Friday, August 23, 2013

Chaperones in Clinical Care

The other day I was asked about the use of chaperones during clinical examinations. Common sense dictates that chaperones should be used when performing intimate examinations (breast exams, pelvic exams), particularly by male providers. 

Should chaperones be present for an intimate examination of a male patient by a male provider? 

Here is a link to the NHS guidance statement on the use of chaperones in the clinical setting.  As summarized by the Medical Protection Society in the UK, although there are no concrete rules about when to use a chaperone, the following should be considered:
  • Being the same sex as the patient does not negate the need for a chaperone;
  • Age is not a factor, the elderly and young children can be just as uncomfortable with the situation as a teenager;
  • Consider the patient’s religious/cultural beliefs; and
  • Follow your gut feeling: if you feel uneasy or the patient seems unwilling to be examined, either arrange for a third party to be present or advise them to see another physician
These are all important considerations. Liberal use of chaperones may be hampered by one practical factor, the availability of a nurse in the clinic to serve as a third party, as summarized in this research article.

Common sense plus nurse availability are likely to remain the driving and limiting factor in the use of chaperones during clinical examinations.