Chaperones

Question 1

You are an FYl working a busy weekend night shift in an emergency department. A young woman with known alcoholism has attended due to an episode
of bleeding per rectum. You suspect rectal varices and wish to examine the anus and perform a digital rectal examination. The young woman smells of alcohol and has obviously been drinking. She consents to the examination, but
when you offer her a chaperone she declines on the basis that it will rake a few minutes to find a chaperone, and she has already been waiting to be seen for four hours and wants to go home as soon as possible.
Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate).
A Perform the examination and document fully in the notes the patient’s refusal of a chaperone.
B Explain to the patient the reasons for having a chaperone present during intimate examinations and refuse to undertake the examination until one is present.
C Explain to the patient the reasons for having a chaperone present during intimate examinations but that because of her long wait to be seen you will bypass this protocol this time.
D Decide not to undertake the examination at this time.
E Ask the advice of the emergency department registrar regarding the need for a chaperone in this case.

Answer 1

B,E, A, D, C

Chaperones
-chaperones are advisable for every intimate examination as it helps to protect the doctor and patient
-in this case especially since the doctor is intoxicated
1. B- highlighting the need of a chaperone during intimate exams
2. E- asking for a senior’s advice would be appropriate
3. A- it is still possible to perform examinations without chaperone, although not advisable, but documentation must be written clearly
4. D-not taking examination less appropriate
5. C-time restraints should not be a reason to not have a chaperone

Question 2

What do intimate examinations refer to?
How should doctors explain intimate examinations to patients (including children and young adults)?

What is the role of a chaperone?
What happens if patient does not want chaperone?

Answer 2

Intimate examinations
-refer to examinations which involve close contact with patient for example breast, genitalia, DRE examinations
Explanation of intimate examinations
-explain thoroughly what examinations entail, what to expect-pain or discomfort
-offer a chaperone
-gain consent and clearly document this
-give them privacy to dress/undress; make sure that they are covered as much as possible

For children and young adults
-assess their capacity. If they do not have capacity-> seek consent from parents

Chaperones
-healthcare professionals that know the routines of intimate examinations
-must be sensitive and respectful to patient’s dignity and confidentiality
-raise concerns if they feel that doctor’s are not respectful towards patients
-name of chaperone clearly documented; if patient does not want chaperone-> explain importance of having chaperone in intimate examination-> document this (can still go ahead)
-if not arrange another date for chaperone if does not adversely affect health