Summary
Regardless of the patient’s role, the guidelines from medical regulatory bodies are clear: it is always the doctor’s responsibility to manage and maintain professional boundaries – utilising chaperones effectively is a way of managing relations with patients, where the ultimate responsibility for ensuring that relations remain on professional footing rests with you.
Background
In 2004 the Committee of Inquiry looked at the role and use of chaperones, following its report into the conduct of Dr Clifford Ayling (see useful links). It made the following recommendations:
- Each trust should have its own chaperone policy and this should be made available to patients.
- An identified managerial lead (with appropriate training).
- Family members or friends should not undertake the formal chaperoning role.
- The presence of a chaperone must be the clear expressed choice of the patient; patients also have the right to decline a chaperone.
- Chaperones should receive training.
Why use chaperones?
- Their presence adds a layer of protection for a doctor; it is very rare for a doctor to receive an allegation of assault if they have a chaperone present.
- To acknowledge a patient’s vulnerability.
- Provides emotional comfort and reassurance.
- Assists in the examination.
- Assists with undressing patients.
- Enables them to act as an interpreter.
What is an intimate examination?
Obvious examples include examinations of the breasts, genitalia and the rectum, but it also extends to any examination where it is necessary to touch or be close to the patient; for example, conducting eye examinations in dimmed lighting, taking the blood pressure cuff, palpitating the apex beat.
The chaperone policy
Here is a useful checklist for the management of a consultation:
- Establish there is a need for an intimate examination and discuss this with the patient.
- Explain why an examination is necessary and give the opportunity to ask questions; obtain and record the patient’s consent.
- Offer a chaperone to all patients for intimate examinations (or examinations that may be construed as such). If the patient does not want a chaperone, record this in the notes.
- If the patient declines a chaperone and as a doctor you would prefer to have one, explain to the patient that you would prefer to have a chaperone present and, with the patient’s agreement, arrange for a chaperone.
- Be aware and respect cultural differences. Religious beliefs may also have a bearing on the patient’s decision over whether to have a chaperone present.
- Give the patient privacy to undress and dress. Use paper drapes where possible to maintain dignity.
- Explain what you are doing at each stage of the examination, the outcome when it is complete and what you propose to do next. Keep the discussion relevant and avoid personal comments.
- Record the identity of the chaperone in the patient’s notes.
- Record any other relevant issues or concerns immediately after the consultation.
- In addition, keep the presence of the chaperone to the minimum necessary period. There is no need for them to be present for any subsequent discussion of the patient’s condition or treatment.
(Written information detailing the policy has been provided for patients, in the form of a letter on the notice board)
Where should the chaperone stand?
Exactly where the chaperone stands is not of major importance, as long as they are able to properly observe the procedure so as to be a reliable witness about what happened.
Key points to remember
- Inform your patients of the practice’s chaperone policy.
- Record the use, offer and declining of a chaperone in the patient’s notes.
- Ensure training for all chaperones.
- GPs do not have to undertake an examination if a chaperone is declined.
- Be sensitive to a patient’s ethnic/religious and cultural background. The patient may have a cultural dislike to being touched by a man or undressing.
- Do not proceed with an examination if you feel the patient has not understood due to a language barrier.