Policy Lead: Practice Manager
Policy Aim: 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.
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.
- 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 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. 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.
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.
There may be rare occasions when a chaperone is needed for a home visit. The following procedure should still be followed.
Who can act as a chaperone?
A variety of people can act as a chaperone in the practice. Ideally chaperones should be clinical staff familiar with procedural aspects of personal examination, however, in practice this is not always possible and where 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 undertaken chaperone training provided by the PCT.
- 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.
- 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 non clinical chaperone will normally attend outside the curtain at the head of the examination couch and not 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 clinician will make a record in the patient’s notes after examination and note the person who acted as the chaperone.
- The patient can refuse a chaperone. If so this must be recorded in the patient’s medical record.
Guidelines for Chaperones
These guidelines are intended as in information resource for staff who may be asked to become chaperones, either on a casual (one-off) basis or as a routine role.
All examinations will place patients in a situation in which they may feel uncomfortable, and this may be compounded further by the need to undress, consent to intimate touching or intrusive examination. The presence of a third party may alleviate some of these concerns and provide protection for both patient and clinician.
It is often not known prior to an examination commencing whether a chaperone will be desirable. Often, staff may be called upon to undertake this role without prior warning, enabling them to prepare. It is essential therefore that chaperones are trained in their role, familiar with what is expected of them in carrying this out, and understand the support aspects of the role for the patient.
Ideally, the clinician will have explained the nature of the examination, the reasons for it, and what is involved prior to it commencing, and will have given the patient the opportunity to have a chaperone present. Alternatively, the clinician may themselves have elected to have a chaperone present for their own security. Either way, it is important for at least one of the persons present that the third party is also there.
This will vary a great deal, and may be passive (simply a presence in the room) or active (assisting with patient preparation or the procedure itself). It may involve:
- Providing patient reassurance
- Helping the patient to undress or prepare, or helping with clothing or covers
- Assist with procedures (if a nurse or healthcare assistant)
- Helping with instruments
- Witnessing a procedure
- Protecting a clinician
- Being able to identify unusual or unacceptable behaviour relating to a procedure or the consultation
- Being able to identify whether the implied or implicit consent given at the start of the procedure remains valid throughout, and determine whether the attitude of the patient or the clinician has changed
It is expected that, in general practices, you will be specially and formally trained in your role, either through professional competencies (e.g. nurses) or through formal training courses delivered by the PCT or other bodies (reception or other staff). It is essential that you thoroughly understand what is expected from you, not only what the practice / the GP expects, but also what a patient may reasonably expect by virtue of your presence.
Clinical staff acting as chaperones may be the most appropriate staff group to undertake this role, as they may be able to interpret the procedure / examination, and form a judgement as to whether the actions are appropriate to the investigation or not. This is a fundamental part of the ability to reassure the patient. For this reason you, as a chaperone should be of the same sex as the patient.
As a chaperone you should bear in mind that the patient may decline to have you present (as an individual) whilst still requiring a chaperone generally. This is within the rights of the patient and should be considered as usual, and not a personal slight on your abilities.
You should be comfortable in your role across a range of examination type, and if you do not feel confident in what you are being asked to observe, or how to do it, ask for guidance or further training, perhaps externally.
Understand your duties
- Understand where you are expected to be at each stage of the examination, and what you are expected to hear, and observe
- Understand the rights of the patient relating to your presence, and their ability to halt an examination
- Understand how to identify concerns and raise them within the practice so that they are given a fair hearing in an objective manner, perhaps with other clinician, without causing offence. This should be done immediately following the consultation.
In some cultures, examinations by men (on women) may be unacceptable. Some patients may be unwilling to undress, or raise concerns related to culture. These concerns should be respected and recorded, and in a similar way, if there is a language difficulty, it may be best to defer an examination until an interpreter is available.
Where mental health patients are concerned, or those who may have difficulty in understanding the implications of an examination, it may be inappropriate to proceed until more secure arrangements can be made.
There may be instances where, as a chaperone, you may be required to act in this capacity outside the practice (e.g. on a home visit). Where a GP wishes to examine a patient in their own home where another family member may not be present, it may be more important that a chaperone is present, and you need to be aware of your responsibilities in these circumstances
Formal training is recommended, preferably delivered by the PCT. You may discuss your role with your clinical trainer (e.g. senior partner) and obtain their endorsement for your attendance on a course, with a commitment to review your training on your return in order to:
- formalise your role, and give you post-course support
- incorporate your training and views into your job description
- establish the practice expectations of you based on what you have learned, and a “mode of operation” for you to adopt in a variety of situations
- incorporate your role into the practice Chaperone Policy [*]
- establish a recognised mechanism whereby you can discuss cases and concerns with another member of the clinical team (perhaps another GP) without awkwardness
- agree refresher training at an appropriate interval