Are You Chaperone Aware - Asks MDU?
The MDU said that by having a clear chaperoning policy in place, GP practices and trusts could avoid confusion among staff, for example, about when to offer a chaperone. Dr Emma Cuzner, an MDU medico legal adviser, commented:
"Having a chaperone present can provide reassurance for patients during certain examinations, particularly intimate ones. Chaperones can provide support when undergoing an examination which may be embarrassing or uncomfortable for the patient.
"It is important that hospital trusts and general practices have clear policies in place covering, for example, when to offer a chaperone, who can act as a chaperone and what to do if a chaperone is refused, and that staff performing clinical examinations are aware of the policy. The GMC also recommends in its advice on Maintaining Boundaries (2006) that doctors offer chaperones for intimate examinations wherever possible.
" A secondary function of a chaperone is to protect the doctor from an allegation of improper behaviour. Fortunately, it is our experience that allegations of impropriety during clinical examinations are rare, and findings of guilt are even less common.
"In a recent MDU study of women's health complaints in general practice, there were just 48 cases about the use, or more usually the absence of a chaperone over a five-year period.2 However, when allegations do occur, they can be very distressing for the doctor, as well as for the patient who perceived the doctor acted inappropriately.
"It is worth pointing out that a chaperone alone does not provide a doctor with a guarantee of protection against a complaint, and we are aware of cases where a complaint has arisen when a chaperone was present. However, a chaperone can provide independent evidence of what took place if the patient complains for any reason."
The MDU's advice to its members on chaperones includes:
- Chaperones should be routinely offered for intimate examinations, such as of the genitalia or breasts. It is also advisable to offer one for examinations conducted under dim lights where doctors need to get very close to a patient, for example with an ophthalmoscope.
- Good communication with patients is the key to avoiding misunderstandings - explain to the patient why the particular examination is necessary and what it entails so they can give fully informed consent.
- Record the consent discussion in the notes along with the identity of the chaperone or if a chaperone was offered but declined.
- If possible, use a chaperone of the same gender as the patient.
- Allow the chaperone to hear the explanation of the examination and the patient's consent.
- Position the chaperone where they can see the patient and how the examination is being conducted.
- Ensure patients' privacy during the examination and when they are dressing and undressing.
- Avoid personal remarks.
- Be aware that allegations have been made by patients of both sexes against doctors of both sexes, although they are most commonly made by female patients against male doctors.
1. The extent to which chaperone policies are used in acute hospital trusts in England, Metcalf et al, Postgraduate Medical Journal, 19 August 2010. The study compared results from 2005/6 to 2007/2008. See here.
2. A review of GP women's health claims and complaints, MDU Journal, November, 2009, pp 9-11
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