Drs Tatiana + Rishi Advanced Aesthetics is committed to providing a safe, comfortable environment where the safety of patients and staff is of paramount importance. Patients experiencing consultations, examinations and investigations need to feel and be safe and to experience as little discomfort and distress as possible. Equally, health professionals are at a potential risk of their actions being misconstrued or misrepresented if they conduct examinations where no third party is present. Clinicians have a professional responsibility to minimise the risk of false accusations of inappropriate behaviour.
This policy presents principles and outlines the procedures that are in place at Drs Tatiana + Rishi Advanced Aesthetics for appropriate use of chaperones for patients during examinations, investigations and care.
This policy is designed to protect both patients and staff at Muse Studios Limited from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and treatment/care arrangements.
This policy provides guidelines such that any possible misunderstanding can be avoided when treating or examining patients.
Adequate privacy must be provided and all effort must be made to maintain the patient’s dignity.
RELEVANT CQC FUNDAMENTAL STANDARD/H+SC ACT REGULATION (2014)
- Regulation 12: “Safe Care and Treatment”.
- Regulation 9: “Person Centred Care”
Good practice guidelines
Patients may find any examination distressing, particularly if these involve the breasts, genitalia or rectum (known as “intimate examinations”). Patients may also be distressed by consultations involving dimmed lights or close proximity of the clinician to the patient. Some individuals for personal or cultural reasons, may feel uncomfortable if the clinical examination requires them to undress and / or be touched and may feel vulnerable.
Chaperoning may help reduce distress, but must be used in conjunction with respectful behaviour, explanation, informed consent and privacy. The following “good practice” guidelines will therefore be followed:
- Staff (male and female) should always consider whether an intimate or personal examination of the patient (either male or female) is justified, and whether this poses a risk of misunderstanding.
- In attending a consultation, it is assumed that a patient is seeking appropriate clinical assessment, diagnosis and treatment and therefore is granting implied consent to necessary physical examinations. However, before proceeding with a physical examination, a healthcare professional should always seek to obtain, by word or gesture, some explicit indication that the patient understands the need for examination and agrees for it to take place.
- Patients are routinely offered a chaperone for all consultations, investigations and treatments. All the clinic’s consent forms ask patients if they would like a chaperone. They can either click yes or no.
- The patient should be given a clear explanation of what an examination, investigation or treatment will involve.
- Staff should always adopt a professional and considerate manner.
- Staff should always ensure that the patient is provided with adequate privacy to undress and dress.
- Patients who request a chaperone should never be examined without a chaperone being present. If necessary, where a chaperone is not available, the examination should be rearranged for a mutually convenient time when a chaperone can be present.
Who can act as a chaperone
A chaperone is present as a safeguard for both parties (patient and healthcare professionals) and is a witness to the conduct and the patient’s continuing consent to the examination or procedure.
The precise role of the chaperone varies depending on the circumstances. It may include providing a degree of emotional support and reassurance to patients but more commonly incorporates:
- Providing protection to healthcare professionals against unfounded allegations of improper behaviour.
- Assisting in the examination or procedure, for example handing instruments during an examination or procedure
- Assisting with undressing, dressing and positioning patients
A chaperone does not have to be professionally qualified but will need to be:
- Sensitive, and respectful of the patient’s dignity and confidentiality
- Prepared to reassure the patient if they show signs of distress or discomfort
- Familiar with the procedures involved in a routine intimate examination
- Prepared to raise concerns if misconduct occurs.
The role of a chaperone should be made clear to both the patient and the person who is undertaking the role.
Who may Chaperone?
There are two main types of Chaperone: ‘formal’ and ‘informal’.
Informal Chaperones are family, friends or supporters of the patient invited by the patient to accompany them in the consultation. Many patients feel reassured by the presence of a familiar person. Clinicians will accept the patient’s wish for an informal chaperone in almost all cases. The shortcomings of utilising informal chaperone include:
- they may not understand the boundaries between appropriate and inappropriate clinician behaviour within an examination or procedure.
