Why do I have to get semi-naked to see a doctor?
October 27, 2014 11:29 PM   Subscribe

So I finally got health insurance in the US and made a 'new patient' appointment for a physical. After talking the nurse through my (very limited) medical history, I was asked to undress and put on a medical gown. I then met my new doctor, talked about my medical history again, asked for a referral to a chiropractor (I have scoliosis and associated back pain, and wanted to re-establish treatment). She took my blood pressure, did the stethoscope thing on my back, and did a bit of abdomen pressing. The rest was talking. So why did I need to undress and wear a medical gown?

My experience with doctors in the UK and Australia is that doctors are easily able to do those things by lifting up / adjusting my clothes (and when I see a doctor, I wear clothes appropriate for these checks - I'm not stupid). Apart from pap tests and IUD insertion, when I've been asked to remove the bottom half of my clothing - of course.

What is the purpose of this disrobing for general primary care visits in the US?

It takes more time (they gave me 5 minutes to disrobe and 5 minutes to put my clothes back on - rather excessive given that I have been dressing and undressing myself for over 38 years, and it takes a lot less than 5 minutes!). It made me feel uncomfortable - I wasn't wearing my clothes. It made me feel like I should have had a medical problem to be there (this was a long overdue physical, without any presenting problem). It made me feel disempowered (she was fully clothed, I was wearing a gown with nice pretty flowers on it that left my back and ass exposed).
posted by finding.perdita to Health & Fitness (40 answers total) 2 users marked this as a favorite
 
Makes the encounter standard for the doctor and then any issue is a ready to do quick exam with no delay while the disrobing occurs. Naked feet, ankles, knees reveal any clues, rashes show up etc. and it is the way the training is done at school.
posted by Freedomboy at 11:41 PM on October 27, 2014 [7 favorites]


Wow, I'd forgotten about that particular unpleasant aspect of going to the doctor in the US. You're right, it's much more civilised to keep your clothes on.

My only suggestion is that they cause maximum inconvenience to you, the patient, so as to cause minimal inconvenience for the doctor in case the doctor should require the removal of clothing for any reason. If not, it's your bad luck.
posted by Athanassiel at 11:51 PM on October 27, 2014 [3 favorites]


Put quite bluntly, your time is worth less than the doctor's time.

If it takes you 5 minutes to get undressed should the doctor need you to get undressed, you would have spent 5 minutes of the doctor's time unnecessarily. There isn't much else the doctor can do in 5 minutes, so there's no option of switching tasks while you get undressed.

Since the medical industry in the USA has insufficient doctors, the solution is to maximize doctor productivity - and that means minimizing unnecessary delays.
posted by saeculorum at 11:55 PM on October 27, 2014 [8 favorites]


Best answer: There are practices in the US where this is not standard. In fact, I don't think I've had a single doctor in my adult life that has asked me to disrobe by default. Additionally, as a student preparing to go to medical school, I haven't seen this as standard practice with any of the physicians I've shadowed.

I'm sure it happens, but I wouldn't be so quick to assume that it is the American norm.
posted by ocherdraco at 12:06 AM on October 28, 2014 [15 favorites]


This has never happened to me, unless I was having a below-the-belt examination, as you said. It's not a standard thing for US doctors. (Although when I do have to get undressed, they do give me way more time than needed. But that's why iThings were invented, right?)
posted by donajo at 12:31 AM on October 28, 2014 [2 favorites]


Seinfeld said it best: http://www.youtube.com/watch?v=anFf_mwLWUg

"in any discussion pants trumps no pants".....
posted by alchemist at 12:48 AM on October 28, 2014 [4 favorites]


I don't know if it will make you feel any better, but when I go for my yearly physical - and also when starting off with a new doctor - the routine has always been to get into the same state of undress you were and then the doc listens to my heart and lungs, front and back, checks my throat/thyroid, palpates my abdomen and checks for liver size, enlarged spleen, tenderness, etc, sometimes a breast check, then knee reflexes - as a typical example, but at the same time she's looking over my skin for bruising or rash or moles that don't look right, and for scoliosis. Then a gait check, quick touch-your-nose and stand with your eyes closed neuro check, eyes and ears and throat. I think that's about it. That was the routine for years and years and it works just fine for me, since there are so many things the average person may not even be aware of but a quick scan of the body by a knowledgable doctor can pick out.

