I must admit I've never come across a situation where the patient refused a
chaperone. But that's probably because I tend not to "sell it" as a
chaperone; rather, I ask a nurse to assist me with the examination. The
nurse explains things to the patient and positions her, and sometimes even
gets me the equipment I need, thereby allowing me to concentrate on the
examination.
In this situation I think of the nurse as someone who helps the patient
through the process and who assists me, rather than as a chaperone for
medicolegal purposes. That way I don't think of it as an inconvenience to
get a nurse and the patient doesn't worry about their confidentiality etc.
No doubt the modern nurse feels more comfortable being asked to help the
patient rather than to assist or to protect the doctor but that's another
story entirely!
AF
----- Original Message -----
From: "McCormick Simon Dr, Consultant, A&E" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, January 22, 2007 8:39 AM
Subject: Re: chaperones
I know we 'advise' all our SHOs to have chaperones present but I suppose
the question is, is the chaperone there to protect the patient, the
doctor or both.
If it is the doctor, then you need the chaperone to be trusted,
something that seemed open to question in the case Andy brought to
light. You also need the chaperone to be present during EVERY part of
the patient contact, not just the 'official' examination as you could
certainly be accused of doing or saying something inappropriate prior to
the chaperone arriving.
If it is the patient, then again the chaperone needs to be present for
all patient contact, as anyone who genuinely wishes to be inappropriate
with a patient could find any number of opportunities to do so during a
consultation.
Bottom line, a chaperone needs to be present at ALL times for ALL staff
(not just doctors) for ALL patients but we know this just isn't
practical so we apply a degree of risk management to the situation. How
much risk we are prepared to bear as individuals, as a department or as
a Trust is the question.
I regularly examine patients on my own in minors and not infrequently on
majors, but if I am doing certain examinations or feel that a patient is
'high risk' (not sure how I decide this!) I get a female chaperone
(which can be hard to find when it's busy). I also cannot be the only
person who sometimes relies on the presence of relatives. How many of
us men examine young girls/women etc and rely upon the fact that the
presence of a parent, partner or child will be seen as good enough to
ensure I wouldn't be tempted to do anything inappropriate? However, if
they decided to make up a malicious complaint I'm stuck in a two against
one situation and there's a fair chance my career is over. We come back
to the principle that all patient contacts by all staff require a
chaperone.
I know a recent draft Trust policy on Vaginal Examination was circulated
which stated that a patient should be 'offered a chaperone and if they
decline this should be recorded in the notes'. There were objections to
this saying that the patient should not be offered a chaperone, it
should be expected and if they decline then it is questionable whether
the examination should take place at all. Which is more important, the
examination, the principle of confidentiality or the protection of staff
from potential malicious complaints?
Simon
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