Questions and Answers About Chaperones

Questions and Answers About Chaperones

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Patient Safety

The American Medical Association’s Code of Ethics, the American College of Obstetrics and Gynecology, the American Academy of Pediatrics and the American College of Physicians all recommend the use of chaperones, at least in certain situations. Several states mandate that medical chaperones be present during intimate exams. And while statistics are hard to come by, Jon Porter, a health care attorney with more than 20 years of experience, says he has definitely seen a trend toward the use of chaperones.

Still, many clinicians have concerns, so we asked Porter, who is also a PBI faculty member, to answer the most common questions about chaperones.

Why should I use a chaperone?
I’ve been practicing for more than 20 years and never had a single complaint. Chaperones are like insurance, something you pay for and hope never to use. Most states now require you to carry malpractice insurance, even if you’ve gone 20 years without a problem. The likelihood of your being sued may be small, but the potential consequences are huge. The same holds true for boundary violations.

The next patient who walks through your door may be the one who files a complaint against you. If the case goes before the board, it’s likely to be your word against your patient’s, and the board’s job is to protect the public, not you. In fact, during a board hearing, the complainant is going to be called “the victim” until proven otherwise, which puts you behind the 8-ball right from the start.

Having a chaperone to back you up does not guarantee success, but it comes close. In the vast majority of cases, if the person has a chaperone I’ve been able to get the case resolved in their favor very quickly.

Do I need a chaperone with every patient?
Many complaints are the result of miscommunication, which can happen at any time, with any patient, so the ideal is to have a chaperone present whenever you are with a patient. Of course, that’s not always possible, so I recommend using a chaperone any time a patient is partially or fully undressed. At a minimum, intimate examinations (involving breasts, buttocks, or genitalia) should never be conducted without a chaperone in the room. If you’re not doing that, you might as well just put your medical license in a shredder.

That said, it’s worth noting that the majority of complaints we hear about in PBI courses stem from non-intimate, un-chaperoned cases. And in my experience, accusations of improper touching are as likely when a patient is clothed as when they are undressed.

I’m a female ob-gyn. Why would I need a chaperone?
Times have changed. You can never be sure of a patient’s sexual orientation, so gender doesn’t matter much anymore. I’ve had gay people complain about gay people, and straight people complain about straight people, and straight and gay people complain about each other. The point is, you just don’t know.

How do chaperones interact with patients?
I don’t want them putting ideas into people’s heads. Your chaperone should know ahead of time how to deal with situations that may arise. If a patient misunderstands something you are doing or saying, you might ask the chaperone to help clear things up and reassure the patient. If the chaperone wants to alert you to a potential problem, they can simply ask to speak to you privately.

Who can I use as a chaperone?
First of all, it’s important to understand that family members are not chaperones. They are unlikely to be objective and will rarely testify in your favor, which is why the chaperone needs to be a member of your staff. If a family member does stay during an exam, remember that you need to communicate with everyone in the room and be the educator.
In a perfect world, a chaperone would have enough medical training to know what is appropriate during an exam and be able to help reassure nervous patients. If that’s not always possible, it’s better to have someone than no one. If the chaperone is not medically trained, you should prepare them ahead of time by explaining what they will be seeing and what you’ll be doing, and answer any questions afterwards. It’s also important that they understand and respect the rules about patient confidentiality.

What if my patients object?
In the age of patient-centered care, many doctors and hospitals let patients decide if they want to have a chaperone present. That’s a mistake. Neither you nor your patient knows ahead of time when a chaperone might be needed. It’s best to have a policy in place and make patients aware of it. If they object, it’s up to you to educate them about the benefits of having a chaperone and to respond to their concerns as best you can. In many cases, it helps to have a chaperone of the same gender as the patient.

If your patient still objects, you have two choices. You can explain why the exam is important and that given office policy, you will not be able to examine them without a chaperone. If they decline, be sure to document this matter in their chart. Your other choice is to go ahead without the chaperone, understanding that you are taking a serious risk.

Chaperones are expensive. How am I supposed to cover the cost?
If you think a chaperone is expensive, consider the cost of defending yourself. An inexpensive lawyer is going to cost you at least $300 an hour, and without a chaperone, “he said, she-said” cases burn up a lot of hours.

The simplest way to hold down costs is to use people already on staff as chaperones. Scribes, who have been trained in specific specialties, are a particularly good option. While scribes generally make $15 to $20 an hour, advocates claim they more than pay for themselves by increasing clinicians’ efficiency and effectiveness. And since the scribe is already in the room, it costs nothing extra to have them serve as a chaperone. Patients also tend to prefer chaperones who are actively doing something, rather than just sitting and watching them.

The one downside to using scribes as chaperones is that while tending to their primary job, they may miss something important. An effective chaperone has to be fully aware of what’s going on in the room at all times. That can be more challenging for a scribe who’s also taking notes, but it’s doable. Ultimately, it’s a balancing act.

A word of caution: In your zeal to be efficient, resist the temptation to use your chaperone as a gofer. A chaperone should stick with you like a shadow. They should not leave the room while you are with the patient and they should not stay behind if you leave the room.

What kind of documentation is needed?
As I tell the people in the PBI Medical Record Keeping course, if you don’t write it down, it didn’t happen. It’s essential that you clearly document in the patient’s chart who the chaperone was and that they were present throughout the visit. It’s a good idea for the chaperone to co-document their presence, but it’s not essential.

Jon Porter, JD, is an experienced attorney who focuses primarily on physician licensure defense and professional licensing for healthcare providers. Earlier in his career Porter served as both a prosecuting attorney and Director of Investigations and Compliance for the Texas Medical Board.