There are 2 sides to the conduct of a consultation visit.
The expectations of the patient and the professional duties of the
doctor.
The patient expects to get the best possible opinion of the doctor
regarding her problems.
The doctor has to perform his duties as expected of the standard
necessary to meet the expectations of the patient.
Rather than saying that you would always need a chaperone, which
you should to shield yourself. Doctors more importantly need to
communicate their intentions and justify their actions to the
patients.
Patients should also realize that in order to meet their
expectations, the doctors had to practise the reasonable standard
expected of them.
In the case of a "simple" upper respiratory tract infection, the
physical exam should include the lungs, heart, throat, nose and
ears, and neck.
The proper conduct of this exam would require adequate exposure of
the patient. In order to maintain some degree of patient modesty,
you may examine under clothes but if the undergarments are
obstructing or reducing the audio quality you would need to disrobe
adequately.
Patients (male or female) may have thicker chests (fat) or breasts,
and even listening to heart sounds are impeded in the best of
circumstances.
In professional exams (doctor tests) it is requirement to disrobe
sufficiently and often-times this is more than what I typically see
in a GP clinic in Singapore.
Our super short visits and what I think is a relatively
under-developed culture (Singapore) of using exam robes impedes on
what I think are inadequate exams in terms of patient
exposure.
Listening to heart sounds and lungs through clothes are usually
"immediate failures" in professional exams.
I would mark down a candidate during a physical exam test when I
proctor at the medical school (USA) if they examine through the
clothes.
As it is, we have move completely from "Victorian times", say in
medical school exams where examination of the abdomen (belly) would
require an exposure from the nipples to the knees, though it would
dissuade patients who would come in to get an MC for abdominal
pain/diarrhea.
Educating patients on the need for adequate examination which
includes adequte exposure for a thorough physical, is the only way
to reduce patient accusations of improper conduct.
