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I remember a scene in one of my favorite movies that depicts “dating in Sicily.” The Godfather’s son Michael was courting his sweetheart and wherever they went they were followed by a group of females who ranged from mothers, grandmothers and friends. This prevented the young couple from spending time alone and possibly falling into a sexual temptation. The idea was that this long standing tradition helped to “prevent the very appearance of impropriety.”
A couple of months ago there was broad discussion on the forums concerning the use of chaperones in an examination room. Many of us have used common sense and were accompanied during genital, pelvic or breast examinations, but what about other exams? This is a controversial subject however one that needs to be considered by PAs. Accusations, no matter how baseless, have the ability to ruin a professional’s career and involve them in many months of defense. The laws concerning complaints against a physician or PA are similar in most states and when a complaint is filed the Office of Professional Medical Conduct or its equal, is obliged to investigate. Investigations take time and in the interlude between the accusation and the official findings, the person will usually be terminated or relieved of their clinical duties.
Reputation, license and defense costs are all on the line; therefore, this is a subject that requires our consideration. This year, through some of the online communities and professional organizations, chaperoning will be a subject of focus. We need to look at this subject from the standpoint of the person who is the “witness” and their sex (Should a male be with a female or vice versa?) Does this witness need to be another health care provider? Can the patient sign a consent that states that they DO/DO NOT wish to have another person present during an examination? We need to consider that this will require the input of practice administrators, lawyers, possibly state DOH personnel as well as representatives from the insurance company.
What can we offer at the moment, in terms of protection? First, it is imperative that the physician assistant have a personal liability insurance policy. This suggestion removes the concern for a proper defense without emptying a savings account or selling personal property. This obligation to you and your family cannot afford to be held off for a better time as insurance cannot be purchased after the fact. Secondly, I suggest good judgment. This means having someone present during exams that may be considered riskier from a potential complaint point of view. This person could be a nursing assistant, orderly, nurse or anyone designated by a practice administrator. Lastly, for the moment, there should be a meeting of the involved professionals of the institution, hospital or office to both discuss this subject and write a policy that offers some protection to both.
“There can be no malpractice without established practice; a physician cannot be convicted of deviating from accepted standards if no accepted standards exist.”-James C Mohr. Our profession is faced with the reality of the need to address this issue and establish the standards.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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