To enable a GP to diagnose a patient symptoms and to provide advice on how to treat the patient it may be necessary to carry out an examination and in some cases an intimate examination. Where an intimate examination is necessary consideration should be given to the presence of a chaperone.
The general medical Council, in providing guidance to GPs states that when a GP carries out an intimate examination they should offer the patient the option of having an impartial observer (a chaperone) present, wherever possible. This condition, to an intimate examination, applies whether or not the GP is the same gender as the patient.
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A chaperone should usually be a health professional. The GP must be satisfied that the chaperone will:
- Be sensitive and respect the patient dignity and confidentiality
- reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- stay for the whole examination and be able to see what the doctor is doing, if practical
- be prepared to raise concerns if they are concerned about the doctors behaviour or actions
the GMC state that a relative or friend of the patient is not an impartial observer and so would not usually be a suitable chaperone. However, the GMC also makes clear that the GP should comply with a reasonable request to have a relative or friend present in the consulting room, as well as a chaperone.
If either GP or the patient does not want the examination to go ahead without a chaperone present, or if either the GP or patient is uncomfortable with the choice of chaperone, the GP may offer to delay the examination to a later date, when a suitable chaperone will be available, provided the delay will not adversely affect the patient’s health.
If the GP doesn’t want to go ahead without a chaperone present in the room, but the patient doesn’t want a chaperone, the GP must explain clearly why they require a chaperone to be present. Ultimately, the patient’s clinical needs must take precedence. The GP may want to think about referring the patient to a colleague would be willing to examine them without a chaperone, as long as a delay would not adversely affect the patient’s health
The GMC make clear that the GP must record any discussion about chaperones and the outcome in the patient’s medical record. If a chaperone is present the GP should recall that fact and make a note of their identity. If the patient does not want a chaperone, the GP she recalled that the offer was made and declined.
It was said in the second trial at the Old Bailey that Dr Manish Shah, GP from Romford, who practised at the Mawney Medical Centre breached guidelines on the use of chaperones during intimate examinations.
Dr Myles Bradbury, a former paediatric haematologist at Addenbrooke’s Hospital in Cambridge, was able to avoid detection due to, what was described as, an “inadequate” chaperone policy. Dr Bradbury sexually abused children in his care.
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