Awkwardness in exam room avoidable

Dear Dr. Gott: I am concerned about how I was examined by a new cardiologist.

While using his stethoscope to listen to my heart, he reached under my sweater and felt me up, first one side, then the other. Finally, he released my bra and continued to cup my breast in his hand as he bent forward. Then he re-hooked my bra, continued to listen to my heart, and is sending me for a heart ultrasound exam.

Is this a normal procedure? Was I just giving the doctor a free feel? Should I return to him?

Dear Reader: Your doctor behaved appropriately, with one exception that I will address below.

I don’t know why you were referred to a cardiologist. I suspect it was because of a murmur, an extra “whooshing” sound in your heart that could reflect valvular damage.

In evaluating this sound, the cardiologist needed to determine three things: the nature and location of the murmur, its relation to body position, and whether it was present during the cardiac cycle of contraction or relaxation. In order to investigate a murmur, a doctor needs to listen to the patient’s heart in a variety of positions.

I suspect that your concern about your breasts may, in fact, be the consequence of a normal, thorough and appropriate heart exam, in different positions.

If the physician were motivated by other factors, I doubt that he would have re-fastened your bra and moved on to a more traditional heart exam. In my opinion, your cardiologist behaved professionally.

My concern, which I am now expressing, is that the cardiologist failed to give you a warning, or a “heads up” before he involved your breasts in a heart exam. When I examine female patients, I routinely describe what I’m going to do and ask permission, with statements such as: “I am going to listen to your heart. Is it OK if I loosen your bra, check your lungs and listen to your heart in different positions? I need your permission to involve your breasts in the exam.”

I believe that if the cardiologist knew of your valid concerns, he would be mortified — and would properly revise his examination procedure, and learn to be more tactful and respectful.

I suggest that you cut this question and answer out of the newspaper, send it to him, and — perhaps — address the issue forthrightly with him during your next follow-up appointment.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.