What brings this to mind is my mother's boss years ago, who had heart disease and had frequent cardio checkups which almost always involved the doctor listening to his chest through his shirt or undershirt. No problem, everything was fine. Then he had to find a new PCP (they called them General Practitioners then) and that doctor made him take his shirt off. He had several moles on his back, one of which the doctor didn't like the looks of. It was, of course, a melanoma, far advanced. They took a piece of meat off his back which he said was "the size of a dinner plate" and he went through all the treatments, but he passed away a few months later - I think he was about 50 years old.

Having worked in hospitals doing patient care, I can tell you for sure that the doctors and nurses have seen so many naked bodies they all look the same anymore - and that's the honest truth. Your doctor doesn't want you to be uncomfortable and I'm sure she regrets that part of your exam, but she does take your health seriously and she can tell more about your health from an even cursory exam than you can imagine.

Hope this helps.
posted by aryma at 1:11 AM on October 28, 2014 [27 favorites]


My dr does this for yearly physicals but not for standard appointments or follow ups. Most Drs I've seen examine you and then allow you to dress before coming back in for discussion.
posted by tamitang at 2:58 AM on October 28, 2014 [4 favorites]


Lifelong US resident. Other than my GYN, I've never had to disrobe for a sick or well visit at my doctors' offices. I've only gone to DOs though, perhaps MDs do it differently?
posted by kimberussell at 3:43 AM on October 28, 2014 [1 favorite]


Best answer: Just like people's opinions and preferences, it varies widely.

Some people think it's more civilized to keep their clothes on and just lift their shirt if necessary, some people think it makes the interaction far less respectful if their doctor is basically undressing them. I have seen that cited in the past as a reason for patients to be gowned. Obviously there are lots of doctors in the US who disagree.
posted by telegraph at 3:48 AM on October 28, 2014


I am US Citizen. I have never undressed for any doctor check-up, and I have changed doctor and insurance a bunch of times.
posted by Flood at 4:18 AM on October 28, 2014 [1 favorite]


... made a 'new patient' appointment for a physical.

Yeah, for a physical, the doctor wants to see your whole body. Melanomas, rashes, pustules, lumps, etc.
posted by Bruce H. at 4:22 AM on October 28, 2014 [4 favorites]


My internist is very thorough. When I go for a physical I change into a gown and he goes through everything, including doing a weird freckle check, looking at scars and bruises, and poking most of my lymph nodes. It always seems like my lack-of-clothes-ness has a purpose. When I go to see him because my foot hurts, I take off my shoe and nothing else. Physicals are different.

and when I see a doctor, I wear clothes appropriate for these checks - I'm not stupid

Lots of people are, though, and will just wear whatever without even thinking about it. Or, you know, winter happens. During the polar vortex last year I was doing things like tucking t-shirts into leggings and then pulling another pair of leggings up over those with another two sweaters on top. Can't do much with that.
posted by phunniemee at 4:43 AM on October 28, 2014 [2 favorites]


You don't. Just because they offer you a gown doesn't mean you have to put it on. "No thanks, I'm more comfortable in this." I would walk out if they insisted I wear a gown when it wasn't necessary. (You don't have to wear bibs at the dentist either. "No thanks, I can wash this shirt if I need to.")
posted by Violet Hour at 5:43 AM on October 28, 2014 [3 favorites]


Yes, if I call and make the appointment for a "physical" then the expectation is that I will disrobe because the doctor will be checking my body for lots of things.

On the other hand, when I call for a specfic problem--recently I went in with complaints about sinus pain and foot pain--then I don't disrobe; here, all I took off was the one shoe and sock.

