Chaperone Policy:
It is advisable to publish a chaperone policy to define what happens before the examination, during the examination, and after the examination. This can help manage patients' expectations and encourage them to make their wishes known at an early stage.
Checklist for Intimate Examinations:
Before the Examination:
Consider any communication barriers that could impact on the patient’s experience or understanding of an intimate examination and address those if applicable.
Explain to the patient why a particular examination is necessary and what it entails so they can give fully informed consent.
Explain to the patient the role of the chaperone during the examination.
Give the patient the opportunity to ask questions about both the examination and the presence of a chaperone.
Record the consent discussion in the notes, along with the identity of the chaperone or if a chaperone was offered but declined.
If possible, use a chaperone of the same gender as the patient.
Allow the chaperone to hear the explanation of the examination and the patient's consent.
During the Examination:
Ensure patients' privacy during the examination and when they are dressing and undressing, for example by using screens and gowns/sheets. Do not help the patient remove clothing unless they ask you to, or you have checked if they want your help with this.
Position the chaperone where they can see the patient and how the examination is being conducted.
Explain what you are going to do before you do it and seek consent again if the examination differs from what you have told the patient before.
Be alert to the patient showing signs of discomfort or distress. It can be helpful to invite the patient to tell you if the examination becomes uncomfortable. If they do, stop the examination to check whether the patient has questions, wants to stop the examination permanently, or agrees for the examination to continue.
Stop the examination if the patient asks you to.
After the Examination:
The chaperone should leave the room following the examination and once the patient is dressed so the consultation can continue in private.
Frequently Asked Questions (FAQ):
Can a patient request a chaperone for visits that are not sensitive in nature?
Patients may request a chaperone during any visit and for any reason. If a chaperone is not available when requested, the patient may reschedule the examination, treatment, or procedure.
Can a patient request a chaperone of a specific gender?
Patients may request a chaperone of a specific gender. If a gender specific chaperone cannot be accommodated, the patient may choose to move forward with the visit with a chaperone not of their preferred gender or they may reschedule the appointment to a time when the practice can accommodate the request.
When does the chaperone enter and exit the examination room?
The chaperone will only be in the examination room during the sensitive portion of the exam unless the chaperone is also providing medical assistance to the physician or advanced practice provider.
Why can’t I decline a chaperone when one is required?
Chaperones are a healthcare “best practice” and assist both patients and providers in completing visits in a consistent, safe, and respectful manner. This is accordance with an effort to ensure safety and dignity for both patients and providers during sensitive visits.
Is a chaperone needed in the case of medically urgent examinations, treatments, or procedures?
If a chaperone is not immediately available in an emergency situation that would typically require a chaperone, the procedure may occur without a chaperone. Following the visit, the clinician will need to provide detailed documentation about why the exam, treatment, or procedure needed to proceed without a chaperone.
When should I offer a chaperone?
Offer a chaperone routinely before conducting an intimate examination. This applies to both female and male patients. (Transgender transitioning).
Some patients may require a chaperone for other examinations too. For example, particularly vulnerable patients or those who have suffered abuse may need a chaperone for examinations where it is necessary to touch or be close to them.
In these circumstances, you should use your professional judgement about whether to offer a chaperone, depending on the patient's views and level of anxiety.
What documentation should I note in the patient’s medical record?
You should note in the patient’s records the details of the discussion about the presence of a chaperone. Where a chaperone is present it is advisable to document both the presence of a chaperone and their identity (name and full job title) in the records.
If an accusation of improper behavior is made several years later and there is no record of who acted as chaperone, it would be difficult to recall who witnessed the examination.
For patients who refuse a chaperone, you should document that you offered a chaperone, but the patient declined.
What if the patient refuses a chaperone?
Patients have a right to refuse a chaperone. If you are unwilling to conduct an intimate examination without a chaperone, you should explain to the patient why you would prefer to have one present. You may need to offer an alternative appointment, or an alternative doctor, but only if the patient's clinical needs allow this.
If a patient declines a chaperone, this decision should be respected, and the refusal documented in the patient’s medical record. However, if the healthcare provider feels uncomfortable proceeding without a chaperone, they may consider referring the patient to another provider who is willing to examine them without a chaperone.
What if there is no chaperone available or the patient is not happy with chaperone chosen?
When no chaperone is available or the patient is unhappy with the chaperone offered (for example, if they will only accept someone of the same gender), you can ask the patient to return at a different time, if this is not against their clinical needs.
Try to avoid putting pressure on the patient to proceed without a chaperone or make them feel as if they are inconveniencing you.
In Sum:
In medical practice, the presence of a chaperone during sensitive examinations serves as a critical safeguard for both patients and healthcare providers. A chaperone is an impartial observer, typically a trained healthcare professional, who is present during intimate examinations to ensure transparency, comfort, and professionalism.
The use of chaperones in medical exam rooms is a fundamental practice that upholds patient dignity, ensures professional conduct, and provides legal protection for healthcare providers. By implementing clear policies, selecting appropriately trained chaperones, and respecting patient preferences, providers can foster an environment of trust and safety for all parties involved. |
|
