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Your first... situation that calls for a chaperone

It is essential to arrange for a chaperone when you perform an intimate examination, even on a same-sex patient, advises Dr Stefan Cembrowicz

It is essential to arrange for a chaperone when you perform an intimate examination, even on a same-sex patient, advises Dr Stefan Cembrowicz

Who should be offered a chaperone? A survey of 800 patients in the British Journal of General Practice1 showed most women (90 per cent) and men (78 per cent) would like to be offered a chaperone for an intimate examination. But 15 per cent strongly resisted the idea, believing it would have a negative impact on the consultation.

Having never routinely offered a chaperone to my male patients (unless they fall into the categories below) I was surprised when GMC advice on chaperones did not specify the sex of doctor or patient – the offer of a chaperone should apply to any intimate examination. Despite this advice, many doctors still do not routinely offer a chaperone to same-sex patients ('Would you like nurse to be with us while I examine you?').

There are circumstances where it is sensible not to examine someone alone. Do not ignore non-verbal signals – the patient who gives a coy or ambiguous look or who seems rather excited at the prospect of an intimate examination certainly should not be seen alone. When examining a minor, someone in a confused or psychotic state, in any situation where there is the slightest doubt about the patient's competence for consent, someone who may be under the influence of alcohol or medication (prescribed or otherwise), someone who has been sexually assaulted or where an intimate examination could be particularly distressing, such as a victim of childhood sexual abuse, routinely arrange for a chaperone. ('This is nurse Sarah who is here to help us with the examination – is that all right?').

Patients should be able to undress behind the privacy of a screen, and be covered with a drape when undressed. The GMC suggests that you should not assist a patient in removing clothing unless asked to, and warns against making 'unnecessary or casual' remarks during an intimate examination.

If a nurse is not available you may offer a receptionist, though 74 per cent in the survey stated that receptionists were not acceptable. Your receptionist must be aware of issues of confidentiality.

Family members – even minors – are acceptable medicolegally, but should not be taken for granted. It is good practice to record that a chaperone was accepted or refused. Speedkeys can be set up on the computer to do this, and it is sensible to name your chaperone. Chaperones protect doctor and patient from any question of the professional relationship being abused.

Sadly the GMC does need to deal with such allegations – not always unfounded – regularly.

Practice varies, and getting it right with the chaperone may seem a pedantic issue, but the distress and disruption caused by an allegation of inappropriate behaviour (which does happen) must be avoided at all costs.

Stefan Cembrowicz is a GP trainer in Bristol

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