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What is a chaperone?
A chaperone is a person who accompanies a patient during an examination or procedure.
In most situations, a chaperone will be a trained health professional, such as a healthcare assistant, who is familiar with the procedure or examination they are observing. While patients can sometimes find it helpful to have a family member present, you should not rely on them to act as a chaperone.
It is important to be aware of your employer’s local chaperone policy and the General Medical Council (GMC) guidance, which defines a chaperone as an impartial observer.
GMC guidance
While GMC guidance applies only to registered practitioners, it’s important for medical students to be mindful of what is expected of them as future doctors and to be able to demonstrate knowledge of this during exams.
Additionally, the GMC’s guidance for students (Achieving good medical practice) emphasises the importance of a student’s role in contributing to and complying with guidelines and systems to protect patients.
The role of a chaperone
A chaperone is there to support the patient. Their role is to:
- Reassure the patient if they experience distress
- Help to protect the patient’s dignity
- Offer emotional support at an embarrassing or uncomfortable time
- Facilitate communication, especially if there is a language barrier
Additionally, GMC guidance (Intimate examinations and chaperones) lays out that a chaperone should be prepared to report if they have any concerns about the doctor’s behaviour or actions.
If you, as a medical student, are asked to act as a chaperone while on placement or during your elective, you should consider whether you can fulfil the above requirements and whether you are sufficiently independent to fulfil this role. You might not be if you are involved in the patient’s care or there to perform part of the intimate examination under supervision.
It could be helpful to demonstrate knowledge of the chaperone role during exams, such as your OSCEs, including when one is needed (especially for any simulated intimate examination of a patient).
When to offer a chaperone
Intimate examinations
A chaperone should be offered routinely before conducting any intimate examinations. This applies to all patients, regardless of whether you are the same gender as the patient.
A patient should still be offered a chaperone even when a medical student is being supervised by a clinician.
Intimate examinations include the physical examination of, or a procedure involving the genitalia, rectum or breasts.
Non-intimate examinations
Some patients may require a chaperone for other non-intimate examinations where it is necessary to be close to or touch the patient.
GMC guidance refers to intimate examinations as possibly extending beyond an examination of the genitalia, rectum or breasts to include “any examination where it is necessary to touch or even be close to a patient” – such as using an ophthalmoscope in a darkened room or when carrying out ultrasound scans.
A doctor being in close proximity in a dark room can sometimes cause alarm for some patients, especially when they are often unaware of what an examination involves.
Patients requiring a chaperone for other examinations could include vulnerable adults, those with learning disabilities or a language barrier, or those who have suffered abuse. You should use your professional judgement about offering a chaperone in this situation.
Children
For any examinations of children, the parents will usually accompany the child. For non-intimate examinations of adolescents, having a chaperone will depend on the examination, their age and wishes. Again, you would need to use your professional judgement.
Medico-legal considerations
While you may not feel a chaperone is needed for some clinical circumstances or when requested by a patient, remember that a chaperone can also act as a safeguard for both patient and doctor.
Documentation in the medical records
Clinicians should document the presence of a chaperone and their name and job role (if a health professional) in the medical records.
If a friend or family member acts as a chaperone, their relationship with the patient should be documented. If the patient does not want a chaperone, you should record that the offer was made and declined.
If no chaperones were available and a decision was made to proceed with the examination due to the patient’s clinical needs, this should also be documented.
Why is documentation so important?
Should a clinician be subject to a complaint or allegation after conducting an examination or procedure, recalling whether a chaperone was involved – or if one was absent – can be difficult. It may also be unclear if the absence of a chaperone was due to the patient declining, or a lack of available chaperones at the time.
Examinations without chaperones
Patients have a right to refuse a chaperone.
This can leave a doctor in an uncomfortable position. 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 as per GMC guidance, only as long as the delay would not adversely affect the patient’s health.
If there is no chaperone available or if the patient is unhappy with the chaperone (e.g. they will only accept someone of the same gender), then, as before, you can ask the patient to return at a different time. This should be approached sensitively. Asking a patient to return another time might make the patient feel pressured to accept the chaperone, cause distress, and prompt a complaint.
Reviewer
The Medical Defence Union (MDU)
As an MDU member, we can offer advice and support on specific medico-legal and ethical issues. Find out more in our student hub and read more guidance and advice on our website.
References
- General Medical Council. Intimate examinations and chaperones. 2013. Available from: [LINK]
- The MDU. Guide to chaperones. Published in 2022. Available from: [LINK]
