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kevin d. evans
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Dear friends,
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I just hate to open up this can of worms but...this topic was posed to
--
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me yesterday at work so I would like your experienced feedback:
Yesterday, the medical director of our satelite hospital asked me
personally, if I was using a chapprone when conducting pelvic and
transvaginal ultrasound. My response was no, and in some part it is due
to the low staffing in our department not allowing for this opportunity.
It appears that a male sonographer at the main campus hospital has been
excused from conducting gyn sonography because they also have no one to
chapprone his exams. I was shocked!
I have been conducting pelvic sonography since 1981. In that time, I
have rarely had anyone available to chapprone my exams. I will also say
that I have never inserted the transvaginal probe. I ALWAYS have the
patient insert the probe themselves. On occasion that has been tricky
for older patients but 99% are completed by the patient. All my
patients are covered by a sheet and are constantly questioned about
their comfort level.
The only exception to this rule are of course minors and then I just
involve the mother as my "helper".
I just refuse to give up a medical procedure that I give to patients in
a professional manner due to risk management's hysteria. I have been
known to tip patients for barium enemas and no one can be found to
chapprone that activity. I even recently heard a NP tell me that the
colorectal surgeon is now using chapprones when he checks patients due
to his fears. Amazing!
I have had conversations with a local nurse attorney about this subject,
her advise was," Kevin, always do the exam the same way. Never change
what you are doing because if you were ever asked to testify about the
manner in which you conduct the exam, you should be 100% accurate. Your
memory might not serve you as to the patient or her exam but..you are
certain as to how it was conducted. You should never say
well...sometimes I insert the probe and ....sometimes the patient
inserts the probe. Sometimes I use a staff chapprone and sometimes I
don't. That just opens up the issue of why you are not consistent. Why
do some patients get treat differently? Why did you choose this patient
to do the exam in a different way??" Yikes!
So here we go, as ultrasound professionals can we continue to conduct
our work in a highly professional manner or.. are male sonographer
going to be excluded from this challenging and exciting part of our
profession??
Kevin D. Evans, MS, RT(R)(M), RDMS
Rich Dempsey
USA
88 Posts Posted - 09/22/2001 : 18:57:23
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Kevin:
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There are no medical facilities that I have "temped" at (50+ over 10
years) where males are performing vaginal ultrasounds without
chaperones. ABSOLUTELY NONE.
Department policy in many facilities now require a female to be present
even while a male physician does breast (US) exams. The requirement for
male GYN's to have a chaperone present during bi-manual pelvic exams is
long-standing, and wise.
Kevin...YOU ARE RUNNING AN INCREDIBLE RISK!!!!!!!! STOP.
A single allegation will destroy your reputation and your ability to
practice. You can be ruined finacially trying to legally defend
yourself against an allegation of impropriety. No one will employ you
in the years that it takes a civil suit to work its way through the
courts.
Eh......I could go on. FOREVER.
Stop doing unchaperoned endovaginal exams , at least untill, you have
reviewed your malpractice insurance to see if you are protected both in
civil and criminal lawsuits. You might ask your accountant how much you
would stand to lose if you became a victim of a civil lawsuit. (Where
evidence standards are less stringent)
You might also consider your employer saying "Gee Kev, we know this
allegation of "improper touching" is BS, but it looks bad for our
facility, the way the newspapers are playing it. We've lost all of our
GYN referrals. We think it is best for you to resign. We will
certainly be glad to consider re-hiring you when you have cleared your
name." Adios MF.
You might also remember the tendency of people to think "where there's
smoke, there's fire", after some wacko claims they felt "violated,
humilated, and demeaned" after you did an un-chaperoned EV exam on them.
The Plaintiffs lawyer will ask in court if it SOP or the
"community-standard" for unsupervised males to perform EV exams.
I ASSURE YOU KEVIN....IT IS NOT!
As to EV's on minors with the girls MOTHER alone present... sheech..
really !!!!!!!!!
No legal protection there.
STOP!
