Use of chaperones in clinics for genitourinary medicine: survey of consultants

Participants, methods, and results

In November 1996, 255 lead consultants in genitourinary medicine clinics were invited to participate in a confidential postal survey They were asked about their departmental and hospital policies on chaperoning during genitourinary examinations in several clinical scenarios. Replies were received from 175 consultants (69% response).

When female patients are being examined by male doctors, clinic policy is that chaperones are almost always present (table). By contrast, male nurses sometimes perform unchaperoned genital tests and treatment on female patients. Female doctors are more likely than nurses to be chaperoned while performing genital tests on female patients. Most units do not routinely use chaperones during examinations and genital tests on male patients.

Although most chaperoning is done by female nurses, one quarter of departments sometimes delegated this role to health advisers. Chaperones were sometimes relatives of patients (in 21 departments), medical students (14 departments), or secretarial or clerical staff (8 departments). Most chaperones were female, but male chaperones were used in six departments while female patients were being examined by male doctors.

Thirty seven departments were more likely to offer chaperones during examinations of patients aged under 16. Only 20 respondents said that their hospital had a policy on chaperoning. Fourteen knew of allegations of impropriety concerning medical or nursing staff in their department during the preceding five years. In the opinion of half of these respondents, allegations could have been prevented had a chaperone been present.

Comment

To our knowledge this is the first survey on chaperoning policies in genitourinary practice. Use varies widely among the respondents, and only one tenth of hospitals have a policy on chaperones. Doctors are more likely than nurses to be chaperoned while performing genital tests. The working party of the Royal College of Obstetricians and Gynaecologists concluded that a chaperone should be offered to all patients having intimate examinations in gynaecology and obstetrics, irrespective of the sex of the gynaecologist, and that if the patient declines one the response to the request should be honoured and recorded in the notes. Surveys in primary care show that many women decline chaperones.2 On the other hand, our survey identified allegations of impropriety, half of which might have been prevented by the presence of a chaperone. On this basis we believe that chaperones should be offered more widely during genitourinary examinations. Perhaps clinicians in other specialties should encourage their patients to accept chaperones during vaginal or rectal examinations.

Who should act as chaperone in genitourinary medicine clinics? Some patients (particularly adolescent females) prefer a relative to be present during pelvic examinations in general practice.4 A nurse seems better suited to the role of chaperone in genitourinary practice because he or she can help the examiner, reassure patients if they are anxious, and safeguard both parties against abuse or subsequent allegations. Many would argue that the sex of the chaperone should match that of the patient. Small clinics may face difficulty in funding nurses to fulfil this role, but costs have to be balanced against time taken to deal with complaints. Perhaps wider use should be made of auxiliary nursing staff as chaperones.