Survey of 200+ men’s satisfaction with annual physical exams

Medical professionals wrongly assume that men are less sensitive about modesty than their female patients, but that may not be true. Most men would not be comfortable with a doctor, even a male one, watching them give a urine specimen. Men in public restrooms would object if they caught another man eying them while using a urinal. Yet in the doctor’s office, any manner of watching and inspection may occur, and it is perfectly natural for patients to feel a loss of privacy. Men who desire modesty in medical settings are sometimes mocked, but health care professionals need to respect patients’ rights to decline examinations.

For those who are afraid to speak up, perhaps this article can be printed out and handed to doctors as a discussion starter. It all boils down to which is going to trump: patients’ desire for modesty even at the expense of following the standard routine for care, or the doctors’ desire to care for patients in a style the doctor prefers even if it makes patients feel an invasion of their privacy. If a patient declines to undress completely for a physical exam, that patient is merely exercising his right to choose what types of health care services he receives.

One medical doctor expressed the idea of patient rights to modest very well in the following quotation. “The concept that physical modesty will ever trump diagnosis and treatment of disease as a decision by a patient is also, I believe, one patient decision that all in medical teaching or practitioners of medicine are unaware. It will take specific education along with changes in the systems, not just of medical students, but also the physicians, nurses, technicians and all of those who run medical schools, nursing schools, hospitals and clinics, so that they can be made aware that all the undressing, draping techniques, positioning, touching and standard communication with patients are still inadequate to meet the emotional needs and demands of some patients with regard to their patient modesty.” http://patientprivacyreview.blogspot.com/2012/01/teaching-medical-students-about-patient.html

For one project, I interviewed over 200 men about their experiences getting physical exams. About 70% were generally satisfied with their doctor and their physical, but some suggestions emerged about better ways to conduct physicals. One complaint I heard frequently is that the doctor does his standard routine for a physical in an impersonal, almost robotic style. If you click on this link

you will see that I used the phrase “robot-like” in an interview I gave for a Web TV program on the health outcomes effectiveness of the head-to-toe physical exam. Second, and this was one of the biggest complaints, doctors never took any time to talk about trust with patients. If they had taken the time to talk about trust, it would have made a big difference in the satisfaction level. Talking about trust for 10 minutes would go a long way towards solidifying the doctor-patient relationship — but it can’t be fakey. The doctor has to acknowledge his own modesty issues and not treat the patient as someone who does whatever he is told.

Instead, the men reported that their doctors just presumed if they scheduled appointments then they consented to a head to toe physical exam. Surprisingly, men who think of themselves as being in control at work suddenly become very passive around doctors. Most did not seem to mind that their doctors ordered them to undress, rather than politely asked them to undress. Nearly half of the sample reported being examined by seemingly bored and indifferent physicians: the patients were just specimens to be examined rather than treated as human beings.

A third complaint concerned a sense of being violated unintentionally during the GU portion of the exam. Basically, the patient remains covered for the whole exam, and then lowers his pants and underwear at the end for a couple minutes. The patient feels exposed and vulnerable and maybe gets a digital rectal exam, and then he zips up his pants and leaves. He has not had time to adjust to the sudden nudity, exposure, and invasive exam before it is all over, and he is getting redressed. Some men still sense the lingering feeling of violation as they are walking to their cars in the parking lots. Doctors sometimes trivialize patient anxiety over the GU portion of the exam, and that demeans the patients.

My sample of about 220 men suggested that most would prefer the doctor talk about trust, and then begin the exam with either a skin cancer check or the testicular exam. If there is a DRE, it can come after the testicular cancer check. By getting that part over up front, the patient avoids dreading it throughout the exam. By commencing with the GU exams, the patient has time (20 – 30 minutes) to adjust to his exposure and relax with it. After the DRE, medical ethics would normally require that the patient be draped so his private parts are not left exposed. Surprisingly, most men who have remained uncovered for the remainder of the exam say they prefer it that way, not because they are exhibitionists, but because it gives them time to relax in that state and shake off that initial feeling of being exposed and then violated.

Even though the doctor is professional, men will often feel somewhat violated with the DRE, simply because it feels invasive or unnatural. Contrary to doctor assertions that “patients should just get over it,” many men do not get over it — and we have seen as a consequence that men are much less likely than women to see a doctor for preventive check ups. Some of the men in my survey made comments such as “I’ve been fingered seven times.” Why would a man keep count like that if he was not slightly traumatized each time it happened?

“It is apparent that most doctors have rarely considered how their patients feel in similar situations, yet they don’t have to be told that they want their own modesty protected. . . . Not many patients are comfortable sitting around naked. Beyond that, most physicians are not comfortable interviewing and examining naked patients,” Joel Sherman, MD, as posted on http://patientprivacyreview.blogspot.com/2012/01/teaching-medical-students-about-patient.html

We can distinguish between two scenarios. If the doctor takes the time to talk about trust with the patient, and the patient achieves a degree of comfort as a result in being undressed around the doctor, then some men are comfortable remaining undressed for the rest of the exam. However, if the patient is ordered — not asked politely — to strip off all clothes and sit on the exam table waiting for the doctor, then men are more likely to resent the doctor, but only a few would not comply.

On a separate but related subject, 10% of the men in my survey reported inappropriate touching and comments during a physical exam at some point in their lives. The most common age groups to be exploited were (1) young naïve teenagers, followed by (2) guys in their 20s getting their first required physical for employment, followed by (3) men getting their 3rd or 4th DRE. What happens? It all seems to focus on the doctor deciding to amuse himself by seeing if he can get the patient erect. Thus, e.g., these unethical doctors wait until they are palpating the testicles and then ask the patient about his wife/girlfriend, sexual practices, etc. Some doctors palpate the testicles far longer than necessary to see if they can get the patient aroused. One urologist in Newark, Delaware, had a 35 year old asymptomatic patient, who made an appointment because his father had been diagnosed with prostate cancer. The urologist has the man with pants and underwear down and massages the testicles for 4 or 5 minutes until the man becomes erect. Then he has the patient step out of his pants and underwear, orders the patient to place the patient’s two hands behind the patient’s head in an obvious sign of submission, while the doctor resumes palpating the testicles. When he is finished, the doctor says “Let’s see what you’ve got,” and gives the patient three quick tugs on his glans. Then he smiles and types in some notes on the computer.

The DRE abuse concerns primary care doctors performing the DRE, and then instead of turning away and giving the patient privacy to clean up, the doctor withdraws his finger and immediately takes the patient by the shoulders and spins him around just so the doctor can see if he is erect for the doctor’s own amusement. Whenever a patient tells me that has happened to him, I always encourage the patient to report the doctor to the medical licensing board. If every patient remains silent, the doctor will think he can continue with this lewd conduct and not get caught.

My recommendations as a health outcomes researcher and also a lawyer are for PCPs (1) take 5 – 10 minutes to talk to the patients about trust, find out if the patient has modesty issues, don’t presume the patient wants to be examined rather than feels he has to be examined. (2) give the patient the option of changing the sequence of the body systems covered in a physical exam, and (3) for those who choose to get the GU portion upfront, offer the patient the option of being covered or remaining uncovered for the rest of the exam, and (4) do not badger patients who decline the GU portion of physicals. It all boils down to dropping the “one size fits all” approach to head-to-toe physical exams in which patients are forced to conform to the doctors’ style of examination and adopting a format and structure tailored to each patient’s medical concerns as well as his degree of modesty.

Both comments and pings are currently closed.

Comments are closed.