Rich Dempsey RDMS/RVT
http://communities.msn.com/RichWendysAwayFromHomePage
Edited by - Rich Dempsey on 09/22/2001 18:59:56
Edited by - Rich Dempsey on 09/22/2001 19:09:32
hxrosw
USA
3 Posts Posted - 09/22/2001 : 19:34:01
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I am a 53y/o reg. in Abd., Og-Gyn.& RVT; I have benn working for a
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Catholic Hosp. system. in N.Y.C. since 1993. I have worked all 4
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Hospitals in our systems, at all imagaginal hours. I have never perf.
an unchaperoned TVag. study, as per our policies. However, I do perf.
unchaperoned Breast Sonos. Unless impossible to avoid and life
threatening, we, i.e. the male technologists, do not perf. Transvag.
sono on pts. under 18 y/o; We have demanded written guidlines for this
exigency & never have we received an adequate written response. I do
not condider getting a pos. FHM 5 days earlier an emergant situation;
respectfully yours H. Rosenzweig RDMS; RVT; Queens New York City.
9/22/01
H. Rosenzweig RDMS; RVT
PCB
USA
21 Posts Posted - 09/23/2001 : 18:20:46
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I have never heard of a Male Sonographer doing this study by themselves.
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Even I as a female Sonographer "never" insert the probe myself. I
--------------------------------------------------------------------------------
alsways have the patient reach under the sheet and insert probe. Times
have changed. All it take is one spitefull patient to destroy your
career.
quote:
--------------------------------------------------------------------------------
Dear friends,
--------------------------------------------------------------------------------
I just hate to open up this can of worms but...this topic was posed to
--------------------------------------------------------------------------------
me yesterday at work so I would like your experienced feedback:
Yesterday, the medical director of our satelite hospital asked me
personally, if I was using a chapprone when conducting pelvic and
transvaginal ultrasound. My response was no, and in some part it is due
to the low staffing in our department not allowing for this opportunity.
It appears that a male sonographer at the main campus hospital has been
excused from conducting gyn sonography because they also have no one to
chapprone his exams. I was shocked!
I have been conducting pelvic sonography since 1981. In that time, I
have rarely had anyone available to chapprone my exams. I will also say
that I have never inserted the transvaginal probe. I ALWAYS have the
patient insert the probe themselves. On occasion that has been tricky
for older patients but 99% are completed by the patient. All my
patients are covered by a sheet and are constantly questioned about
their comfort level.
The only exception to this rule are of course minors and then I just
involve the mother as my "helper".
I just refuse to give up a medical procedure that I give to patients in
a professional manner due to risk management's hysteria. I have been
known to tip patients for barium enemas and no one can be found to
chapprone that activity. I even recently heard a NP tell me that the
colorectal surgeon is now using chapprones when he checks patients due
to his fears. Amazing!
I have had conversations with a local nurse attorney about this subject,
her advise was," Kevin, always do the exam the same way. Never change
what you are doing because if you were ever asked to testify about the
manner in which you conduct the exam, you should be 100% accurate. Your
memory might not serve you as to the patient or her exam but..you are
certain as to how it was conducted. You should never say
well...sometimes I insert the probe and ....sometimes the patient
inserts the probe. Sometimes I use a staff chapprone and sometimes I
don't. That just opens up the issue of why you are not consistent. Why
do some patients get treat differently? Why did you choose this patient
to do the exam in a different way??" Yikes!
So here we go, as ultrasound professionals can we continue to conduct
our work in a highly professional manner or.. are male sonographer
going to be excluded from this challenging and exciting part of our
profession??
Kevin D. Evans, MS, RT(R)(M), RDMS
--------------------------------------------------------------------------------
jaldendifer
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USA
4 Posts Posted - 09/24/2001 : 00:43:39
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Being a male sonographer I have established the following protocol and
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find that it to reasonable:
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Joseph R Aldendifer, R.D.M.S., R.V.T.
PROTOCOL FOR ENDOVAGINAL ULTRASOUND
1. EXPLAIN PREP AND PROCEDURE TO PATIENT
A. Female Chaperon to be present during explanation of the procedure
through the completion of the procedure.
