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Chaperones for exams.

  • 1.  Chaperones for exams.

    Posted 01-15-2019 18:56
    Chaperones are very important for sensitive exams for both patient and physician protection.  Even though physician/patient gender technically should not matter, we all know that male physician - female patient is the highest risk situation.

    So, my question is particularly for male physicians practicing solo without staff:  How do you handle exams that should have chaperones?

    I asked this question to a individual (who happens to be a female physician).  She is a big proponent of going solo without staff as one of the best ways to practice and sells a product teaching people how to do so.  I didn't feel that she really had a good answer for me, as she basically expressed that she has never felt the need of having chaperones as a female physician.

    -An obviously easy solution is to have at least one staff member.  (However, it seems silly to hire a full-time assistant only because you need a chaperone if you were hoping to go the extremely low overhead model of having no staff.)
    -Have medical students rotate with you and use them? (Male student not ideal, and there is the question of whether or not a student should serve as a chaperone at all.)
    -Make sure the patient has a family or friend present? (Also not an ideal chaperone if there were accusations.)
    -Use a student premed/prenursing volunteer? (Seems a little strange).

    I may be overthinking things, but this actually seems to pose a big potential barrier to a male physician going solo without staff.  I am not married to this model, but would prefer it at least early on in my transition to an ideal practice.  Thanks!

    Bradley Shumway
    Gilbert AZ

  • 2.  RE: Chaperones for exams.

    Posted 01-15-2019 19:32
    Another obvious option is to just refer those patients to a female provider or gynecologist...

    Bradley Shumway
    Gilbert AZ

  • 3.  RE: Chaperones for exams.

    Posted 01-16-2019 08:28
    Great question and very pertinent.

    A few quick thoughts:
    Have an employee part time and schedule new patients or "higher risk" encounters during the time your employee is working.
    Obviously, the longer you know your patient, the lower the risk becomes to seeing them alone
    Have patients bring someone else into office for those higher risk visits (not ideal but perhaps better then seeing them alone)
    Especially if you are compensated for telephone calls, email, CCM, or have a DPC model, a large % of your work occurs without patient in office.

    Sublet space from another physician and "borrow" their employee when needed - you can work out compensation for that service.

    I have always been a proponent of the1 employee model.    I find there is always enough work to delegate to that person.  That is a major reason I keep billing "in house".  The 6-8% that would be charged by billing companies pays a large chunk of my assistants salary.  Frankly, I find it more "social" and just a nicer atmosphere having a long term employee in the office and more comfortable for the patients.

    Michael S. MD

  • 4.  RE: Chaperones for exams.

    Posted 01-17-2019 12:16

    This is a micro medical practice, that is, no staff..  It is different for male and female physicians, just the way it is I guess now.  I discuss this with new female patients over the phone prior to our first exam. Most of them  have their own gynecologist or go to Planned Parenthood.  I'm able to see them urgently if they have sudden concerns such as a breast lump or infection etc. but they come in with a chaperon, usually a spouse or close friend, even though they often say it is not necessary.  This arrangement seems to have worked well for the past five years.  I chronically weigh the pros and cons of having an assistant versus no employees, or joining a group. 

    Greg Putalik MD

    Harbor Springs Med Ctr

  • 5.  RE: Chaperones for exams.

    Posted 01-16-2019 12:47
    I have a part-time medical assistant, which is a big help. She is able to work on things that are not extremely time sensitive when she is in the office. The overhead for one part-time staff member is not much.

    I try and schedule exams such as these for times when she will be in the office. It is not a perfect solution but it works well enough.

    Lastly, although I know it sounds cliché, if you focus on doing the right thing for the patient, you will be OK. So, for times when the patient really Needs a “sensitive exam” and it is unexpected, I just do it anyway.