For U.S. appointments, be very clear about the nature of your complaint when booking the appointment.
posted by TwoStride at 5:44 AM on October 28, 2014 [2 favorites]


Best answer: I also want to add that in some other countries it is normal for the doctor to stay in the room/continue chatting while you disrobe, if disrobing is necessary. In the US, the doctor leaves the room (thus taking more time). I find it kind of silly, personally, especially for something like the obgyn.
posted by melissasaurus at 5:56 AM on October 28, 2014 [1 favorite]


As for why they give you so long to do this: it may not take you five whole minutes to get dressed/undressed, but it may take others that long (people with mobility impairments, say), and it's more straightforward to give everyone the same amount of time.
posted by dorque at 6:06 AM on October 28, 2014 [3 favorites]


My doctor does a partial disrobe for my annual physical. He's checking my skin for things, poking, banging, listening, and palpating. He's on the autism spectrum and one of the heartiest laughs I ever had was when he was leaving to give me privacy to get dressed. I just threw the gown off and went to grab my bra and he said, aghast, "Modesty!" So my doctor is a bit uncomfortable with nakedness that isn't for medical purposes.
posted by Ruthless Bunny at 6:08 AM on October 28, 2014


I don't generally get asked to put a gown on unless it's for an annual well visit, and I've also seen many doctors for many reasons and with several health insurance plans. If I'm just there for a sprained ankle or cold symptoms, they never ask.

They do always ask when I'm going somewhere specifically for imaging (X-ray, MRI, CT, etc.) Because of an autoimmune thing I have, I get imaged a LOT. I can tell you from experience that if you wear loose clothing and no jewelry to those, and tell them you have no metal buttons/zips/underwires/etc, they don't usually make you disrobe. Exceptions I've found are mammograms (there is no effective way to have a mammogram without the stupid robe) and sometimes they make you take your shoes off, regardless.

It wouldn't be so bad if medical gowns weren't universally designed for doll-sized people by blind sadists with only a passing acquaintance with human anatomy. Two arms, one head - how is this so difficult?!
posted by kythuen at 6:44 AM on October 28, 2014 [1 favorite]


I'm in the US. For an annual physical, my doctor only has me take my shirt off -- and listens to my heart and lungs. I presume this is so the clothing does not interfere with the stethoscope. For any other appointment, I remain fully clothed (or am asked to remove only whatever clothing is necessary to remove).
posted by tckma at 6:45 AM on October 28, 2014


Just because they offer you a gown doesn't mean you have to put it on.

I recently had a followup visit with a new doctor to discuss the results of some tests. The nurse showed me into the exam room, pointed to the gowns, and told me to disrobe and the doctor would see me soon. I told her I am not here for an exam and did not think it necessary to disrobe, and she actually gave me attitude, something to the effect of "that's the way we do things here." I ignored her and kept my clothes on, and the doctor when he came in just took my blood pressure (which certainly doesn't require disrobing) and proceeded to have the discussion of the previous test results with me. End of story. There is absolutely nothing wrong with stating that you would rather not disrobe.

That being said, please do be aware that for a general checkup, it is absolutely necessary for the doctor to see your lower legs and ankles, as swelling could be a sign of several serious conditions. And also, as someone mentioned, a skin check for any possible growths is a good idea.
posted by RRgal at 6:45 AM on October 28, 2014


You don't. Just because they offer you a gown doesn't mean you have to put it on. "No thanks, I'm more comfortable in this." I would walk out if they insisted I wear a gown when it wasn't necessary.

I don't recommend following this particular advice. When they give you the gown, that does mean you're supposed to put it on. It's not like a hair salon offering customers water or coffee. It's not there for your personal enjoyment or convenience.
posted by John Cohen at 6:50 AM on October 28, 2014 [3 favorites]


John Cohen, it's always worked for me. If they NEED me to wear a gown, they can tell me why (but they've never actually needed it). Gowns aren't standard in the UK, and they do just fine.
posted by Violet Hour at 6:55 AM on October 28, 2014 [1 favorite]


I'm not sure it's a country-specific phenomenon, but this sort of thing is just a "protocol". It might be the clinic's or the doctor's or the organisation's, but it's just one of the standard practices in the premises you attend. It may well be mostly enforced, as others suggest, when it's an initial consultation, but um, I dunno: of all the things to get thrown by, when your medical wellbeing is of paramount concern in the situation, the wearing of a gown seems like an unnecessary fixation in all the circumstances. They do it to make their job easier is all. You may disagree or be skeptical, but that's what it's for. Having that whole awkward "drop your knickers" etc etc conversation is going to be a drag for the staff 20 times a day.

