- Chaperones are there to support patients and staff.
- Chaperones should routinely be offered before intimate examinations.
- Patients can refuse a chaperone.
- Note the discussion on chaperones and 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.
Who can act as chaperone?
A chaperone should usually be a health professional. You must be satisfied that they have been trained for the role and understand what is involved in the proposed examination.
Intimate examinations
Intimate examinations are examinations of the breast, genitalia and rectum. It could also include any examination where it is necessary to touch, examine intimate parts of the patient’s body via remote consultation, or even be close to the patient, such as examination of the fundi using an ophthalmoscope in a darkened room.
It is important to be mindful that some patients may have particular concerns about undressing or exposing parts of their body but feel hesitant to speak up.
Chaperone role
A chaperone is there for the patient. Their function is to:
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be sensitive and respect the patient’s dignity and confidentiality
- be alert to the patient showing signs of distress or discomfort
- be aware of the most appropriate route to raise concerns and do so if they are concerned about the medical professional’s behaviour or actions
- be able to stay for the whole examination and to see what you are doing, as much as practical, without obstructing the examination or interfering with the patient’s dignity
- offer emotional support during 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
You should note in the patient’s records the details of the discussion about the presence of a chaperone. Where a chaperone is present 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
- Consider any communication barriers that could impact on the patient’s experience or understanding of an intimate examination and address those where present.
- 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 you 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 will differ 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.
- Avoid personal remarks.
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.
GMC guidance
The GMC’s 'Intimate examinations and chaperones' (2024) highlights some of the issues involved in carrying out intimate examination. It states that this must not deter you from carrying out intimate examinations where necessary.
This page was correct at publication on 30/01/2024. 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.