Intimate Examinations Research Articles

P085 A re-audit looking at chaperoning in an integrated sexual health clinic

Background According to the General Medical Council (GMC) intimate examination guidelines 2013, the British Association of Sexual Health and HIV and the Royal College of Nursing guidelines, a chaperone should be offered when conducting an intimate examination. The GMC guidance supports clinicians who do not want to perform an intimate examination unchaperoned. The presence of a chaperone is considered essential in The Royal College of Obstetricians & Gynaecologists clinical governance advice, January 2015. Aim A retrospective audit was conducted in our integrated sexual health clinic to see if a chaperone was being used for intimate examinations according to the GMC guidelines. Method: 100 cases were identified in January 2015 and a re-audit was conducted in July 2015. Results In January 2015, 70% of patients accepted an examination. In 9% of these cases the offer of a chaperone was not documented. 44% declined a chaperone and 54% accepted. In July 2015: 63% of patients accepted an examination. In 14% of these cases the offer of a chaperone was not documented. 54% declined a chaperone, 40% accepted. Conclusion Documentation of the offer of a chaperone has worsened. In July 2015, the majority of staff are performing an intimate examination unchaperoned, as patients decline the offer. In order to reduce the risk of false accusation against clinicians and nurses during an intimate examination, it is essential we follow the GMC guidance and ensure a chaperone is present for all intimate examinations.

Success of the First Gynecological Teaching Associate Program in Turkey

BackgroundGiven the sensitive nature of the examination, intimate examination procedures such as breast and genital examination create increased difficulties for students that other noninvasive techniques do not. The purpose of this study was to explore the feasibility and efficacy of an innovative instructional technique, breast examination training via a Gynecological Teaching Associate (GTA), in graduate nursing training in a part of the world where cultural norms dictate a more conservative approach to medical training. MethodA qualitative study design was used, and semistructured interviews were undertaken with four female graduate nursing students. ResultsStudents expressed feelings of anxiety, embarrassment, and hesitation at the first meeting with the GTA. However, owing to the encouraging and relaxing approach of the GTA, students overcame their initial difficulties, successfully completed the project, and reported both surprise at the unexpected success of the methodology and enthusiasm with the instructional technique. ConclusionOur study clearly shows that even in cultures where the methodology has never been used before and where a more conservative approach to medical training is used, the effectiveness of this kind of education crosses numerous boundaries and eliminates obstacles to provide excellent clinical examination instruction to all learners.

Thanks for asking: Adolescent attitudes and preferences regarding the use of chaperones during physical examinations.

There is no uniformity as to how and when chaperones should be used for general and intimate (genitalia and/or breasts) physical examinations of adolescents. To explore adolescents' attitudes and preferences regarding the use of medical chaperones during physical examinations. The present analysis was a cross-sectional descriptive study performed as part of a quality improvement project in the Adolescent Medicine Clinics at The Hospital for Sick Children (Toronto, Ontario) between January 1 and April 30, 2011. Adolescents 13 to 18 years of age completed an anonymous 10-item, self-administered questionnaire regarding their thoughts on chaperones during physical examinations. Demographic and descriptive data were collected. A total of 127 adolescents participated in the present study. The mean (± SD) age was 16.3±1.5 years and the majority (93.7%) were female. More than one-half (61%) of female adolescents had previous experience with an intimate examination; however, a chaperone was present only 36% of the time. Seventy percent of female adolescents wanted the choice of a chaperone for a general examination compared with 61% for an intimate examination. Among female adolescents with past chaperone experience, 78% wanted the choice of a chaperone for subsequent intimate examinations, compared with 55% among those with no previous chaperone experience. Only 21% believed they would ask for a chaperone if one were not offered. Although there was variation in adolescents' attitudes and preferences regarding the use of chaperones, many females indicated a desire to discuss the option of a chaperone for all types of examinations.

Asked to carry out an intimate examination without consent.

Marika Davies, a medicolegal adviser, gives advice on some common ethical dilemmas faced by medical students

An audit on the use of chaperones during intimate patient examinations.

BackgroundThe general medical council stipulate all intimate examinations should be chaperoned, and their identity documented within patients' notes. We decided to audit our surgical unit for compliance to these guidelines.MethodsA prospective audit before and after intervention was performed. Patients undergoing an intimate examination on the surgical assessment unit over five working days were recruited. Data was collected for the following: chaperone use, identity or decline by a patient. Statistical significance calculated using the unpaired t-test. Intervention following audit results included design of a chaperone sticker and posters to act as an aide memoir to clinicians.Results61 patients recruited before intervention. Examination of notes revealed documentation of chaperone use in 10patients(16.4%), identity in 9patients(14.8%) and decline in 3patients(4.9%). Chaperone documentation was found in only 13 medical notes(21.3%). After two-months of intervention, 53patients were recruited. Analysis revealed documentation of chaperone use in 27patients(50.9%), identity in 20patients(37.7%) and decline in 5patients(9.4%). Following intervention chaperone documentation was found in 32 medical notes, an improvement to 60.3%(p = 0.0001).ConclusionA chaperone should be offered to all patients who undergo an intimate examination. The identity of the chaperone or decline by a patient should be documented within their medical notes. Our team have demonstrated how effective an audit tool is to improve compliance to guidelines, patient safety and care. A further audit will be undertaken once our surgical proformas have been redesigned to incorporate an area for the chaperone to sign and we encourage other surgical units to do the same.

