The Value and Reality of Chaperones - Crozer-Keystone Health System - PA

The Value and the Reality of Chaperones in the Health Care Setting

March 2010

The American Medical Association (AMA) recommends that an authorized health professional should serve as a chaperone “whenever possible”. That said, what does “whenever possible” mean?

Is a chaperone needed for any or all of the following?

  • Inserting a foley catheter
  • Assisting a patient when they are in state of undress- Helping a patient up after a fall whose gown got tangled and exposed private parts
  • Doing a Mammogram
  • Doing a rectal exam
  • Inserting vaginal ultrasound
  • Giving bed baths

Is a chaperone only needed for care/studies done by a healthcare provider on patients of the opposite sex?

Does the patient’s mental capacity, age, cultural or religious belief, urgency of exam/treatment, or past sexual experience play a role in dictating the need for a chaperone?

This issue is very broad and complicated. It raises more questions than the law or professional organizations have answers to provide. 

Patient presenting for any procedure or exam, especially an intimate procedure or exam, can be nervous and embarrassed. The feelings can be escalated if the provider, surroundings, and procedure are new to the patient. The uncertainty of what to expect and/or outcome can create an emotion of anxiety and apprehension. 

As healthcare providers there is the need to respect the dignity of every patient and conduct all interactions and care in a professional manner. Focus should be centered on the relationship, behavior, and attention to the patient’s specific needs. For example, all patients should be provided appropriate gowns, privacy for dressing/undressing, appropriate draping and secure environment. Communication is a critical factor in building trust and setting realistic expectations- a clear explanation as to why the procedure/exam is necessary, explanation of the exam/study/intervention, steps involved and what to expect physically expect should be provided in simple, lay terms. False allegations of assault, abuse, or inappropriate touching could surface after a procedure if the patient did not understand the type of physical pressure involved with the procedure/exam or location of the given procedure. For example, an examiner should explain why both breasts need to be examined when a patient presents with a complaint of only one breast with a lump. 

All patients should be offered a chaperone, especially during sensitive examinations and treatments. The offer should be made in such a way so it cannot be misconstrued and offend some patients, who may interpret it as a lack of trust.  When an offer is made, it should be clearly understood that the chaperone is for the patient’s benefit, not an unwanted spectator for an already potentially sensitive experience. Note, it is the patient’s right to request a chaperone- whether it be a family, friend, or healthcare provider. Conversely, a healthcare provider may request that a chaperone be present. In these scenarios, their role should be explained to the patient. Regardless, healthcare providers need to be cognizant of the patient’s right to privacy and confidentiality in the presence of a chaperone, i.e., limit sensitive inquiries while chaperone is present. Additionally, chaperones must understand their limited role and not go beyond the scope as observer. They should not serve as interpreter or share confidential information learned or seen during the exam. 

The relationship between patient and practitioner is based on trust. If either party requests (caregiver or patient) a chaperone then accommodations should be made and documented. The chaperone is there to protect both patients and staff to safeguard against formal complaints of inappropriate behavior or allegations. When a chaperone is provided then it should be documented in the medical record.  If the request is not feasible due to the emergent nature of the exam/study then that should be documented as well. 

During any intimate examination/sensitive interaction the environment as well as the provider’s behavior and conversation should be professional. The healthcare professional should ensure that the discussion is relevant to the situation, avoid unnecessary personal comments, encourage questions and discussion related to the exam/treatment, and remain alert to verbal and nonverbal indications of stress from the patient. An insensitive, casual, or humorous remark during a stressful, sensitive exam/procedure can be misinterpreted. Reference to how a person’s private physical body appears or personal attributes beyond medical conversation can be misinterpreted and is inappropriate. 

Each patient encounter is unique. Each patient may perceive a given action/behavior differently. The goal is clear communication, provision of a safe environment, and to maintain professionalism at all times.

If an allegation is made then it must be reported immediately to risk management.  Any allegation regardless of source or severity is taken seriously and followed up.  A report is made directly to the police of any allegation. This is done to protect all the parties involved. While these scenarios are extremely rare, the appropriate notification and documentation is necessary. The majority of allegations are not founded, but it can be one persons’ word against another. 

Risk Management CME Questions and Answers  March 2010

The Value and the Reality of Chaperones in the Healthcare Setting March 2010 Questions

The Value and the Reality of Chaperones in the Healthcare Setting March 2010 Answers

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