Chaperones

When it comes to GPs performing intimate examinations on their patients, there is an abundance of advice and guidance about the need for chaperones; see here from the General Medical Council, but also local PCTs.

The recommendation is that chaperones are offered for every intimate examination, and should be medically trained.

I must admit that this is one topic Dr Phibes take very seriously..... for my own sake.

There are already enough things that can go wrong practising medicine, without subjecting myself to an accusation of an inappropriate examination. But even then there is only so far you can go towards the gold standard mentioned in the link above.

Firstly, what constitutes an intimate examination? For me it's relatively straightforward; breast or vaginal examination of a female patient. In these situations it's relatively easy to find another female to chaperone. But what about my female partners? They regularly perform testicular or penile examinations on men without a chaperone. Partly because it's arguably different, but mainly because there are no spare men to act as chaperone.

Secondly is the qualification of the chaperone. Ideally they should have some medical qualification. But in a small branch surgery where the only staff are you and the receptionist, this is also not practical.

And that's before you start to consider same sex examinations in homosexual doctors.

And what about chest examinations of my female patients with coughs and colds? Going by the textbook, a patient should be naked from the waist up for a respiratory examination. But I can't see that suggestion going down too well with many of my female patients.

So where do we draw the line? Do we get written consent for every examination we do? Some have suggested we video every consultation! I can see it now "Yes Mrs Smith, just to document that I'm not a perv, I'm going to video this."

Dr Phibes has his own way of dealing with the problem; he avoids doing them whenever he can. If during a consultation it becomes apparent that the patient needs an intimate examination, I discuss this need with them. Obviously if the patient needs to be examined immediately, I will bite the bullet and do it (complete with chaperone). But, not infrequently, there is no immediate need to do the examination, and I give them the option, and even encourage them to see one of my female partners. As a quid pro quo my female partners send me men needing testicular or rectal examinations.

And it seems to work very well.