This issue is a perpetual nightmare for GP’s. As a locum I can be alone in a surgery with one receptionist and several patients. To call the receptionist to chaperone means leaving the phone unattended and the ability for anyone to steal prescriptions. At least in hospitals you have nurses all the time.

 

But the issue is even more difficult than that. Anyone, male or female, can walk out of any consultation and complain that they were groped. You don’t even need to have touched them. You were alone with them, and they can cause you serious angst. You do not want them to bring a chaperone because they can be in collaboration to lie against you. It sells newspapers and people make money from selling their story. If however you have a nurse present there is no guarantee that she will watch everything you do (they have this habit of filling in forms for you at the desk whilst you’re still behind the screen) and anyway the Moors murderers were a couple, Fred & Rose West were a couple, and Mrs Shipman saw no wrong in old Harold. The two of you could be getting off on humiliating women (or men) on the examination couch. Tape recording proves nothing – I know two drug squad officers who were accused of waving a bag of heroin in front of an interviewee whilst it the tape was running. The person said that the sign language was “Say what we want to hear if you want this”. How do you prove otherwise? I suppose the only answer is to video the consultation, but then you’ll be accused of making porn to sell, after all, if you can’t photograph your children in school activities any more… The trouble is that the patient has the right to refuse a chaperone, taping or video, and we have difficulty refusing to see the patient in these circumstances.

 

But seriously one tip I would offer is that the chaperone should be the one that records their presence in the notes, or if using a computer system, records it with their password. I had to endure a GMC hearing in 1999 based on a complaint made in 1996 about a consultation that occurred in 1982. Will you remember which nurse was the chaperone then? Will she?

 

I offer everyone a chaperone for an intimate examination saying “The General Medical Council says all doctors must now offer all patients chaperones for intimate examinations. I can call the receptionist in whilst I examine (the lump in your testicle, vagina, breast) if you want……”

 

Of course they all say no, and then I record that they have declined the chaperone – there is even a Read Code for it, but I am desperately aware that that is no proof of my honourable approach.

 

I think the lawyers have got it all wrong. After all Harold did not write in his notes “ Administered 200mg diamorphine iv to the old bitch at 16:41hrs”, he probably wrote “c/o dyspnoea and cough for 3/7, yellow sputum, coarse breath sounds RLL, ?recent increase in angina, refuses hospital, advised TCA SOS, meanwhile C. Amoxicillin 250 tds (21)”, so what do good notes mean? We all make copious notes about the woman with the “come to bed eyes” and clothes that would fit in an Medical Record Envelope, but not the librarian who wants a Pill repeat. What is to stop her going out saying that you said she would need a VE before you repeated the Pill and you became fascinated with her clitoris? How do you prove you always call a chaperone in?

 

The mere fact you end up at the GMC means you didn’t see it coming at the time of the consultation. The fact that your notes are inadequate means you didn’t see it coming. If you had have chewed on her nipples your entry would something like “ Auscultation of chest normal, percussion note equal,  no breast masses, nipple discharge or induration of tissue, no Pagets Disease seen,but marked apex beat visible on careful visual examination.” That gives you plenty of reason why your head was adjacent to her areaolae!

 

I believe that imperfect clinical records mean you really didn’t have any misgivings about the consultation. But which barrister will try that defence?

 

Vic Calland

 

-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of John Ryan
Sent: 21 January 2007 19:06
To: [log in to unmask]
Subject: chaperones