What should GPs be doing about chaperones?

WHAT IS THE ONGOING ‘ISSUE’ WITH MEDICAL CHAPERONES?

The concerns surrounding medical chaperones have been debated elsewhere over nearly three decades now and are not the purpose of this commentary.²,⁴,⁵ Rather, what should GPs be doing about chaperones (now, in the 21st century)? The latter phrase has specifically been added in parentheses to reflect our ever-changing social norms and attitudes. We need to acknowledge that general practice is very different from the hospital setting: GPs generally work alone as independent practitioners in their consulting rooms, when conducting home visits, and in doing out-of-hours work.

Perhaps the key issue with medical chaperones is that the offer (and uptake or not) of a chaperone and its subsequent documentation is erratic, not only between GPs but also where an individual GP is inconsistent in his or her approach.⁴,⁵ It is perhaps this practice variance that leaves GPs and other health professionals open to criticism, inference, potential allegation, and litigation.

IS THE TERM ‘MEDICAL CHAPERONE’ JUST A WESTERN CONCEPT?

There are certain limitations when comparing studies on chaperoning conducted in different countries, for example, with differences in healthcare systems, consultation style, and patient expectations. This is emphasised by the small number of studies, which were conducted in various secondary settings rather than in general practice. In addition, there is limited information about whether chaperones are used in some countries of the world.⁶ The research literature about medical chaperones in general practice is limited to a handful of predominately English-speaking countries.⁴–⁸ However, one would be naïve to think that sexual misconduct only occurs in these Anglosphere countries. This is evidenced by the number of medical negligence claims and episodes of sexual misconduct by doctors that have been reported beyond these predominately English-speaking countries.⁹,¹⁰ Whether the offer (and use) of a medical chaperone is merely specific to general practice in a few predominately English-speaking countries requires further research. One can argue that perhaps chaperoning is not necessarily a concept relevant to a particular region, and/or culture that is, not just a Western concept, but an intervention based on need across all health professions.

To explore this further, we conducted a small pilot survey¹¹ among international GPs attending a world primary care conference in 2013. The results make for interesting reading and warrant further exploration. It showed that those participants who were not familiar with the term ‘chaperone’ or similar were more likely to have qualified in Europe (excluding the UK) and less likely to offer a chaperone. Although almost two-thirds of participants overall would consider offering a chaperone to a patient, only one in five reported that they would always use a chaperone. Chaperone availability, the time constraints of the consultation itself, and issues related to confidentiality and privacy were the three most frequently identified barriers among chaperone ‘users’. The least three problematic factors were: cost; personal choice of the doctor; and lost opportunities to discuss intimate issues between the practitioner and patient. In comparison, non-users reported the ‘personal choice of the doctor’, ‘confidentiality’, and ‘impact of the doctor–patient relationship’ as the three main areas influencing their decision not to use a chaperone.

CONCLUSION

Doctors who do and do not use chaperones hold different views about their effect on the consultation and their impact on the doctor–patient relationship. Likewise, the views of contemporary patients may also differ and are dependent on their understanding of what ‘chaperoning’ entails. We cannot assume that social norms are unchanged in 21st-century Britain and there is a need to look again at this ‘well established’ topic. This is not only because of our changing society, but also because of uncertainty about custom and practice internationally. There are new opportunities for research in areas such as electronic documentation of chaperone offer and uptake.