Why do we use chaperones in clinical practice?
A chaperone’s main role is to provide reassurance and emotional support for a patient undergoing a procedure they may find embarrassing or uncomfortable such as intimate examinations or examinations under dim lights or where the doctor needs to get very close.
“Wherever possible, you should offer the patient the security of having an impartial observer (a chaperone) present during an intimate examination. This applies whether or not you are the same gender as the patient.” (Guidance from GMC)
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 show they recognise an examination may be uncomfortable or embarrassing which may itself may be reassuring.
If a patient requests a chaperone then, if possible, one should be provided. If no one is available, try to rearrange the examination, though it may need to go ahead if it is urgent and in the patient’s best interests. This will need to be discussed with the patient.
Protecting the doctor:
Protecting the doctor from an allegation of improper behaviour is a secondary function of a chaperone; nor does a chaperone provide a guarantee of protection. However, a chaperone can provide independent evidence if the patient complains for any reason.
To be a chaperone:
The guidance says that chaperones don’t have to be medically qualified. They could be a member of practice staff, or a relative or friend of the patient. However, they will ideally be sensitive, respectful of patient dignity and confidentiality, and prepared to reassure the patient if they show signs of distress or discomfort. They will also be familiar with the procedures involved in a routine intimate examination and prepared to raise concerns about a doctor if necessary. All of our Hobs Moat chaperones are fully qualified and trained to provide this service.
Doctors and chaperone awareness:
It is recommended that doctors record any discussion about chaperones and the outcome. This means the presence of a chaperone should be recorded, along with the chaperone’s identity - as well, of course, if the offer of a chaperone was made and declined.
Process of using a chaperone:
1. the GP should explain clearly to the patient and chaperone beforehand what you will be doing during the examination and at each stage of the procedure and encourage questions.
2. GP should document clearly in the notes the offer of a chaperone, the patient’s answer and (if applicable) who the chaperone was. This is especially important if the patient refused to have a chaperone.
3. If possible, use a chaperone of the same gender as the patient.
4. Allow the chaperone to hear the explanation of the examination and the patient’s consent.
5. Position the chaperone where they can see the patient and how the examination is being conducted.
6. Don’t continue the examination if the chaperone leaves the room, unless the patient agrees.
7. GPs or a practice chaperone cannot assist the patient with undressing and can leave the room while they are doing so, or draw a curtain around them to give the patient their privacy.
8. Provide a sheet to keep the patient covered before you start and when you have completed your examination, and only expose the part of the body you are examining at any point.
9. GP must be alert to any signs of discomfort or distress.
10. If the patient asks a GP to stop, they must do so immediately.
11. Allow the patient to get dressed in private before talking to them about your findings and management plan.
12. Once the patient is dressed or the examination completed, politely ask the chaperone to leave to allow one-to-one communication to take place between the patient and doctor maintaining patient confidentiality.