Chaperones in Clinical Practice

The presence of a chaperone during medical consultations can be of reassurance to both patients and doctors, especially when there is a need for an intimate examina­tion to be performed, regardless of the gender of either the doctor or the pa­tient. Chaperones help preserve dignity, offer emotional support, and provide an additional safeguard against misunder­standings or allegations.

Section 1.2.4 of the Medical Council of Hong Kong’s (MCHK) Code of Professional Conduct states: “An intimate examination of a patient is recommended to be conducted in the presence of a chaperone to the knowledge of the patient. If the pa­tient requests to be examined without a chaperone, it is also recommended to record the request in the medical records.”

Allegations arising from clinical ex­aminations can result in various med­icolegal processes, ranging from local complaints to the clinician’s clinic/hospi­tal, MCHK complaints and investigations, to criminal investigations. As such, the presence of a chaperone during an exam­ination can prove invaluable as the chap­erone can offer his/her account of events, including any discussions or consent-taking he/she may have witnessed as well as details of the examination itself.

In what circumstances should a chaperone be offered?
The most obvious example is with intimate examinations, and in these sit­uations, a chaperone should be offered. However, it is important to remember that what can be classed as an intimate ex­amination may depend on the individual patient.

It may also be appropriate to offer a chaperone in other circumstances, such as consultations with particularly vulnera­ble patients. The presence of a chaperone in these circumstances may be advanta­geous during the entirety of a consultation or for a specific part, not necessarily in­volving a physical examination.

It is important to always explain to a patient the reasons for any examina­tion and detail what you are intending to do before obtaining their permission to proceed.

Why use a chaperone?

• The presence of a chaperone adds a layer of protection for both the doctor and the patient. It is rare for an allega­tion of assault to be made if a chaper­one is present.
• To acknowledge a patient’s vulnerabil­ity and to ensure a patient's dignity is preserved at all times.
• A chaperone may assist the health professional in the examination. For example, the chaperone may assist with undressing/dressing patients as required.
• The presence of a chaperone pro­vides emotional comfort and reassur­ance to the patient.

Intimate examinations may be em­barrassing or distressing for patients, and such examinations should be carried out sensitively. This is likely to include exam­inations of breasts, genitalia and rectum, but also extends to any examination where it is necessary to touch or be close to the patient. Medical Protection has seen a number of cases relating to exam­inations of a patient’s chest, for example.

What if a chaperone is not available?
There may be occasions when a chaperone is unavailable (for exam­ple, in an out-of-hours setting). In such circumstances, the doctor should consider the clinical indication for the examination and discuss this with the patient, so that the patient’s decision to proceed with the examination or not is an informed one.

If the patient declines to consent to an examination due to the lack of avail­able chaperones, the risks of not pro­ceeding with the examination should be clearly communicated, as well as any implications on reaching a diag­nosis and the management plan. This discussion should also be documented in the medical records.

What if a patient declines a chaperone?
Even if a patient declines the offer of a chaperone, doctors or nurses may feel that in certain circumstances (for example, an intimate examination on a young adult), it would be wise to have a chaperone present for their own com­fort/protection. In these circumstances:

• The doctor should explain that it would be preferred to have a chap­erone, explain that the role of the chaperone is in part to assist with the procedure and provide reassur­ance. It is important to explore the reasons why the patient does not wish to have a chaperone and to address any concerns the patient may have.


• If the patient still declines, the doc­tor will need to decide whether or not to proceed in the absence of a chaperone. This will be a decision based on both clinical need and the requirement for protection against any potential allegations of an un­consented examination or improper conduct.


• Another option to consider is whether or not it would be appro­priate to ask a colleague to under­take the examination (although the chaperone issue may still prevail).


• The doctor or health profession­al should always document that a chaperone was offered and de­clined, together with the rationale for proceeding in the absence of a chaperone.