Re: Chaperone Use During Pap Smears: A Newsmaker Interview With Mack T. Ruffin IV, MD, MPH

[Guest guest]

Here's another link to the original article in ls of Family

Medicine:

" Chaperone Use by Family Physicians During the Collection of a Pap

Smear "

http://www.annfammed.org/cgi/content/full/1/4/218

Personally, I was surprised to see that only 84.1% of male physicians

used chaperones. In this litigious day and age, I would think it'd be

100%.

Seto

South Pasadena, CA

> I believe we've talked about the issue of chaperones and solo

> practices before.

>  

> Here is an interesting article.

>  

> http://www.medscape.com/viewarticle/464821

>  

>

> Locke, MD

> Basalt, CO

> FP Residency Graduate 1994

> 5 Years in Air Force (Texas, Germany)

> Private Group Practice since 1999

> www.alpinemedical.md

> Job Share w/ Wife

> =======================================================================

> =

> 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 thels 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 D. Vogin, MD

>

>

>

>