Chaperones and intimate physical examinations: consultant practice and views on chaperones

Abstract

PurposeThe purpose of this paper is to determine if recommendations from the General Medical Council (GMC), Royal College of Obstetricians and Gynaecologists (RCOG) and Ayling Inquiry with regard to chaperoning are observed in the hospital setting by consultants performing intimate physical examinations, and to ascertain consultants' views on the availability, nature and role of chaperones.Design/methodology/approachA quantitative postal questionnaire was carried out based on the GMC and RCOG recommendations, and point 2.58 of the Ayling Inquiry. Participants were all consultants specialising in obstetrics and gynaecology, colorectal surgery, breast surgery, urology, genito‐urinary medicine, and paediatrics in York and West Yorkshire Hospitals. The questionnaire covered consultant practice and views on the role of chaperones for intimate physical examinations.FindingsA response rate of 70 per cent was achieved. All gynaecologists, paediatricians, urologists, colorectal surgeons and genito‐urinary physicians request a chaperone when performing female intimate examinations. A total 90 per cent of genito‐urinary physicians request a chaperone compared to only 39 per cent of colorectal surgeons and 28 per cent of urologists for male intimate examinations. Of the consultants 97 per cent reported that a chaperone was “always” or “usually” available. A total 94 per cent considered health‐care professionals to be appropriate chaperones. Cited roles of a chaperone include doctor protection (93 per cent), patient protection (84 per cent), patient comfort (73 per cent), and medico‐legality (72 per cent). Only 20 per cent of consultants stated they document the presence of a chaperone.Originality/valueThe paper reveals that consultants use a chaperone for all female genital examinations, but inter‐speciality differences exist for male intimate examinations in spite of national recommendations. A minority of consultants document the presence of a chaperone for intimate examinations. Consultants consider health‐care professionals to be the most appropriate chaperones, and believe chaperones add to patient comfort and protect both doctor and patient.

Chaperone use amongst UK urological surgeons – an evaluation of current practice and opinion

“…Commonly, examiners from a variety of specialities will not use a chaperone for a patient of the same gender as themselves, but will almost always use a chaperone if the patient is of the opposite sex. 2,8,10 Evidently there is work to be done to promote the guidelines set in place by the GMC and change practice.…”

“…Interestingly 72% of consultants felt that the use of a chaperone was important for medicolegal purposes. 2 There are two important and basic principles to consider when examining a patient. First, that the examination is proven to aid the assessment of a patient and is clinically necessary.…”

What are the perceptions of women towards transvaginal sonographic examinations?

“…Of the 5% that stated they would prefer to have a third person present during their examination, only one of them gave chaperoning as the reason. This finding is in conflict with the professional guidelines for intimate studies in the UK, where this study was performed, which recommends the use of chaperones . The women in the study by Gentry‐Maharaj et al .…”

“…This finding is in conflict with the professional guidelines for intimate studies in the UK, where this study was performed, which recommends the use of chaperones. 11 The women in the study by Gentry-Maharaj et al 4 were mostly examined by females, and this may had been a factor in having a preference for no chaperone. This study contained only post-menopausal women, which may have also influenced the results.…”

The Attitudes and Practices of General Practitioners about the Use of Chaperones in Melbourne, Australia

“…A search of the published literature worldwide found limited research about the use of chaperones overseas whether in primary care [ 5 , 12 , 14 , 15 ] or hospital clinics [ 6 , 16 – 19 ] about patients' awareness [ 13 , 17 , 20 ], protection for patients and/or doctors [ 3 , 11 , 21 ], or guidelines [ 22 – 24 ]. Similarly, little literature was found about the use of chaperones in Australia; results of two studies conducted in sexual health clinics [ 4 , 25 , 26 ], commentaries about doctors' misconduct [ 1 ], and risk management [ 27 ], as well as three documents providing medicolegal guidance [ 7 , 28 , 29 ].…”