Use of chaperones in general practice

Editor—In two separate papers Rosenthal et al and Conway and Harvey studied the use of chaperones in general practice settings.¹,² Conway and Harvey say that chaperones are used for the protection of the doctor rather than the patient. We have found that practitioners who perform vaginal examinations feel that they are juggling competing interests when deciding on the offering and use of a chaperone.

We interviewed primary care practitioners about their approach to the management of menstrual disorders.³ The role of the chaperone was understood as both protecting the doctor and reducing the patient's perception of vulnerability. Practitioners were aware of the guidelines produced by professional bodies and the potential medicolegal consequences of not using a chaperone. A chaperone could, however, adversely affect patient and consultation.

In keeping with general social perceptions, female patients being examined by male doctors were considered most vulnerable and hence in most need of a chaperone. Protecting the patient from vulnerability and embarrassment required that the chaperone be of the same sex as the patient. The use of a male chaperone for the examination of a female patient or of a female chaperone when a male patient was being examined was judged inappropriate by interviewees of both sexes.

For many practitioners, blanket guidelines were a source of stress. In primary care, where patients may choose the doctor they see, practitioners judged that many patients had already made a decision about which doctor they felt comfortable consulting. Suggesting that a chaperone might be required was perceived as introducing into a previously good relationship between doctor and patient the idea that the doctor was not trustworthy. More experienced practitioners argued that the key to reducing difficulties for practitioners and patients lay in better communication training.