A chaperone’s main role is to provide reassurance and emotional support for a patient undergoing a procedure they may find embarrassing or uncomfortable such as intimate examinations or examinations under dim lights or where the doctor needs to get very close.
While doctors already have an ethical duty to ensure patients understand what an examination entails and the reasons for it, by offering a chaperone, they also show they recognise an examination may be uncomfortable or embarrassing which may itself may be reassuring.
Protecting the doctor from an allegation of improper behaviour is a secondary function of a chaperone; nor does a chaperone provide a guarantee of protection. However, a chaperone can provide independent evidence if the patient complains for any reason.
If a patient requests a chaperone then, if possible, one should be provided. If no one is available, try to rearrange the examination, though it may need to go ahead if it is urgent and in the patient’s best interests. This will need to be discussed with the patient.
Evidence on usage
Studies have shown that while chaperones may routinely be offered for certain examinations, many patients appear not to feel they are necessary. For example, a study of 709 patients attending a urology department found three quarters of male patients and over a half of female patients did not want a chaperone.
Similar research by patients having breast examinations also found most patients were happy to proceed without a chaperone.
This data does not detract from the need to make an offer of a chaperone, particularly for intimate examinations. If a doctor feels uncomfortable without a chaperone and the patient has refused one, they are entitled to insist a patient sees someone else, unless of course there is a serious and immediate clinical need for the examination.
Doctors are expected to familiarise themselves with their trust’s chaperone policy including specific provisions for particular specialities. Of greater importance, however, is a doctor’s ethical duty to “treat patients as individuals and respect their dignity” (Good Medical Practice).
Maintaining Boundaries gives further GMC guidance on the use of chaperones. Paragraph 10 states: “Wherever possible, you should offer the patient the security of having an impartial observer (a chaperone) present during an intimate examination. This applies whether or not you are the same gender as the patient.”
The guidance says that chaperones don’t have to be medically qualified. They could be a member of practice staff, or a relative or friend of the patient. However, they will ideally be sensitive, respectful of patient dignity and confidentiality, and prepared to reassure the patient if they show signs of distress or discomfort. They will also be familiar with the procedures involved in a routine intimate examination and prepared to raise concerns about a doctor if necessary.
It recommends doctors record any discussion about chaperones and the outcome. This means the presence of a chaperone should be recorded, along with the chaperone’s identity - as well, of course, if the offer of a chaperone was made and declined.
Tips for doctors on chaperone awareness
1. Explain clearly beforehand what you will be doing during the examination and at each stage of the procedure and encourage questions.
2. Document clearly in the notes the offer of a chaperone, the patient’s answer and (if applicable) who the chaperone was. This is especially important if the patient refused to have a chaperone.
3. If possible, use a chaperone of the same gender as the patient.
4. Allow the chaperone to hear the explanation of the examination and the patient’s consent.
5. Position the chaperone where they can see the patient and how the examination is being conducted.
6. Don’t continue the examination if the chaperone leaves the room, unless the patient agrees.
7. Always talk in a respectful manner to patients, avoiding over-friendly terms even though you are likely only to be trying to put the patient at ease. Avoid sexual humour at all costs!
8. Do not assist the patient with undressing and leave the room while they are doing so, or draw a curtain around them to give them privacy.
9. Provide a sheet to keep the patient covered before you start and when you have completed your examination, and only expose the part of the body you are examining at any point.
10. Be alert to any signs of discomfort or distress.
11. If the patient asks you to stop, do so immediately.
12. Allow the patient to get dressed in private before talking to them about your findings and management plan.
13. Once the patient is dressed or the examination completed, politely ask the chaperone to leave to allow one-to-one communication to take place between the patient and doctor.
Fictional case history - based on cases from the MDU’s files
A male ST2 doctor in general surgery was asked to assist at a clinic for the first time. When he arrived, he was asked to see a man in his 20s with a painful lump in his right groin. His GP had diagnosed a hernia and referred the patient for consideration for surgical repair.
The doctor introduced himself and proceeded to take a history. He asked if he may examine the lump and requested the patient remove his trousers and lie on the examination couch. The patient blushed and asked why he needed to take his trousers off and he would prefer to just pull them down. The doctor explained he needed to examine the lump thoroughly, but agreed the patient could just pull his trousers down slightly.
During the examination, the doctor explained he needed to examine the patient’s testicles and pulled down the patient’s boxer shorts. He confirmed the presence of a hernia and explained what surgery would involve. The patient said he had no more questions and left the room.
The patient wrote a letter of complaint to the chief executive that he had been inappropriately examined by a young male doctor. The MDU assisted the doctor with preparing a response to the patient which included an apology for any distress that may have been caused by his actions. He gave a clear explanation of the consultation, why he felt it was necessary to examine the patient in the way he had and how this was an essential with a suspected hernia. He explained the lessons he had learnt from this experience: he should clearly explain every aspect of what an examination involves and the reasons for it in order to gain consent for the procedure. He also said that in future he would ensure the patient was given the opportunity to have a chaperone present. The patient later decided he did not wish to pursue the complaint.
Tags: Chaperones, Complaints
3. If possible, use a chaperone of the same gender as the patient.
the “possible” if only for women . great double standard in clinical practice !
men have no chance to avoid a female nurse or worse a female secretary …
but who cares ? everybody knows that men have less modesty …