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Medical Justice

Making healthcare safe for doctors


Healthcare Reform

Why Not Bring The Entire Staff Into the Exam Room for My Prostate Exam?

02/26/16 3:17 PM

I live in North Carolina. Each year I have a general physical exam. This includes the ritual known as the prostate exam. I don’t particularly look forward to it. But, it takes a few seconds and I’m reassured knowing that there are no lumps or bumps. My internist is male. And, in the exam room, it’s just the three of us – my doctor, the electronic medical record, and me.

But, if I cross the border into Georgia for the same exam, the exam room may be more crowded.

The Georgia Composite Medical Board recently proposed new rules defining “Unprofessional Behavior.” One new rule, if adopted and enforced, would redefine “unprofessional conduct” to include:

Rule 360-3-.02(12):

“Conducting a physical exam of the breast and/or genitalia of a patient without a chaperone present.”

This Rule would replace the existing Rule 360-3-.02(12) which currently reads:

“Conducting a physical exam of the breast and/or genitalia of a patient of the opposite sex without a chaperone present.”

The pre-existing rule was not perfect. If a patient does NOT want another person in the room, it should be their right to keep the traffic down – even if the examining doctor is of the opposite sex. The old rule is silent on whether the chaperone needs to the same sex as the patient. So, read literally, a male doctor could bring in another male staff-member to comply with the pre-existing rule for say, a gynecologic exam.

Now for the potential consequences of the proposed rule.

My yearly prostate exam would fill the room with yet another individual. I’m male. My internist is male. The proposed rule would add another body in the exam room. Might be male; might be female.

And, my exam is more than a prostate exam. My shirt is off and my heart and lungs are auscultated. Since the stethoscope touches my breast, does this now turn into a “breast exam?” Must the chaperone come back in?

Why not put in some bleachers?

On January 7, 2016, the Georgia Composite Medical Board referred the proposed updated rule back to the Rules Committee “to address concerns.” So, it’s not a done deal just yet.

It’s not clear from the Board’s minutes what these “concerns” were. But, my chest and my prostate can name a few.

Posted by Medical Justice | in Healthcare Reform | 10 Comments »
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Rebecca
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Rebecca

In Georgia, actually, someone I was in residency with was accused of sexually assaulting a woman during a breast exam. It protects the doctors as much the patient if a patient were to fabricate sexual assault.

Now, I cannot imagine sexual assault occurring during a prostate exam, but people continue to do inappropriate things.

I am all for having a chaperone in the room when I am with a patient who is disrobed and in a potentially compromising situation.

Eric
Guest
Eric

The law of unintended consequences.
Touching a breast when listening to the chest is one such example.
The doctor and patient should decide who is in the room NOT the state.
As a male I personally never perform breast or genital exams without female nurse present.
I am sure that 99.9% of my male pts do NOT want a female nurse in the room for testicular or rectal exams.

Gregory Laurence
Guest

I’m just glad they haven’t legislated whether a physician must either perform or avoid the prostate/DRE. I grew up in central Texas, and we remember when Kenneth Cooper (the father of aerobic exercise) almost had his license taken away because he exercised post-myocardial infarction patients. The more our professional boards stay out of our exam rooms and the insurance companies stay out, the better off we all are.

Anon
Guest
Anon

The last prostate exam I allowed was four years ago, and I ended up with a terrible complication – The internist opened up an anal fissure with his fat finger. The unbearable pain that followed led to a colorectal consultation, and sphincterotomy which thankfully was curative. For sure, whoever coined the phrase, “pain in the ass”, had an anal fissure. I know this is off topic, but my experience made me go through the algorithm of what would follow if a nodule were palpated during the “finger sweep”, and none of it is good – even with Gleason >5 CA,… Read more »

Michael M. Rosenblatt, DPM
Guest
Michael M. Rosenblatt, DPM

Why doesn’t the GA Medical Board also require at least one plaintiff’s attorney be present for each prostate/breast exam to proctor the procedure? The attorneys could charge 350 dollars/hour from the doctor/hospital for their presence. The attorneys could then create a separate “proxy service” for all doctors.

Your technical assistant would then call the Bar to arrange a proctor. I’m sure the regulation would be backed by their lobby.

Michael M. Rosenblatt, DPM

Michael M. Rosenblatt, DPM
Guest
Michael M. Rosenblatt, DPM

(Correct submission)

Why doesn’t the GA Medical Board also require at least one plaintiff’s attorney be present for each prostate/breast exam to proctor the procedure? The attorneys could charge 350 dollars/hour from the doctor/hospital for their presence. The attorneys could then create a separate “proctor service” for all doctors.

Your technical assistant would then call the Bar to arrange a proctor. I’m sure the regulation would be backed by their lobby.

Michael M. Rosenblatt, DPM

Anon
Guest
Anon

MMR – Still laughing at proctologist proctor.

steven teitelbaum
Guest
steven teitelbaum

Jeff- I think a prostate exam in Georgia will remain as a dinner for two because the proposed law in question called for a chaperone when examining “genitalia.” Need I remind anyone that “genitallia” are the external reproductive organs? Though the anus lives in that neighborhood and though some people let it party with the genitals, indeed as written the law would not apply to an anal exam. But wouldn’t examining for a hernia require a chaperone? True, the doctor’s finger does feel the inguinal canal through the scrotum. But they aren’t examining the scrotum, and the proposed language does… Read more »

Anon
Guest
Anon

It’s true that the majority of male genitalia is external, but not all of it –

“The male internal genitalia comprise the testis, epididymis, vas deferens, seminal vesicle, ejaculatory duct, bulbourethral gland, and the prostate.”

@PathologyChief
Guest

Has anyone recently validated the DRE? As a pathologist, I not infrequently examine prostates removed for CA and can have difficulty palpating prostate CA, even when the gland is serially sectioned on a table in front of me! I just don’t think the DRE is that important… Would love to hear some Urology input on this issue…