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Inconsistent guidelines lead to wide variation in chaperone use during Pap smears, U-M study finds

ANN ARBOR, Mich. When doctors were first encouraged to have a nurse or medical assistant in the room while collecting a Pap smear, it was so the patient would feel comfortable. In time, hospital lawyers began to advocate chaperones for legal protection.

Today, few guidelines and little consistency exists, leaving patients at the mercy of their doctor's training, gender or geographic location.

A study by doctors at the University of Michigan Health System found three-quarters of family physicians surveyed said they routinely use a nurse or medical assistant as chaperone during Pap smears. But a woman living in the South is more likely to have a chaperone in the exam room while her doctor performs a Pap smear than is a woman living in the Midwest. At the same time, women who have male doctors will see an extra face in the room more often than women with female doctors.

"Before I did the research for this study, I always used a chaperone," says lead researcher Pamela Rockwell, D.O., clinical assistant professor of family medicine at U-M Medical School. "I was trained that you always had someone else in the room for legal reasons, and I always insisted on having a chaperone. Then I started reading that some women didn't like them. I had never thought to ask."

Now, for routine Pap smears, Rockwell forgoes the chaperone. She says most of the women she sees prefer it that way, especially if they are long-time patients who know her and her staff well.

The study, which will be published in the Annals of Family Medicine, surveyed 5,000 members of the American Academy of Family Physicians, a trade group for that specialty. The questionnaire was designed to follow the steps a doctor takes during a Pap smear; chaperone use was a secondary item.

The study found that gender was the biggest predictor of whether a doctor used a chaperone, with 84 percent of male doctors and only 31 percent of female doctors having someone else in the
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25-Nov-2003


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