Inappropriate chaperoning during intimate examinations could be endangering vulnerable patients

Inside the examination room. Beaukeh Bottega/Shutterstock

Intimate health examinations can be an uncomfortable experience for anyone, regardless of age, health or gender. We are taught to trust doctors, believing they will not judge, that they are simply there to medically assess us, but still the prospect can be a daunting one.

There are protections in place, however. Anyone can ask for a chaperone (an impartial adult) to attend a health screening with them. Though there is no legal basis for a patient requesting a chaperone, it has become a common practice within the NHS, and accepted by bodies such as the General Medical Council.

But despite overhauls in the law, there is still little concrete guidance on the exact role and responsibilities of a chaperone. And though the purpose of this person is to independently observe what is going on during a medical examination, doctors have been encouraged to use a chaperone to protect themselves from potential accusations of inappropriate behaviour.

Unclear laws

Following the imprisonment of GP Clifford Ayling for sexually abusing female patients in 2004, a Department of Health inquiry found that there were actually four definitions that could be attached to the chaperone’s role, including that they are a “safeguard” for the patient, who “provides physical and emotional comfort” and will “identify unusual or unacceptable behaviour” from a healthcare professional, but also protect the professional from “potentially abusive patients”.

The lack of further clarity on the role and responsibilities of a chaperone is concerning. The idea of chaperoning is linked to the legal principle of equality of arms. This forms part of the right to a fair trial, where both sides in a dispute should have the same opportunities to defend themselves. It should mean that chaperones are objective in their reporting of an examination, and that they are not involved solely to safeguard the patient, nor only to provide a second voice to support a doctor’s case.

Reassurance. nuiza11/Shutterstock

The inquiry did recommend that robust policies be put in place, and that only trained chaperones witness medical examinations. But 16 years on, many NHS trusts and health boards still do not have standardised procedures to follow. This lack of definitive safeguarding may be putting patients at risk, with potential problems ranging from improper practices (such as patients being given inadequate psychological and emotional support during traumatic examinations, by either chaperone or doctor) up to sexual assault.

While chaperone rules have stagnated, several cases involving the sexually motivated abuse of patients by doctors – which could have been mitigated by the presence of chaperones – have come to light. These include paedophile doctor Myles Bradbury (who ignored a hospital chaperone policy), and more recently, GP Jaswant Rathore, who “deliberately avoided offering chaperones” and was jailed after sexually abusing female patients between 2008 and 2015.

However, the presence of a chaperone does not always prevent inappropriate behaviour – as illustrated by the Ayling case. The inquiry was told that the availability of a chaperone did not prevent Ayling from acting unprofessionally. In fact, the chaperone was sent out of the room from time to time.

Rates and research

The rates of chaperone uptake are low – as is the amount of research being done on this issue. One six-month survey of doctors found that while 92% of the 252 patients seen were offered a chaperone, only 22% accepted, while 12% expressed no preference. The remaining 66% declined because they trusted the doctor, thought it unnecessary, wanted privacy, were embarrassed, or were not bothered. Fewer male patients in the study accepted chaperones than female patients (3%). But significantly more female patients accepted chaperones from male doctors (85.4%) than from female doctors.

Other studies have found that nearly half of male GPs never or rarely use chaperones when intimately examining women. While some – worryingly – use receptionists as chaperones. In fact, in 2005, researchers found that only 37% of GPs had a chaperoning policy, with lack of staffing and resources given as excuses.

It is clear that more needs to be done to protect the vulnerable and prevent abuse – but what? It could be argued that there is no role for a chaperone and the installation of video cameras could provide a more effective way of preventing inappropriate behaviour, also serving to protect doctors from false allegations. But that may give rise to other privacy concerns.

The system is in a mess, and although policies are in place, they are not robust enough to ensure patients aren’t at risk. To begin with – and to ensure there is patient autonomy and transparency of professional practice – the role of the chaperone needs to be properly defined. They must be employed with a contract that clearly shows the parameters of the role. In addition, patients must be fully informed of the whole process for it to be lawful. Only then can we start to address and stop any sexual abuse that may occur.