Abstract
BackgroundPhysicians 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. 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.MethodsQuestionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. 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.Results276 of 500 were returned (56%), of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p < 0.001), with the female pelvic exam being the most likely of the five exams to be attended by a chaperone (53%). 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. Logistic regression analyses identified two independent factors – sex of physician and availability of a nurse – that were significantly associated with chaperone use. For female pelvic exam, male physicians were significantly more likely to report using a chaperone (adjusted Odds Ratio [OR] 40.62, 95% confidence interval [CI] 16.91–97.52). 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). This pattern of results was consistent across the other four exams. 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.ConclusionClinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.
Highlights
Physicians have long been advised to have a third party present during certain parts of a physical examination; little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care
The objectives of the present study are as follows: to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients; to identify the factors associated with chaperone use by family physicians; and to investigate whether these factors vary with the type of examination being performed
The age and practice location distributions of our sample closely resembles that of the CFPC National Family Physician Workforce Survey (Janus Survey) [20]
Summary
Physicians have long been advised to have a third party present during certain parts of a physical examination; little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. There has been an increasing call by medico-legal societies and medical insurance companies for greater use of chaperones during intimate examinations [5] Despite this trend, the frequency of chaperone use has generally remained low – it varies considerably depending on the specific setting and circumstance [6,7,8]. The frequency of chaperone use has generally remained low – it varies considerably depending on the specific setting and circumstance [6,7,8] Another recent trend is that, rather than insisting on the use of chaperones for all intimate examinations, some professional bodies recommend that the offer of a chaperone be made to patients. There is some recent data indicating an increase in the offering of chaperones [13]
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