The scene

An obstetrics and gynaecology trainee doctor contacted the MDU for advice. He explained that he had seen a patient in clinic who required a gynaecological examination. The doctor had offered a chaperone, but the patient had declined, saying, "Oh, that’s all right. I trust you and I’m in a bit of a hurry. Just go ahead."

The doctor felt uncomfortable with this and explained that he would prefer to have a chaperone present. After further discussion, the patient reluctantly agreed. The doctor was able to find a suitable chaperone quickly, and the examination proceeded without incident. The doctor was upset by these events and asked whether his actions were appropriate.

MDU advice

The doctor’s reluctance to go ahead without a chaperone is understandable. Having a chaperone present during intimate examinations can offer reassurance and act as a safeguard for both the patient and the doctor.

The GMC’s guidance, Intimate examinations and chaperones (2013), says that doctors should offer the patient the option of a chaperone wherever possible before conducting an intimate examination. This applies to both male and female patients.

Bear in mind that an intimate examination may extend beyond an examination of the genitalia, rectum or breasts and include "any examination where it is necessary to touch or even be close to a patient". Doctors are expected to use their professional judgment when deciding whether a chaperone should be offered. They should also consider any views expressed by the patient, the patient’s level of anxiety and whether the patient may be deemed vulnerable.

The chaperone should usually be a trained health professional familiar with the procedure involved in the examination. A family member or friend is not an appropriate chaperone, as they would not be deemed an impartial observer, but they may be present if the patient wishes, along with the chaperone.

The chaperone’s role is to reassure patients during an examination that they may find embarrassing or distressing, ensure the patient’s dignity and confidentiality are protected, offer support and facilitate communication where appropriate. The chaperone must be prepared to raise a concern if they feel that the doctor acted inappropriately. Having a chaperone present during intimate examinations may also help protect the doctor from unfounded allegations of improper conduct.

Some patients may insist they don’t want another person present while they’re being examined. While patients have the right to decline a chaperone, this can leave the doctor in an uncomfortable position. In these cases, the doctor should follow the GMC's guidance and explain why they would prefer a chaperone present. If the patient continues to decline, the doctor may defer the examination and refer the patient to a colleague willing to examine the patient without a chaperone. 

Remember, however, that this approach would not be appropriate if the delay would adversely affect the patient's health. If the examination is needed immediately and there is no other option, the doctor should proceed with the examination without a chaperone. The doctor should then document the discussion with the patient in the clinical record carefully, and why they deem it necessary to proceed.

It may also be worth deferring a non-urgent examination if a patient wants a chaperone but no one is available, or if the patient is unhappy with the chaperone offered – particularly if the patient knows the chaperone, such as in a small community. However, asking a patient to return another time might make the patient feel pressured to accept the chaperone, cause distress and perhaps prompt a complaint. 

It's helpful for trusts to publish a chaperone policy that clarifies what happens in these situations. This can help manage patients' expectations and encourage them to communicate their preferences early on in order to meet their needs.

This is a fictionalised case compiled from actual cases from the MDU's files.