Chaperones for Intimate Examinations: Guidance for Doctors

Doctors should always be aware of maintaining the privacy and dignity of the patient, especially when undertaking physical and intimate examinations. Protecting your patients and your practice from allegations of impropriety is a core principle of risk management, and a key reason why having appropriate medical indemnity insurance for doctors is essential.  The doctor should consider what each patient may regard as an intimate examination, naturally, this will differ from patient to patient. Similarly, if a patient is vulnerable in any way, it may be appropriate for the doctor to offer a chaperone. A chaperone can prove important should a clinician face allegations of impropriety.

There are two considerations in having a chaperone to assist during intimate examinations:

• the comfort and dignity of the patient.
• the protection of the doctor from allegations of impropriety. 

The General Medical Council provides guidance on the use of chaperones in “Intimate examinations and chaperones”. 

Para 16 states that: “When you carry out an intimate examination, you should, wherever possible, offer the patient the option of having a chaperone who can act as an impartial observer. You should explain what the chaperone’s role would be during the examination.”

What is an intimate examination?

The GMC describes intimate examinations “to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch or even be close to the patient”. 

Each doctor must use their clinical judgement to decide if an examination is intimate depending on the individual circumstances of each examination, including age, gender and culture.

At PMP, one of the UK’s leading medical indemnity providers, we suggest the best practice is to adopt a policy of offering a chaperone to patients for all examinations, not just intimate examinations. This approach reduces your exposure to complaints and strengthens your position should a claim ever be made against you.  However, you are only obliged to offer a chaperone for intimate examinations.

Who should be a chaperone?

It is advisable that family members or friends of the patient should not undertake the chaperoning role. They may not fully appreciate the nature of the physical examination performed and may not be completely impartial. 

Ideally, the chaperone should be another healthcare professional, properly trained and clinically independent.

Record in the patient notes

PMP recommends you record the presence of the chaperone and their identity, including name and job title, in the patient’s record.

If a patient refuses a chaperone, you should record that you offered a chaperone, but the patient declined.

If you use electronic records, you may find it useful to use a chaperone template to record the patient’s relevant decision.

If a chaperone is not available

There may be occasions, eg, during an evening consultation or domiciliary visit, when a chaperone may not be available. In these circumstances, you should consider whether the examination is urgent and necessary. If it is not urgent and the patient requests a chaperone, you could reschedule the appointment for a time when a chaperone is available.

If a patient declines a chaperone

The presence of a chaperone protects both the doctor and the patient. Even if a patient declines a chaperone, the doctor may feel it would be more prudent to have one in attendance for their own protection and/or comfort.

In such circumstances, the doctor should explain their position to the patient. If the patient still declines the offer of a chaperone, the healthcare professional will need to determine whether they are happy to proceed with the examination or not. This is a personal decision that the doctor will need to make, exercising their clinical skills and judgement. If the doctor does proceed in the absence of a chaperone, they should carefully document that a chaperone was offered and declined.

PMP recommends that the doctor also makes a note detailing their rationale for commencing the examination in the absence of a chaperone.

Checklist

Explain to the patient why the examination is necessary and what it entails, including any pain or discomfort. Give the patient time to ask any questions about the procedure. Be aware of and respect any cultural or religious issues.

• Ensure the patient provides permission for the examination and record this consent in the patient’s records.
• Offer the patient a chaperone, where possible, use a chaperone of the same gender as the patient. The chaperone should be informed of the nature of the examination and the patient’s consent.
• Provide the patient privacy to dress/undress and keep them covered as much as possible to maintain their dignity, eg, use paper drapes. Do not help the patient to remove clothing unless they have asked you to do so, or you have checked with them that they want you to help.
• The chaperone should stand in a position where they can see the patient and the process of the examination.
• Provide the patient with an explanation of each stage of the examination. Stop the examination if the patient asks you to do so. 
• The chaperone should leave the room following the examination. They do not need to be present for any subsequent discussion of the patient’s condition or treatment.
• Immediately after the consultation, record the identity and job title of the chaperone in the patient’s notes, as well as any other relevant issues or concerns. Additionally, record if a friend or relative was present during the examination.

If you are involved in a patient safety incident, receive a complaint, or become aware of a claim or potential claim, you must complete a claims notification form as soon as possible so our claims team can review the matter promptly. 

If you require advice or guidance relating to the situation, please contact the PMP medicolegal helpline. Our experienced team is available 24 hours a day, seven days a week to provide immediate support and assistance.