Clinicians’ attitudes and utilization of a chaperone for intimate
examinations within a Contraceptive and Reproductive Health Care Service
Abacus Clinics for Contraception & Reproductive Health Care, North
Liverpool Primary Care Trust, UK
Introduction: Abacus Liverpool has adopted a policy of always offering
a chaperone when conducting intimate examination regardless of the examiners
gender. This was in response to the Royal College of Obstetricians and
Gynaecologists (RCOG) and the General Medical Council guidelines.
Aims and Method: The aim was, via conducting an audit, to examine the
adherence to the chaperone policy one year after implementation and possible
reasons behind non-compliance. The audit was a questionnaire with a mix of open
and closed questions and was sent to all 65 members of the clinical staff
working within the clinics in Abacus Liverpool. The results are based upon 44
questionnaires returned, a response rate of 69%. Of the questionnaires returned
19 were Doctors and 25 were Nurses divided by gender as 2 males and 42 females.
Results: Only 8 staff always offered a chaperone when performing an
intimate examination. The majority of staff only sometimes offered a chaperone
for intimate examinations, and only 2 staff had never offered a chaperone. It is
note worthy when offered it was well documented. The reasons given for not
offering a chaperone were varied but the most common was time pressures and
staff shortages, 10 staff reported forgetting to offer a chaperone and 2 thought
it was an interruption to the client/practitioner relationship. In direct
contrast to this when asked if at all times a designated chaperone was made
available, 75 percent of staff thought that this would make no difference in the
offering of a chaperone. On the occasions where a chaperone has been required
most staff had no problem obtaining one with only 4 members of staff having
occasions where they could not obtain a chaperone at the time requested. Staff
estimated that only 6 percent of clients requested a chaperone when offered and
the clients’ own anxiety determined this. Two members of staff thought that
gender difference between client and clinician was an issue.
Conclusion: Complex and varied reasons were given by clinicians for
non-adherence to the chaperone policy. Clinicians within contraceptive and
reproductive health care work autonomously, and this may have an impact for
policy adherence. This audit did not clearly define this and the offering of a
chaperone for intimate examinations has shown to be a more subjective decision.
The time impact on a fully staffed and balanced clinic is questionable.
Consistent remainders of the policy may improve adherence. The unique nature of
contraception and reproductive health care is such that the sensitivity of the
consultation changes the influence of the chaperone and more investigation is
needed on this issue.