The use of chaperones for intimate examinations is often impractical in primary care
I found this article which showed suboptimal use of chaperones in emergency departments to be of great interest. In my clinical work in primary care in the UK, I often struggle with providing a chaperone for intimate examinations. The two main issues I have are who we should bring in, and what should they see.
Firstly I feel that the person brought in should be someone who is allowed to examine patients themselves. The presence of a nurse would be much better than that of a receptionist. I am not sure it is acceptable to the patient or the non-clinical member of staff for someone non-clinical to observe the patient in a state of undress. However in most practices nurses are very busy-they are not waiting around to be called upon to chaperone when necessary. They have their own patient lists, as do we. The delay involved waiting for a nurse to become available impacts significantly on the patients waiting for both nurse and doctor.
Secondly what should the chaperone see? The idea, as I understand it, is that their presence protects the patient from a doctor doing something inappropriate to the patient, but also as a protection for the doctor in case the patient alleges that the doctor did something wrong. This necessitates that they witness the examination explicitly--it is not enough then for them to be in the same room behind a curtain.
I feel that the current concepts regarding chaperone use need to be revised. Perhaps clearer guidance should be developed that is more practical for everyday clinical practice, both in primary and secondary care.
Conflict of Interest: