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with Rod Moser, PA, PhD

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Wednesday, November 15, 2006

Paper or Cloth Examination Gowns

Paper or plastic? If I select paper, then I may be destroying trees (unless it is recycled paper). If I pick plastic, then I am using a petroleum-based product (unless that is recycled, too). This is always a dilemma. Perhaps, I should just toss the groceries in the back of my truck.

When you go to your doctor’s office, the nurse never says, “Cloth or paper” when she is handing out the gowns. Most of the time, it is paper. The era of the more comfortable cloth gowns is coming to an end (literally, sometimes). Perhaps it is time.

During my medical training, we always used cloth gowns. Why? There wasn’t any choice. We also used cloth diapers. Every hospital had huge wheeled carts where soiled gowns, sheets, pillowcases, and blood-stained operating room scrubs were tossed on their way to the laundry. The smell of chlorine bleach and other chemicals permeated the basement. On the shelves, stacks of neatly-laundered and sanitized linens were ready to be distributed and used again. To this day, I still wondered about the source of those mysterious stains that never came out, or who was wearing that gown last. I tried not to think about the content of those diapers we used on our children from the diaper service.

In the old days (before my time), needles were also used over again. They were just sharpened and sterilized again; or worse, NOT sharpened and only soaked in alcohol before the next use. In some countries, re-using needles is still commonplace. I know medical providers who travel to Third World countries who bring their own needles and syringes…just in case they are hospitalized. Of course, we still use surgical instruments over and over, carefully washed and sterilized after each use. Those cold, metal vaginal speculums see quite a lot of milage, too, in practices that still use them.

I have similar concerns about trying on clothes at Penneys. Yes, I should try on those pants. Loosening my belt to check the size of the ones I am wearing is not always accurate, but I still have problems trying them on. What if some guy had impetigo when he tried them on before me? Aaarrgh! Or, someone with head lice was trying on that hat I am considering.

No one disputes that cloth examination gowns are more comfortable and less likely to self-destruct during the examination. However, as far as sanitation is concerned, the one-use-only, disposable paper gowns have the top spot. Although professional laundries can certainly de-germ just about anything, it is the idea that you are wearing someone else’s gown that really bugs me.

When medical providers become patients, we endure the same indignities. About ten years ago, I took an unexpected ambulance ride when I had an anaphylactic reaction to a new antibiotic. I arrived in my underwear, was promptly treated, and then released in my underwear. I asked if I could take the cloth gown or borrow some scrubs. I was told that this was not permitted. Since I worked for the same hospital, I sort of expected some courtesy in this request. I had no intention of keeping the scrubs or that ass-baring gown. I promised to return them the next day. When the nurse refused again, I told her that I would proudly walk out — in my underwear — through the Waiting Room, and explain to everyone why I am dressed this way. I will tell them that my OWN hospital would not let me borrow something to wear. I was given a paper gown. Much to my disappointment, there were no patients waiting at 3 a.m. for me to address. I did write a nasty letter when I returned that paper gown in an envelope.

Most men prefer to sit in an examination room in their underwear, rather than wear an effeminate gown or a paper napkin. Sitting in our underwear is really quite comfortable and masculine. Women, on the other hand, deserve the dignity of a body-covering gown.

Paper gowns come in one size only. They will not fit a big, ‘ol sweaty guy or a morbidly obese woman preparing for a Pap smear. The hairy, sweaty guy will witness the gown melting before his eyes. When men stand, there will be a sweaty ass print left on the paper sheet, assuming it does not adhere to their butts like toilet paper. This has happened to me. Women in paper gowns (Please leave the opening to the front) will most likely experience the embarrassment of a breast escaping at some point. Granted, the breasts will be carefully examined, but you don’t really want ‘em out prematurely. A gown open to the front to facilitate a breast exam will not permit a dignified back exam. You definitely do not want to bend over for a scoliosis check in a paper gown, even with one of those easy-to-tear paper sheets. There will be a full moon, I can assure you.

From the examiner’s point of view, I would much rather take the entire history with the person completely clothed and comfortable. It only takes a few minutes for the patient to gown-up, so I leave the room, make some notes, and patiently wait for them to undress. Over the course of my three-decade career, I once opened the door only to see a completely nude woman sitting on the table with the paper gown still neatly folded. Not expecting this open display, I quickly exited again, insisting on that gown! A teenage boy in a room directly across was breathing on his nebulizer. He caught a full, unobstructed view of this nude woman. His respiratory rate increased dramatically and I could see a grin under his nebulizer mask. Another time, I entered the exam room to do a physical on a huge man. He was pissed off because the nurse gave him a tiny, paper gown, open to the front, of course, covering 5% of his hairy chest and man boobs. “Do I have to wear this damn thing?”, he said. “No,” I replied.

For the last five years, my practice has been limited to pediatrics. Teenagers are never gowned up for sports examinations. They will take off their shirts when requested and reluctantly “drop their drawers” at the end. Adolescent girls need to be properly gowned, depending on the exam. They are not happy with cloth OR paper gowns. A few minutes ago, a little kid happily ran past my office, naked as the day he was born. He will not need to be gowned…just diapered for my protection.

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Posted by: Rod Moser, PA, PhD at 8:27 pm

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