What's normal during a medical exam and what isn't? Here's what you need to know — and how to advocate for yourself.
It’s easy to view your doctor's office as a safe space and, in the vast majority of situations, it is. But several stories over the past few years have shown some patients have been victimized by the very people who are supposed to keep them healthy.
The latest is former Columbia University ob-gyn Dr. Robert Hadden. As a recent joint ProPublica and New York magazine story detailed, the 65-year-old was sent to jail after horrifically sexually assaulting several patients.
More than 245 patients have alleged that Hadden abused them, and he was sentenced in July to 20 years in federal prison. Columbia University also agreed to pay $236.5 million to resolve lawsuits from 226 of Hadden’s victims.
Hadden’s story is eerily similar to that of Larry Nassar, a former doctor for the American gymnastics team who was sentenced in 2018 to up to 175 years in prison for sexually abusing more than 150 young women in his care, including several Olympic gymnasts.
There have been countless stories of patients being assaulted by doctors, including pediatricians. With that, doctors say it’s important to be aware of what’s normal — and not — when it comes to doctor’s visits. Here’s what you need to know.
What can you expect during a medical exam?
What will happen in a doctor's visit can vary by specialty, practice and even doctor, Jeffrey Levine, a physician at Rutgers Robert Wood Johnson Medical School, tells Yahoo Life. “The American Medical Association has a code of ethics and a lot of it is practical when it comes to patient care,” he says. “But there can be a lot of variation.”
Still, Levine and other doctors say there are some things you can expect during common doctor's visits.
General practitioner
If you’re seeing your general practitioner or family medicine doctor for an annual exam, you may or may not be asked to put on a gown. “Some providers feel that, in order to do a non-genital exam, you still need the patient undressed because you need to see their skin and listen to their lungs — it’s easier when they’re in a gown,” Levine explains. “But there are other providers that don’t feel it's necessary.”
If your doctor prefers to have you in a gown, you should be given one to change into and left alone in a private space to get undressed, Levine says. A nurse will typically instruct you if you should leave your underwear and/or bra on, depending on what exams you may be having.
Levine notes that the United States Preventive Services Task Force (USPSTF) no longer recommends screening for testicular cancer, so the traditional test of having a doctor give a rectal exam and having a patient with a penis cough while their doctor cups their testicles is no longer advised. “If someone comes in with a [testicular] complaint, that’s different,” Levine says. “But for routine screening in average-risk people with a penis, that is no longer standard of care for most organizations.”
Some women will have a gynecologic exam as part of their annual exam with their provider but, if you already see an ob-gyn for these, it should not be a part of your exam, Levine says.
Pediatrician
Children have regular check-ups as they grow, and it's a good idea to let them know in advance what to expect, Danelle Fisher, a pediatrician and chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, Calif., tells Yahoo Life.
“A checkup is to measure growth and development, and to check on general health as well,” she says. Children will have their height and weight measurements taken, and will be asked along with their parents to answer questions about their family history and health in general. Then there is a physical exam.
“Many patients get into gowns, but some pediatricians don’t have children take their clothes off,” Fisher says. “Kids should be prepped in advance that their bodies will be checked and that their parents will be there.”
Pediatricians will often explain to children what is going on. “I use a constant narration of what I’m doing,” Fisher says. “When we get to more sensitive exams, I really want to make sure that they understand that there are safe exams and unsafe exams. I tell children before I check the downstairs area that the people who are allowed to look down there are mom, dad and a doctor but, when a doctor is looking, mom or dad has to be in the room with them.”
Fisher says it's important that parents remain with children during doctor’s visits. “Some older patients do not want their parents in the room — they are allowed to have a non-parent chaperone,” Fisher says. “That means I’m not going to be performing an exam in a room with a child alone. Typically someone like a nurse will be there, and that is for the patient’s safety. It’s important that they always understand that.”
She adds that, every once in a while, she’ll have a child who doesn’t want her to examine their genitals during an exam. “If the child declines, I will just document that in the chart,” she says.
Overall, Fisher says that patients “should always know what to expect and should always have appropriate supervision.”
Ob-gyn
Annual exams at your obstetrician or ob-gyn typically involve a pelvic exam, Dr. Mary Jane Minkin, a clinical professor of reproductive sciences at Yale School of Medicine, tells Yahoo Life. “During a typical yearly gynecological exam, women will undergo a breast exam, an abdominal exam and a pelvic exam, where the provider will look into the vagina with a speculum and then palpate the pelvic organs with a bimanual examination — one or two fingers in the vagina, one hand on the abdomen,” she says.
But “everyone does this a little differently,” Dr. Lauren Streicher, a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells Yahoo Life. “You can expect that you will be asked to change into a gown and that someone will leave the room while you’re changing,” she says. Medical staff will also often give you a drape to cover your lower body, unless the gown is roomy enough to do the same thing, she says. This means that you should not be seated with your breasts or vagina exposed before the physical exam.
“They should always explain to you what they’re doing prior to doing it,” Streicher says. During a breast exam, typically one breast will be exposed at a time and the provider will use fingertips to press down on different areas of the breast. “There is never a time when you’re cupping the breasts with a full hand,” she says.
When your provider does a pelvic exam, they should be wearing gloves, Minkin says. “If you are coming only for a breast examination, you do not need to have a pelvic exam — presuming you are up to date on your annual exams,” she says. (If not, your provider may suggest you also have a pelvic exam and, she says, it’s up to you to decide if you want to have it during the same visit.)
What isn't normal during a medical exam?
In terms of a pediatric visit, it’s not normal for parents to be asked to leave the room (unless a child requests it and a chaperone is provided), Fisher says.
In a general practitioner’s office, the door to the exam room should be closed and secured, and there should not be cameras on, Levine says. During a gynecological exam, Streicher says you should see your provider's head. “There should never be a time when the person’s head disappears,” she says. They shouldn’t be hiding behind or under the drape. You can talk to the person when they’re examining you because you can see their face.”
How to protect and advocate for yourself
All practices should have a trained chaperone, and that’s different from a medical assistant, Streicher says. “A medical assistant may be in the room but have their back to the patient or aren’t paying attention because they're taking notes,” she says. “A chaperone is a patient advocate who is there to make sure everything is above board.”
Some practices will even have a chaperone automatically built in. “In many offices, particularly these days, women are asked if they would like a chaperone, or a chaperone will automatically come into the exam room when the provider is ready to do the exam,” Minkin says.
If you would like a chaperone and you’re unsure if one will automatically be provided, Levine recommends asking for one when you check in for your appointment. “Every patient has the right to request a chaperone,” he says.
You can also ask your doctor about the exams they’ll be performing during the appointment so you’ll know what to expect and why you need them. And if anything feels uncomfortable or worse, inappropriate, ask them to stop. (The Bioethics Research Center has a list of what types of behaviors are sexual misconduct, including “touching genitals for any purpose other than appropriate exam or treatment, especially without wearing gloves, or when the patient has refused.”)
If you’re the victim of an assault, doctors say you should absolutely report it to the police. But if you just get a weird vibe from your doctor, they also recommend no longer seeing them. “If you don’t feel comfortable with your provider, by all means find someone else,” Minkin says. “You need to be comfortable.”
