Examination of patients is essential to a surgeon’s role, including intimate examinations, and examinations of vulnerable patients. Examinations are routine for surgeons, but many patients are unfamiliar with the process, and can find them distressing. The GMC’s Good Medical Practice states at 47 “You must treat patients as individuals and respect their dignity and privacy”, and appropriate use of chaperones can help achieve that.
Chaperones are also an aspect of risk management. While sadly there are surgeons who violate a patient’s trust during an examination, there are also patients who will make unmeritorious allegations against an innocent surgeon. Regardless of whether the patient has genuinely misinterpreted an innocent action, or is maliciously making a false allegation for gain, the presence of a reliable witness can be valuable protection for surgeons.
Incision members have access to detailed written guidance materials on this important topic, and this article contains extracts. Incision members also have access to a 24/7 medico-legal/notifications helpline so that they always have access to guidance on individual incidents, or tailored guidance for their specific practice.
What is the key guidance?
The key guidance is in the GMC’s 2013 guidance note “Intimate examinations and chaperones” Intimate examinations and chaperones (gmc-uk.org). But what about video or other remote consultations, given the significant increase in remote consultations in recent years? NHS England published, “Key principles for intimate clinical assessments undertaken remotely in response to COVID-19” key_principles_for_intimate_clinical_assessments_undertaken_remotely_in_response_to_covid19_v1-(1).pdf (gmc-uk.org) It recommends that you should update your chaperone and safeguarding policies to include remote consultations, and confirms that the GMC guidance applies to video consultations. It also addresses some practicalities by commenting, “a chaperone could be present with the practitioner (either virtually or in the same room) [to] witness the nature and extent of the video examination that was undertaken. The chaperone should be visible to the patient.” Also, “if a chaperone is not available (for example because you are remote working) or declined by the patient, use your professional judgement and carefully consider whether a remote examination method should proceed.”
The CQC’s guidance is within their guidance on GPs, but much it would apply equally to surgeons – GP mythbuster 15: Chaperones | Care Quality Commission (cqc.org.uk). This highlights the importance of chaperones receiving the right training, and that non-clinical staff who carry out chaperone duties, “may need a DBS [Disclosure and Barring Service] check”.
Surgeons who only examine patients in private clinics or hospitals managed by others (independent surgeons with practising privileges) should familiarise themselves with the chaperone policy in each hospital or clinic they work at, and know which staff can be available to fulfil that role. Surgeons who examine patients in their own clinics, will be responsible for ensuring that their clinic has a robust chaperone policy, including clear and timely communication to patients that they are entitled to one. The surgeon will also need to ensure that there is a suitable person with the training to be able to carry out the role, and for making sure that the chaperone is ‘impartial’ and empowered to speak up on the patient’s behalf.
Is the word “chaperone” in the healthcare context is overdue for a 21st century plain English overhaul? Is this somewhat antiquated word always understood by patients? Would “Dignity and Safeguarding Attendant” better describe this vital role? Let us know about any alternative phrases coming into use, or your own suggestions!
What about insurance?
The presence of a chaperone cannot necessarily prevent an allegation of inappropriate behaviour or assault, but their witness evidence should make it much easier for the surgeon to prove their version of events. Such an allegation can lead to police investigations or GMC investigations. The Incision policies contain cover for the cost of legal advice and representation in police or GMC investigations, and all surgeons should check that they have this vital type of cover.