Clinicians (doctors and nurses) in our practice always give due consideration to patients’ privacy and dignity when examining and treating patients.
The Purpose of a Chaperone
All medical consultations, examinations and investigations are potentially distressing.
Patients can find examinations, investigations or photography involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as intimate examinations). Also consultations involving dimmed lights, the need for patients to undress or for intensive periods of being touched may make a patient feel vulnerable.
We endeavour to provide an environment in which the patient feels relaxed and is given privacy to undress. All consultation rooms have curtains that will be drawn during intimate examinations and doors locked to ensure the examination cannot be disturbed. The chaperone will be present at all times during the examination to:
- Provide emotional comfort and reassurance to patients
- To act as an observer of the examination to protect the clinician from false
- Alert their line manager should they feel any improper behaviour has occurred
Who can be a Chaperone?
The examining clinician or the patient can request for a chaperone to be present at any time. The chaperone may be:
- Formal: either a clinical member or a trained, DBS checked, non-clinical member of staff such as a receptionist or administrator.
- Informal: could be a friend, relative or carer of the patient; however an informal chaperone may not be appropriate for more intimate examinations and therefore does not replace the need for a formal chaperone.
The chaperone will introduce themselves to the patient and will respect the patient’s dignity and remain confidential at all times.
If the chaperone feels that the patient needs assistance in undressing/dressing, they will ask the patient if they have their consent to do this or the patient can request help at any time.
If the patient is not happy with the chaperone provided and another is not available, it may be that the examination has to be stopped and we have to re-arrange the appointment at a time another chaperone is available.
Declining a Chaperone
If the offer is declined, but the clinician feels they are at risk without a chaperone being present, it is appropriate and correct for the clinician to:
- Further explain why a chaperone is necessary and re-offer one
- Refuse to proceed with the examination and ask the patient to rebook with a clinician of the same sex; this is the best possible scenario for the examination to be safely performed, but even then it may be that a same sex clinician will also feel a chaperone is necessary and again decline to proceed; these cases must be dealt with individually, but the clinician has no obligation to proceed with an action which he is uncomfortable in doing.
- The only exception to this is if there is an urgent medical need for the examination to proceed – in this scenario patient safety may and should override clinician’s assessment of their own risk.
Where a Chaperone is Needed but Not Available
If the patient requests a chaperone, but an appropriate one is not available, we will endeavour to rebook the appointment at a time when a chaperone will be available. The only exception is when there is urgent clinical need, this should be explained to the patient and alternate actions taken (for example referral to A&E).
If the clinician requests a chaperone to be present, but one is not available, then again we will endeavour to rebook the appointment, unless there is overriding medical need when each case should be taken individually, or the clinician may consider the clinical need overrides their own risk to exposure.
Whenever the offer of a chaperone is made, it will be recorded onto the patient’s notes, together with both the fact that it was declined and the conversation relating to that, or the name of the person performing the role of chaperone.
Issues Specific to Children
In the case of children a chaperone would normally be a parent or carer or alternatively someone known and trusted or chosen by the child. Patients may be accompanied by another minor of the same age. For competent young adults the guidance relating to adults is applicable.
Children and their parents or guardians must receive an appropriate explanation of the procedure in order to obtain their co-operation and understanding. If a minor presents in the absence of a parent or guardian then the healthcare professional must ascertain if they are capable of understanding the need for examination. In these cases it may be that the clinician requests a formal chaperone to be present for any intimate examinations.
Issues Specific to Religion, Ethnicity or Culture
The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult, for example, some patients may have strong cultural or religious beliefs that restrict being touched by others.
Patients undergoing examinations are respected and allowed to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation or imaging. Wherever possible, particularly in these circumstances, it would be appropriate for the patient to request a female healthcare practitioner however this may not always be possible. In this case, we will endeavour to provide a chaperone that is female or rebook the appointment at a more suitable time.
If the clinician feels that the patient does not understand the examination due to a language barrier, it may be that the appointment has to be rebooked for a time that there is an interpreter available. However, in life saving situations every effort will be made to communicate with the patient by whatever means available before proceeding with the examination.
Issues Specific to Learning Difficulties or Mental Health Problems
For patients with learning difficulties or mental health problems that affect capacity, a familiar individual such as a family member or carer may be the best chaperone.
Adult patients with learning difficulties or mental health problems who resist any intimate examination or procedure will be interpreted as refusing to give consent and the procedure will be abandoned, unless the patient has been sectioned. In life-saving situations the healthcare professional will use their professional judgement and where possible discuss with a member of the Mental Health Care Team.
In situations where the clinician is away from other colleagues e.g. home visit, the same principle for offering and using a chaperone applies. If a carer or relative is available and all parties consent, then they may be used as an informal chaperone.
If a formal chaperone is considered more appropriate, then the clinician may have to reschedule the visit at another time when a chaperone can also attend, or, if possible, the appointment may have to be rearranged to be held at the surgery.
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