Guidance

The role of patient chaperones in clinical practice

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.

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5 Responses to “The role of patient chaperones in clinical practice”

  1. wazir says:

    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 …

  2. male_advocate says:

    The majority of patients do not want a chaperone, as borne out by the survey above. The real reason why they are so prevalent is because doctors demand it to protect themselves. Has a similar survey ever been done of doctors to find out how many would refuse to do an intimate examination of the opposite sex without one being present? If not, why not? Could it be because it would smash the myth that they are provided for a patients comfort and reassurance?
    Let’s now talk about patient dignity double standards. Are statistics kept on the gender of chaperones offered? This should be 50% male/female to be equally fair to both sexes. However, I am certain that it would be show that over 90% of those offered would be female. Have these statistics been published and if not, why not? Could it be because it would reveal to the world that there is institutionalised sexual discrimination against men and a hidden secret of healthcare?
    No problem then if you are a woman, but if you are a man, what happened to a right to choose? Is this not a breach of human rights? Now let’s reverse the situation in a hypothetical case.

    You are a woman who is forced to agree to a male doctor giving you an intimate examination as a female doctor is not available. To compound the issue, he insists he needs a chaperone to watch (for your comfort!) and only men are available. A young man walks in the room and is not introduced. You had assumed that he would be a nurse or doctor but he is dressed informally and unbeknown to you, actually works in the office doing admin. You object but are told you have nothing he hasn’t seen before and he has been trained in the role and so is a professional. Your case is potentially serious so the examination cannot be delayed so she is forced to agree to it continuing. Does this sound outrageous and implausible? Well it happens to hundreds (thousands?) of men every day but I am sure almost never does to women.

    As chaperones do not need to be medics, office PAs, receptionists and general office staff are all available to aid the doctor. However, these are almost always exclusively female and very often, young and attractive, making many men even more aware of their exposure and increasing their humiliation to new levels. How much longer can we allow this to continue?

    Men cannot expect women to be concerned about this issue as it does not affect them and some may even find men’s embarrassment amusing and payback for female discrimination in the past.

    However, men have been conditioned by society to believe they should have no modesty and anyone who does, is denigrated as being childish, silly or sissy. This attacks a man at his core of manhood and further humiliates and degrades him in a medical situation. That is why the majority of men just suck it up and bite their lip and let it happen rather than complain as they are afraid of the reaction they will get. Men act differently to embarrassment situations. Some make jokes to hide this, often as sexual bravado to mask their true feelings. Some blush and go quiet or complain softly. Some get angry. However, very few will complain about their embarrassment as to admit this only increases their humiliation. They cannot even complain when they get home as male friends will make fun of them and women say they should not be silly. So the status quo continues with no-one willing to drive the changes needed to make healthcare fair to all.
    In my view it should be mandatory for all practises and hospital departments to have at least 2 men available to act as chaperones at all times. As already mentioned, there will be no shortage of female chaperones available without any extra effort. This will be a first needed first step on the long path to equal healthcare standards for all.

  3. WHR says:

    Been there done that. First time was when I had to have a kidney stone removed. The operation is done through the urethra and General anesthesia is used. One male doctor my urologist was in the room.Every one else…..FEMALE. About the time I am heading into La La land,up my legs go into stirrups,done by a female nurse and in walks a whole passel of young (looked to me about 18 to 20 years of age) female nursing students. With my fanny and HooHa out and up in the air,my last thought was,”Well,so much for modesty.”I was wondering which of those individuals was my Chaperon? I have at least 5 more story’s of similar happenings.It has happened so much to me I don’t even care anymore.

  4. Jac says:

    Male_advocate says it all very well, except that a significant percentage of times when I have complained, the attitudes expressed were very condescending (seen it all, no big deal, etc.). Surprise followed, when I insisted, anger/disbelief when I walked out. Stand up for yourselves!

  5. Aperson says:

    These blanket gender statements (always have a chaperone the same gender as the patient, etc.) are ignorant. I am a man and if I had to have a chaperone (which I would prefer not to, but I understand the GP’s concerns), I would want the chaperone to be female – as well as the GP. Having been sexually abused by males, I don’t want males anywhere near my genitals – neither looking at them nor touching them. I would much prefer a female doctor and a female chaperone.

    And what about transitioning transgender individuals, who would often prefer a doctor and chaperone in the gender that they are transitioning to but haven’t yet transitioned to? I also know of a woman who would only want a male doctor and a male chaperone. As far as practical, CHOICE should be given to the patient – it should not just be assumed that because they are a particular biological gender, they would prefer to have a doctor and/or chaperone in that biological gender.

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