Chaperones

The who, when and what of having a chaperone present during intimate examinations.

  • Chaperones are there to support patients and staff.
  • Chaperones should routinely be offered before intimate examinations.
  • Patients can refuse a chaperone.
  • Note the patient's acceptance or refusal in the records.

What is a chaperone?

A chaperone is an impartial observer present during an intimate examination of a patient. They will usually be a health professional who is familiar with the procedures involved in the examination. The chaperone will usually be the same sex as the patient.

Intimate examinations

Intimate examinations are examinations of the breast, genitalia and rectum. However, some patients may regard any examination in which the doctor needs to touch or be very close to them as intimate. Example: examination of the fundi using an ophthalmoscope in a darkened room.

Chaperone's role

A chaperone is there for the patient. Their function is to:

  • reassure the patient if they experience distress
  • protect the patient's dignity and confidentiality at all times
  • offer emotional support at an embarrassing or uncomfortable time
  • facilitate communication, especially if there is a language barrier.

A chaperone also provides a safeguard for both patient and doctor, and can discourage unfounded allegations of improper behaviour.

In rare circumstances, the chaperone may also protect the doctor from physical attack.

When to offer a chaperone

Offer a chaperone routinely before conducting an intimate examination. This applies to both female and male patients.

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 to note in the records

We advise members to document both the presence of a chaperone and their identity (name and full job title) in the records.

If an accusation of improper behaviour 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 record that you offered a chaperone but the patient declined.

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.

No chaperone available/patient unhappy with chaperone

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.

Chaperone policy

It's advisable to publish a chaperone policy to define what happens when a patient refuses a chaperone or prefers a same-sex chaperone. 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

  • Explain to the patient why the particular examination is necessary and what it entails so they can give fully informed consent.
  • 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.
  • 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 will differ from what you have told the patient before.
  • Stop the examination if the patient asks you to.
  • Avoid personal remarks.
  • It can be helpful to invite the patient to tell you if the examination becomes uncomfortable. While performing the examination, watch for any signs of pain or discomfort and check that the patient agrees for you to continue.

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.

For expert advice relating to your individual circumstances, please call the MDU advisory helpline on 0800 716 646.

Current GMC guidance

Current GMC guidance, Intimate examinations and chaperones (2013), says that doctors should offer the patient the option of a chaperone wherever possible before conducting an intimate examination, whether or not they are the same gender as the patient. The chaperone should usually be a trained health professional, although doctors should comply with 'a reasonable request' to have a family member or friend present as well as a chaperone.

This page was correct at publication on 19/01/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.