Given the recent flood of high-profile sexual misconduct claims in the news, SVMIC has received an increased number of questions surrounding the topic of chaperones in an exam room. While there are no legal requirements to do so, the goal should be to make the patient feel comfortable while also protecting the physician against accusations resulting from a misunderstanding. With the increased media focus and sensitivity on the subject, now is a good time to review your office policies and procedures.
SVMIC’s best practice recommendation is to offer a chaperone during any procedure that requires the patient to disrobe. Sensitive examinations such as breast, pelvic, genital and rectal exams should always be chaperoned, regardless of the patient or physician’s gender. The presence of the chaperone should be documented. If the patient declines a chaperone, the discussion and refusal should likewise be documented. Any request for a chaperone should be honored, regardless of the nature of the examination.
If a medical student or other non-practice personnel are accompanying the practitioner during office visits, explain this to each patient prior to bringing the student (or other personnel) into the examination room so that you may obtain his/her consent first. It is prudent to document the patient’s consent, or refusal, in the medical record. Practice staff should serve as a chaperone while students should not fill the role.
The American Medical Association Code of Medical Ethics Opinion 1.2.4 offers the following guidance:
Efforts to provide a comfortable and considerate atmosphere for the patient and the physician are part of respecting patients’ dignity. These efforts may include providing appropriate gowns, private facilities for undressing, sensitive use of draping, and clearly explaining various components of the physical examination. They also include having chaperones available. Having chaperones present can also help prevent misunderstandings between patient and physician.
(a) Adopt a policy that patients are free to request a chaperone and ensure that the policy is communicated to patients.
(b) Always honor a patient’s request to have a chaperone.
(c) Have an authorized member of the health care team serve as a chaperone. Physicians should establish clear expectations that chaperones will uphold professional standards of privacy and confidentiality.
(d) In general, use a chaperone even when a patient’s trusted companion is present.
(e) Provide opportunity for private conversation with the patient without the chaperone present. Physicians should minimize inquiries or history taking of a sensitive nature during a chaperoned examination.
Taking steps to help a patient feel comfortable during a physical examination is helpful in building a solid and trusting relationship. Providing the patient with information about the various types of examinations and the details of what to expect can serve to alleviate anxiety and help prevent a misunderstanding as to the appropriateness of certain actions during the examination.
Stephen Dickens, JD, FACMPE, is the Vice President of the Medical Practice Services Department at SVMIC. Mr. Dickens has spent over 20 years working in medical practice, hospital, and home care executive positions. He is a Past Chair of the Medical Group Management Association. During his tenure, MGMA had more than 33,000 members working in over 18,000 healthcare organizations where some 385,000 physicians practiced. Additionally, he is a Past President of the MGMA Financial Management Society and Tennessee MGMA. He is a Board Certified Medical Practice Executive and Fellow in the American College of Medical Practice Executives.
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