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In 1996 the General Medical Council recommended, where possible, offering chaperones to patients during intimate examinations. This advice was incorporated into a report from a Royal College of Obstetricians and Gynaecologists working party.1 Subsequently, Torrance et al performed a postal survey of practice in 175 genitourinary medicine (GUM) clinics in the United Kingdom.2 This study also concluded that chaperones should be offered to patients more widely during genital examinations in genitourinary medicine (GUM) clinics.2 In contrast, other studies have shown that male patients are comfortable with genital examinations being performed by doctors of either sex,3 and that it is not necessary to provide a chaperone when male patients are examined by a male doctor.4
We carried out a postal survey of the use of chaperones in 31 GUM clinics in the North Thames Region in order to assess current practice. Responses were received from 20 centres (64.5%). Only two (10%) clinics had a written clinic policy and only one (5%) had carried out a patient survey on views about the provision of chaperones. None of the clinics had carried out a staff (nurses and doctors) survey of their views about chaperoning.
We identified two interesting observations (table 1). Firstly, there was a significant difference in provision of chaperones for female patients, depending on whether the person carrying out the examination was a female doctor (12/20) or a female nurse (1/20); Yates’s corrected χ2 test = 11.40, 1 df, p<0.001. Secondly, there was a difference in provision of chaperones for female patients examined by female doctors (12/20) compared with male patients examined by male doctors (2/20); Yates’s corrected χ2 test = 8.90, 1 df, p<0.003 (table 1).
In addition, it was noted that in 18 clinics not offering routine availability of chaperones for male patients being examined by a male doctor or nurse, a chaperone would be offered in six clinics (33%) for cases of sexual assault, or for colposcopy. A chaperone would also be offered for the procedure of prostatic massage in five clinics (28%). Several clinics reported that they were more likely to offer chaperones to those patients with a past history of aggressive behaviour towards staff or to those with psychiatric problems.
Our study does not inform the discussion as to who should act as chaperone in GUM clinics. Previous studies in general practice have suggested that adolescent females prefer a female relative to be present during a genital examination.5 In the context of the GUM clinic, perhaps the specialist nurse or healthcare assistant is the ideal person—as in addition to reassuring the patient, they may aid the examiner and safeguard both patient and healthcare worker against allegations of inappropriate behaviour. In some small clinics this may be an impossible target to meet. However, the time and cost of resolving allegations against healthcare workers must be balanced against the costs of employing appropriate staff.