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Chaperones

Maintaining professional boundaries in doctor-patient consultations has never been more difficult. Consultations now require more detailed discussions with ever-more informed patients, who also have increased control over managing their own care. Since 2004, in the wake of the Clifford Ayling case, the Committee of Inquiry has upheld the following recommendations regarding the provision of chaperones:


What Is a Chaperone?

A chaperone is a trained independent observer of examinations and procedures, whose presence is designed to maintain a healthy doctor-patient relationship. The GMC’s ‘Good Medical Practice’ guidance on chaperones states that a chaperone should usually be a health professional, and that a patient must feel confident that their chaperone will

The chaperone’s details should be recorded in the clinical record, and the patient informed that the details have been taken.

When Is a Chaperone Offered?

Chaperones must be offered before a patient undergoes an intimate examination, but the definition of an intimate examination may vary by patient. Chaperones may also be offered for specific parts of a consultation, as well as for entire meetings, or examinations. It may also be beneficial to have a chaperone present if a patient is

A chaperone must be properly positioned to observe the procedure, and therefore to act as an independent witness as to how the examination was carried out.

What Is an Intimate Examination?

An intimate examination is any examination that may be distressing or embarrassing for a patient. These most commonly include examinations of the rectum, genitalia, breasts, or other examinations involving touching or close proximity – such as eye examinations or applying blood pressure cuffs.

Why Are Chaperones Needed?

Chaperones protect both doctors and patients from inappropriate behaviour and false allegations, and ensure that a patient’s dignity is preserved. They provide emotional comfort and acknowledge the vulnerability of all patients and may assist with the examination or undressing of patients as required.

Practices should use trained chaperones, rather than practice staff to fulfil the role of chaperone. They don’t necessarily have to be medically qualified, but they must be

What If a Chaperone Is Not Available?

If a chaperone is not available – if an examination is due to take place out-of-hours, for example – then doctors should consider whether the examination they are about to undertake is urgent or not. If not urgent, then the most appropriate course of action would be to arrange the examination for a time when a chaperone will be available. In the event that the patient will almost inevitably need admission to hospital, it might be more appropriate to defer examination until after admission. If the examination is urgent, then the patient can give written consent and the examination may have to take place without a chaperone. Full records of procedures should be made.

Chaperone Information

Information on the chaperone policy should be freely available to patients, and when offering chaperone provision to patients, the following points should be addressed:

Declining a Chaperone

Even if a patient chooses to not have a chaperone present, a doctor or nurse may still feel that a chaperone would be wise – for a genital exam of an adolescent of the opposite gender, for example. In this instance, the doctor or nurse should explain that a chaperone would fulfil their role of assisting with the procedure and reassuring them. It is also important to understand why the patient has declined a chaperone, and to alleviate any concerns they may have.

Another option, if the patient continues to decline a chaperone, is to ask a colleague to undertake the examination on your behalf. This may alleviate some gender appropriateness issues, but the chaperone issue may still persist. Referral to a secondary care facility may also be an option.

Summary

Doctors intending to inform their patients of the chaperone policy should also record all interactions regarding the chaperone in the patient’s medical records. All chaperones should also be fully trained, and doctors are not required to conduct examinations if the offer of a chaperone is declined. There should always be a focus on respecting the diverse backgrounds of patients, and examinations should only go ahead if there is no language, communication, or consent barrier.

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