![]() In a recent editorial, a strong case was made for further study of the use of chaperones during examination of male patients. With several notable exceptions, previous studies of chaperone use in primary care have focused exclusively either on one particular examination such as Pap smears or on one particular patient population such as adolescent females or older women. There is some recent data indicating an increase in the offering of chaperones. This change may reflect the fact that there is great variability in the views of patients toward, as well as the increased popularity of shared-decision making. Another recent trend is that, rather than insisting on the use of chaperones for all intimate examinations, some professional bodies now recommend that the offer of a chaperone be made to patients. Despite this trend, the frequency of chaperone use has generally remained low – although it varies considerably depending on the specific setting and circumstance. In recent years, there has been an increasing call by medico-legal societies and medical insurance companies for greater use of chaperones during intimate examinations. For instance, the guidelines of the College of Physicians and Surgeons of Ontario state that both patient and physician have the right (in non-emergency situations) to insist that a third party be present during intimate examinations, and to insist that the examination be postponed if a third party is unavailable. Likewise in Canada, the standards of practice and clinical guidelines vary considerably from province to province. ![]() In the United States, on the other hand, there is no clear national standard as each state medical board drafts its own practice recommendations. In the United Kingdom, the General Medical Council advises that all patients undergoing intimate exams be offered a chaperone regardless of the sex of the patient or physician. Professional guidelines and clinical practice regarding the use of chaperones during intimate physical examinations vary substantially from one jurisdiction to the next. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. Chaperones are used by only a minority of Ontario family physicians. ConclusionĬlinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Approximately two-thirds of respondents reported using nurses as chaperones, 15% cited the use of other office staff, and 10% relied on the presence of a family member. This pattern of results was consistent across the other four exams. Likewise, having a nurse available also significantly increased the likelihood of a chaperone being used (adjusted OR 6.92, 95% CI 2.74–17.46). For female pelvic exam, male physicians were significantly more likely to report using a chaperone (adjusted Odds Ratio 40.62, 95% confidence interval 16.91–97.52). Logistic regression analyses identified two independent factors – sex of physician and availability of a nurse – that were significantly associated with chaperone use. As well, male physicians were more likely to use chaperones for examination of female patients than were female physicians for the examination of male patients. Chaperones were more commonly used with female patients than with males (t = 9.09, p < 0.001), with the female pelvic exam being the most likely of the five exams to be attended by a chaperone (53%). ResultsĢ76 of 500 were returned (56%), of which 257 were useable. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams. Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use. Physicians have long been advised to have a third party present during certain parts of a physical examination however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care.
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