The Expert Edition by MPS: When you need a chaperone

Graham Howarth, Medical South Africa Lead, Medical Protection
Apr 28, 2022

While their role is ostensibly to reassure patients, chaperones also protect doctors from false allegations of sexual abuse. You should, therefore, out of respect for the patient and for your own protection, always offer a chaperone when you intend to carry out an intimate physical examination, even if you and the patient are of the same sex. Intimate examinations include examination of the breasts as well as the genitalia and rectum.

The issue of chaperonage is not always straightforward. For example, many patients reject the offer of a chaperone because they find it embarrassing to have another person present during an intimate examination.

In most cases this is not a problem – just record in the patient’s notes that a chaperone was offered and the patient declined the offer. Sometimes, though, you may feel that it is personally risky for you to proceed without a chaperone present.

Although this is a difficult situation to deal with (to insist on a chaperone implies that you distrust the patient), you should trust your instincts and simply tell the patient that, because of the nature of the examination, you would prefer a chaperone to be present. If the patient still refuses, then you must decide whether to proceed without a chaperone or to suggest that the patient see another doctor.

If a chaperone is present during an examination, record their identity and status in the patient’s notes

Such decisions are not an easy judgment call, but you should be particularly wary of carrying out an unchaperoned intimate examination if the patient has any of the following problems:

  • A history of sexual abuse
  • Apparent difficulty in recognising professional boundaries
  • Mental impairment
  • Mental instability.

If you do decide to go ahead, be scrupulous in your documentation. In all cases, you should explain carefully to the patient what the examination entails and why it is necessary. You should also take care to preserve the patient’s dignity and privacy by the use of gowns, drapes and screens. If a chaperone is present during an examination, record their identity and status in the patient’s notes. If you offer a chaperone, and the patient declines, you should record this fact too.

Ideally, the chaperone should be someone with clinical training, such as a nurse. If no clinically trained assistant is available, it may be necessary to use a member of the patient’s family as a chaperone, but this is far from ideal. If a suitable chaperone is not available, you will have to make a judgment as to whether the examination can be postponed until appropriate arrangements can be made.

In an emergency, you may have to proceed without a chaperone. If so, record your decision and its reason in the patient’s notes. You may sometimes find yourself seeing patients when no one else is present on the premises at all. Although this is a less than ideal situation that you should avoid if, at all possible, you should place your patients’ needs first.

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