Undergoing a medical consultation, examination or investigation can be very distressing for the patient. Certain examinations, such as intimate examinations, consultations involving dimmed lights(such as eye examinations), the need for patients to undress and actually being touched can all make a patient feel vulnerable and anxious.
Chaperoning is the process of having a third person present with you in consultations. A chaperone can provide support to the patient and may actually offer practical support. Chaperones are there to protect both patients and staff. However, the presence of a chaperone does not remove the necessity for adequate explanation, respect, and courtesy, and neither can it provide assurance that the procedure or examination is conducted appropriately.
It is important that children and young people are provided with chaperones, but there may be circumstances in which the young person does not wish to have one; and the reasons for this should be clearly recorded.
Information concerning the availability of chaperones is displayed on signs in each consulting room. It may only become apparent that a chaperone is required once the consultation has started, and then the offer of a chaperone should be made by the clinician. Examples of such circumstances may include:
When an intimate examination is deemed necessary, and the offer must be accompanied by an explanation of why the examination is necessary.
When an examination is not intimate, but involves close proximity, physical contact or dim lighting. Whether the patient and clinician are of the same gender is not relevant: an offer of a
chaperone should be made regardless.
During the consultation
It is important that the utmost effort is made to provide a relaxing environment, and the patient is given privacy to undress in preparation for the examination. Before the examination begins, the patient must be given the full explanation of why it is required, what will be done, and, if possible, how it will feel. There should be no undue delay before the examination once the patient has removed any
clothing. During an intimate examination, reassurance must be offered, and any discussion relevant to the circumstances; no personal comments should be made. The clinician must, at all times, remain alert to verbal and non-verbal indications of discomfort and distress from the patient.
Intimate examinations must take place in a closed room or well screened bay that cannot be entered whilst the examination is in progress.
Where appropriate, the patient should be offered a choice of position, e.g. left lateral, dorsal. This helps the patient to feel less vulnerable and powerless. Once the patient has dressed following the examination, all findings must be communicated.
It is important that any requests that an examination is discontinued are respected.
Who can be a Chaperone?
A friend or relative of the patient is an inadequate chaperone; they are neither trained nor impartial and independent. However, in reality, the clinician may well feel their presence is required. Nonetheless, a chaperone should be offered. Staff must be appropriately trained and have a DRB check. Ideally, the chaperone should be the same gender as the patient, as this allays the patient’s anxiety.
Role of the Chaperone
Broadly speaking , chaperones have a role in the following:
-Providing emotional comfort and reassurance to the patient
- To act as an observer of the examination, protecting the clinician from allegations.
Empowered to alert their manager should they feel anything inappropriate has taken place.
-If the clinician requires practical assistance during the examination, they should request that an HCA or nurse is present. They may be a different gender to the patient, but they are providing a clinical function, and this is acceptable, but a full explanation should be given to
the patient, and their agreement obtained.
-The chaperone should introduce themselves, giving their name and explaining their role in the Practice, and that they have had relevant training. The two parties should have a brief conversation to ensure there is clear understanding of the role and expectations.
Recording of Chaperone offers
Whenever the clinician feels that a chaperone may be necessary it should be offered. Whenever the offer is made, this should be recorded, as should the offer was accepted or declined. The name of the person performing the role should be recorded. If the offer is declined, but the clinician is concerned that one is necessary, it is appropriate
for them to explain why a chaperone is necessary and make another offer. The clinician may refuse to proceed with the examination, and ask the patient to rebook. All reasons and decisions must be carefully recorded.
If the patient requests a chaperone, and one is not available at the time, the appointment should be rebooked: the exception to this is when there is urgent clinical need. This should be explained to the patient.
If the clinician wants a chaperone to be present for whatever reason, but one is not available, the appointment should be rebooked, unless there is an overriding clinical need. All decision making processes must be recorded accurately.
Issues of Consent
Consent may be implicit in attending a consultation, however, it is important to obtain consent after an explanation of any intimate examination. Verbal consent is sufficient. The clinician should ensure that the patient understands the need for nay examination, and agrees to it.
The clinician must be aware that an assessment of capacity may occasionally be necessary to ensure that consent is valid, and that, even if consent is given , the offer of a chaperone must still be made. Written consent may be necessary to validate examinations if they are
required for medico-legal purposes.
In the case of children, a chaperone would normally be a parent or carer, or someone acting in loco parentis. For competent young people, the guidance relating to adults is applicable. The age of Consent is 16, but young people have the right to confidential advice on contraception, pregnancy and abortions. However, the younger the person, the greater the
concern about possible exploitation and abuse. Children under 13 are considered unable to consent to sexual activity, and such activity with a child under 13 is always an offence. Reference should be made to local safeguarding policies. Children and parents should receive an appropriate explanation of any examination or procedure, and, if a minor accompanies the child, the clinician must ensure that they are capable of understanding the need for the examination. In such a circumstance, a formal chaperone should be employed.
Issues specific to religion, ethnicity & culture
The ethnic, religious and cultural background of some ladies makes intimate examinations particularly difficult, and a female should perform these procedures. Patients undergoing examination should be allowed to limit the degree of nudity, and appropriate covers should be used. It is unwise to proceed with any examination if the clinician is unsure whether the patient understands due to a language barrier, but every effort should be made to communicate if the clinician decides to proceed, and these efforts must be recorded.
Issues specific to learning difficulties/ Mental Health problems
For patients with a learning difficulty or certain mental health problems that affect capacity, a familiar person such as a family member may be the best. A careful, simple explanation of any procedure is vital. Adult patients with learning difficulties or mental health problems that resist any examination must be interpreted as having refused consent, and the procedure must be
abandoned, unless a Section is in situ.
If a clinician is on a home visit, the same principles of offering and use of a chaperone apple. This is more likely to be a relative or friend. If a chaperone is not available, the clinician may
feel it is better to rebook the appointment, unless there is an overriding medical need. Clinicians should note that they are at a significant risk of actions being misconstrued or misrepresented if they conduct intimate examinations when no other person is present, especially if they are in a patient’s home. The clinician has every right , except in emergencies, to protect themselves from such risk.
Details of examination including presence/absence of chaperone must be fully recorded in notes. If the patient expresses any doubt or reservations about the procedure, but the clinician feels it is necessary, this should be recorded, as should any reassurance offered by the clinician. The records should make clear the reasons for such an examination.