Chaperones Utilization in Clinical Practice: Intimate and Sensitive Physical Examination Best Practice Strategies and Concepts in Modern Urological Medicine

Abstract

The intention of utilizing chaperones during sensitive physical exams is to show respect to the patient, while simultaneously providing protection to both the patient and the medical provider. Despite clinical practice recommendations to offer chaperones for sensitive urologic exams, there is no data regarding the consistency of chaperone utilization. Our aim was to summarize the patient and provider perspectives on the role of chaperones in urology as well as identify barriers to implement chaperone consistency. In the present investigation, we conducted a systematic review of prospective, case-control, and retrospective studies and followed the PRISMA 2020 guidelines for data reporting. Studies were identified from PubMed, MEDLINE, and PMC using the Medical Subject Headings (MeSH) terms “chaperones, patient”, “chaperones, medical”, and keywords “chaperones”, and “urology”. Studies were included if they addressed patient/provider perspectives on chaperone utilization in urology specifically and were excluded if they investigated perspectives on chaperone utilization in other specialties. Preliminary study identification yielded 702 studies, 9 of which were eligible for this review after applying the inclusion and exclusion criteria. Of these, 4 studies focused on the patient perspective and 5 focused on the provider perspective. The percentage of patients that did not have a chaperone present during their urologic exam ranged from 52.9-88.5%. A greater proportion of these patients were male. Patients (59%) prefer a family member compared to a staff member as a chaperone. Physicians (60%) prefer staff member chaperones compared to family members. One study reported that 25.6% of patients did not feel comfortable to ask for a chaperone if they were not offered one. Two studies reported the percentage of patients who believed chaperones should be offered to all urology patients, ranging from 73-88.4%. Three studies reported the use of chaperones in the clinic which ranged from 5-72.5%. Two studies reported chaperone utilization documentation, ranging between 16-21.3%. Two studies reported the likelihood of chaperone utilization depending on gender of the physician, showing that male physicians were more likely to utilize chaperones and were 3x more likely to offer chaperones to their patients compared to female physicians. Research suggests that there are differing perspectives between patients and physicians regarding the specific role and benefits chaperones offer during a sensitive urologic examination, as well as differences in preferences of who should perform the role of the chaperone. While more work needs to be done to bridge the divide between clinical practice and patient/physician preferences, the act of offering chaperones to urologic patients, regardless if they want to utilize a chaperone for their examination is respectful of patient privacy and decision making.

‘I Did No Harm’

“…Patient trust is important; prior studies have demonstrated that those with less trust in their physician are more likely to report complaints that their needs or services were not met during an office visit. 3,4,7 Offering a chaperone is seen as a sign of courtesy and respect even though many patients do not prefer to have one. 1 This is an opposing view to physicians, most of whom prefer the use of chaperones.…”

“…No doubt, false accusations can damage a physician's reputation and cause a great deal of stress that can last for a long time. 4,7 Documentation is a great asset in providing the evidence for chaperone use. 1,2,5,6,8 The lack of such documentation does not necessarily mean that a chaperone was not present, but it is a real concern that needs to be raised to improve the standard of patients' care and to provide evidence and support to clinicians.…”

“…1,2,5,6,8 The lack of such documentation does not necessarily mean that a chaperone was not present, but it is a real concern that needs to be raised to improve the standard of patients' care and to provide evidence and support to clinicians. 4,5,8 We do agree that it can be enough to document in clinical notes but documenting in the clinic letters would have a more powerful impact since a copy will be available to the patient and his/her General Practitioner. Furthermore, it helps in spreading this good practice among other colleagues who come across the letters even from other specialties setting a reminder to everyone as regards proper chaperone documentation.…”

“…This can be an uncomfortable situation since physicians cannot feel protected from the legal point of view given the expected biased view coming from a patient's relative while the patient is feeling more comfortable in the presence of a friend or a family member. 3,4 Under all circumstances, an issue that can ruin the actual use of chaperones is physician documentation of chaperones. If physicians are not documenting their usage, then it is difficult to assess who is receiving chaperones.…”

“…While 32% of patients prefer a relative or a friend to be their chaperone, 60% of physicians prefer the chaperone to be a staff member not related to the patient. This can be an uncomfortable situation since physicians cannot feel protected from the legal point of view given the expected biased view coming from a patient’s relative while the patient is feeling more comfortable in the presence of a friend or a family member 3,4 …”