Using observers during intimate examinations

Do we really need chaperones for routine examinations?

Exploring the need for an observer with a patient is part of good medical practice. This is particularly relevant when examining minors or those unable to give consent and when performing obstetric and gynaecological/breast examinations – patients in these situations are particularly vulnerable to sexual abuse¹ and misunderstandings.

If you’re concerned about how a patient may react to physical contact, having another person present should be considered and is strongly recommended to protect both you and your patient. It can be useful to think of using an observer as not being something you ‘ask’ the patient about but something you just say is part of standard practice.

What are your thoughts on having your personal assistant as an observer?

An observer should be a qualified health professional, e.g. a registered nurse, someone trained to understand their role as a support person, or someone chosen by the patient.² In a survey of 687 patients across 13 general practices in regional New South Wales, slightly more than half of respondents said they’d feel uncomfortable with reception staff/practice manager having an observer role.³

Can a patient request someone, like a family member, to be present in the examination?

In general, a family member can be present if requested by the patient. Not every environment facilitates observers being able to be provided ‘on demand’. In these cases, it’s important to state on an information sheet that patients are welcome to bring their own person to act as observer if they wish. Though be mindful that this can add difficulties to the process.¹ Aim to just use observers during a physical examination, not the general consultation.¹

What if there is disagreement about an observer being present?

A person’s request for the presence and/or gender of an observer should be respected and documented, as should their declining of the offer.^4,5 If a suitable observer isn’t available the examination can be postponed if it’s not urgent and won’t impact the patient’s health.^4,6

If, for example, a female doctor has the impression that a male patient is requesting an intimate examination when there’s dubious indication, then they should either decline to perform the examination if it’s not clinically indicated, or have an observer present. You can decline to perform an examination if the patient declines to have an observer.

Seek assistance from our Medico-legal Advisory team if a patient behaves inappropriately.

 

More resources

Watch our webinar recording: ‘Intimate Examinations: Respect and Responsibility’
members.mdanational.com.au/My-Resources/Webinars

View our article on maintaining physical contact boundaries
mdanational.com.au/advice-and-support/Library/Articles-and-Case-Studies/2014/12/boundaries-physical-contact

Education Services, MDA National

References

1. Crowley P. In: Subotsky F, et al, editors.Abuse of the doctor-patient relationship. London: The Royal College of Psychiatrists; 2010. p. 114–26.
2. Medical Board of Australia. Guidelines: Sexual Boundaries in the Doctor–Patient Relationship. 2018.
3. Stanford L, et al. Patients' attitude towards chaperone use for intimate physical examinations in general practice. Aust Fam Physician. 2017;46(11):867–73.
4. RACGP Position On The Use of Chaperones in General Practice. [cited 24 May 2019].
5. Paterson R. Independent Review of the Use of Chaperones to Protect Patients in Australia. 2017.
6. AMA. Maintaining Clear Sexual Boundaries Between Doctors and Patients and the Conduct of Patient Examinations. 7 May 2019.