Medisec Factsheet on Chaperone polices and a precedent policy.
Exxplanatory note for practice:
The Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition provides:
“35 Physical and intimate examinations
35.1 Clinical assessments of patients often involve a physical examination as well as relevant history-taking. Before undertaking any physical examination, including an intimate examination, you should explain to patients why it is needed and what will be involved, and get their consent.
35.2 You should respect patients’ dignity by giving them privacy to undress and dress, and keeping them covered as much as possible. You should not help the patient to remove clothing unless they have asked you to do so, or you have checked with them that they want your help.
35.3 Where an intimate examination is necessary, you must explain to the patient why it is needed and what it will entail. You must ask the patient if they would like a chaperone to be present – for example, a nurse or family member – and note in the patient’s record that a chaperone was offered. You should also record if a chaperone was present, had been refused, or was not available but the patient was happy to proceed.
35.4 You must not carry out intimate examinations on anaesthetised patients unless the patient has given written consent to this in advance.”
The Guide introduces new “rules” in relation to chaperones. It states where an intimate examination is necessary, you must explain to the patient why it is needed and what it will entail. You must ask the patient if they would like a chaperone to be present for example a nurse or family member and note in the patient’s record that a chaperone was offered. You should also record if a chaperone was present, has been refused, or was not available but the patient was happy to proceed. We recommend you also record the identity of the chaperone if one is present.
On occasions such as a home visit, or in an out of hours setting, a chaperone may not always be possible. In these circumstances you should consider whether the examination is urgent on a clinical basis. If it isn’t urgent and the patient requests a chaperone, you could reschedule the appointment for a time when a chaperone is available.
You must ensure that at certain times in your working week you will have a chaperone available to comply with your absolute duty to offer a chaperone for intimate examinations. The chaperone could be a family member, nurse or other staff member.
We suggest you speak to your software provider to put in place relevant templates on your system to record the patient’s relevant decision.
A precedent policy that you may wish to adapt for use in your practice is set out below.
Medisec suggests best practice is to adopt a policy of offering a chaperone to patients for all examinations and not just intimate examinations however you are only obliged to offer a chaperone for intimate examinations.
We can offer you a poster for your waiting room informing patients that they can avail of a chaperone service. We have two alterative posters. One option is to offer patients a chaperone for all visits and the other option is to offer patients a chaperone only for intimate examinations.
Medisec cannot provide an exhaustive definition of an intimate examination. Each doctor must use clinical judgement to decide if an examination is intimate depending on the individual circumstances of each examination including age, gender, culture. Intimate examinations might include a breast, vaginal, anal, testicular or scrotal exam.
Precedent chaperone policy for a GP practice
“ xxxxx is committed to providing all patients with a safe, comfortable environment. If you would like a chaperone present during your consultation, please advise the Receptionist when booking your appointment.
You may also ask for a chaperone on arrival for an appointment, although the practice cannot guarantee a chaperone being available at short notice. If this is the case your examination will be cancelled.”