Chaperones

Introduction

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.

Guidlines

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 and the reason why it is necessary. 

• 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 the waiting areas and 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. (This may occur even if the patient and the clinician are both of the same gender)

The offer of a chaperone should be recorded in the clinical notes.  If the patient declines the offer of a chaperone this must also be recorded in the clinical notes   

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.  Equally, if the GP wants a chaperone to be present and the patient doesn’t the GP should try and encourage the patient to agree to a chaperone being present or make arrangements for the patient to see a different doctor.  Where this is not possible the final arrangements should be clearly recorded in the notes

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

Who can act as 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. 

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.   

The lead people who will co-ordinate the training of the chaperones will be Dawn Benjamin.

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.

Procedure

• The clinician will contact Reception to request a chaperone
• The clinician will record in the notes that the chaperone is present, and identify the chaperone
• Where no chaperone is available the examination will not take place – the patient should not normally be permitted to dispense with the chaperone once a desire to have one present has been expressed
• The chaperone will enter the room discreetly and remain in room until the clinician has finished the examination
• The chaperone will normally attend inside the curtain at the head of the examination couch and watch the procedure
• 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 surgery log after examination.   The record will state that there were no problems, or give details of any concerns or incidents that occurred.

Usually a practice will have someone who can be available to act as a chaperone by prior arrangement but more frequently, with the advent of the Extended Hours LES, a doctor may find themselves working alone or with only one member of staff.  In these circumstances both the patient and the doctor should feel comfortable with the arrangements agreed and if necessary the appointment should be re-scheduled to a suitable time when a chaperone can be present.

Who can act as Chaperone in a Patient’s home?

The options available when a GP is undertaking a home visit are more limited however the same principles should apply and if there are times when either the clinician, or the patient, feels uncomfortable, consideration should be given to using a chaperone.  

The GP should, with the patient, consider whether it would be appropriate for a family member to attend or they may wish to return at another time with another healthcare professional/ trained chaperone.  During the Out of Hours period doctors working with for the ‘out of hours provider’ may need to ask whether there is a facility to provide a trained chaperone if necessary.

In an Emergency

In an urgent/life threatening situation emergency care should be given even if a chaperone is not available and either the patient or the GP would have requested it.  In these circumstances the details should be clearly documented in the patient’s notes and the surgery log.

Review date November 2017.