Qualified Chaperon: Nurse, LVN, Aid, Medical Clerk, Technologist
FAMILY MEMBERS DO NOT QUALIFY AS CHAPERON
B. Reason for using Endovaginal Probe
1. Improved Quality of Resolution.
2. Ability to verify anatomy and confirm normal or abnormal findings
C. Patient has right to refuse procedure or to request that the
procedure be discontinued at any time during the procedure.
2. CHAPERON
A. The chaperon will stand at the left of the sonographer’s shoulder so
that they have eye contact with the patient at all times. In addition,
this position allows the chaperon to observe the performance of the
procedure and the placement of the technologist in regard to the
patient. The chaperon must remain in the standing position for the
entirety of the exam. Sitting down during the exam is not permitted, as
this would not allow the chaperon to observe the entire examination.
B. The chaperon is to refrain from comments regarding the findings or
appearance of finding during the exam. The chaperon may talk with the
patient calmly to assure comfort during the exam.
3. CONTRAINDICATIONS FOR ENDOVAGINAL ULTRASOUND
A. Patient refuses this portion of the exam.
B. Patient is a Virgin.
C. Minor with questionable history of sexual activity. Minor must be
tactfully confirmed as sexually active.
4. AFTER COMPLETION OF EXAM
A. Transducer to be cleaned and soaked in Cidex for 15 minutes. Do not
leave probe in the solution for extended period of time as it may result
in damage to probe.
5. RECORD CHAPERONS NAME ON PATIENT WORKSHEET
A. It is advisable that the chaperon signs that they witnessed the exam.
INDICATIONS FOR ENDOVAGINAL STUDY
• All women who are post menopausal 2 years or more
• Early pregnancy - 12 weeks or less
• Rule out Ovarian Cancer
• Obesity
• Not able to properly define anatomy with trans-abdominal technique.
• Physician Order or request.
jaldendifer
USA
4 Posts Posted - 09/24/2001 : 02:10:36
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Kevin,
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--------------------------------------------------------------------------------
This is not a subject I enjoy, because it is full of discrimination,
poor education, and policies made on emotional biases not
professionalism.
A chaperone is a must for all breast exams, endovagional studies, one
family member for all minors (plus chaperone for breast & pelvic)
In regards to not being able to work because of the unavailability of
chaperones in a almost exclusive GYN environment, I have found this to
be a legitimate situation because of staffing and economics. Just a
fact of life, accept it.
As far as having patients insert the probe themselves to reduce risk of
criminal legislation, forget it, you forced the patient to so if there
is to be an issue. I have found after trying many techniques that the
most comfortable and secure way of handling insertion of a vaginal
transducer is to do it yourself. It's quicker, the patient is actually
more comfortable, and it's the most professional way. The gynecologist
does not have a patient insert a speculum, a nurse does not have the
patient insert the foly, granted the following is not like a probe, but
by being coy and not professional there is an issue of sexuality being
raised when it should not be. Besides I have the luxury of my chaperone
turning down the lights after insertion.
I also have found majority of my female peers when quizzed in the past
agree with me. I will not argue the point that my procedure is absolute
but just state that I disagree by the above. For those that insist on
patient insertion, I will not campaign against because it removes a
comfort level that is needed in performing the exam.
Sexuality can also be an issue dealing with this subject such as scrotum
scanning by a female to have a chaperone. I know of several departments
that make that requirement, as well as males being homophobic insisting
on a female sonographer. What if the department sonographer is lesbian?
Should she be required to have a chaperone as well? Maybe the day will
come that we will all have to have a chaperone for all societies’
private anatomy.
With these conversations I find sometimes the most qualified are not
allowed to perform the exam, and that half of the work force is
eliminated because of sexual discrimination, poor patient education, and
no support of ancillary staff.
Good luck on your pursuit of what is correct.
