Using a chaperone during some patient examinations can be beneficial for both the patient and the provider. Making chaperones available is often reassuring for many patients, and lets the patient know that the practice is sensitive to his or her needs. In addition, the presence of a chaperone increases the defensibility of a claim alleging inappropriate advances toward the patient, while lending a professional quality to the exam.
The New Jersey Board of Medical Examiners (BME) regulation, N.J.A.C. 13:35-6.23, addresses the use of chaperones in medical office settings. The regulation states that all patients, or other persons who are to be examined, should be notified of their right to a chaperone. This applies to examinations of the female breast and pelvic exams, and also to genitalia and rectal exams for both sexes.[i]
The BME regulation specifies that patients are to be notified of the availability of chaperones in written form, by posting a conspicuous notice in the office, or by using other methods as necessary to ensure that patients understand the right to have a chaperone present.
Physicians are given certain rights under the regulation. They do not have to proceed with the exam if a chaperone acceptable to the patient is not available, or if the patient refuses to have a chaperone in a situation where the physician believes one is needed.
Any medical practice performing intimate physical exams falls under the regulation. To implement a chaperone process for such a practice:
· Develop a policy and educate staff on how the practice will be handling intimate physical exams going forward. This will mean that certain staff members may be called upon to serve in the role of chaperone, so it is important to make sure they are comfortable with doing so, and that they know precisely what their role is in this regard.
· Provide patient notifications. Such notice can take the form of clearly worded and easily visible signage, written notice in the practice’s intake paperwork given at the time of the first visit, or on the practice’s website intake packet.
The practice may want to include the following points in any chaperone process or policy:
· Talk with patients regarding chaperones. Allow and answer questions, and let patients make their own decision whether they wish to have a chaperone.
· If a patient refuses a chaperone and the physician chooses not to go ahead with the exam, the physician should have an informed refusal discussion with the patient, explaining the risks of going without the exam.
· Make time available for patient and physician to speak privately when the chaperone is not present (before or after the exam) so that more sensitive matters may be discussed, if necessary.
· Make chaperones available to patients of both genders, and do not withhold because the physician is the same gender as the patient.
· Chaperones should be trained healthcare workers, not clerical staff; healthcare workers are expected to respect patient privacy and confidentiality.
· The offer of a chaperone, any refusal of a chaperone and any subsequent informed refusal discussion should be documented in the patient’s record.