Chaperone guidance revised

INTIMATE examinations can be an everyday occurrence for doctors, but they are rarely so for patients. While medical professionals are routinely required to carry out these examinations, the experience can often be embarrassing or distressing for patients.

No doctor wishes to be on the receiving end of an allegation of inappropriate behaviour or, worse, sexual assault. It is crucial to approach these examinations in the right way to ensure the patient is as comfortable as they can be and that they fully understand what to expect.

One measure doctors can take to help avoid such accusations is the use of a chaperone. Updated guidance on this area of medical practice has recently been issued by the General Medical Council.

Intimate Examinations and Chaperones (which came into effect on April 22) contains a key change in advice and now recommends that chaperones should “stay for the whole examination and be able to see what the doctor is doing, if practicable.”

MDDUS has dealt with cases where doctors have been accused of inappropriately touching a patient after a chaperone has left the consultation. Following the updated guidance it is hoped such accusations can be avoided.

The guidance also addresses situations where the patient has declined a chaperone or if either the doctor or patient is uncomfortable with the choice of chaperone. The doctor can offer to delay the examination to a later date when a suitable chaperone will be available, so long as the delay would not “adversely affect the patient’s health”.

If the doctor does not want to proceed without a chaperone, the GMC advises to clearly explain to the patient why you want a chaperone present, adding that “the patient’s clinical needs must take precedence. You may wish to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as a delay would not adversely affect the patient’s health.”

Doctors should offer the patient the option of having an impartial observer/chaperone present wherever possible, even when doctor and patient are the same gender. This should clearly be discussed before carrying out any intimate examination.

While a chaperone does not have to be medically qualified, they must be familiar with normal examination techniques and good conduct. They should be sensitive and respectful of the patient’s dignity and confidentiality and be prepared to reassure the patient if they show signs of distress or discomfort. A chaperone should also be prepared to raise concerns about a doctor if misconduct occurs.

In some circumstances, a member of practice staff may be an acceptable chaperone. The guidance adds that a relative or friend of the patient is not an impartial observer and “would not usually be a suitable chaperone, but you should comply with a reasonable request to have such a person present as well as the chaperone.”

It is important that any discussion about a chaperone is noted in the medical record, including the chaperone’s name.

The GMC advises doctors to “be sensitive to what [the patient] may think of as intimate. This is likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch or even be close to the patient.”

Doctors should also be sure to clearly explain to the patient what the examination will involve and to allow them to undress in private, unless asked for assistance.

ACTION: Where a chaperone is requested, they should be present for the whole examination and, if practicable, be able to see what the doctor is doing.