Abstract
We welcome the study by Osmond et al. 1 for providing data which indicate that, overall, patients attending genitourinary medicine clinics – at least in the UK – do not want a chaperone to be routinely present and that they would prefer to have a choice in the matter. However, we would like to suggest a variation on their recommendation of offering a chaperone to ‘all patients’. We propose this because simply by asking the question and offering chaperones to those who are unlikely to accept it may result in anxiety or discomfort for some individuals. We suggest a better approach based on data from Australian studies is to ask only women being examined by male practitioners, because it is only in this group that a substantial proportion want a chaperone. 2,3
The study by Osmond et al. 1 found that 12% (72/602) of patients reported that they would like a chaperone for future examinations. For women, 19.5% wanted a chaperone, which is similar to that seen in two recent Australian studies, which showed that between 27 and 32% of women wanted a chaperone when being examined by a male practitioner. 2,3 Few men desire the presence of a chaperone, whether the examining practitioner is male or female: in the British study, fewer than 6% wanted one and in the Australian studies fewer than 7% wanted one.
We agree with Osmond et al. 1 that having a chaperone present for every examination is not ideal because most patients in both the British and Australian studies do not want a chaperone present. Moreover, the Australian studies indicate that over 30% of patients feel uncomfortable about the presence of a chaperone. 2,3
The final, more subtle question is whether being asked if they would like a chaperone present causes patients any distress. This was assessed in one study, which demonstrated that 12% of men and 14% of women feel anxious or uncomfortable if they are asked if they would like a chaperone.
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This may be more acceptable when the group being offered commonly want one (i.e. women being examined by men) but less acceptable when few want one (i.e. all men or women examined by women). As outlined previously in the literature,
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we propose the following solution
That women being examined by men are asked if they would like a chaperone present. The data suggest that about a quarter to a third would accept the offer, with only about 12% being made uncomfortable by being asked. We agree with Osmond et al.
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that if a woman declines a chaperone, this should be recorded in the notes. For men being examined by practitioners of either sex, or women being examined by women, we would recommend clients are not routinely offered a chaperone. This approach stems from the finding that only a small percentage of men actually want a chaperone (1–6%), while a larger percentage are made uncomfortable by being asked.
No solution is perfect; however, this approach will address the desires of the majority while causing the least amount of harm. Importantly, no guidelines should be prescriptive and there will always be specific situations when clinicians should deviate from these guidelines (e.g. patient request, first genital examinations or practitioner concern over a possible physical threat).
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