Urgent message: In today’s world of flying accusations of personal misconduct, having a clearly defined (and followed) chaperone policy helps protect both providers and patients.

Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor for The Journal of Urgent Care Medicine.

In light of the recent explosion of sexual assault and abuse allegations being made across the country, many medical practices have turned to chaperones as a way to mitigate risk. Though the idea of a chaperone, due to the nature of the word, may seem archaic or unnecessary, doing so can help protect the facility, its employees, and its patients, all while keeping the practice professional and reliable.

For urgent care centers, this can look a little different due to the episodic nature of treatment and the operational focus on rapid turnaround with high throughput. However, owners and operators of urgent care centers should carefully consider the case for having a chaperone policy and what should be included in it.

What Is a Chaperone in the Medical Setting?

As you might imagine, a chaperone is present in the treatment room with the physician and the patient. He or she observes the exam and ensures that things go according to policy and that nothing inappropriate happens. The role of a chaperone is twofold. They are there to protect both the physician and the patient. Generally, a chaperone is already an employee of the healthcare facility, as it is usually not financially realistic to hire a full-time chaperone. This person could be a front office worker, but preferably is someone with at least some medical training, such as a medical assistant, a nurse technician, or a medical scribe. 

What Does a Chaperone Do?

In essence, chaperones are present to observe a physical examination or other “closed door” medical visit. As long as everything about the visit is appropriate, the chaperone shouldn’t have to do anything else. However, if something inappropriate does occur, initiated by either the physician or the patient, a chaperone should interject. They can stop something inappropriate from happening in the first place by paying attention to the atmosphere of the exam, or at least stop inappropriate actions before they get out of hand. And they serve as a witness after the fact should allegations be made by anyone in the room.

How Does Having a Chaperone Benefit the Patient and the Physician?

For the patient, having a chaperone in the room offers reassurance that they are safe from abuse or sexual misconduct by the physician. Simply having someone else in the room can make them feel better, especially in cases where the physician and patient are different genders or during sensitive exams of the reproductive regions, or times when the patient is undressed. However, a chaperone should be available regardless of gender, as abuse can occur between any two individuals.

For the physician, a chaperone hedges against false claims of abuse or groundless sexual misconduct allegations. Should a patient falsely accuse the physician of something, the chaperone who was present can act as a witness to testify on behalf of the physician. In fact, some prosecutors now argue that having a chaperone is the standard of care for intimate exams. Chaperones also protect the physician by limiting the chances of a patient initiating inappropriate behavior. 

What Should a Chaperone Policy for an Urgent Care Center Include?

As mentioned, a chaperone policy for an urgent care center looks a bit different than it would for another type of healthcare facility. This is due to the fact that patients and physicians don’t have an established relationship, the care setting is often quick and time-sensitive, and urgent care centers must utilize existing employees (ie, nurses, medical assistants or technicians) for the role.

Having a chaperone policy in place can help prevent expensive and damaging false allegations against providers and reassure patients that their care will be handled professionally. Therefore, it is practically essential in today’s society to have such a policy. Urgent care operators and owners should consider including the following points the chaperone policy for their facility:

  • Patients should be informed and free to request a chaperone for any portion of their exam; this request should be honored whenever possible.1
  • Chaperones should be an unbiased individual who is part of the healthcare team or an employee of the healthcare facility. Chaperones should not be a family member.2
  • A chaperone should be used even when a patient’s trusted companion or relative is present.1
  • An opportunity for private conversation with the patient should be provided without the chaperone present. Physicians should minimize inquiries or history-taking of a sensitive nature during a chaperoned examination.1
  • Physicians should require chaperones to adhere to the same patient privacy and confidentiality practices as they do.2
  • Physicians should carefully document the name and information of the chaperone who was present so they can be contacted if an allegation occurs down the road.

Table 1 provides an actionable checklist for intimate examinations.

Table 1. Checklist for Intimate Examinations

Before the examination

·         Explain to the patient why the particular examination is necessary and what it entails so they can give fully informed consent.

·         Record the consent discussion in the notes, along with the identity of the chaperone (or if a chaperone was offered but declined).

·         If possible, use a chaperone of the same gender as the patient.

·         Allow the chaperone to hear the explanation of the examination and the patient’s consent.

 

During the examination

·         Ensure patients’ privacy during the examination and when they are dressing and undressing (eg, use screens and gowns/sheets).

·         Position the chaperone where they can see the patient and how the examination is being conducted.

·         Explain what you are going to do before you do it and seek consent if this differs from what you have told the patient before.

·         Stop the examination if the patient asks you to.

·         Avoid personal remarks.

 

After

·         The chaperone should leave the room following the examination so the consultation can continue in private.

 

Adapted from: The MDU. Best practice in the use of chaperones. Available at: https://www.themdu.com/guidance-and-advice/journals/mdu-journal-april-2014/best-practice-in-the-use-of-chaperones. Accessed October 19, 2018.

 

 Conclusion

Given today’s litigious climate and high-profile sexual harassment allegations, there’s little wonder why having a chaperone present is now considered the “standard of care” for intimate exams. At a minimum, an urgent care center should post signage that a chaperone is available upon request, train support staff in what’s required of being a chaperone when they’re needed, and operate with awareness that patients are increasingly vulnerable to perceptions of sexual impropriety.

 

References:

  1. American Medical Association. Use of chaperones. Available at: https://www.ama-assn.org/delivering-care/use-chaperones. Accessed October 19, 2018. https://professionalboundaries.com/articles/Practical-Professional_Issue-14.pdf
  2. American Medical Association. Council on Ethical & Judicial Affairs Reports. Available at: https://www.ama-assn.org/about-us/council-ethical-judicial-affairs-ceja-reports. Accessed October 19, 2018.

 

 

Does Your Urgent Care Need a Chaperone Policy?
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