Chaperones for Examinations

Chaperones for Examinations

A chaperone is an impartial observer present during a consultation: they provide protection for both the patient and the clinician. This can prove important should a clinician face allegations of impropriety. It is therefore important that clinicians are fully compliant with chaperone guidance.

Doctors should always be cognisant of a patient’s privacy and dignity. In addition, it is imperative that clinicians are aware of their obligations surrounding physical and intimate examinations. Initially, the doctor should consider what each patient may regard as an intimate examination. Naturally, this will differ from patient to patient. Similarly, if a patient is vulnerable in any way, it may be appropriate for the doctor to offer a chaperone. 

There are two considerations in having a chaperone to assist during intimate examinations:

  • 1. the comfort and dignity of the patient
  • 2. the protection of the doctor from allegations of impropriety. 

The General Medical Council provides guidance on the use of chaperones in “Intimate examinations and chaperones”. 

Para 8 states 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.”

What is an intimate examination?

The GMC describes intimate examinations “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”. The latter could be, for example, listening to the apex of the heart, examination of the fundi using an ophthalmoscope in a darkened room or similar types of examination where physical proximity is necessary.

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

PMP suggests the best practice is to adopt a policy of offering a chaperone to patients for all examinations, not just intimate examinations. However, you are only obliged to offer a chaperone for intimate examinations.

Who should be a chaperone?

It is advisable that family members or friends of either the patient or the doctor should not undertake the chaperoning role. They may not fully appreciate the nature of the physical examination performed and may not be completely impartial. However, the GMC states in “Intimate examinations and chaperones” that “you should comply with a reasonable request to have such a person present as well as a chaperone.”

Ideally, the chaperone should be another healthcare professional, properly trained and clinically independent.

If non-medical staff members, eg, secretary/administrator, are to undertake the chaperone role, you should ensure that they are fully trained, which includes training in maintaining patient confidentiality, familiarity with the procedure, where to position themselves during the examination and how to raise concerns about a healthcare professional if misconduct occurs.

Record in the patient notes

PMP recommends you record the presence of the chaperone and their identity, including name and job title, in the patient’s record.

If a patient refuses a chaperone, you should record that you offered a chaperone, but the patient declined.

If you use electronic records, you may find it useful to use a chaperone template to record the patient’s relevant decision.

…record the presence of the chaperone and their identity, including name and job title, in the patient’s record.

If a chaperone is not available

There may be occasions, eg, during an evening consultation or domiciliary visit, when a chaperone may not be available. In these circumstances, you should consider whether the examination is urgent and necessary. If it is not urgent and the patient requests a chaperone, you could reschedule the appointment for a time when a chaperone is available.

Where possible, healthcare professionals should make every effort to ensure the availability of a chaperone at certain times in the working week. This will ensure that a chaperone will be available to comply with the absolute duty to offer a chaperone for intimate examinations.

If a patient declines a chaperone

The presence of a chaperone protects both the doctor and the patient. Even if a patient declines a chaperone, the doctor may feel it would be more prudent to have one in attendance for their own protection and/or comfort.

In such circumstances, the doctor should explain their position to the patient. If the patient still declines the offer of a chaperone, the healthcare professional will need to determine whether they are happy to proceed with the examination or not. This is a personal decision that the doctor will need to make, exercising their clinical skills and judgement. If the doctor does proceed in the absence of a chaperone, they should carefully document that a chaperone was offered and declined.

PMP recommends that the doctor also makes a note detailing their rationale for commencing the examination in the absence of a chaperone.

Checklist

Explain to the patient why the examination is necessary and what it entails, including any pain or discomfort. Give the patient time to ask any questions about the procedure. Be aware of and respect any cultural or religious issues.

  • Ensure the patient provides permission for the examination and record this consent in the patient records.
  • Offer the patient a chaperone, where possible, use a chaperone of the same gender as the patient. The chaperone should be informed of the nature of the examination and the patient’s consent.
  • Provide the patient privacy to dress/undress and keep them covered as much as possible to maintain their dignity, eg, use paper drapes. Do not help the patient to remove clothing unless they have asked you to do so or you have checked with them that they want you to help.
  • The chaperone should stand in a position where they can see the patient and the process of the examination.
  • Provide the patient with an explanation of each stage of the examination. Stop the examination if the patient asks you to do so. Keep all discussions relevant and avoid personal comments.
  • The chaperone should leave the room following the examination. They do not need to be present for any subsequent discussion of the patient’s condition or treatment.
  • Immediately after the consultation, record the identity and job title of the chaperone in the patient’s notes, as well as any other relevant issues or concerns. Additionally, record if a friend or relative was present during the examination.

If you have any queries or concerns surrounding the issues raised in this fact sheet, please do not hesitate to call the PMP medicolegal helpline. The helpline is open 24/7, and contact details can be found on your policy documents or customer card.

Information correct at time of publication March 2021

Last reviewed February 2023

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. We recommend that you seek independent legal and/or professional advice in relation to your legal or medical obligations or rights. Premium Medical Protection Limited is the owner of this material and its contents are protected by copyright law © 2023. All such rights are reserved.

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