Chaperon / Chaperones in Medicine
Intimate examinations of patients are conducted by doctors so routinely that a number of doctors each year forget to take proper steps to protect themselves from false complaints. Consequently, certain patients misinterpret their doctor’s use of touch, during the intimate examination, and come to doubt the doctor’s motivations. Such misunderstandings can and do lead to fitness to practise concerns being raised.
Each year, a number of patients misinterpret the examination by a doctor of their intimate areas, such as the vagina, breasts, anus, rectum, testicles or penis – misinterpreting the examination as being something sinister, untoward, unnecessary, and sexually motivated. Such patients will often go home in distress and then, a few days later, after further thought, report their concerns to the police or to the GMC. The police or GMC or possibly both, will investigate. Some allegations go to criminal trial, while others go to fitness to practise hearings at the GMC.
A fair number of doctors are reported to the General Medical Council (GMC) each year by patients who have misunderstood what has taken place during the examination, or who have failed to understand the clinical justifications for such an intimate examination. The lawyers at Doctors Defence Service have represented a number of doctors who find themselves in such a situation.
By way of example, Dr Z, a busy clinician, during a physical examination, examined the testicles of a patient who had arthritic and boney changes. The doctor was looking for possible atrophied testicles (as the patient had also had an alcohol dependency for some years), which might have explained the condition that the patient was suffering from. However, the doctor failed to explain his rationale for the examination, failed to obtain the patient’s consent, and failed to document that the examination had taken place. The patient misinterpreted the examination as being sexually motivated and reported the matter to the GMC. The patient felt that he had attended for one thing but then had his testicles felt, which he could not see the relevance. The case was referred to a fitness to practise panel. The MPTS panel found that the doctor had acted without sexual motivation in an entirely professional manner, but the panel also commented that had the doctor taken a more considerate approach the patient would have been unlikely to have misinterpreted the examination.
The GMC has issued new guidance (March 2013) to doctors who undertake intimate examinations. The guidance encourages doctors to explain the reasons for the intimate examination, to make proper records, to obtain appropriate consent, to offer a chaperone and record the details of the patient’s wishes if a chaperone is accepted or declined, and to provide an appropriate setting for the intimate examination. The use of chaperones are encouraged because they offer reassurance to patients and reduce the likelihood of complaints. Ultimately, a doctor must empower their patient to make informed decisions about the circumstances in which an examination will be carried out. For further details, read the GMC Guidance Intimate Examinations and Chaperones (pdf). The policy applies even in cases where the doctor and patient are of the same sex or gender.
Very occasionally, doctors do take advantage of vulnerable patients. A small number of doctors are struck off the professional register each year for such conduct. For additional reading, see our Doctors Defence Service article: GMC Guidance on Intimate Procedures and being accompanied by Chaperones.
For legal advice or representation in GMC matters or where allegations of criminality have been made, contact Doctors Defence Service in strict confidence on 0800 10 88 739 or use our Contact Form.