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Chaperones No Sure Thing During Pap Smears

More male doctors than female tend to have aides during procedure

FRIDAY, Dec. 5, 2003 (HealthDayNews) -- While most family doctors use chaperones when administering Pap smears to women in their offices, there are few rules to guide them and their patients as to whether someone should be in attendance during the procedure.

The result is a surprising lack of consistency in when chaperones are used during the procedure, says a University of Michigan Medical School study.

"I had no idea there was so much variation. I assumed you had to have a chaperone during the procedure, but found there weren't any laws in any state that said that the doctor had to have a chaperone," says study author Dr. Pamela Rockwell, a clinical assistant professor of family medicine at Michigan. Her report appears in the November/December issue of the Annals of Family Medicine.

Rockwell and her colleagues reviewed 2,748 responses to a questionnaire sent to some 5,000 members of the American Academy of Family Physicians, and found 75 percent reported using chaperones when they performed Pap smears.

The biggest discrepancy between chaperoned and non-chaperoned Pap smears was according to gender. Eighty-four percent of male doctors used the chaperones, compared to only 31 percent of the female physicians. Geography was another divider, with 89 percent of doctors in the South using chaperones, compared to 66 percent of Midwestern doctors and 72 percent chaperone use in both the Northeast and West.

In addition, doctors who performed fewer than 20 Pap smears annually were much more likely to use a chaperone than those physicians who did more than 20 a year.

A chaperone, which Rockwell defined as a medical assistant or a nurse, helps the doctor by handing him or her the equipment used for the test, which is recommended for women for early detection of cervical cancer.

In the early part of the 19th century, the chaperones were recommended to comfort patients in the doctor's office. Starting in the 1930s, however, medical literature began recommending the presence of chaperones to protect the doctor, suggesting "it was unwise to examine women without a third party," Rockwell says.

However, she says, no state has any regulations mandating chaperones, "although there's a lot of strong language to suggest that this should be encouraged."

"In today's litigious society, although there is no legal stipulation, gynecologists should always have a chaperone. Men especially, but women, too, can still be accused of sexual impropriety," says Dr. Megan Bray, a gynecologist at the Georgetown University Medical Center.

Bray herself always uses chaperones except when she's treating longtime patients, but adds it might be easier for her because she works in a teaching hospital so there are students who can act as the third party during examinations.

"A lot of people don't have the office staff to do the moving of patients in and out and then also be available to chaperone," she says.

What's important to note, Rockwell says, is that whether or not a doctor uses a chaperone can be quite random, depending on geography, the doctor's gender and the training he or she had, so patients shouldn't be shy about asking their doctors about it.

Rockwell finds that, in her practice, "the majority don't care" if a chaperone is present. But, she adds, "If a woman truly has a preference, she should voice it because she's not necessarily going to get asked."

More information

The American Society for Clinical Pathology outlines why it's important to have Pap smears. Meanwhile, Vanderbilt Medical Center explains a new kind of Pap smear.

SOURCES: Pamela Rockwell, D.O., clinical assistant professor, family medicine, University of Michigan Medical School, Ann Arbor; Megan Bray, M.D., assistant professor, gynecology, Georgetown University Medical Center, Washington, D.C.; November/December 2003 Annals of Family Medicine
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