Practice Tips

When conducting patient examinations, especially those of an intimate nature, the presence of a chaperone can play a crucial role in ensuring a safe, respectful, and comfortable environment for both the patient and the healthcare provider. Utilizing a chaperone helps maintain professional boundaries and reassures the patient, fostering trust and transparency in the clinical setting. This practice tip outlines critical considerations and best practices for effectively incorporating a chaperone during patient examinations.

Key Considerations and Best Practices:

• Policy and Procedure: Establishing a clear policy and procedure for incorporating chaperones during patient examinations to ensure consistency. This policy should outline when a chaperone should be initiated (all intimate examinations, other exams as identified, and when requested by the patient), the roles and responsibilities of chaperones, the process for obtaining patient consent, and guidelines for maintaining patient privacy and dignity.
• Inform the Patient: Always explain to the patient the role of the chaperone and why their presence is essential. This helps build trust and ensures the patient feels comfortable.
• Consent: Obtain verbal consent from the patient before proceeding with the examination in the presence of a chaperone.
• Trained Staff: The chaperone should be a trained healthcare professional who understands the procedures and can effectively provide support.
• Gender Consideration: Whenever possible, consider the patient's preference for the gender of the chaperone to ensure their comfort.
• Respect Privacy: Ensure the chaperone respects the patient’s privacy and dignity. This includes proper draping and minimizing exposure.
• Documentation: Record the presence of the chaperone in the patient's medical record, including their name and role during the examination. Document the medical record thoroughly. Any offer or declination of a chaperone should be reflected in the medical record.
• Patient Comfort: Encourage the chaperone to engage with the patient, offering reassurance and support throughout the examination.
• Confidentiality: Remind the chaperone to maintain patient confidentiality and professionalism. After the exam, a separate opportunity for private discussions between the patient and provider should be made available.

Other Acceptable Times to Use a Chaperone

In addition to intimate examinations, there are several other situations where the presence of a chaperone can be beneficial. These could include:

• Strained Provider/Patient Relationship: When there is a history of misunderstanding or a strained relationship between the healthcare provider and the patient, a chaperone can help ensure a professional and respectful interaction.
• Patient Prone to Violence: If a patient has a history of violent behavior or there are concerns about potential aggression, having a chaperone present can provide additional safety for both the patient and the healthcare provider.
• Mental Health Concerns: A chaperone can offer additional support and reassurance for patients with mental health issues, helping to create a calm and secure environment.
• Provider’s Discretion: Healthcare providers may also request a chaperone at their discretion if they feel it is necessary to ensure the comfort and safety of the patient and themselves.

References:

AMA, Code of Medical Ethics, Opinion 1.2.4 Use of Chaperones Use of Chaperones | AMA-Code

ACP, American College of Physicians, Chaperones, Professional Boundaries and the Potential for Misunderstandings Chaperones, Professional Boundaries and the Potential for Misunderstandings | ACP Online

AAFP, The Case for Medical Chaperones, It’s Time for more discussion about how best to incorporate chaperones in primary care, 2018 The Case for Medical Chaperones | AAFP