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Life in Emergistan: A Brave New World

Leap, Edwin MD

doi: 10.1097/01.EEM.0000469330.22755.d2
Life in Emergistan

Dr. Leapis a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available atwww.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, www.edwinleap.com/blog. Follow him @edwinleap, and read his past columns athttp://bit.ly/LeapCollection.

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For my entire life as a physician, from medical school, through residency, and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic, and rectal exams on women. Why is this?

On some level, the woman being examined probably feels more at ease having another woman in the room when a man is there. There is a remarkable vulnerability and intimacy to those sorts of exams. But at least as important, the tradition exists to prevent any inappropriate sexual advances or behavior by the provider and to witness that they did not occur. It was an idea predicated on a traditional view of sexual attraction and behavior. Men did not typically use chaperones when examining men, and women did not generally use them when examining women. In fact, I recall that women seldom were chaperoned when examining men. After all, we were taught that only men are sexually aggressive, and a female physician would never do anything like that.

Now, however, it's a brave new world. I wonder, what shall we do with the whole chaperone thing? I did a little reading online, and one of the fundamental tenets of LGBT health care is that nobody feel compelled to reveal his sexuality. Fair enough. But what does that mean in terms of chaperones?

If a gay physician examines a straight man's genitals or performs a rectal exam on him, should that physician bring a male or female chaperone? And what about the sexuality of the chaperone? If the gay physician has a male chaperone, shouldn't we ensure that the chaperone is straight? And if the female chaperone is a lesbian, I suppose it would be better than having a straight female chaperone because she might also find the exposed man sexually interesting. And if a lesbian physician performs a pelvic exam on a woman, it makes sense that she have a straight female chaperone. But would a gay man be just as good? A straight man certainly wouldn't do.

What if the patient is gay? Would a lesbian physician need a chaperone? Would a lesbian patient need her gay physician to have a chaperone? What about a patient or provider who is bisexual?

Sexuality aside, what happens when the patient or physician is transgender? I mean, I'm a baby-boomer and a little confused, but it stands to reason that a man who identifies as a woman could be a lesbian who is attracted to women and comes sort of, you know, full circle. Dare we inquire, in medicine, about gender and sexuality when it pertains to being alone with a patient? Should we update the charts of our patients regarding gender? Can a female physician, who is a self-identified male, be trusted to examine a lesbian patient alone? Or indeed, a gay patient?

What happens when the accusations fly in any of these scenarios? Who will be liable when someone alleges that he was assaulted or touched by someone who was sexually attracted to them, but who the patient never realized was of an alternate gender or sexuality?

Of course, this is not to suggest that any of these groups are particularly prone to sexual predation. Most of us, even the whitest, male, and straight, are not sexual predators. But for the good of our patients, it was always assumed that we might be.

We tend to believe that when we change societal norms, it's always a liberation, always a move from uneducated to enlightened, from repressed to expressed. But as I ponder the issue of chaperones, I'm not sure. What I am sure of is this: Equality means that everyone gets distrusted just as much as everyone else. It means that we're all equally nice and good at times and equally bad and dangerous at others. And I suspect it means we'll be needing a lot more chaperones in the future.

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