A Sensitive, Deliberate Approach to Draping

For some patients, the prospect of disrobing for a physical exam can be a source of fear, anxiety and embarrassment. For that reason, the College urges physicians to be sensitive to patient stress and find the right balance between draping, in order to preserve patient modesty and exposure when it is necessary to access areas of the patient’s body that need examination.

Recently, Drs. Jaideep S. Talwalkar and Joseph Donroe, two internal medicine specialists from the Yale School of Medicine, created a video published by JoVE Science Education Database, which demonstrates proper draping and gowning techniques in order to minimize any misunderstanding.

Dr. Talwalkar told Dialogue that the video was created to help students learn a sensitive and deliberate approach to draping while learning physical examination. “We hoped that by building sensitivity and awareness of draping into our teaching as part of the exam right from the start, we will help students develop good habits as they learn and practise. We want to be sure that students do not compromise their examination out of concern for not knowing how to drape,” he said.

The video makes clear, right from the start, that the proper use of drapes is an important component of correctly performing 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 auscultation is performed over clothing. Accordingly, 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.

The Sensitive Use of Drapes and Gowns

• Explain to the patient that you need to 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?”)
• If the patient has limited mobility, ask the patient if she or he would like assistance in changing.
• Provide instructions on what to do with the gown and drape, including that it be kept open at the back.
• Step out of the room while the patient changes.
• Communicate to the patient about what is about to be done before moving a gown or drape.
• Don’t reach under a gown or clothing to 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.
• Only expose the area of the body being 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.
• If you have untied the gown during the 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).