True or False: Chaperones are a Luxury I Just Can’t Afford
The vast majority of physicians in North America do not use chaperones, and there are no regulations requiring their use. Yet experts in the field strongly urge providers examining patients to have a third party in the room. What’s your opinion? How well-founded is it? Take our brief quiz and find out.
True or False
- A chaperone’s primary responsibility is to protect the patient.
- Chaperone’s are essential only during intimate exams.
- As long as a patient’s family member is present a chaperone is not needed.
- The mere presence of a chaperone can prevent problems.
- Doctors with high ethical standards and spotless records need chaperones as much as anyone.
- There is little evidence that chaperones are ever cost justified.
Circle as many as apply
7 If a patient doesn’t want a chaperone, the doctor should:
a. Refuse treatment
b. Explain the benefits of having a chaperone
c. Respect the patient’s wishes
d. Get the patient to sign a waiver.
8 To ensure the effective use of a chaperone, physicians should:
a. Develop a clearly stated chaperone policy
b. Train those who will be serving as chaperones
c. Clearly communicate to all patients how and why chaperones are used
d. Insist that chaperone enter and leave exam rooms whenever the doctor does
The following answers are based on interviews with Jon Porter, an experienced attorney who defends physicians in licensure cases and formerly prosecuted cases for the Texas Medical Board, and with Dr. Stephen Schenthal, founder and CEO of Professional Boundaries, Inc.
True or False
A chaperone’s primary responsibility is to protect
FALSE. The chaperone has a dual responsibility: to protect the patient from inappropriate behavior by the physician and to protect the physician from unjustified accusations by the patient.
Chaperone’s are essential only during intimate exams.
FALSE. It’s certainly a good idea to have a chaperone during intimate exams. In fact, official guidelines in the UK strongly recommend it. But both Porter and Schenthal urge physicians to use chaperones in other cases as well.
At a minimum, says Porter, “When you have someone in a state of undress you absolutely have to have a chaperone present at all times, regardless of gender. I don’t care if both patient and doctor are the same sex. I’ve seen complaints regardless of sexuality or gender.” Still, he notes,” I’ve seen many, many occasions when there are allegations that providers said something improper or touched body parts when patients are clothed.”
Schenthal adds that while most practitioners who use chaperones do so only in intimate exams, “in fact the majority of cases that end up in our courts are non-intimate, un-chaperoned cases.”
As long as a patient’s family member is present a chaperone is not needed.
FALSE. Porter warns that family members will always side with the patient, and are therefore not reliable witnesses.
The mere presence of a chaperone can prevent problems.
TRUE. Lack of accountability is a risk factor for violations, so it stands to reason that the presence of an eye witness helps restrain physicians who might otherwise act inappropriately. Porter points out that most violators do not go into the office intending to do harm, but get caught up in the moment. The presence of an observer, especially one charged with monitoring the doctor’s behavior, can prevent such moments from getting out of hand.
Doctors with high ethical standards and spotless records need chaperones as much as anyone.
TRUE. Most physicians think, “I’m not a bad person so I don’t need to worry about a chaperone.” But says Porter, “people should worry about it, because you never know what patient is going to come through the door and what their issues are.” Chaperones can also prevent innocent mistakes or misperceptions from getting out of hand. Consider the following hypothetical case cited by MPS, a UK protection organization for healthcare professionals.
“Dr. A is seeing a patient, Miss F, who is complaining of a problem in her right eye. Dr. A explains that “he will need to look at the back of the eye”. He promptly turns out the light in the consulting room and proceeds to perform a fundoycopic exam. While Dr. A is leaning forward, his tie inadvertently (and unbeknown to Dr. A) comes into contact with Miss F’s blouse. She leaves the consultation thinking that Dr. A has touched her inappropriately and makes a complaint.”
There is little evidence that chaperones are ever cost justified.
FALSE. Chaperones are similar to insurance policies that you pay for and hope never to use. The cost of the chaperone is like the premium you pay: it may seem high as long as you don’t need it, but if the chaperone prevents you from losing your license, the amount you’ve spent will seem minuscule.
Porter also notes that a chaperone doesn’t have to just stand around. “I support the idea of the chaperone also serving as scribe,” he says. “It builds in natural efficiencies and is a good use of resources. Even in a small office, I’ve found that the efficiencies of having a scribe are worth the cost (usually around $15/hour). The scribe saves the physician hours of work and guarantees contemporaneous records, which is what you’re supposed to do anyway.”
If a patient doesn’t want a chaperone, the doctor should:
ALL OR NONE OF THE ABOVE— IT’S A JUDGMENT CALL. The first step is to listen to and address the patient’s concerns. As “educator-in-chief,” says Porter, the physician should make sure that the patient understands the benefits of having the chaperone present. If the patient’s concerns are about the gender of the chaperone, ideally the doctor will be able to offer a more acceptable person, either at the time or at a rescheduled appointment.
If the patient still refuses to have a chaperone, and the doctor has made it clear that this is standard policy in the office, the physician can simply refuse to treat the patient or ask them to sign a waiver. The latter is far from ideal and in reality offers little protection.
Ultimately, of course, informed consent and the doctor’s fiduciary responsibility rule the day. So if the patient refuses a chaperone and the doctor feels strongly that it is in the patient’s best interest to be seen, the doctor can choose to see the patient without a chaperone. But it’s important for the physician to understand that he or she is taking a real risk.
The keys to a successful chaperone are:
ALL OF THE ABOVE. A clearly stated policy ensures that everyone understands their obligations. While there is no official training available for chaperones at the moment, the chaperone should be clearly instructed in the duties they are expected to perform, which should include shadowing the doctor throughout the patient visit (entering and leaving the room with the doctor) and noting their presence clearly in the medical record. Chaperones should also know ahead of time how to respond to specific situations that may arise. It is also very helpful to explain chaperone policy to patients both in new-patient information sheets and in signs posted in the lobby.