Primary Care

Use and offering of chaperones by general practitioners: postal questionnaire survey in Norfolk

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38320.472986.8F (Published 27 January 2005) Cite this as: BMJ 2005;330:235
  1. Shaun Conway (Shaun.Conway{at}nhs.net), general practitioner1,
  2. Ian Harvey, professor of epidemiology and public health2
  1. 1 The Surgery, Hingham, Norfolk NR9 4JG
  2. 2 Population Health Group, School of Medicine Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  1. Correspondence to: S Conway
  • Accepted 24 November 2004

Introduction

Ten years ago in Norfolk, 65% of male general practitioners and 95% of female general practitioners never or rarely used a chaperone.1 The figures for offering chaperones were almost identical. The General Medical Council advises offering a chaperone for intimate examinations (those involving the genitals, anus, or breasts).2 The Royal College of Obstetricians and Gynaecologists advises using a chaperone for every intimate examination.3

A study of patients' preferences in Tyneside in 2001 found that 90% of women and 78% of men thought that a chaperone should be offered for intimate examinations.4 Half (51%) of women wanted a chaperone to be used if their own male doctor was examining them. We wanted to see if the use of chaperones has changed in the past 10 years and as a result of the 2001 survey.

Participants, methods, and results

We invited a random sample of 200 (out of 348) male general practitioners in Norfolk and every female general practitioner (124) to complete a postal questionnaire. We used EpiInfo for data entry and SPSS for analysis.

Overall, 284 (87%) responded. Mean age was 46.3 (men) and 43.8 (women). Only 23 were not white. The mean number of partners per practice was six. More than half (155; 55%) were in dispensing practices. Three fifths of doctors (170; 60%) described their practices as either rural or market town, 60 (21%) as city, and 54 (19%) as mixed or other.

The usual chaperone was the practice nurse for 75% (155/208) of those GPs who use a chaperone, but 18% (37/208) of doctors used a receptionist. Three fifths (141/235; 60%) stationed the chaperone beside the patient and 36% (84/235) had the chaperone in the examination room but outside the curtain. Three fifths of doctors (115/197; 58%) said that if they thought that a chaperone should be used but the patient declined then they would insist on a chaperone anyway (table).

Use of chaperones by general practitioners. Values are numbers (percentages) of doctors

View this table:

Nearly half of male general practitioners (45%) never or rarely use chaperones when intimately examining women. Chaperones are used rarely or never for the other three permutations of intimate examinations—only 2% (3/178) for male doctors examining men, 8% (9/106) for female doctors examining women, and 13% (14/106) for female doctors examining men.

We asked participants to state what factors influenced their use of chaperones. Themes related to a patient's reputation were the most commonly given reasons. Supporting the patient was also important. However, the second, third, and fourth most common reasons given for use of chaperones were that the patient was a youth or minor, patient choice, and patient anxiety or need for comfort.

Comment

In the past 10 years offering of chaperones by general practitioners has increased. The proportion of male general practitioners never or rarely offering chaperones when examining female patients has fallen from 65% to 23%. Norfolk is more rural than much of the United Kingdom, but these temporal changes may reasonably be extrapolated.

We found high rates for offering of chaperones. The Tyneside study indicates that patients want to be offered a chaperone, so general practitioners may be responding to societal demand.4 Merely offering a chaperone does not protect either the patient or the doctor. Stern said that even when a qualified nurse chaperone is present the patient is not protected.5 Given that in most cases (58%) the final decision as to whether or not to have a chaperone rests with the doctor it seems that ultimately the chaperone is there for the protection of the doctor rather than the patient.

What is already known on this topic

A survey 10 years ago showed that most general practitioners did not offer and use chaperones for intimate examinations

What this study adds

Offering of chaperones has increased in the past decade, but use of chaperones shows less change

This article was posted on bmj.com on 16 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38320.472986.8F

Acknowledgments

We thank the doctors who completed the questionnaires, Jon Cooke, Sheila Ward, and Sheila Hawkins.

Footnotes

  • Contributors SC had the original idea for this study, which was to follow up Speelman's work 10 years on, ran the project, and wrote the bulk of the report. IH commented on the design, analysis, and write up and is guarantor.

  • Funding Eastern Region NHS R&D department via an enterprise award to SC.

  • Competing interests None declared.

  • Ethical approval Norwich Local Research Ethics Committee.

References

  1. 1.
  2. 2.
  3. 3.
  4. 4.
  5. 5.
View Abstract