discipline summaries not in contact with the patient ’ s skin . Listening to the front of the patient ’ s chest , however , Dr . Peirovy ’ s usual practice was to place his hand , holding the stethoscope , underneath the patient ’ s clothes . The presence of overlying clothing restricted the space , such that he held the stethoscope differently , with the bell between his index and middle fingers and his other fingers extended . Auscultating the anterior aspect of a patient ’ s chest Dr . Peirovy would typically listen on two or three locations on each lung , moving the stethoscope from place to place underneath the patient ’ s clothing . For female patients wearing bras , he would place the stethoscope under the bra , directly on the patient ’ s skin . He acknowledged that , as a result , the stethoscope , and his hand , would come in contact with the patient ’ s breast , and possibly with the nipple . Dr . Peirovy stated that , in the walk-in clinic , he would usually not ask patients to remove any clothing . Although gowns were available in the clinic , he would generally not make use of them . Exceptions would occur if his initial examination detected more serious problems , indicating the need for a more thorough examination or , in the case of a full annual examination when the patient might be requested to disrobe . In this case , a gown would be provided for the patient . Dr . Peirovy explained that his practice in this regard was both on account of the limited time available in the walk-in setting , and also in the interests of the patient ’ s privacy , as they were not required to undress . Dr . Peirovy testified also about his routine for examining the heart . He stated that , in auscultating the heart , he focused on the apex area as the best location for auscultating the mitral valve . He stated that the apex is typically located underneath the left breast . In female patients , there would be occasions where the apex was covered by the left breast , which might require him to displace the breast with his hand in order to properly auscultate the apex . With female patients , he would generally ask them to lift their clothing in order to make the apex accessible . His examination of the cardiovascular system would also include auscultating the lungs , particularly the lower lobes . Dr . Peirovy testified about his recollection of his encounters with the six complainants in these proceedings . He had no independent recollection of Ms . V , Ms . W or Ms . X . He could recall the other three , because in each case something out of the ordinary had occurred which caused him to remember these particular patients . Specifically , he recalled the argument involving Ms . U ’ s boyfriend after he had examined her , the anxiety-related problems of Ms . Y and the difficulty in her examination on account of the malfunctioning of the examination table , and the alleged misunderstanding of Ms . Z which resulted in her breasts being exposed , in addition to his subsequently having asked her out on a date . Dr . Peirovy had reviewed his records for each of these patients . Dr . Peirovy testified that , in relation to each of these six complainants , he had examined them in a manner which was consistent with his usual routine . He stated that , in each case , he felt that his examinations were medically indicated and undertaken for a legitimate medical purpose . He denied any sexual interest in any of these patients , and he denied that his touching of them , during the course of his examinations , had been sexually motivated . Dr . Peirovy was , for the most part , clear and consistent in his testimony . The Committee observes that , in fact , there is considerable common ground between the accounts of the various complainants and Dr . Peirovy ’ s own recollections of what happened or , in the cases for which he had no recollections , his assumptions about his actions based on his review of the records and his usual routine in examining such patients . Each of the complainants states that Dr . Peirovy touched their breasts during the course of medical examination of their lungs and / or heart ; Dr . Peirovy acknowledges that , indeed , he may have done so . Five of the complainants state that Dr . Peirovy placed his hand , holding his stethoscope , underneath their clothes including their bras ; Dr . Peirovy confirms that this is his usual practice . Ms . Z states that her breasts were fully exposed while Dr . Peirovy was examining her chest ; Dr . Peirovy recalls that this was in fact the case . Ms . Z alleges that Dr . Peirovy asked her out on a date ; Dr . Peirovy does not deny having done so ,
Full decisions are available online at www . cpso . on . ca . Select Doctor Search and enter the doctor ’ s name .
Issue 1 , 2017 Dialogue 67