Fremont Community Health Services

Provider Manual

/

Policy#

/ PR2003-04 / Original Date: / 1998
Revision Date(s): / 1/30/03
Review Date(s): / 8/11/05
Prepared by: / R. Scott Dyer / Approved by: / R. Scott Dyer
Title: / FCHS Exam Chaperone Policy
Purpose: / Define policies for chaperoning exams
Scope: / Providers, MAs, RNs

Policy:

Genital exams, female breast exams, and other examinations can be perceived as embarrassing, invasive or threatening to privacy by some patients. Having a second person present in the examination room during a sensitive exam can ease the discomfort of the patient, and ensure that patient privacy is respected. The most sensitive situation is usually the male examiner with a female provider, but male - male, female - male, and female - female interactions can also be sensitive. Genital and rectal examinations of children pose a special sensitivity problem. To ensure that patients are comfortable with an examination, to protect their privacy and to protect providers from patient misinterpretation of appropriate but uncomfortable exams, FCHS expects providers to offer chaperoned exams under sensitive exam situations. Special attention should be given to patients with culturally specific privacy issues.

The chaperone in most circumstances will be a medical assistant, though a nurse, another provider, a student, or a lab tech could also serve. Only clinically trained staff should serve as chaperones. The chaperone must be in a position which ensures adequate observation of the examination procedure.

Chaperones should be offered when appropriate for the following exams:

  • Female pelvic exams
  • Female breast exams
  • Male genital exams
  • Rectal exams
  • Pediatric genital exams (for children under 11, the parent or guardian should be the chaperone, and the exam should be deferred if the parent or guardian is not available.)

If the medical assistant or nurse who rooms a patient is aware that a sensitive exam will be required, they may ask the patient if they would like a chaperone, and inform the provider of the response. If the exam is not anticipated, the provider should ask the patient if a chaperone is desired. For first pelvic examinations, patients who are obviously uncomfortable with the exam, or if the provider feels the need for a chaperone, it may be appropriate to inform the patient that a chaperone is necessary.

When the patient is accompanied by a family member or friend, they should be asked if they prefer to have their companion leave the room. This is particularly appropriate for adolescent exams, and provides an opportunity for more private conversation with the patient regarding matters that they would prefer not to discuss with their parent present. If an opposite sex interpreter is present, they should be asked to leave the room while the patient prepares for the exam, and should be positioned so that the patient’s privacy is protected with drapes, curtains, or otherwise, if interpretation is necessary during the exam.

The presence of the chaperone should be documented in the chart in any situation in which the patient seemed particularly concerned or uncomfortable with the examination, or if the provider perceives inappropriate patient behavior during the exam.

R. Scott Dyer MD, Medical Director / Date

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