1. Chaperones are used for intimate examinations, right? That means I need to be careful about:
a) any examination of a patient of the opposite gender.
b) any examination of breasts, genitalia or rectum.
c) any examination the patient might find unusual or intimate, even if I don't need to touch the patient.
Correct answer: c
The GMC advises in 'Intimate examinations and chaperones' (2013) that you should always be sensitive to what the patient may think of as intimate. Although this is likely to include examinations of the breasts, genitalia and rectum, it could include any examination where you need to be close to the patient - even if you don't actually touch them.
Whether or not you consider an examination to be intimate, it's important to explain beforehand what you intend to do and why, and invite the patient to ask questions. This should avoid them misinterpreting your actions and ensure they have given informed consent for you to proceed.
Imagine a patient doesn't understand what a fundoscopy involves and you haven't explained it to them. How might they feel when you shut the door, switch off the lights and lean in towards their face in the dark?
The same care should be taken regardless of gender. In a recent audit of MDU cases where a member was accused of sexual assault, one in four involved patients of the same gender as the doctor.
Examining any patient without consent can lead to allegations of assault. If convicted the doctor could face a lengthy prison sentence, plus the likelihood that the GMC would erase their name from the medical register. The stakes are high.
2. When I need to examine a patient I should:
a) only assist them if they say they want help.
b) always help them to get dressed and undressed.
c) try to put the patient at ease by chatting to them about non-clinical issues.
Correct answer: a
You should give your patient privacy to undress and dress and keep them covered as much as possible in order to maintain their dignity. Only assist a patient in removing their clothing if you have checked they want your help.
Patients may feel vulnerable when being examined, so keep discussion relevant and avoid any unnecessary personal comments.
3. If I want to have a chaperone present for an intimate examination:
a) I should tell the patient that I can't examine them without a chaperone present.
b) I should ask if the patient would consent to a chaperone being present as I am explaining that I want to examine them.
c) I'll just nip out and find a nurse to chaperone us while I leave the patient to get undressed. There's no need to mention it to the patient - chaperones are routine for this sort of thing.
Correct answer: b
Give the patient the option of having a chaperone present for intimate examinations. If both you and the patient are happy to proceed without one, you should document in the records that the offer was made and declined.
Even if you feel a chaperone is needed, the patient could be unhappy with one being present, or with who's been chosen. In that situation you can defer the examination or ask a colleague to see the patient, as long as that delay will not adversely affect the patient's health. If the examination is needed immediately and no other option is available then you should go ahead without a chaperone, in the patient's interests. Document carefully the discussions with the patient about this.
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4. Suitable chaperones include:
a) the patient's friend/partner.
b) a health professional.
c) all of the above.
Correct answer: b
The GMC advises that a friend or relative of the patient is not usually a suitable chaperone, but if the patient wishes they could remain present along with the chaperone.
A chaperone should be an impartial observer who will reassure the patient and respect their dignity and privacy. Ideally they will be familiar with the procedure and stay for the whole examination, in a position where they can see what you're doing. They should be prepared to raise any concerns they have about a doctor's behaviour or actions, and the expectation therefore is that they will usually be another healthcare professional.
5. I have examined the patient with a nurse acting as chaperone. In my notes I should record my examination findings and:
a) that I offered a chaperone.
b) that I had a chaperone present.
c) that a chaperone was present, giving the nurse's full name.
Correct answer: c
Always record that a chaperone was present, and make a note of their identity.
It may surprise you to know that a recent audit of our cases showed that in over 40% of the incidents where doctors were accused of sexual assault the allegations were not made until over a year after the consultation.
A year or more on, could you be sure which nurse was available in clinic that day and acted as your chaperone for this particular patient? If you have documented the chaperone's name it is much easier to identify them and obtain their evidence if you need defending.