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.
A chaperone does not have to be medically qualified but will ideally:
- be sensitive, and respectful of the patient's dignity and confidentiality
- be prepared to reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- be prepared to raise concerns about a doctor if misconduct occurs.
In some circumstances, a member of practice staff, or a relative or friend of the patient may be an acceptable 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.
It is particularly important to maintain a professional boundary when examining patients: intimate examinations can be embarrassing or distressing for patients. Whenever you examine a patient you should be sensitive to what they may perceive as intimate. This is likely 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.
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 ;
- 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;
- 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 & Learn
Please see our Lunch and Learn Training Resource on Chaperone Training https://www.wessexlmcs.com/lunchandlearn
DBS & 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: https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-15-chaperones