Chaperones in the age of Covid

THE risk of a doctor receiving a complaint or accusation of inappropriate behaviour in relation to an intimate examination can be reduced with the appropriate use of chaperones.

But with more consultations being carried out remotely due to the pandemic, how can hospital doctors ensure they provide this type of care safely?

The increase in video consultations has seen a corresponding increase in calls to our advice line on this topic. Common questions include when is it advisable to carry out an intimate examination remotely and what are the implications on the role and use of chaperones?

The General Medical Council (GMC) says: “When you carry out an intimate examination, you should offer the patient the option of having an impartial observer (a chaperone) present wherever possible. This applies whether or not you are the same gender as the patient.”

While the guidance does not explicitly exclude the possibility of an intimate examination taking place remotely, it is clear that a face-to-face examination would be preferable.

The regulator has recognised that, during the pandemic, doctors may need to depart from established procedures and it may be argued that in certain circumstances there can be valid reasons for undertaking a remote examination.

Limitations

If an intimate examination is indicated, there are key elements you should discuss with the patient in advance. Highlight the limitations of conducting this type of examination remotely and consider whether it would be in their best interests to defer the examination until they can attend in person. If delaying the examination could potentially cause further harm to the patient or delay further investigation, you may decide a remote examination at this point is appropriate.

Defining intimate

You should document the reasons behind your decision and offer a chaperone for any examination which the patient may consider “intimate”. Remember that this is not restricted to examinations of genitalia, breasts and rectum, but could also include a situation where a patient is required to undress even partially.

If you are working remotely and the option of a chaperone is unavailable, you should again weigh up the risks of continuing the examination without one present versus any potential harm in delaying the examination. Clearly document the reasons for your decision.

Reaching agreement

If you feel a chaperone would be appropriate but the patient disagrees, carefully explain your reasons for having one and try to reach an agreement. GMC guidance is clear that ultimately the patient's clinical needs must take precedence. It adds: "You may wish to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as a delay would not adversely affect the patient's health."

Where a chaperone is deemed necessary, you should again consider whether a virtual consultation is appropriate. If so, ensure measures are in place to allow the chaperone to properly fulfil their role.

Appropriate person

Any individual taking on the role of chaperone must be trained to understand what an appropriate examination should look like. Patients may suggest having a friend or family member present, but the GMC cautions: “A relative or friend of the patient is not an impartial observer and so would not usually be a suitable chaperone, but you should comply with a reasonable request to have such a person present as well as a chaperone.”

Some clinics may have a nurse or junior doctor present during a remote consultation. As well as offering clinical assistance, they can also be useful when the need for a chaperone arises. You should clearly explain to the patient the reasons for having them present and their role as a chaperone. Document the patient’s consent and don’t forget to note the name/details of the chaperone.

Logistics

Consideration should be given to logistical and security issues involved in a chaperone joining a remote consultation if it is not possible for the person to be physically present alongside you. It’s important that all technical and connectivity aspects work appropriately during the examination.

Consider the patient’s surroundings. Make sure they are in a private place where they feel comfortable, where no one else is likely to overhear/interrupt the call.

Check also whether your hospital system automatically saves video consultations straight into the patient notes. If so, you must ask for the patient’s explicit consent and explain how their information will be stored and used going forward.

The Royal College of Surgeons of England has practical advice for delivering virtual consultations on its website. It highlights when it is appropriate to use virtual consultations, technical considerations and advice on data protection.

Action points

• Follow GMC guidance Intimate examinations and chaperones as far as is practical .
• If delaying an examination could potentially cause further harm to the patient or delay further investigation, you may decide a remote examination at this point is appropriate.
• Keep clear and accurate records of any discussions and decisions made with the patient.

Kay Louise Grant is a risk adviser at MDDUS