The presence of a chaperone can be of reassurance to both patients and doctors, especially when there is a need for an intimate examination to be performed, regardless of the gender of either the doctor or the patient.
GMC guidance in Good Medical Practice 2013 states, in para 9: “A chaperone should usually be a health professional and you must be satisfied that the chaperone will:
- be sensitive and respect the patient’s dignity and confidentiality
- reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- stay for the whole examination and be able to see what the doctor is doing, if practical
- be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.
You should record any discussion about chaperones and the outcome in the patient’s medical record. If a chaperone is present, you should record that fact and make a note of their identity.”
In what circumstances should a chaperone be offered?
The most obvious example is with intimate examinations, and in these situations a chaperone must be offered. However, it is important to remember that what can be classed as an intimate examination may depend on the individual patient.
It may also be appropriate to offer a chaperone in other circumstances such as consultations with particularly vulnerable patients. Their presence may be advantageous during the entirety of a consultation or for a specific part, not necessarily involving a physical examination.
It is important to always explain to a patient the reasons for any examination and detail what you are intending to do before obtaining their permission to proceed.
Why use a chaperone?
- Their presence adds a layer of protection for both the doctor and the patient; it is rare for an allegation of assault to be made if a chaperone is present.
- To acknowledge a patient’s vulnerability and to ensure a patient's dignity is preserved at all times.
- They may assist the health professional in the examination; for example, the chaperone may assist with undressing/dressing patients as required.
- Provides emotional comfort and reassurance to the patient.
Intimate examinations may be embarrassing or distressing for patients and such examinations should be carried out sensitively. This is likely to include examinations of breasts, genitalia and rectum, but it also extends to any examination where it is necessary to touch or be close to the patient. Medical Protection has seen a number of cases relating to examinations of a patient’s chest, for example.
A number of bodies including the GMC, NMC, RCOG and RCP provide advice on intimate examinations.
What if a chaperone is not available?
There may be occasions when a chaperone is unavailable (for example, 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, then it would be appropriate, after explaining to the patient, to rearrange the appointment for a mutually convenient time when a chaperone and the patient will be available.
- If the examination is clinically indicated on an urgent basis, and the doctor has enough information from the history to indicate that the patient would require an admission to hospital in any event, then it may be appropriate to defer this examination until admission to hospital, again explaining this to the patient and in the referral letter.
- If the examination is urgent, and hospital admission is not indicated on the history alone, any delay must not adversely affect the patient’s health, so there may be occasions when a doctor goes ahead in the absence of a chaperone. In such circumstances, the patient’s written consent should be obtained. In addition, the fact that the patient was examined in the absence of a chaperone should be recorded, together with the rationale for this.
Practices should no longer use untrained practice staff to fulfil the role of a chaperone. Chaperones need to be trained so that they understand what a legitimate clinical examination entails and at what stage it may become inappropriate. Your Local Area Team may be able to help in terms of identifying locally available training courses for chaperones.
Although a chaperone does not have to be medically qualified they must be:
- A health professional.
- Aware of their duty of confidentiality.
- Prepared to reassure the patient.
- Familiar with the procedures involved in the relevant examination.
- Prepared to raise concerns about a doctor if misconduct occurs.
It is important to note that family members cannot fulfil the role of chaperone.
Written information detailing the chaperone policy should be freely available to patients – for example the policy might be displayed in waiting rooms, consultation rooms, and on the practice/Trust website. This empowers patients to address the topic themselves if they would feel more comfortable with a chaperone present.
What if a patient declines a chaperone?
Even if a patient declines the offer of a chaperone, the doctor/nurse may feel that in certain circumstances (for example, an intimate examination on a young adult of the opposite gender), it would be wise to have a chaperone present for their own comfort/protection.
- The doctor should explain that they would prefer to have a chaperone, explain that the role of the chaperone is in part to assist with the procedure and provide reassurance. It is important to explore the reasons why the patient does not wish to have a chaperone and to address any concerns they may have.
- If the patient still declines, the doctor will need to decide whether or not they are happy to proceed in the absence of a chaperone. This will be a decision based on both clinical need and the requirement for protection against any potential allegations of an unconsented examination/improper conduct.
- Another option to consider is whether or not it would be appropriate to ask a colleague to undertake the examination (although the chaperone issue may still prevail).
- A further option would be to consider referring the patient to secondary care for the examination (although the chaperone issue may, again, still prevail).
- The doctor/health professional should always document that a chaperone was offered and declined, together with the rationale for proceeding in the absence of a chaperone.