Joe Aldendifer, RDMS, RVT
Charlotte Henningsen
USA
109 Posts Posted - 09/24/2001 : 10:15:35
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Kevin,
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You certainly have sparked some lively conversation. I have never
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worked in a facility that did not require male sonographers to have a
chaperone during EV and I do believe it is prudent in our legally
conscious society. I did look on the SDMS and AIUM website for position
statements regarding chaperones and did not find any. I do want to add
that comments from a patient made me feel very uncomfortable once, so I
asked the radiologist to be my chaperone. Once he came in, she ceased
her inappropriateness.
Charlotte
Orlando, FL
Anne Conner-Day
19 Posts Posted - 09/24/2001 : 13:35:44
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Kevin,
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It is the patient and the patient alone that has the right to determine
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who performs the transvaginal procedure. After explaining to the paient
that you are the most qualified to perform the exam then offer the
chaperone. I think this should work vice versa with testicular exams
too.
No one determines who does the exam except the patient after they have
been properly informed of all the facts.
Anne Conner-Day
jherzog
32 Posts Posted - 09/24/2001 : 13:55:58
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Kevin,
--------------------------------------------------------------------------------
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I have to agree with others on this topic. I feel that you are putting
yourself at professional risk by performing these exams unchaperoned. I
am, without a doubt, certain that you ARE extremely and consistently
nothing less than professional in carrying out these exams. However, I
have worked in one facility before and after the implementation of a
policy regarding chaperoning private exams. It was only after one
individual received the treatment that Rich is talking about that the
policy was generated. Unfortunately, this incident affected all of us
within the department, but certainly not to the extent it did the
individual. All it takes is ONE case of your word against the
patient's. Please BE CAREFUL!!!!
Regards,
Jill Herzog
VIE
3 Posts Posted - 09/24/2001 : 19:43:27
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To Joe Alfed...
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I think you are making a big mistake by inserting the trans-vag probes
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yourself on every patient, esp. without chaparone... as far as
legality, no one "forces" a patient to insert the probe themselves, it
is NOT a "no option" situation. Where we work, a patient is told that
they need to insert it themselves so that we are sure the transducer is
being inserted in the right direction, in the right place, and that it
doesn't hurt going in, and we assure the patient that if there is any
pain at any time the procedure is stopped immediately. At all times the
patient is covered by a sheet. I have not met one patient yet who told
me it would have been better if the ultrasonographer inserted the
transducer, that it would have made them more comfortable.
Please be careful in your practices.
DuBose
USA
172 Posts Posted - 09/25/2001 : 13:08:34
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Back when I was doing endovaginal exams, I used a chaperone; however
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most of the time I was in a teaching clinic and had a student with me.
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But I have also used file room clerks, secretaries, other sonographers.
Oddly enough, the hospital/clinics never brought up my having a
chaperone for breast scans, only endovaginal. But I would get one when
possible.
Also, the women sonographers were never required to have a chaperone for
scrotal scans.
I do know that all male Gynos that I know of do have a chaperone.
As someone said, this is one area where there is definitely some gender
discrimination going on… but it is going to be very difficult to deal
with, considering the costs.
Peace, Terry J DuBose, M.S., RDMS, APS
Peace, Terry J DuBose, M.S., RDMS, APS
http://www.io.com/~dubose/
jaldendifer
USA
4 Posts Posted - 09/25/2001 : 14:26:42
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To Vie,
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This is a response to I believe your comment on my two postings
regarding endovagianal exams; I am not completely sure since you
misspelled my name, but I am the only Joe on these postings.
First, my advice to Kevin was that there are situations to where a male
sonographer just does not full fill requirements because of gender and
economic cost of providing a chaperone, an accepted situation, hence,
deal with it.
Before Commenting on a discussion, you should READ all of the comment
and you will read that I DO NOT ADVOCATE NOR CONDONE BREAST OR
ENDOVAGIONAL PROCEDURES WITH OUT A CHAPORONE, NOR DO I DO SUCH
PROCEDURES WITHOUT A CHAPERONE. You will also note that my preceding
posted protocol state the above.
It is your prerogative to have the patient insert the transducer, it is
your exam. I in turn a sonographer who does routine endovagianal
ultrasounds with my patients’ permission and with a chaperone present,
has developed a routine around me personally inserting the transducer.
