Dialogue Volume 14 Issue 4 2018 - Page 44

PRACTICE PARTNER ing physical examination manoeuvres. Skin lesions are missed when inspection occurs through clothing, crackles are erroneously reported when the lungs are examined through a T-shirt, and subtle findings on the heart exam go undetected when auscul- tation is performed over clothing. Accord- ingly, the best practice standards call for examining with one's hands or equipment in direct contact with the patient's skin. In addition to its clinical value, the correct draping technique is important for improving the patient's comfort level during the encounter, Dr. Talwalkar said. “There are many powerful testimonials from patients about the value they place on a sensitive approach to the exam. The provider who makes the effort to properly drape is perceived as more attentive and empathic, which are certainly attributes we want patients to recognize in us,” he said. For information regarding the College’s guidelines for maintaining professional boundaries, please refer to our Maintaining Appropriate Boundaries and Preventing Sexual Abuse policy. MD The Sensitive Use of Drapes and Gowns  the patient has limited mobility, ask If the patient if she or he would like as- sistance in changing.  Provide instructions on what to do with the gown and drape, including that it be kept open at the back.  tep out of the room while the patient S changes.  ommunicate to the patient about what C is about to be done before moving a gown or drape.  on’t reach under a gown or clothing to D examine a patient. Enlist the patient's help in moving the gown or drape throughout the exam, as this allows the patient to maintain some control over the degree of exposure.  nly expose the area of the body being O directly examined. When you complete the examination of an exposed area, replace the gown or drape.  Limit the exposure times for sensitive areas (e.g., anterior chest, inguinal re- gion) but do not compromise the exam in order to do this.  you have untied the gown during the If exam, retie it before asking the patient to step down from the table. Source: JoVE Science Education Database. Physical Examinations I. Proper Adjustment of Patient Attire during the Physical Exam. JoVE, Cambridge, MA, (2018). 44 DIALOGUE ISSUE 4, 2018  xplain to the patient that you need to E do an examination, and that the patient should put on a gown. Seek consent from the patient (e.g., “Are you comfort- able proceeding with an examination?”)