• chaperones
• genitourinary

I read with interest the result of the postal survey regarding chaperoning in genitourinary medicine (GUM) clinics.¹ The notable observation is that female patients were offered a chaperone far more often than males on all occasions when the examiner was a male (32/32) and frequently when the examiner was a female (13/40). Chaperoning was offered less frequently when the patient was a male with a female examiner (7/37) and infrequently with a male examiner (3/39).

GUM nurses and doctors are particularly vulnerable because the open access of the services exposes them to situations where they have no prior knowledge of the patients background, social, behavioural, psychological, or mental state. The vulnerability is accentuated by the fact that sexual history and intimate examination are part of the routine clinical assessment in most of the situations. This vulnerability was called into a course of action in our clinic in 1996 when a senior male clinical assistant was a recipient of allegations (from a male patient in his 50s). The clinical assistant was nearing retirement, after an unblemished long service in general practice, with over 20 years experience as an assistant in GUM. The patient expressed extremes of behaviour, grandiose imagination, and swings of mood, which became a reason for clinical concern. The concerns were raised with the patients general practitioner (GP) who advised that the patient suffered problems with alcoholism and was undergoing mental rehabilitation, and that he would attend the patients condition urgently at home. The GP telephoned the clinic later to indicate that the patient had recovered from his episode and he would like to speak with the consultant GU physician. The patient offered a clear and strong apology regarding what he described as inappropriate course of behaviour and action and reiterated that his initial allegations against the senior clinical assistant were, in all, unsafe and untrue.

The incident of false allegations has proved the particular vulnerability of doctors and nurses in the GUM clinic setting. A review of the procedures of chaperoning in the GUM clinic was conducted. The clinic then introduced a system of guidelines whereby all clinical examinations and tests are done in the presence of a chaperone (irrespective of the sex of the patient or the examiner). The nursing staff have realised and appreciated the benefits of attendance to support the patients and to assisst the doctors (during the clinical examination and tests). The time spent in the clinical room proved useful in the preparation and labelling of samples. Gaining knowledge about the clinical assessment of clients proved to be valuable to nurses during health advising. The application of the named nurse procedures has meant that the attending nurse would follow the patient all through the clinical assessment, microscopic tests, the introduction of treatmenttherapy, and health advising thereafter. This continuity of care is more acceptable to the patient and more satisfactory to the nursing staff.

The issue of funding for chaperoning could be argued under the remit of professional safety. Professionals in other services take stringent methods to protect themselves from what could be less dangerous and damaging situations to their professional careers. Therefore, chaperoning in GUM must be viewed in the light of providing support to patients and protection to staff.