This policy is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and consultations.
Guidelines
Clinicians (male and female) should consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.
The Clinician should give the patient a clear explanation of what the examination will involve.
Always adopt a professional and considerate manner - be careful with humour as a way of relaxing a nervous situation as it can easily be misinterpreted.
Always ensure that the patient is provided with adequate privacy to undress and dress.
Ensure that a suitable sign is clearly on display in each consulting or treatment room offering the chaperone service if required.
This should remove the potential for misunderstanding. However, there will still be times when either the clinician, or the patient, feels uncomfortable, and it would be appropriate to consider using a chaperone. Patients who request a chaperone should never be examined without a chaperone being present. If necessary, where a chaperone is not available, the consultation/examination should be rearranged for a mutually convenient time when a chaperone can be present.
Complaints and claims have not been limited to male doctors with female patients - there are many examples of alleged homosexual assault by female and male doctors. Consideration should also be given to the possibility of a malicious accusation by a patient
There may be rare occasions when a chaperone is needed for a home visit. The following procedure should still be followed.
Who Can Act as a Chaperone?
A variety of people can act as a chaperone in the practice. Where possible, it is strongly recommended that chaperones should be clinical staff familiar with procedural aspects of personal examination. Where suitable clinical staff members are not available, the examination should be deferred to a trained member of the reception/admin team with a passed DBS check, if a member of staff who has a DBS with chaperone training is not available, a member of staff with adequate chaperone training will suffice. Please note that if the chaperone does not have a DBS check, they cannot stay in the room alone with the patient and all staff should be aware of this.
Where the practice determines that non-clinical staff will act in this capacity, the patient must agree to the presence of a non-clinician in the examination, and be at ease with this.
The staff member should be trained in the procedural aspects of personal examinations, comfortable in acting in the role of chaperone, and be confident in the scope and extent of their role. They will have received instruction on where to stand and what to watch and instructions to that effect will be laid down in writing by the practice.
Confidentiality
The chaperone should only be present for the examination itself, and most discussion with the patient should take place while the chaperone is not present.
Patients should be reassured that all practice staff understand their responsibility not to divulge confidential information.
Click here to link to the latest GMC guidelines for intimate examinations: https://www.gmc-uk.org/guidance/ethical_guidance/21170.asp
Procedure
The Clinician will contact reception to request a chaperone.
Where no chaperone is available, a Clinician may offer to delay the examination to a date when one will be available, as long as the delay would not have an adverse effect on the patient’s health, or use a trained non-clinical chaperone.
If a Clinician wishes to conduct an examination with a chaperone present but the patient does not agree to this, the Clinician must clearly explain why they want a chaperone to be present. The Clinician may choose to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as the delay would not have an adverse effect on the patient’s health.
The Clinician will record in the notes that the chaperone is present, and identify the chaperone.
The chaperone will enter the room discreetly and remain in the room until the Clinician has finished the examination.
The chaperone will attend inside the curtain and will stand where appropriate for the examination.
To prevent embarrassment, the chaperone should not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards.
The chaperone will make a record in the patient’s notes after examination. The record will state that there were no problems, or give details of any concerns or incidents that occurred. Both the Clinician and the team member who chaperoned will make an entry in the Patients record.
The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record.
Chaperones During Home Visits
In most cases, the need for a chaperone will be established during the telephone interaction. Many housebound patients have carers or family members who would request to be present on the approval of the patient. Equally, if one of the Practice clinical team members requires a chaperone, this should be organised in advance.
If on attending a home visit, the patient later requests a chaperone – the home visit should be rescheduled for a mutually convenient time. Of course, in such cases, red flags should be advised and advice to call 999 if any emergency situation.