As long as they maintain your bodily, if not sartorial, dignity by letting you change in private and keeping curtains drawn and that they don't pull the gown apart or whatever so that passerbys can see you naked underneath, then I think you should concentrate more on listening to the doctor and staff members and ask relevant questions, if you have them, about your health state and future needs etc in that regard. Being thrown off by a gown, of all things, means you'll probably forget the real important things to speak up about during the brief consultation.
posted by peacay at 7:31 AM on October 28, 2014


In future, feel free to ask about this on the phone before you make an appointment. The time to ask is before you go in and if you don't like their policy, feel free to ask if they know of a clinic who does what you prefer - they are likely to know.

At the clinic where I go, they are all about "dignity preservation" (their words). History and most of the exam is done with clothes on. For some stuff, obviously (Pap smear, for example), clothes come off - BUT they have you get dressed again to talk briefly after that is over and see if you have any questions. It is much easier to be your normal self with clothes on, so I am all in favor of this policy. They allow a little extra time for this, they said (I asked), but since it is so common these days to have 2-3 patients with the same appointment time, I imagine everyone gets plenty of time to change.

forgot - I'm in the US.
posted by AllieTessKipp at 8:25 AM on October 28, 2014 [2 favorites]


I'm in the US. I hate being expected to try to have an adult conversation about private stuff with a stranger while you're sitting there mostly naked. I love, love, love, that my new GP doesn't do this. Before even doing a physical exam, he actually sat and talked to me about my health for nearly an hour at my first appointment. Nothing about my age, current complaints, or medical history required a disrobing, so he did the standard poking and prodding while I was wearing my clothes. He was also able to concentrate more on areas where I didn't have complaints, because he knew the trouble areas would soon receive more thorough examinations from specialists anyway. I did disrobe for maybe 5 minutes at my next appointment, but it was for a specific reason and I got dressed again immediately after he was done examining me, and then he came back in to discuss further treatment. In general, he's a really thorough, caring doctor, and it just fits with the rest of his style that he recognizes the awkwardness and indignity of getting naked with a stranger for no reason.
posted by lesli212 at 8:58 AM on October 28, 2014


Best answer: As someone from Australia that moved to the US I find it highly embarrassing when going in for something boring like a script renewal when all they are going to do is ask me questions & take my blood pressure so I don't do it. If they don't want to treat me like an adult I can treat myself like one, lord knows I'm paying them enough if they suddenly with no warning, need to examine part of me they can wait 5 seconds while I lift my shirt up. Of course for pap smears, full exams etc I disrobe no worries. Doctors in the US like to act like they are doing you a favour, they are providing a service. There are more than enough doctors in the US desperate for business, if you don't like the clinic you are at or they give you shit change doctors.

Playing up the confused foreigner card can buy you a lot of leeway in situations like this too, but don't tell the Yanks I said that.
posted by wwax at 9:06 AM on October 28, 2014 [3 favorites]


Skin cancer screening is part of a typical annual or new patient physical, and it's hard to see much of your skin when it's wearing clothes.
posted by sageleaf at 9:38 AM on October 28, 2014


Best answer: I worked in several pain clinics where the expectations from On High (be it the Dr or the Dr's bosses) was all new patients got robed. Period. Sometimes this was practical and useful, and sometimes it was not. I suspect a lot of doctors are under even more pressure from things like insurances, meaningful use, balah blah blah to do more than they might usually.
posted by Jacen at 10:11 AM on October 28, 2014 [1 favorite]


Skin cancer screening is part of a typical annual or new patient physical, and it's hard to see much of your skin when it's wearing clothes.

