A Patient Complaint Following an Intimate Examination in Private Practice

The risk of a consultant receiving a complaint or accusation of inappropriate behaviour in relation to an intimate examination can be reduced with the appropriate use of a chaperone.

Case scenario

A 50-year-old patient, Mrs S, had a private appointment with a consultant dermatologist, Mr C, at his private rooms, following a referral from her GP regarding a genitalia skin condition.

Mrs S attended the appointment at 17.00 accompanied by a female friend. The lone receptionist asked her to take a seat in the waiting room. Mr C collected the patient and escorted her to his consulting room. Her friend remained in the waiting room.

After a discussion about her condition, Mr C explained that he would need to examine her genitalia. He asked her to step behind the screen, remove her lower clothing and use the cloth blanket provided for modesty.

Mrs S was unsurprisingly anxious but did as requested. Whilst she was undressing, Mr C informed her that due to the late afternoon appointment, the clinic nurse had already left for the day, and no chaperone was available. Despite this, he hoped she was ‘OK’ to proceed with the examination without a chaperone. Mrs S quietly agreed.

Mr C completed the examination and asked Mrs S to get dressed. He explained the proposed treatment plan and issued Mrs S with a private prescription.

Some weeks later, Mr C received a letter of complaint from Mrs S stating that she had found the consultation embarrassing and outlined that she had felt uncomfortable not having a chaperone present during the examination. She also complained about having to use a cloth modesty blanket that may have been used previously by other patients.

Response to the complaint

PMP’s medicolegal team, provided by Clyde & Co LLP (a law firm) assisted Mr C in preparing an appropriate response to the patient, which included an apology for any distress his actions may have caused.

The response to Mrs S’s complaint gave a clear explanation of the consultation and the reasons why the examination was necessary. It detailed the lessons Mr C had learnt from this experience, particularly in relation to ensuring patients are given the opportunity to have a chaperone present.

Mrs S decided she did not wish to pursue the complaint any further.

What is the GMC guidance on the use of chaperones?

Doctors should always be sensitive to a patient’s privacy and dignity. In addition, it is imperative that clinicians are aware of their obligations surrounding physical and intimate examinations.

The General Medical Council in Intimate examinations and chaperones states in Para 8 that:
“When you carry out an intimate examination, you should offer the patient the option of having an impartial observer (a chaperone) present wherever possible. This applies whether or not you are the same gender as the patient.”

Para 3 describes that intimate examination is: “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.”

Each doctor must use their clinical judgement to decide if an examination is intimate depending on the individual circumstances of each examination, including the age, gender and culture of each patient.

Role of the chaperone

The primary role of the chaperone is to provide reassurance and emotional support for a patient undergoing a procedure they may find embarrassing or uncomfortable, such as the examination that Mrs S underwent. While doctors already have an ethical duty to ensure patients understand what an examination entails and the reasons for it, by offering a chaperone, they also demonstrate that they recognise an examination may be uncomfortable or embarrassing for some patients.

Another reason for using a chaperone is to protect the doctor from an allegation of improper behaviour. Although using a chaperone does not guarantee protection, it can provide independent evidence if a patient complains for any reason.

Record in the patient notes

The GMC details in Para 13 of the above guidance that the presence of the chaperone and their identity, including name and job title, is recorded in the patient’s record. If you use electronic records, you may find it useful to use a chaperone template to record the patient’s relevant decision.

Refusing a chaperone

If a patient does not want a chaperone, you should record that the offer was made and declined.

There may be occasions where you feel uncomfortable conducting an intimate examination without a chaperone. If this is the case, you should explain to the patient why you would prefer to have a chaperone present. If the patient still declines a chaperone, you may wish to consider referring the patient to an alternative doctor, who would be willing to examine them without a chaperone, as long as such a delay would not adversely affect the patient’s health.

For further information regarding the use of chaperones and a checklist, please refer to the PMP fact sheet Chaperones for examination, available on our website.