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Publication Date

4-2-2015

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Advisor:

M Romney, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA.

Abstract

Unchaperoned intimate medical examinations are associated with physical and psychosocial harms. Intimate examinations are defined as examinations of genitals and rectums in all individuals and/or breasts, if female. Patients experience disparities in power, unique vulnerability and immense potential harm in unchaperoned intimate examinations. In recognition of these risks and reported harms, seven states have implemented legal mandates for the presence of medical chaperones during these examinations. The ethics codes of the leading professional medical associations, including the American Medical Association, American Academy of Pediatrics, American College of Obstetrics and Gynecology and American College of Physicians, also include these recommendations. In addition, the Federation of State Medical Boards’ (FSMB) “Essentials of a State Medical and Osteopathic Practice Act,” provides professional conduct guidelines including ethical principles. A nationwide assessment and qualitative analysis of ‘medical chaperone’ state legal provisions were conducted. The respective state ‘medical chaperone’ provisions were coded for specific content as well as for the nine ethical principles codified in the FSMB Practice Act. Variability in scope and specifications of the provisions across the seven jurisdictions were noted in such areas as patient age and gender, examination type, scope of role and perception of examination. Consistent mandatory standards are necessary to support ethical standards of care for protecting patients’ security, safety, trust and dignity. Based upon the literature, review of the professional and ethical medical standards and the qualitative analyses of state mandates, model medical chaperone statutory language has been developed. A strategic campaign to encourage legislators to support bills to incorporate the model language will follow. The public health impact of using medical chaperones has the potential to increase preventive care, e.g., annual gynecological examinations, earlier prenatal care, pap smears, mammograms, prostate examinations, which will reduce disparities.

Presentation: 20 minutes

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