ONE of the most serious complaints a doctor can receive is that they inappropriately touched or examined a patient. Worse still is an allegation of sexual assault.
These types of complaints are not uncommon and if examinations of an intimate nature are not approached in the right way, a patient may complain to the GMC, or even the police, with potentially catastrophic consequences for a doctor’s career.
There are a number of measures doctors can take to help avoid such accusations. It is crucial to follow GMC guidance Maintaining boundaries – guidance for doctors, with one key element of this being to “offer the patient the security of having an impartial observer (a ‘chaperone’) present during an intimate examination.”
So just what is an “intimate examination”? Generally this would include examination of the breast, genitalia and rectum but may also extend to the chest, groin or abdomen. For some patients, just touching or close physical proximity could be perceived as intimate.
The role of the chaperone is to reassure patients and offer emotional support as intimate examinations can be embarrassing or uncomfortable for patients. Also, by having a chaperone present, a doctor can reduce the risk of complaints or allegations during intimate examinations. It is recommended that even where the doctor and patient are of the same gender, the offer of a chaperone is still made.
The chaperone does not have to be medically qualified but should have received appropriate training and must be sensitive and respectful of the patient’s dignity and confidentiality. He or she should be prepared to reassure the patient if they show signs of distress or discomfort and be familiar with the procedures involved in a routine intimate examination.
The chaperone must be prepared to raise concerns about a doctor’s behaviour where necessary. Any discussion about a chaperone should be noted in the medical record, including the chaperone’s name. If the patient does not want a chaperone and the doctor is happy to proceed, then it should be noted that a chaperone was offered and declined.
Should no chaperone be available and the doctor or patient is unwilling to proceed without one, the patient should be given the option of delaying the examination to a later date. If either party is uncomfortable with the choice of chaperone then the examination can be delayed until a suitable replacement is found.
The GMC offers clear guidance on conducting intimate examinations even with a chaperone present. You should always explain to the patient why the examination is necessary and give them plenty opportunity to ask questions. Explain just what will be involved in clear language that the patient can understand, including any potential pain or discomfort. Obtain clear consent from the patient before the examination and record that consent in the notes.
Patients should be given privacy to undress and you should ensure they are covered as much as possible during the examination to maintain their dignity. Do not help the patient undress unless you have clarified with them that some assistance is required.
Should the examination differ in any way from the procedure you have already described to the patient, explain why this is necessary and seek further permission to go ahead. Always be prepared to discontinue the examination if asked by the patient. Keep any comment to the patient relevant and do not make unnecessary personal observations.
Remember that any decision you make should take into account the patient’s best interest. Use of a chaperone can prevent unfounded allegations of inappropriate behaviour during intimate examinations. Therefore, chaperones not only benefit the patient, but the doctor too.
• Chaperones should be offered to all patients during intimate examinations.
• Chaperones need not be medically qualified but should be appropriately trained.
• Complaints and serious allegations can be avoided by having a chaperone present.
• Keep a record of use of chaperones (including their name) – even if they are offered and declined.
• Chaperones are for the doctor’s benefit as well as the patient.
Dr Anthea Martin is a senior medical adviser at MDDUS