Patient draping is a very basic part of any medical procedure to promote
comfort of the patient and should be an understood part of all
examinations.
Your out of text comment is why I usually do not get involved with
subject at hand in this type of format, because of your misguided
response in an delayed open forum does put me and others at risk simply
by you stating that proper procedure in your mind was not followed.
Joe Aldendifer, RDMS, RVT
wgreenhut
USA
21 Posts Posted - 09/26/2001 : 09:28:46
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I have run into the situation, as a supervisor of a large (10
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sonographer) department where males were forbidden to perform routine TV
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exams, that I had to do them on call, always with a female chaperone.
Consequently, I did them so infrequently, (rotating every eleventh week
or so) that it was impossible to maintain a level of comfort in my
ability when it was emergent and most important for the patient.
You cannot get more hypocritical than that. Nevertheless, you must
protect yourself and the only way is by adhering to policy and accepting
that chaperone. Additionally, once Risk Management gets involved you
can forget about independent decision making.
Alan Sansome
USA
49 Posts Posted - 09/26/2001 : 16:58:55
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quote:
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Qualified Chaperon: Nurse, LVN, Aid, Medical Clerk, Technologist
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FAMILY MEMBERS DO NOT QUALIFY AS CHAPERON
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I am a male sonographer and in a prior life I was Lead Sonographer for a
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childrens' hospital.
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Over the years I have done countless endovaginal studies on adult and
minor patients. At all times I had a chaperone. Day, night, weekend,
the President's Birthday whatever.
Every single exam!
AND ON THE NOTE OF MINORS....
Family members are NOT chaperones. Chaperones are an employee of your
institution.
Imagine yourself in court to defend yourself against patient Little
Sally AND her mother, you can kiss that career goodbye.
Getting a chaperone is an inconvenience that we sonographers have to
deal with. Notice that I did not say male sonographers. Female
sonographers that worked in my lab would request male a chaperone when
performing testicular sonography.
Also one last thing, document who your chaperone was. The power of the
written word.
Perhaps I sound paranoid, but I worked hard to get where I am
today......
Alan Sansome RDMS, RVT
DMS Instructor
Baptist Health System
Institute of Health Education
San Antonio, TX
http://www.baptisthealth.org/ihe
http://www.radiologyce.com
Anderson, Copnnie
1 Posts Posted - 09/26/2001 : 18:24:36
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Whoa-I am shocked you would put yourself in that risk category. I will
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not do ev without a chaperone and I am a female tech.
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Our management totally supports this, in fact it was one of the Rads
that pointed out that women are in an even higher risk category
depending on the patient populus.
Chaperones do not have to be techs, we discourage another sonographer as
a chaperone. We tap into the rad techs, nurses, secretaries-any woman
in the dept.
It is our policy that any female coming from the ER that is having a
pelvic u/s must come with a chaperone.
Every dept is short-your reputation and legal battles would be a lot
worse-violation is a felony not covered by malpractice. Is your job
really worth losing everything?
Sonographers have too much ego attached to that transducer and we are
putting ourselves in the malpractice ring for very little compensation.
I never and repeat NEVER, try to talk a patient into an ev study-if the
patient does not want it, fine by me. I report this to the Rad and they
can put it in their report.
kevin d. evans
USA
70 Posts Posted - 09/27/2001 : 06:13:19
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Dear friends,
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Old dogs CAN learn new tricks and thanks to all of your well made
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points, we as a department are now using chapprones. ER seems to be
very supportive and Radiology a little less so. We have used many of
your points to go to our Physician director to ask that he support a
written policy. Our staff consists of 3 males and 3 females. We want
to make sure that all of us our doing the same thing and so this policy
will cover all our staff members regardless of gender.
Again thank you each and every one! My most favorite comment was the one
about ego attached to the transducer and that certainly was me!
Kevin D. Evans, MS, RT(R)(M), RDMS
--
Peace, Terry J DuBose, M.S., RDMS
University of Arkansas for Medical Science
Little Rock, Arkansas, USA
