Managing risk with chaperones

The use of chaperones during intimate examinations and other sensitive situations varies amongst the health profession. 

The nature of intimate examinations can leave practitioners open to accusations of inappropriate behaviour, which could have very significant effects on their career and well-being.  The use of chaperones is recognised as a factor in minimising the risk in clinical practice.

The use of a chaperone does not of itself suggest some issue on the part of a practitioner or their patient.  Instead, it represents a realistic view of the inherent intimacy of certain aspects of clinical practice, different backgrounds, perceptions and experiences patients can have and inherently differing levels of comfort a practitioner can have. 

When to use a chaperone

It is recommended that professional guidelines, such as the AMA Patient Examination Guidelines, rather than individual discretion, be used to dictate practice.
 
The following points may help in making a judgment on involving a chaperone:

• Don’t assume that you do not need a chaperone if you are the same sex as the patient
• There are no upper or lower age limits: adolescents probably have a lower embarrassment threshold than most; young children are not immune from feelings of embarrassment; nor are elderly people
• Take cultural considerations into account where necessary
• Be mindful of a particular patient’s medical or social history
• Don’t make assumptions about the preferences of different groups of patients – age, sex, race, etc. Research shows that there are widely different preferences within groups
• Trust your instincts – if you feel uncomfortable, or your patient seems unduly reluctant to be examined, arrange for a chaperone or suggest that they see another practitioner.  

Choosing an appropriate chaperone

• The most appropriate person would be a member of the clinical team, such as nursing staff – administrative staff are not considered appropriate but MIGA accepts that there may be no other option
• Potential embarrassment and inadvertent breaches of confidentiality make friends and relatives poor choices as chaperones. All other alternatives should be considered first, but in some cases there may be no option
• The patient must be introduced to the chaperone and told what their position is within the team
• Never force a chaperone on an unwilling patient. Some patients may not feel embarrassed being examined, but would be uncomfortable in the presence of an observer
• If the offer of a chaperone is declined, document this in the patient notes. If you don’t want to proceed with the examination in the absence of a chaperone, tell the patient and ask them either to re-consider or to accept a referral to another practitioner
• Be circumspect about what you say to the patient while the chaperone is present – you could easily release confidential information in these circumstances
• Record the name and qualifications of the chaperone in the patient notes.

Ideally a chaperone would be present for all breast, genital or rectal examinations. Whether this is enforced will depend upon a number of factors, including the patient’s wishes.

Be aware that almost anything you do can be misconstrued if the patient is taken by surprise. Potential misunderstandings can easily be averted by telling the patient your reasons for any particular examination, and also warning them about any discomfort or sensations they may feel.

Further resources
RACGP - Position paper on use of chaperones
RACGP standards - Presence of a third party