It is always the doctor’s responsibility to manage and maintain professional boundaries – and utilising chaperones effectively is a way of managing relations with patients.
Why use chaperones?
The guidelines from the Medical Council are clear: a doctor must always examine a patient, whether female or male, or a child, with a chaperone present in the consultation room. This is particularly important if you are considering conducting a intimate examination.
A doctor should use a chaperone because they:
- add 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
- acknowledge a patient’s vulnerability
- provide emotional comfort and reassurance
- assist in the examination
- assist with undressing patients
- can act as an interpreter.
What should you do?
- Explain why an examination is necessary and give the opportunity to ask questions; obtain and record the patient’s consent.
- If the patient does not want a chaperone, record this in the notes.
- If a patient refuses a chaperone, your overriding duty is to act in the patient’s best interests, which may include proceeding with an examination without a chaperone, especially if clinically urgent.
- It is important to give the patient ample privacy to undress for the examination and to insure that only the necessary areas are exposed whilst covering the rest to reassure the patient.
- 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.
- 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 period. There is no need for them to be present for any subsequent discussion of the patient’s condition or treatment.
What should you not do?
- Allow a relative or friend of the patient to be a chaperone, as they may not fully appreciate the nature of the physical examination performed, and may even testify against you in the event of allegations of misconduct or physical abuse.
- Allow one of your relatives, who is not an impartial observer, to be a chaperone.