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?”)