14/09/2017
In recent years, there has been a field change in the healthcare-patient relationship, from that of paternalism, to shared decision making. Increasingly patients want a hand in choosing their management. Often a physical examination is not only part of this process, but also represents good care. We therefore should to be able to justify the need for what can often be an intimate procedure, as well as explain it at a level where the patient can reasonably understand what to expect. If not done correctly, patients can sometimes feel humiliated or even abused. In the worst case scenario, a patient or their relative may make a complaint, even if the intentions and indeed the procedure carried out by the doctor or nurse were appropriate.
All trusts and healthcare organisations should have a validated policy easily available both to patients as well as employed professionals. The role of the chaperone is principally to protect the dignity of the patient, and to safeguard against potential abuse of power by the person examining. Although they do not have to be medically or nursing qualified, these staff should have had formal training in chaperoning as well as being aware of what the examination entails. They should remain for the whole of the procedure but no longer and importantly feel able to raise concerns, should they witness something untoward.
As doctors and nurses, our intentions tend to be honourable, but it is important to recognise that what may be a routine procedure for you, may cause considerable anxiety in a patient. Always offer a chaperone. This is regardless of whether you and the patient are the same sex, and indeed irrespective of whether you deem the procedure intimate. Even for an examination which involves touching or close contact, it may be pertinent to offer a chaperone. Document both the name and status of the chaperone as it is unlikely you will be able to recall this at a later date. Ensure the patient’s dignity by the use of screens and sheets to limit exposing them unnecessarily. Explain the procedure before and throughout, more so if you need to do something different midway through. Always be willing to stop, especially if the patient expresses pain or distress. Never pass personal comment and always keep any verbal observations appropriate to the procedure.
It is often a sign of trust that a patient declines the offer of a chaperone, for example in the primary care setting, where they may have built up a strong rapport with an individual clinician or set of professionals. Still make the offer before each examination as well as documenting the patient’s refusal. If you feel uncomfortable with a patient’s refusal, be this an intimate examination or where the patient displays sexualised behaviour, it may be appropriate to refer them to another clinician, if the examination can wait, and this delay will not compromise their care. Equally if a patient demands a chaperone, or a professional of the opposite sex and this is not available, their request should be balanced against clinical requirements. This is an important consideration in the emergency setting.
“It is important to recognise that what may be a routine procedure for you, may cause considerable anxiety in a patient”
Useful websites
https://www.themdu.com/guidance-and…/best-practice-in-the-use-of-chaperones
www.gmc-uk.org › Good medical practice › Read the explanatory guidance
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