- they may not necessarily be relied upon to act as an independent witness to the conduct or continuing consent of the procedure.
Under no circumstances should a child be expected to act as a chaperone. However, if the child is providing comfort to the parent and will not be exposed to unpleasant experiences it may be acceptable for them to stay. It is inappropriate to expect an informal chaperone to assist in or take part in the examination or to witness the procedure directly.
A ‘formal’ chaperone implies a health care professional, trained as a chaperone. This person may be a Doctor, skin therapist, receptionist or patient coordinator. This individual will have a specific role to play in terms of the consultation and this role should be made clear to both the patient and the chaperone. Chaperones must have sufficient training to understand the role expected of them and they must not be expected to undertake a role for which they have not been trained.
Protecting the patient from vulnerability and embarrassment means that the chaperone will usually be of the same gender as the patient. There may be occasions when no staff of the same gender as the patient are available. On any such occasion, provided it is clinically appropriate to delay the examination / procedure, the patient will be offered the option to rebook for the examination / procedure at a time when a clinician of their choice is available.
The patient always has the opportunity to decline a particular person as a chaperone if that person is not acceptable to them for any justifiable reason.
Offering a chaperone
The relationship between a patient and healthcare professional is based on trust. A practitioner may have known a patient for a long time but a chaperone should be offered in all circumstances that meet the criteria outlined in this policy regardless of how long the patient is known to the practitioner. Therefore, all patients have equity of access to chaperones in identical clinical situations. Any patient is entitled to a chaperone if they feel one is required.
Staff should be aware that intimate examinations might cause anxiety for both male and female patients whether or not the examiner is of the same gender as the patient.
It is good practice to offer all patients a choice of the gender of their chaperone for their examination or procedure. If the patient is offered and does not want a chaperone it is important to record that the offer was made and declined.
If a chaperone is refused, a healthcare professional cannot usually insist that one is present. However, there may be cases where the practitioner makes a professional judgement that they cannot conduct the examination of procedure without a chaperone present and may decline to proceed without a chaperone. Examples include: where the healthcare professional considers here is a significant risk of the patient experiencing distress, displaying unpredictable behaviour, or making false accusations. In any such case, the practitioner must make his/her own decision and carefully document their decision and rationale in the notes along with the details of any procedure undertaken.
Where a chaperone is needed but not available
If the patient has requested a chaperone and none are available at that time the patient must be given the opportunity to reschedule their appointment within a reasonable timeframe (this may include simple waiting in the practice until a member of staff is available). If the seriousness of the condition dictates that a delay is inappropriate, then this should be explained to the patient and recorded in their notes. A decision to continue or otherwise must be jointly reached.
In cases where the patient is not competent to make an informed decision, then the healthcare professional must use their own clinical judgement and be able to justify their course of action. The decision and rationale should be documented in the patient’s notes.
It is acceptable for a healthcare professional to perform an intimate examination without a chaperone if the situation is life threatening or speed is essential in the care or treatment of the patient. The rationale for any such examination should be recorded in the patient’s notes.
Issues specific to children
Note that Drs Tatiana + Rishi Advanced Aesthetics only sees and treats adult patients. So providing a chaperone to a child is not applicable.
Issues specific to religion, ethnicity, culture and sexual orientation
All patients undergoing examinations should be allowed the opportunity to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation. Some patient’s ethnic, religious, cultural background and sexual orientation can make intimate examinations particularly difficult. For example, men or women may have a strong cultural or religious or belief system reason why they are adverse to examinations by clinicians of the opposite gender. A lesbian woman or gay man may wish intimate examinations to be performed by a healthcare professional of the opposite gender.
The patient’s beliefs, attitudes and concerns will not be presumed and will be discussed with the patient and taken into account. Each individual has very different needs and before the procedure these should be mutually agreed with the healthcare professional. The healthcare professional, however; will not collude with patients who are practising discrimination.
