Dr Ben White, a Medical Protection Medicolegal Adviser, discusses the use of chaperones during intimate examinations
Read this article to:
- Understand the importance of a chaperone during intimate examinations
- Watch a video, which answers common questions on the use of chaperones
- Learn from two case studies involving foundation doctors
Many patients will find being examined by a doctor embarrassing; however, a physical examination is an important part of an assessment of a patient.
- Chaperones are helpful in supporting a patient during an examination in a number of ways, including:
- recognising the vulnerability of the patient and helping to protect their dignity
- providing reassurance and support for the patient
- assisting with the practicalities of the examination, for example, dressing/undressing
- providing protection for the patient, being able to recognise any variation from a normal examination.
Chaperones also provide protection for doctors against allegations of inappropriate contact or assault.
Dr Ben White, medicolegal adviser at Medical Protection, addresses common questions about the use of chaperones in this video:
- What is a chaperone?
- Why use a chaperone?
- When should a chaperone be offered?
- How do you approach the topic of chaperones with patients?
- What if a chaperone is not available?
- What if a patient declines a chaperone?
- What happens during the examination?
- Chaperones provide protection for patients and doctors.
- Chaperones should be offered for intimate examinations/procedures but also considered for other examinations where there could be potential for misunderstanding (for example, respiratory examination/application of ECG leads).
- When a chaperone is declined or not available then consideration should be given to whether there is an urgent clinical need for an examination. The patient’s clinical need, however, is paramount.
- It is important that chaperones should have appropriate training and they should usually be a health professional.
- It is important that the offer, presence or declining of a chaperone is documented in the patient’s notes, along with any rationale for continuing without a chaperone when the doctor would have preferred one was present.
A male FY1 doctor is seeing a female patient in the surgical admissions unit for clerking whilst on call at 1am. The patient presents with fever, vomiting and rigors, and complains of a red, hot, tender swelling to the right breast. The doctor is concerned the patient is septic and may have a breast abscess. The doctor would like to undertake an examination. He explains this to the patient and offers the presence of a chaperone during the examination. The patient declines a chaperone. There is no other colleague immediately available. The doctor explains the reason for wanting a chaperone to be present but the patient still declines. The doctor decides, as the patient appears to be unwell and delay in assessment may be seriously detrimental to her health, to proceed with the examination. He clearly documents the offer of a chaperone in the notes, the patient’s refusal, his explanation and why he felt it clinically appropriate to proceed.
- The patient’s health is paramount. In the absence of an appropriate chaperone, the doctor must decide if examination is needed owing to clinical urgency.
A female FY2 doctor is seeing a male patient in general practice. The patient has presented with several weeks of altered bowel habit and the doctor would like to undertake a digital rectal examination. The doctor offers a chaperone and the patient accepts. However, on trying to find a suitable chaperone, she discovers that the only two people available are her supervising GP, who is currently dealing with an emergency, and a receptionist. The receptionist offers to help but is not trained. The doctor discusses with the patient the absence of a suitable chaperone, and offers the opportunity to return the following day when a suitable chaperone is available. The patient accepts this offer and returns the following day.
- Chaperones should be trained and ideally should be health professionals (although not necessarily medically qualified).
The cases mentioned in this article are fictional and are used purely for illustrative purposes.
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