Answers

1. A 22-year-old woman attends surgery with her mother. She presents with a single episode of rectal bleeding. With regards to having a chaperone present during an intimate examination, which one of the following is correct?

A. There is no need to offer a chaperone if the patient is the same gender as the doctor.
B. The chaperone should not be a relative or carer for the patient.
C. The chaperone must be medically qualified in some way, eg, a nurse or healthcare assistant rather than a receptionist.
D. If a chaperone is not available, in some cases it is appropriate to delay the examination until one is available.
E. There is no need to offer a chaperone for this type of examination.

The correct answer is D. The GMC guidance on chaperones recommends offering a chaperone for intimate examinations wherever possible – this includes but is not limited to examinations of the genitalia, breast, rectum and internal examinations. A chaperone should be offered even when a patient is of the same gender as the doctor. Chaperones do not need to be medically qualified, although ideally they should have had some training and be familiar with the examination being performed. In some cases, it is appropriate to have a member of the practice team (eg, a receptionist), a relative or a carer as a chaperone.
  
If a chaperone is not available, then, if clinically acceptable, it may be appropriate to delay the examination until one is available.

2. A 15-year-old boy attends surgery alone and requests treatment for severe acne. His parents are also registered patients at the surgery, and he has always attended with his mother in the past. Regarding consent to treatment, which one of the following is correct?

A. The patient cannot consent as he is under 16 years old.
B. The patient can consent but his parents must be informed first.
C. The patient can consent as long as his parents are told afterwards.
D. The patient can consent if he meets the Fraser guidelines.
E. The patient can consent if the GP deems him to be Gillick competent.

The correct answer is E. A patient under the age of 16 may consent to treatment if they are deemed to be Gillick competent. If he is deemed competent, then the parent’s permission is not needed, and the validity of the consent is NOT dependent on the parents being informed, although unless the child objects, it would be good practice to keep them informed. Fraser guidelines are specific to contraception, so do not apply here.

3. A 44-year-old woman presents with a suspected breast lump. She accepts the offer of a chaperone during the examination, and a healthcare assistant is present throughout the examination. With regards to the medical record, which ONE of the following is correct?

A. The fact that a chaperone was present does not need to be noted.
B. The fact that a chaperone was present should be noted, along with their identity (including name and job role).
C. The fact that a chaperone was present should be noted, but no further details are necessary.
D. The fact that a chaperone was present should be noted, along with their job title only.
E. Details of the chaperone should be noted only with the chaperone’s permission.

The correct answer is B. GMC guidance recommends that where a chaperone is present during an examination, this should be recorded, along with the identity of the chaperone. The job title alone is not enough as it may be difficult to identify exactly who chaperoned (eg, there may be many receptionists).

Dr Mahibur Rahman is the medical director of Emedica, and works as a portfolio GP in the West Midlands. He is the course director for the Emedica AKT and CSA Preparation courses, and has helped hundreds of GP trainees achieve success in their MRCGP AKT and CSA examinations. MPS members can get a £20 discount off the Emedica MRCGP courses. Details of the courses are available at: www.emedica.co.uk