Wednesday, March 24, 2010

First time here?

In the shadow of historic health care reform's bill signing, newFNP gently knocked on a patient's door prior to doing her physical exam.

NewFNP does not room her own patients, but she has instructed her MAs to have the patient completely undress, don the paper gown open in front for ease of breast examination and place the paper drape over the lap for maximum modesty protection.

Rarely does the patient take this instruction, passed along by newFNP's MA, to heart.

Most often, the gown is open in the back. No big whoop - newFNP just opens the gown in the front for the breast exam. Sometimes, the patient will undress from the waist down only. Gentlemen will often keep their underpants on while otherwise undressed.

But for the first time, newFNP opened the door to see a 38-year old woman stark naked sitting on the exam table, folded gown and drape sitting untouched beside her. NewFNP reminded her as to how to utilize the paper goods and exited the room.

In what universe do we just hang out nude in the exam room? NewFNP knows that this woman has been introduced to Western medical practice because it was not her first time at newFNP's clinic. So what gives? Are there places in which patients are examined in the buff?

It's also shockingly common for newFNP to enter the exam room for a well woman exam and see the patient supine on the exam table, as though newFNP wasn't going to talk to her at all prior to assessing for cervical motion tenderness or discharge. It's not a stretch for newFNP to imagine that in other countries, where paternalism is a more welcome value in medicine or where there is a large uneducated, illiterate population, providers really do just do the exam and move on.

But newFNP really would like to have some type of therapeutic partnership with her patients and would hope that she could give them some health tools to take home. Therefore, it's pretty helpful for newFNP to chat them up while A) clothed, albeit in paper and B) in a seated position rather than in the relatively powerless supine or lithotomy positions!


Anonymous said...

Just 2 cents-dont know where this lady is from but in parts of europe where my family now lives, this is normal and expected. the doc checks you from head to toe naked. theres no shame - the pt is there for a physical anyway and its more wholistic done nude. to exam a gowned pt is lazy on doc part over there.

Laura said...

I've had similar experiences.. in fact that might be a good blog post.. how to behave in an exam room!

Anonymous said...

I sometimes lie down on the exam table when not feeling well.

Not feeling well is one of the main reasons I go to a healthcare provider.

Sometimes, it's a long wait for the provider to get into the room. I almost always sit up when the door opens.