Chaperone Policy

Practice Leads

  • Doctors: Ramesh Mehay & Sudhir Krishnan
  • Nurse: Zoe Booth
  • Admin: Vicky O'Shea

Date Reviewed

6th July 2016

Date of Next Review

September 2017

This webpage provides information for patients, staff and other health professionals.  A chaperone is a third party who oversees what is happening in a medical  consultation/examination/investigation inorder to protect the patient from improper behaviour and to protect the health professional from allegations of improper behaviour or an attack.   Often, a chaperone will help out with other things like helping the patient undress, assisting with the examination or investigation, attending to the patient's comfort, explaining or interpreting and providing emotional support.

REMEMBER: 
Doctors examine patients every day but an individual patient gets examined rarely.   So, be caring, sensitive and empathic.  Cover up patients - don't leave them naked.   Don't leave them waiting too long for an examination (for example, whilst your finishing off the notes).

Protecting patients:

  • All medical consultations, examinations and investigations are potentially distressing. Those involving the breasts, genitalia or rectum particularly intrusive (these examinations are collectively referred to as “intimate examinations”). Also consultations involving dimmed lights, the need for patients to undress or for intensive periods of being touched may make a patient feel vulnerable.  A chaperone can help put the patient at ease and help explain what is happening or going to happen through to them.
  • Also, chaperones help protect the patient by ensure the health professional does not go beyond what is clinically necessary.  GP Clifford Ayling spent 20 years indecently assaulting female patients. The use of chaperones helps stop this sort of thing from happening.

Protecting health professionals:

  • A chaperone oversees what the health professional is doing.   In so doing, the chaperone helps protect the health professional from false claims of abuse.
  • A chaperone can help the health professional with their examination by helping prepare the patient and attending to their comfort.
 A chaperone is present as a safeguard for all parties (patient and practitioners) and is a witness to continuing consent of the procedure.

This organisation is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.  All patients are entitled to have a chaperone present for any consultation, examination or procedure where they feel one is required. This chaperone may be a family member or friend. On occasions a patient may prefer a formal chaperone to be present, i.e. a trained member of staff.  Wherever possible  the patient should make this request at the time of booking appointment so that arrangements can be made and that the appointment is not delayed in any way. Where this is not possible we will endeavour to provide a formal chaperone at the time of request. However occasionally it may be necessary to reschedule the appointment.  The healthcare professional may also require a chaperone to be present for certain consultations in accordance with our chaperone policy.  A copy of our Chaperone Policy is provided below.  If you have any questions or comments regarding this please contact our practice manager, Chris Rushton.

When to offer

  • It is good practice  to offer all patients a chaperone for any consultation, examination or procedure where the patient feels one is required.

How to offer

  • The offer of chaperone should be made clear to the patient prior to any procedure, ideally at the time of booking the appointment. Most patients will not take up the offer of a chaperone, especially where a relationship of trust has been built up or where the examiner is the same gender as them.
  • When offering a chaperone, explain what a chaperone is (many will not know or even heard of the word) and explain the purpose of a chaperone is to keep them comfortable and safe.

Who to offer

  • When an intimate examination is clinically necessary, offer the patient the choice of a male of female health professional to carry out this investigation.
  • In the first instance, a nurse or doctor will be asked to act as a chaperone.  Where this is difficult, a trained member of reception staff will asssist.    You can only be a chaperone if you have recieved chaperone training.   Formal chaperones need to understand their role and responsibilities so that they are competent to perform that role.
  • Doctor/Nurse - please make sure you ask the patient if they are comfortable with the specific person offered to be the chaperone.
  • Chaperone - if you know the patient on a personal level or if the patient feels uncomfortable because they know you too well - please inform the doctor and get someone other suitably trained person to chaperone.

If the patient refuses

  • If the patient is offered and does not want a chaperone it is important to record that the offer was made and declined. If a chaperone is refused a healthcare professional cannot usually insist that one is present and many will examine the patient without one.
  • Where the patient declines but the doctor or other health professional feels uneasy about this (e.g. because there is a real risk of false allegation, unpredicatable behaviour from the patient), a chaperone should still be sought - explain to the patient why you would like one present and see if the patient will (without any coercion) agree.    Otherwise, book the patient in with another health professional (of the same sex) - this situation is very rare.

Documentation

  • Health professional - document in Systm1: Whether chaperone offered, whether accepted or not, Name of the chaperone and their role.
  • Chaperone - again document in Systm1 that you were present: record your name, position and time present.

Practical things

  • The first thing to remember is that whilst doctors and nurses examine patients several times a day, being examined is a relatively infrequent experience for a patient and can unsurprisingly lead to anxiety and apprehension.
  • Therefore, when examining a patient, please give attention to the environment ensuring adequate privacy is afforded in order to maintain the patient's dignity.  This is BOTH the health care professional's and chaperone's responsibility.  For example, after they have undressed, make sure they are not kept waiting too long before the examination or procedure.  Also, make sure their dignity is maintained by covering up exposed areas until the examination or procedure is due (use the large paper rolls or the patient's own clothing or even both).   Make sure the curtain is drawn around them and the window blinds are drawn closed.
  • The chaperone must be INSIDE the curtain otherwise they cannot observe what is being done.  DO NOT STAND OUTSIDE THE CURTAIN.   Where the chaperone postiions themself within the curtain space depends on what is being examined.  They need to be able to see what is being done.   If the chaperone is unsure where to stand, ask the health professional to advise them.
  • The chaperones role is as an impartial observer.   Also attend to the patient's comfort.
  • Refrain from personal comments like 'you smell nice'.  This is a clinical procedure.
  • The chaperone leaves the room ONLY when the patient is dressed and ready to resume the consultation.

Clinical staff remember...

Explanation is the key to ensuring patients understand what is being asked of them or done to them.  In this way, it gives them truly informed choice.    Explanation is therefore also the key to minimising complaints.   Remember, patients are not doctors or nurses and so cannot second guess why you might be doing something.  For sure, there are some things that you will do that will be obvious to them as to why you are doing them (like listening to the heart for chest pain).   But there are other things that might appear illogical to them and some of these are listed below.   You should explain more explicitly in these situations and ensure the patient understands.

  • Intimate examinations cause anxiety for both male and female patients.
  • A male patient might be puzzled as to why you are checking their back passage (i.e. a PR) when they came in with front passage (urinary) complaints.
  • A female patient might be wondering why your hand is holding up her breast even though you know you are feeling for the apex beat.
  • Some patients may feel uncomfortable at how close you will get to them when examining the eye with an ophthalmoscope - tell them beforehand.
  • A patient may wonder why you are feeling their groin (inguinal area)
    • in an abdominal examination(even though you know you are checking for hernia)
    • when all they came in for was pain in the calf and cold legs (even though you are checking the peripheral vascular system)
    • when all they complained of was sore neck and axillary lymph nodes (even though you know you are checking for inguinal lymph nodes)

FAQs

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