Medico-legal - The essential role of chaperones

MDU adviser Dr Brigid Simpson says communication with the patient before an examination is key.

A chaperone could be a relative or friend of the patient, or a member of the practice staff
A chaperone could be a relative or friend of the patient, or a member of the practice staff

A recent MDU study of complaints against GPs found that just 48 complaints were made over a five-year period about the use of, or absence of, a chaperone for intimate examinations.1

However, when allegations do occur they can be distressing for the GP concerned. It is for this reason the MDU is often asked for advice on the use of chaperones.

The majority of the 48 complaints identified alleged an inappropriate examination had taken place or were about a failure to have a chaperone present. The most commonly seen allegations were:

  • Improper conduct during an intimate examination
  • Inappropriate examination
  • Pain/discomfort during the examination
  • Attitude of the healthcare professional.

Communication
Communication is key to avoiding complaints. Problems may occur because of failure to provide an adequate explanation about the nature of the examination, a lack of appropriate consent, a lack of privacy, or following inappropriate comments made during the examination.

The GMC guidance Maintaining Boundaries (2006), says it is important to maintain a professional boundary when examining patients, emphasising the need to give information and seek consent beforehand, give privacy to undress and to ensure unnecessary personal comments are not made.

The role of chaperones
A chaperone does not have to be medically qualified: he or she could be a relative, friend or a member of the practice staff.

Whoever is used will ideally be sensitive, respectful of the patient's dignity and confidentiality, and be reassuring if the patient shows signs of distress. The chaperone should be familiar with the procedures involved in an intimate examination and be prepared to raise concerns about a doctor if misconduct occurs.

If either the GP or the patient does not wish the examination to proceed without a chaperone present, or if either is uncomfortable with the choice of chaperone, the doctor may offer to delay the examination to a later date when a chaperone (or an alternative chaperone) will be available.

In the MDU study, six patients complained about the presence of the chaperone or the doctor's refusal to examine without one.

If a doctor feels uncomfortable carrying out an examination without a chaperone being present and the patient has refused one, the doctor might ask a colleague to see the patient, unless there is a serious and immediate clinical need for the examination.

Record keeping
It is important to record any discussion about using a chaperone. If a chaperone is present, the GP should record the identity of that person. If the patient does not want a chaperone, the doctor should record that the offer was declined.

It is equally important to record that the doctor explained the reason for the examination and what it will entail.

Case study
While it is common practice for GPs to routinely offer chaperones for intimate examinations, they may not necessarily be aware of the dangers of other types of examinations, for example, where dim light is required or where the doctor needs to get very close, such as in this fictional scenario.

One afternoon a teenage girl, accompanied by her mother, consulted a male GP because of pain in her ear. The mother left when her mobile phone rang and the GP continued an examination, which included an otoscopic examination of the girl's eardrum.

A week later the GP was distressed to learn that the girl had alleged he 'had got much too close'. She accused the doctor of deliberately brushing against her breasts and of looking down her top.

The worried GP contacted the MDU. He said he felt the examination of an ear was such a routine part of general practice that he had not even considered waiting for the mother to return.

While he thought it was possible he may have accidentally brushed against the girl while examining her, he vehemently denied her allegations of inappropriate behaviour.

With the MDU's help, the GP responded to the complaint by apologising for the distress caused. He explained that the examination had taken longer than expected because of the difficulty in viewing the eardrum due to the swelling in the ear canal.

He said that, with hindsight, he should have waited for the mother to return and should have explained the nature of the examination.

He said that he would bear this in mind for the future. The mother and daughter accepted the explanation and it went no further.

Doctors with specific concerns should contact their medical defence organisation for individual advice.

  • Dr Simpson is a medico-legal adviser at the MDU

Reference
1. A review of GP women's health claims and complaints. MDU Journal, 2009; 25.

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