Checklist- Using chaperones to reduce risk

Checklist: Using chaperones to reduce risk

All patients must always be treated with respect for their dignity.
Medical Council, Guide to Professional Conduct and Ethics

Using chaperones helps to safeguard patient dignity and allows a doctor to fulfil their responsibility to maintain professional boundaries. But not all practices use chaperones appropriately, all of the time.

MPS conducts Clinical Risk Self Assessments throughout the UK and Ireland. In 2012, 46% of practises we visited had an issue with training chaperones. Forty per cent of practices we visited did not have a chaperone policy in place, and of those that did, 24% applied their policy inconsistently.

A chaperone:

Adds a layer of protection for a doctor – it is very rare to receive an allegation of assault if you have a chaperone present
Acknowledges a patient’s vulnerability
Provides emotional comfort and reassurance
Can act as an interpreter.

Who should be a chaperone?

Although chaperones do not have to be medically qualified, they must be trained. In 46% of practices MPS visited, poorly-trained chaperones were identified as a risk area, eg, some practices were using untrained receptionists.

Chaperones must be sensitive to the patient’s confidentiality; be prepared to reassure the patient; familiar with the procedures involved in an intimate examination; and prepared to raise concerns about a doctor if misconduct occurs. Ideally, family members or friends of both the patient and the doctor should not be a chaperone – they may not fully appreciate the nature of the physical examination performed, and they may not be completely impartial.

What if a chaperone is not available?

On a home visit, or in an out-of-hours setting, a chaperone might not be possible. In such circumstances, you should consider whether the examination is urgent on a clinical basis. If it isn’t, you could rearrange the appointment for a time when a chaperone is present.

If the examination is urgent, but hospital admission is not indicated on the history alone, there may be occasions when a doctor goes ahead in the absence of a chaperone. In such circumstances, obtain and record the patient’s consent. In addition, record the fact that the patient was examined in the absence of a chaperone, along with the clinical reasons why.

Further information: Medical Council, Guide to Professional Conduct and Ethics(2009)

How to use a chaperone

Before performing an intimate examination, explain what the examination will entail, and explain why it is necessary – provide an opportunity for the patient to ask questions.
Obtain and record the patient’s consent.
Offer a chaperone to all patients for intimate examinations (this can also extend to examinations where it is necessary to touch or be close to the patient, eg, conducting eye examinations in dimmed lighting).
If the patient does not want a chaperone, record this in the notes. (Eighteen per cent of practices MPS visited did not write whether a chaperone was offered and accepted/declined in a patient’s records). If the patient declines a chaperone and as a doctor you would prefer to have one, explain this to the patient and, with their agreement, arrange for a chaperone. Doctors do not have to undertake an examination if a chaperone is declined.
Give the patient privacy to undress and dress. Use paper drapes where possible to maintain dignity.
Explain what you are doing at each stage of the examination, the outcome when it is complete and what you propose to do next. Keep the discussion relevant and avoid personal comments.
Be sensitive to a patient’s ethnic/religious and cultural background.
Record the use, offer and declining of a chaperone in the patient’s notes.
Record the identity of the chaperone in the patient’s notes.
Record any other relevant issues or concerns immediately after the consultation.
Keep the presence of the chaperone to the minimum necessary. There is no need for them to be present for any subsequent discussion of the patient’s condition or treatment.

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