Chaperones
Page Contents
Introduction
The GMC has guidance at: Intimate examinations and chaperones
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.
Although a chaperone does not have to be medically qualified, they should usually be a health professional, and you must be satisfied that they have been trained for the role, which is to:
- be sensitive and respect the patient’s dignity and confidentiality
- reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- stay for the whole examination and be able to see what the doctor is doing, if practical
- be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.
MPS guidance on Chaperones states:
Practices should no longer use untrained practice staff to fulfil the role of a chaperone. Chaperones need to be trained so that they understand what a legitimate clinical examination entails and at what stage it may become inappropriate.
A relative or friend of the patient is not a trained impartial observer and so would not usually be a suitable chaperone. However, the presence of a chaperone does not override a patient’s wish to be supported by a relative, friend or advocate. You should comply with a reasonable request from the patient to have such a person present as well as a chaperone.
If either you or the patient does not wish the examination to proceed without a chaperone present, or if either of you is uncomfortable with the choice of chaperone, you may offer to delay the examination to a later date when a chaperone (or an alternative chaperone) will be available, if this is compatible with the patient’s best interests. You should record any discussion about chaperones and its outcome. If a chaperone is present, you should record that fact and make a note of their identity. If the patient does not want a chaperone, you should record that the offer was made and declined.
Intimate examinations or procedures can be embarrassing or distressing for patients. Before you carry out an intimate examination or procedure, it is essential that every effort is made to make sure patients feel as safe and in control of the situation as possible.
Whenever you examine a patient you should be sensitive to what they may perceive as intimate. Intimate examinations are likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch, examine intimate parts of the patient’s body digitally, or even be close to the patient. Some patients may have particular concerns about undressing or exposing parts of their body.
Intimate Examinations
Before conducting an intimate examination you should:
- explain to the patient why an examination is necessary and give the patient an opportunity to ask questions
- consider and address any communication barriers that could impact on the patient’s experience or understanding of an intimate examination
- explain what the examination will involve, in a way the patient can understand, so that the patient has a clear idea of what to expect, including any potential pain or discomfort;
- explain to the patient that they can ask at any time for the examination to stop
- offer the patient a chaperone and explain what the chaperone’s role would be during the examination
- obtain the patient’s permission before the examination and record that permission has been obtained
- give the patient privacy to undress and dress and keep the patient covered as much as possible to maintain their dignity. Do not assist the patient in removing clothing unless you have clarified with them that your assistance is required
During the examination you should:
- explain what you are going to do before you do it and, if this differs from what you have already outlined to the patient, explain why and seek the patient’s permission;
- be prepared to discontinue the examination if the patient asks you to;
- keep discussion relevant and do not make unnecessary personal comments.
You must follow the guidance in Consent: patients and doctors making decisions together..
By highlighting some of the issues associated with intimate examinations, this guidance does not intend to deter you from carrying them out when necessary. Following this guidance and making detailed and accurate records at the time of examination, or shortly afterwards, will help you to justify your decisions and actions.
Lunch and Learn
Please see our Lunch and Learn Training Resource on Chaperone Training Chaperone Training- Lunch and Learn
DBS and Training
There is an expectation that formal chaperones should have undertaken training and will have had a DBS check. For more information, go to the CQC’s guidance at: GP mythbuster 15: Chaperones