Not in my parts (NEAmerica), they expect a special skin doc for that. Ka-ching, of course, but he is the expert. (We also go robed for other doctors.)
posted by IndigoJones at 10:34 AM on October 28, 2014 [1 favorite]


So...I get cold easily and I HATE the gowns so for appointments where disrobing would be helpful for the above mentioned reasons, I bring my own sheet. It has brought out giggles in some doctors, but it makes me feel more modest and happy and doesn't interfere with them doing their job.
posted by eleanna at 11:55 AM on October 28, 2014


I've never been asked to do this since I was a child. I was even in the hospital, and it was presented to me as optional. (All in the Northeast US.)
posted by thegreatfleecircus at 12:38 PM on October 28, 2014


Best answer: I was actually surprised when my new physician did NOT have me disrobe for a new patient physical this year. My previous physician did, but he also always did a EKG as a standard part of a physical so the reason for disrobing was obvious. Before your appointment, did you fill out a form that asked about health concerns, and mention on it the scoliosis? Because your doctor could well have looked at your spine while listening to your lungs. But also, as said by others, the doctor's time is worth more than yours in this setting, so some offices have you disrobe as SOP, just in case the doctor needs to look at something that would require it.
posted by AliceBlue at 2:10 PM on October 28, 2014


My dr does this for yearly physicals but not for standard appointments or follow ups.

Also my experience. A proper physical almost always seems to involve something you'd have to undress for anyway (notably the "friendly finger" for us males of a certain age and our prostates). Otherwise, no need to undress or be in a robe.
posted by gimonca at 3:15 PM on October 28, 2014 [1 favorite]


but um, I dunno: of all the things to get thrown by, when your medical wellbeing is of paramount concern in the situation, the wearing of a gown seems like an unnecessary fixation in all the circumstances.

It's not, though, because it makes people uncomfortable to the point where they avoid seeking care, and it's not medically necessary (obviously, since it's not normal in the UK and not standard in the US). If medical wellbeing is so important, don't put unnecessary barriers between clients and healthcare. Gowns obviously make a significant amount of people feel bad about their visit, so don't use them unless it's needed. Would you rather people went in street clothes or not at all?
posted by Violet Hour at 3:42 PM on October 28, 2014 [2 favorites]


Hello! I don't think any other physicians have responded to you (or at least not identified themselves as such) so I wanted to respond even though I don't have time to get detailed.

In brief, I'm fully in agreement that it's not necessary for a patient to change into a gown for every single visit, but for an annual physical or for most other issues beyond a check-in about medications/refill/blood pressure check or whatever, you are really not getting your money's worth out of the visit if you have your clothes on.

For many many reasons which I don't have time to detail here, doing a physical exam without clothing on is very helpful, especially in cooler climates. Jeans, boots, and sweaters/sweatshirts are some things that particular hinder an effective physical exam. Yes, doing a skin check and checking for ankle edema are two of the basic things that can be difficult to do with clothing on, but there are actually a myriad of other physical findings that cannot be seen easily with clothing in place (discolorations, bruising, cuts, asymmetry, lumps/bumps, rashes, vascular issues, hair patterns, subtle hernias, signs of infection, scars, and so much more!). Trying to listen/look down through people's shirt collars and in between buttons/having them pull up shirts is a poor substitute.

I also don't recommend insisting on wearing your clothing and having your doctor ask you to take it off if needed, unless you have issues with past abuse or other anxiety issues that would cause you to cancel or avoid the appointment unless you could leave the clothes on. The problem is that doctors are human too and are trying to be as efficient as possible in seeing patients quickly - it helps not to incentivize them to do a cursory job. If they come in in a rush, already late (like they almost always do) and you're wearing all your clothes, and you say "just tell me to take them off if you need me to" (and let me add that it is not always obvious that you're going to find something on the physical exam until you've found it - what you find may be unrelated to the chief complaint, or may be something you wouldn't have expected from the history alone) - then they are going to be more likely to just try to do a less thorough exam on you and move on. Also, remember that there are protocols in place for a reason - when you're trying to see 20 patients in a day, you cannot count on the fact that some people are going to be snappy changers and that everyone's going to be smart enough to wear clothing that allows some degree of access to their body, or that the staff is going to be able to accurately assess whether exactly how fit you are or how much clothing you are wearing is going to be appropriate for how much time they'll give you to change or whether you need to change. A policy of "only idiots who wear really bulky clothes have to change into a gown" isn't very helpful because quite honestly even people who are wearing thin and adjustable clothing still aren't exposing as much as we'd be able to see if they were wearing the gown.

In short, if you want to have the most effective and thorough doctor's appointment when you go in for any but the most small issues, I strongly would recommend changing into the gown. I personally always do it and I ask all my patients to do so as well.
posted by treehorn+bunny at 3:52 PM on October 28, 2014 [7 favorites]


Nice answer treehorn+bunny.

