The primary purpose of a chaperone is to provide support and reassurance to the patient. However, the presence of a properly trained chaperone also provides protection for the doctor against allegations of inappropriate behaviour and as a witness regarding consent.
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 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 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, or 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 is 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 during the examination. 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.
A chaperone:
> adds a layer of protection for a doctor against allegations of inappropriate behaviour
> acknowledges a patient’s vulnerability
> provides emotional comfort and reassurance
> can assist in the examination, for example passing equipment to the doctor
> can act as an interpreter.
How to use a chaperone
Here is a useful checklist for the management of a consultation:
1. Establish there is a need for an intimate examination and discuss this with the patient.
2. Explain why an examination is necessary and what it will involve, giving the opportunity to ask questions – obtain and record the patient’s verbal consent.
3. Offer a chaperone to all patients for intimate examinations (or examinations that may be construed by the patient as such). If the patient does not want a chaperone, record this in the notes.
4. 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. If the patient still declines a chaperone, and if the examination is not urgent, an alternative might be to arrange for the patient to see a different doctor, who may agree to examine the patient without a chaperone.
5. Give the patient privacy to undress and dress. Use paper drapes where possible to maintain dignity.
6. 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.
7. Be sensitive to a patient’s ethnic/religious and cultural background. For example, the patient may have a cultural objection to being touched by a doctor of the opposite gender or fully exposing a particular area of their body.
8. Record the use, offer, and declining of a chaperone in the patient’s notes.
9. Record the identity of the chaperone in the patient’s notes.
10. Record any other relevant issues or concerns immediately after the consultation.
11. 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 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.
Medical Council, Guide to Professional Conduct and Ethics for Registered Medical Practitioners (8th Edition, 2019)