The presence of a chaperone can be of reassurance to both patients and doctors, especially when there is a need for an intimate examination to be performed, regardless of the gender of either the doctor or the patient.

Section 1.2.4 of the Medical Council of Hong Kong’s Code of Professional Conduct states:

“An intimate examination of a patient is recommended to be conducted in the presence of a chaperone to the knowledge of the patient. If the patient requests to be examined without a chaperone, it is also recommended to record the request in the medical records.”

In what circumstances should a chaperone be offered?

The most obvious example is with intimate examinations, and in these situations a chaperone must be offered. However, it is important to remember that what can be classed as an intimate examination may depend on the individual patient.

It may also be appropriate to offer a chaperone in other circumstances such as consultations with particularly vulnerable patients. Their presence may be advantageous during the entirety of a consultation or for a specific part, not necessarily involving a physical examination. 

It is important to always explain to a patient the reasons for any examination and detail what you are intending to do before obtaining their permission to proceed.

Why use a chaperone?

• Their presence adds a layer of protection for both the doctor and the patient; it is rare for an allegation of assault to be made if a chaperone is present.
• To acknowledge a patient’s vulnerability and to ensure a patient's dignity is preserved at all times.
• They may assist the health professional in the examination; for example, the chaperone may assist with undressing/dressing patients as required.
• Provides emotional comfort and reassurance to the patient.

Intimate examinations may be embarrassing or distressing for patients and such examinations should be carried out sensitively. This is likely to include examinations of breasts, genitalia and rectum, but it also extends to any examination where it is necessary to touch or be close to the patient. Medical Protection has seen a number of cases relating to examinations of a patient’s chest, for example. 

What if a chaperone is not available?

There may be occasions when a chaperone is unavailable (for example, on a home visit or in the out-of-hours setting). In such circumstances, the doctor should first consider whether or not on a clinical basis the examination is urgent.

• If the examination is not urgent, then it would be appropriate, after explaining to the patient, to rearrange the appointment for a mutually convenient time when a chaperone and the patient will be available.
• If the examination is clinically indicated on an urgent basis, and the doctor has enough information from the history to indicate that the patient would require an admission to hospital in any event, then it may be appropriate to defer this examination until admission to hospital, again explaining this to the patient and in the referral letter.
• If the examination is urgent, and hospital admission is not indicated on the history alone, any delay must not adversely affect the patient’s health, so there may be occasions when a doctor goes ahead in the absence of a chaperone. In such circumstances, the patient’s written consent should be obtained. In addition, the fact that the patient was examined in the absence of a chaperone should be recorded, together with the rationale for this.

What if a patient declines a chaperone?

Even if a patient declines the offer of a chaperone, the doctor/nurse may feel that in certain circumstances (for example, an intimate examination on a young adult of the opposite gender), it would be wise to have a chaperone present for their own comfort/protection.

• The doctor should explain that they would prefer to have a chaperone, explain that the role of the chaperone is in part to assist with the procedure and provide reassurance. It is important to explore the reasons why the patient does not wish to have a chaperone and to address any concerns they may have.
• If the patient still declines, the doctor will need to decide whether or not they are happy to proceed in the absence of a chaperone. This will be a decision based on both clinical need and the requirement for protection against any potential allegations of an unconsented examination/improper conduct.
• Another option to consider is whether or not it would be appropriate to ask a colleague to undertake the examination (although the chaperone issue may still prevail).
• A further option would be to consider referring the patient to secondary care for the examination (although the chaperone issue may, again, still prevail).
• The doctor/health professional should always document that a chaperone was offered and declined, together with the rationale for proceeding in the absence of a chaperone.