Hospital doctors are being urged to ensure their trust has a chaperoning policy in place.
It follows research in the Postgraduate Medical Journal which shows that nearly half of the 92 hospital trusts responding to a survey did not have a chaperoning policy in place (43.5%) and that only half of these (52%) intended to put one in place.
Trusts need to avoid confusing staff about when a chaperone should be offered and who can act as one. The GMC recommends in its advice on Maintaining Boundaries that doctors offer chaperones for intimate examinations wherever possible.
The use of chaperones was originally encouraged by the Ayling Inquiry in September 2004. This report was produced after an independent inquiry had reviewed the way the NHS dealt with allegations about the conduct of Clifford Ayling, a GP from Kent, who was convicted of 13 counts of indecent assault on female patients between 1991 and 1998 and was sent to prison for four years.
The Ayling Inquiry suggested that each NHS trust has a chaperoning policy, makes it explicit to patients, and resources it accordingly.
The research concludes, however, that most trusts have ignored the Ayling Inquiry recommendations. It calls for them to create a chaperone policy, increase the training for chaperones, and resource the policy efficiently. The latter may be aided, it says, if more trusts consider advertising the policy with posters and leaflets.
The research authors, Metcalf et al, also propose that regular auditing of the use of chaperones be done as a matter of important national health policy.
They said: “The current financial difficulties seen in many trusts may be placing a relative unimportance on the chaperone role. Money may be deemed to be more appropriately spent in other areas.
“However, in a climate of increasing legal cases and improving patient satisfaction, the cost effectiveness of this stance may be questioned.”
The MDU provides the following advice to its members on chaperones:
1. Chaperones should be routinely offered for intimate examinations, such as of the genitalia or breasts. It is also advisable to offer one for examinations conducted under dim lights where doctors need to get very close to a patient, for example with an ophthalmoscope.
2. Good communication with patients is the key to avoiding misunderstandings - explain to the patient why the particular examination is necessary and what it entails so they can give fully informed consent.
3. Record the consent discussion in the notes along with the identity of the chaperone or if a chaperone was offered but declined.
4. If possible, use a chaperone of the same gender as the patient.
5. Allow the chaperone to hear the explanation of the examination and the patient’s consent.
6. Position the chaperone where they can see the patient and how the examination is being conducted.
7. Ensure patients’ privacy during the examination and when they are dressing and undressing.
8. Avoid personal remarks.
9. Be aware that allegations have been made by patients of both sexes against doctors of both sexes, although they are most commonly made by female patients against male doctors.
Commenting on the findings, Dr Emma Cuzner, an MDU medico legal adviser, said: “Having a chaperone present can provide reassurance for patients during certain examinations, particularly intimate ones. Chaperones can provide support when undergoing an examination which may be embarrassing or uncomfortable for the patient.
“It is important that hospital trusts and general practices have clear policies in place covering, for example, when to offer a chaperone, who can act as a chaperone and what to do if a chaperone is refused, and that staff performing clinical examinations are aware of the policy.”
She added: “A secondary function of a chaperone is to protect the doctor from an allegation of improper behaviour.
“A chaperone alone does not provide a doctor with a guarantee of protection against a complaint, and we are aware of cases where a complaint has arisen when a chaperone was present. However, a chaperone can provide independent evidence of what took place if the patient complains for any reason.”
Tags: Chaperones