Violet Hour, I come at this thing from having been a trained nurse in about 7 emergency depts in 2 countries. I can only think that the people who would NOT attend a medical centre or doctor or hospital etc because it involves putting on a gown are scouring the horizon for any wrinkle to justify not attending. This (refusing to put on a gown) is one of the 20,000 little happenstances in an emergency room (or a private doctor's office for that matter, if that's their protocol) that costs time and is passed on to the next patient and the next and is, in part, the reason why the wait is so long despite your not being able to see what level of "busyness" is going on beyond observing staff walking by and not treating you. They've been held up by some righteous person who thinks that wearing a gown demands an argument or is a slight against their freedoms or liberty or some other drivel. Everyone who walks into a clinic or a hospital or a doctor's rooms should just suck it up and just cooperate for everybody's sake.
posted by peacay at 12:18 AM on October 29, 2014


Best answer: I don't think 'it saves time for the doctor' can be the main reason - NHS staff are under a huge amount of pressure to get you seen and done as quickly as possible, and I've only been asked to change into a gown twice in my adult life, once for an imminent operation and once to be assessed for possible emergency surgery I ended up not needing. Never for general checkups/appointments for illness/physio appointments/MRI/pap smears/pregnancy appointments/giving birth. It's just not really a feature of the healthcare system here.

So my best guess, OP, is that gowns/no gowns is a "we've always done it this way" thing which the system then develops to support. Here, asking all patients to change into gowns would cost the doctor's practice more time, because then you're hanging around taking up a room while you change - in the US (I imagine?) the system works slightly differently so that taking up a room isn't an issue, and time is then possibly saved by the doctor not having to wait even the short time for you to adjust your clothes? Plus, there's an advantage to things being standardised - if the doctor always assesses patients in a gown, then that's what the doctor expects to see, and changing that means interrupting a routine the doctor has got down to a fine art. Once something's ingrained in the healthcare system and the healthcare system has grown up around it, it becomes the easiest way to do things in that system by definition.
posted by Catseye at 5:59 AM on October 29, 2014 [3 favorites]


http://mobile.reuters.com/article/idUSKCN0HH2NO20140922?irpc=932"Clearly he was capable of wearing normal clothes - it was our system and its expectations (and perhaps his preconceived notion of them) that led to him awkwardly strutting down the hall in that fashion,” Lee told Reuters Health in an email. Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don’t, according to a small Canadian study.

That could have an important effect on patient dignity, the authors suggest."
posted by Violet Hour at 2:30 PM on November 1, 2014


Response by poster: Thank you to all you lovely people who took the time to respond!

I've had excellent health care for decades in Australia and the UK without this requirement, and your responses tell me that it isn't a uniform practice in the USA either. My conclusion is that this "requirement" is based on my clinic's standard practices rather than medical need. So I just need to suck it up and follow protocol. I'm perfectly capable of articulating my needs even while semi-naked. But in the back of my mind I'm still going to be judging them for inefficient use of resources and for making me feel uncomfortable unnecessarily.

(To respond to individual reasons given for why wearing a robe is a medical requirement - (a) I turned up wearing tights - my ankles were easily observable, (b) 2 of the 3 moles my UK dermatologist has instructed me to keep an eye on were under my gown - and my doctor either didn't notice or comment on the one on my back that was visible, (c) I was the one that mentioned my lower spine scoliosis and upper spine torsion - I needed a referral, and (d) the doctor also either didn't notice or acknowledge the sebacious cyst on my back - let alone the one on my front ribs, (e) if I had an unexplained rash, I'd have seen the doctor long before now!

In addition, she left the room in order to let me put my clothes back on before coming back to finish up the consultation - even though I said I was happy to get dressed while she was there. It's not like she saw another patient in the time I was putting on my clothes! So I don't understand any claim that this is a cost saving exercise - clearly it's not - especially as I assume (hope?) that they launder the gowns between patients. I'm not going to make a big deal about it, because my employer is paying 95% of my health insurance costs, but I do feel bad for those who aren't as lucky as I am.)
posted by finding.perdita at 8:08 PM on November 10, 2014 [1 favorite]


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