctor scuttles out of the room after the exam is over? How do you feel about conducting the pre- or post-exam interview while still undressed and gowned?

7 comments:

Ruth said...

My doctor gives us a paper sheet and leaves the room while we are left to disrobe and drape our bodies. He always conducts his post examination interview in his office with everyone fully clothed. And he always has an assistant present for a genital or internal exam. You cannot be too careful when it comes to professional boundaries.

JeanMac said...

I think it's "nicer" to do the post exam,dressed, and in his office.Personally nothing bothers me at this stage so I wouldn't be upset either way.

Dreaming again said...

I would be shocked if a doctor did not remove themselves for me to get into the exam gown.

There is something intimate about dressing and undresssing ..it is normally done in private ...or in front of the persons significant other. It is not a public action.

I dont' know how else to describe it other than 'too intimate'

"his-self" said...

I don't think I ever really thought about it? I guess I thought it was a time issue with the Dr.

Having spent time in the Army I wouldn't be offended either way but I can follow your logic.

Anonymous said...

There's a creepy factor if the doc stays in the room. Oddly intimate and definitely inappropriate.

dorsey said...

My massage therapist follows the same protocol and it seems sensible for anyone's modesty. As an aging hippie myself, I'd be fine with either of you
there while I undress, provided we're chatting or preparing to jump into a lake. However, dressing (making sure things are right side out, aligning fasteners, etc.) would distract me from having a serious conversation. And I do agree that one person naked/one person clothed can create a power imbalance. (I'd rather be naked than in the creepy gown). I think it comes down to respect, which you've always shown, and to time management (I don't believe you wait outside the door tapping your foot). Your current procedure works fine for me; I've never been hurt that you've left while I change, nor felt that you were denying my humanity (just the opposite).

Different story if you were male, I'd be more modest except in the swimming circumstance.

Anonymous said...

How about being left in an exam room for exam room etiquette?
I was on time for my appointment and brought into an exam room right straight away where I was left for 40 minutes. I couldn't possibly wait another minute. I dressed and spoke to the receptionist about rescheduling. Her jaw dropped when I asked her. Maybe because I called her earlier to see if the doc was running on time and once again asked during the check-in process. She was on-time is what I was told. I waited an hour the last time in the waiting room.

The climate at my work is delciate with lay-offs because of the economy. I took an hour and 1/2 from work to make this appointment and frankly, she was no-show.

Is this really a usual wait standard? Should I find another? Should I write her a letter?