I recall ages and ages a go a discussion on this subject. I think you were a party to it. If so, you might find this interesting. If now, well, hope the rehearsals are going well.
Chaperone Use During Pap Smears: A Newsmaker Interview With Mack T. Ruffin IV, MD, MPH
Laurie Barclay, MD
Nov. 25, 2003 — Editor's Note: Family physicians in the U.S. vary significantly in reported chaperone use, according to a study published in the December issue of the Annals of Family Medicine. Those using chaperones are more likely to be male, younger, and from the South.
A survey of 5,000 randomly selected members of the American Academy of Family Physicians assessed practice procedures employed by physicians during a Pap smear, with chaperone use a secondary item rather than the main focus of the questionnaire. Response rate was 71%.
As expected by the investigators, gender was the best predictor of chaperone use, reported by 84% of male doctors and 31% percent of female doctors. Surprisingly, however, there were other significant predictors of chaperone use, including frequency of Pap smears performed, age, and regional variations.
Despite potential medicolegal or ethical issues surrounding unattended Pap smears, there have to date been no guidelines or requirements concerning chaperone use, and the authors note that the topic is "poorly addressed both by the medical literature and our current medical education system." To learn more about the implications of this study's findings, Medscape's Laurie Barclay interviewed senior author Mack T. Ruffin IV, MD, MPH, an associate professor of family medicine and a research scientist in epidemiology at the University of Michigan.
Medscape: What were the main findings of this study?
Dr. Ruffin: Family physicians vary significantly in the reported use of a chaperone during the collection of a Pap smear. Significantly more male physicians (84.1%) reported using a chaperone than female physicians (31.4%). Physicians reporting routine use of a chaperone were significantly younger and did fewer Pap smears per month. There was a significant regional variation of reporting chaperone use with 71.6% in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West. Female physicians in the South are as likely to report use of a chaperone as male physicians in the Midwest or West.
Medscape: What factors best explain variations in chaperone use?
Dr. Ruffin: From our study, we are unable to explain the variation. We theorize that it might be related to training differences related to age or regional differences in culture or in women's expectations.
Medscape: Were you surprised that factors other than physician gender played a role in chaperone use?
Dr. Ruffin: No. In my professional life I have practiced in several different regions of the country. In the South, where I trained, I was taught that you always use a chaperone for a pelvic exam. In Minnesota, I was considered strange and very conservative because I used a chaperone. This response came from physicians, staff, and patients.
Medscape: What are the main study limitations?
Dr. Ruffin: The data was self-reported by physicians, so some responses may not have been valid. However, the focus of the data collection was not on chaperone use but on cervical cancer screening, so it seems unlikely that the physicians would have been strongly motivated to respond in some socially desirable manner that did not reflect their practice.
Medscape: What are the medicolegal issues underlying chaperone use for Pap smears?
Dr. Ruffin: I am not a lawyer so I am not qualified to respond. All legal experts' opinions on this topic are very directive that use of a chaperone is essential to protecting yourself. They point out that if there is a misunderstanding then it evolves to a matter of the physician's statement versus the patient's claims, with no supporting witnesses. There are very inconsistent requirements by states. There is no data related to medical license governing bodies that lack of a chaperone would have avoided suits or claims against physicians.
Medscape: What role should patient preference play in the decision to use a chaperone?
Dr. Ruffin: It remains unclear; the data are limited and inconsistent.
Medscape: Should guidelines be issued for chaperone use during Pap smears? If so, what should they be, and how would they change existing practice?
Dr. Ruffin: I do not believe there is need for a guideline since we lack data to determine if there is a need for such a guideline.
Medscape: Is additional research planned in this area? What questions should future studies address?
Dr. Ruffin: We would like to proceed with understanding the views and perceptions of women and men. There are no data on men with respect to their desires related to chaperone use during genital exams. We would also like to explore the issues of cost, time, and patient satisfaction with a chaperone.
Medscape: Is there anything you would like to add in closing?
Dr. Ruffin: This is a topic and line of research that the [National Institutes of Health] and private foundations are not interested in funding. It does not reflect the current interest in molecular issues. It seems that some group or organization would be interested in such issues that have a direct impact on patients' satisfaction with their interactions with the healthcare system.
Editor's Note: The Research Council of the Department of Family Practice and Community Health at the University of Minnesota, the Bureau of Health Professions HRSA Grant for Faculty Development in Family Medicine, the Minnesota Medical Foundation, the American Academy of Family Physicians Foundation, the American Cancer Society, and the Research Committee of the University of Michigan Department of Family Medicine supported this study. The National Cancer Institute supported Dr. Ruffin. None of the authors report any potential financial conflicts of interest.
Ann Fam Med. 2003;1(4):218-220
Reviewed by Gary D. Vogin, MD |
