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?
A doctor should always have a chaperone present in the consultation room when conducting an intimate examination regardless of the age or sex of the patient. It is preferable to have a chaperone present for all other examinations and a chaperone should always be offered to the patient.
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 to the patient that there is independent party observing the doctor’s examination.
- can act as an interpreter.
What should you do?
- Establish that there is a need for an intimate examination and discuss this with the patient.
- Explain why an examination is necessary and what the examination will entail.
- 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, if they decline, you can decline to treat them, unless such a refusal would put the patient at risk of harm.
- 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.
- Make sure the chaperone is present throughout the examination.
- Record the identity of the chaperone in the patient’s notes.
- Record any other relevant issues or concerns immediately after the consultation.
What should you not do?
- Allow one of your relatives, who is not an impartial observer, to be a chaperone.
- Do not help the patient undress or dress