• chaperoning
• GUM clinics

In the report by the MSSVD on chaperoning in genitourinary medicine (GUM) clinics, it was suggested that patient acceptability with regard to chaperoning needed to be assessed.¹

We have recently completed a survey on patients attending our GUM clinic looking at our practice for offering chaperones for intimate examinations.

A proforma was completed by senior full time doctors before clinical examination of patients requiring such procedures. The survey took place over consecutive clinical sessions in June 2003. The sheet documented the patient’s details, member of staff examining, and whether a chaperone was offered. Reasons for either not offering a chaperone or the patient declining were recorded. The chaperone’s details were also noted.

Patients were excluded from the survey if attending only for treatment or for an asymptomatic screen by a nurse, as GMC guidelines on performing intimate examinations have related to doctors but not other professionals.

Reasons given by patients for not accepting a chaperone included that they trusted the doctor, felt it unnecessary, wished privacy, felt embarrassed, or were simply not bothered.

Overall, significantly fewer male patients accepted the offer of a chaperone compared to female patients: 5% (95% CI 1 to 16) and 51% (95% CI 36 to 66) respectively. A significantly greater proportion of female patients accepted a chaperone with a male doctor (100%) compared to a female doctor (20%) (table 1), p = 0.001 using a χ² test statistics with Yates’s correction.

These findings should be seen in conjunction with the findings of Miller et al’s postal survey on chaperoning practice,² where chaperones were more likely to be provided for examination of female patients by a female doctor than by a female nurse. In our survey, the majority of patients declined the offer of a chaperone, except where the patient was female and the doctor male. This may mean that an increase in costs for the provision of chaperones may not be as high as previously anticipated. However, in light of the GMC guidelines, our clinic sheets now include specific boxes to allow doctors and nurses space for recording information relating to chaperones and notices have been displayed in consulting rooms informing clients about their right to request a chaperone. But despite our findings regarding patient preferences for examination without a chaperone, the issue for clinicians who perform an intimate examination without one remains unresolved. They could be placed in a vulnerable position if any allegations of misconduct were made, and it is for this reason that we advocate proper documentation in the notes. Furthermore, we believe that clinicians performing intimate examinations need to be able to reserve the right to insist on a chaperone to be in attendance in certain circumstances.

This project included only three men having sex with men (MSM), and more information is required addressing the acceptability of offering chaperones to this group who may require proctoscopic review, in addition to a genital examination. We hope to collect more data on MSM in a future survey.