Issues specific to people with learning difficulties and mental health problems
For patients with learning difficulties or mental health problems that affect capacity, a familiar individual such as a family member or carer may be the best chaperone. A simple and sensitive explanation of the technique is vital.
Adult patients with learning difficulties or mental health problems who resist an examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned. In life-saving situations the healthcare professional must use their clinical judgement as to the best interests of the patient and must record their rationale fully in the patient’s notes. Please seek advice and assistance where required from the CQC Registered Manager – Rishi Mandavia.
Non English speaking patients
If a non-English speaking patient is examined an independent interpreter should be enlisted. This will help ensure the patient understands the proposed examination / procedure and is able to grant (or decline to grant) informed consent. An interpretation service is available over the telephone (Language Line). The use of a formal chaperone may still be appropriate. A family member or interpreter should not be used as a formal chaperone.
In all cases where the presence of a chaperone may intrude in a confidential clinician-patient relationship their presence should be confined to the physical examination. Confidential communication between the healthcare professional and the patient should, where possible, take place before and after the examination or procedure when confidentiality is easier to maintain.
Communication and record keeping
The key principles of communication and record keeping will ensure that the healthcare professional and patient relationship is maintained. This will assist patient comfort and dignity, their confidence in the professionalism of the clinician and practice and also safeguard the clinician against formal complaints, or in extreme cases, legal action.
The most common cause of patient complaints is a failure in communication between both parties, either in the practitioner’s explanation of, or the patient’s understanding of the process of examination or treatment. It is essential that the healthcare professional explains the nature of the examination and offers patients a choice whether to continue. Chaperoning in no way removes or reduces this responsibility.
Details of the examination including the presence or absence of a chaperone and the information given must be documented in the patient’s clinical record. The records should make clear from the history that the examination was necessary.
In any situation where concerns are raised or an incident has occurred this should be dealt with immediately in accordance with the Incident Reporting Procedure.
The member of staff should record any discussion about chaperones and its outcome. If a chaperone is present, that fact should be recorded and a note made in the patient’s notes of their identity.
If the patient does not want a chaperone, a record that the offer was made and declined should be made in the patient notes.
All staff undertaking Chaperone duties will be competent for the role, and trained accordingly. This training will include aspects such as:
- How to raise any Safeguarding or other concerns that they may have.
- What is meant by the term chaperone.
- What is an ‘intimate examination’.
- Why chaperones need to be present.
- The rights of the patient.
- Their role and responsibility.
- The specific details of different types of intimate examinations
- The rights of the patient
- The role and responsibility of the chaperone
- Policy and mechanism for raising concerns
In addition all chaperones will:
- be sensitive and respect the patient’s 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
- be prepared to raise concerns if they are concerned about any aspect during the examination.
- have had a Disclosure and Barring Service check
- be trained appropriately for their role as a Chaperone.
CHAPERONE POLICY STATEMENT FOR SERVICE USERS
Drs Tatiana + Rishi Advanced Aesthetics is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.
We recommend that all patients are seen at some point during the consultation process alone with our clinician, to ensure patients are free to express any concerns or worries in their own words and without fear of coercion or threat from any accompanying individual. However, all patients are entitled to have a chaperone present for any consultation, examination or procedure where they feel one is required.
Regardless of gender of the patient or clinician, you will be offered the option of having an impartial observer (chaperone) present for any intimate examination. Our trained staff routinely undertake this role and will:
- Be sensitive and respect your dignity and confidentiality
- Reassure you in the event of distress or discomfort
- Be familiar with the procedures involved
- Stay for the whole examination and be able to see what the clinician is doing, if practical
- Be prepared to raise concerns if they are concerned about the clinician’s behaviour or actions.
Your healthcare professional may also require and request a chaperone to be present for certain consultations in accordance with our chaperone policy.