It is a doctor’s responsibility to manage and maintain professional boundaries – utilising chaperones effectively is a way of managing relations with patients.
Why use chaperones?
The offer of a chaperone is for the protection of both the patient and the doctor. The Medical Council in A Guide to Professional Conduct and Ethics for Registered Medical Practitioners advises that before undertaking any physical examination, you should explain to patients why it is needed and what will be involved, and get their consent.
Where an intimate examination is necessary, you must explain to the patient why it is needed and what it will entail. Obvious examples of intimate examinations include those of the breasts, genitalia and the rectum, but it can also extend to any examination where it is necessary to touch or be close to the patient; for example, conducting eye examinations in dimmed lighting, placing the blood pressure cuff and palpating the apex beat.
“You must ask the patient if they would like a chaperone to be present – for example, a nurse or family member – and note in the patient’s record that a chaperone was offered. You should also record if a chaperone was present, had been refused, or was not available but the patient was happy to proceed.”
It may also be useful to record the identity of the chaperone so that corroboration may later be obtained if that is required.
The guidance also advises that you should respect the patient’s dignity. This will involve giving them privacy to undress and dress, and keeping them covered as much as possible. You should not help the patient to remove their clothing unless they ask you to do so or you have checked with them that they would like your assistance.
The guidance also advises that you must not carry out an intimate examination on an anaesthetised patient unless the patient has consented for you to do so prior to being anaesthetised.
- Adds a layer of protection for a doctor; it is very rare for a doctor to receive an allegation of assault if they have a chaperone present.
- Acknowledges a patient’s vulnerability.
- Provides emotional comfort and reassurance.
- Can assist in the examination.
- Can act as an interpreter.
How to use a chaperone
Here is a useful checklist for the management of a consultation:
- Establish there is a need for an intimate examination and discuss this with the patient.
- Explain why an examination is necessary and give the opportunity to ask questions; obtain and record the patient’s consent.
- Offer a chaperone to all patients for intimate examinations (or examinations that may be construed as such). If the patient does not want a chaperone, record this in the notes.
- If the patient declines a chaperone and as a doctor you would prefer to have one, explain to the patient that you would prefer to have a chaperone present and, with the patient’s agreement, arrange for a chaperone. Doctors do not have to undertake an examination if a chaperone is declined.
- Give the patient privacy to undress and dress. Use paper drapes where possible to maintain dignity.
- Explain what you are doing at each stage of the examination, the outcome when it is complete and what you propose to do next. Keep the discussion relevant and avoid personal comments.
- Be sensitive to a patient’s ethnic/religious and cultural background. For example, the patient may have a cultural dislike to being touched by a man or undressing.
- Record the use, offer and declining of a chaperone in the patient’s notes.
- Record the identity of the chaperone in the patient’s notes.
- Record any other relevant issues or concerns immediately after the consultation.
- In addition, keep the presence of the chaperone to the minimum necessary. There is no need for them to be present for any subsequent discussion of the patient’s condition or treatment.
Who should be a chaperone?
You should ensure that all chaperones are fully trained. Although they do not have to be medically qualified, they must be sensitive to the patient’s confidentiality; prepared to reassure the patient; familiar with the procedures involved in an intimate examination; and prepared to raise concerns about a doctor if misconduct occurs.
Ideally, family members or friends of both the patient and the doctor should not undertake the chaperoning role, as they may not fully appreciate the nature of the physical examination performed, and may not be completely impartial.
What if a chaperone is not available?
There may be occasions when a chaperone is unavailable, e.g., on a home visit or in the out-of-hours setting. In such circumstances, the doctor should first consider whether or not on a clinical basis the examination is urgent.
If the examination is not urgent, it might be possible to rearrange the appointment for a time when a chaperone is present. If the examination is urgent, but hospital admission is not indicated on the history alone, there may be occasions when a doctor goes ahead in the absence of a chaperone. In such circumstances, the patient’s consent should be obtained and recorded. In addition, the fact that the patient was examined in the absence of a chaperone should be recorded, together with the clinical reasons for this.