Chaperone use amongst UK urological surgeons - an evaluation of current practice and opinion.

Introduction Intimate examinations are routinely performed by urologists as part of clinical practice. To protect patients and doctors, the General Medical Council offers guidance on the use of chaperones for intimate examinations. We assessed the opinions and use of chaperones amongst members of the British Association of Urological Surgeons (BAUS). Methods An online questionnaire comprising 12 questions on the use of chaperones in clinical practice was sent to all full, trainee and speciality doctor members of BAUS. Results The questionnaire had a response rate of 26% (n=331). The majority of respondents were consultant urologists, comprising 78.8% (n=261), with a wide range of years of experience. Of the respondents, 38.9% were not aware of the GMC guidance on chaperones. While 72.5% always used a chaperone., 22.9% never use a chaperone when the patient was of the same sex. Chaperones were most commonly used for intimate examinations (64.6%), and for examinations involving members of the opposite sex (77.3%). A majority of respondents felt that chaperones protect both the patient (77.3%), and the doctor (96.6%). However, 42.5% did not feel that using a chaperone assists the doctor's examination, and some (17.2%) participants felt that chaperones were unnecessary. Conclusions This study shows considerable variability amongst urologists in their use of chaperones. A significant proportion of respondents were not aware of the GMC guidelines and did not regularly use a chaperone during an intimate examination. In addition, practice appears to be gender biased. Further study and education is suggested.

Patients attitudes to vaginal examination and use of chaperones at a public hospital in South Africa.

Obstetrics and gynecology units in public hospitals in South Africa (SA) are often overloaded with patients. Most physical examinations/consultations in these units involve vaginal examination (VE) and often because of the rapid turnover of patients the pelvic examination may be performed hurriedly without due consideration being given to the psychosocial aspects of such procedures. This study surveyed the attitudes of patients to VE and the use of chaperones. A descriptive cross-sectional survey of patients attending obstetrics and gynecology clinics at a public hospital in SA was carried out. A structured questionnaire was used to collect sociodemographic data such as age, ethnic group, gravidity, feelings toward VE, and preferences about the gender of the examining doctor, as well as the presence of a chaperone. Most women (68%) were aged between 20 and 35 years. The respondents stated that the most intimate examination was VE in 48.3% and abdominal in 25% of cases; 19.0% and 1.5% of respondents felt that breast and rectal examinations, respectively, was the most intimate. On the response to the statement "there is no need for chaperone during VE;" 54% of the participants were in support of chaperone while 45.1% were against chaperone. Women aged 20-35 years, preferred a nurse as their chaperone; younger women, aged ≤19 years preferred their mother as a chaperone. In an SA public hospital, women are more likely to regard VE as the most intimate examination. Women are equivocal on the use of a chaperone and if it was necessary; nurses are their preferred choice except for teenagers, who preferred their mothers.

Peer review report 1 on “An audit on the use of chaperones during intimate patient examinations”

Peer review report 1 on “An audit on the use of chaperones during intimate patient examinations”

Peer review report 2 on “An audit on the use of chaperones during intimate patient examinations”

Peer review report 2 on “An audit on the use of chaperones during intimate patient examinations”

Failure to Obtain Informed Consent for Intimate Examinations by Medical Students

Failure to Obtain Informed Consent for Intimate Examinations by Medical Students

Feedback for Sheffield Children's Hospital Sexual Assault Referral Centre: Are we getting it right?

Introduction: The Sexual Assault Referral Centre (SARC) at Sheffield Children’s Hospital is a relatively new service for children who have been victims of sexual assault or rape. Assessment of these children involves taking a full history of the assault as well as a medical and sexual history, and is followed by both a general and intimate examination. Feedback is essential to improve the services the SARC offers to victims and their familiesat such a traumatic time.Aims: To assess user satisfaction and suggest improvements to the existing SARC service.Method/Results: Completed questionnaires from SARC users were collected over a period of 13 months and the data analysed. Analysis of the 38 returned questionnaires demonstrated that the majority of feedback from users was positive. There were only four responses that could be interpreted as neutral. There were numerous positive and few negative comments in the free-text boxes.Conclusion: Child sexual abuse victims use the service at a difficult time. After such a traumatic experience one would expect at least some negative feedback. However, the analysis of the small numbers giving feedback demonstrated that the majority of them found the experience to be positive or very positive.Learning points: Patient feedback is a valuable tool in service evaluation and improvement. It can be used for quality improvement in a SARC setting.

Documenting the use of chaperones during intimate patient examinations; adherence to gmc guidelines

Documenting the use of chaperones during intimate patient examinations; adherence to gmc guidelines

The importance of a medical chaperone: a quality improvement study exploring the use of a note stamp in a tertiary breast surgery unit

ObjectivesThe project aim was to determine current use and documentation of medical chaperones within a major breast service unit. It explored ways of improving adherence to professional guidelines concerning chaperones.SettingThe...

P134 Chaperones for intimate examinations in a genitourinary medicine clinic: audit of documentation

<h3>Introduction</h3> BASHH, GMC, RCP and FSRH provide guidance stating that a chaperone should be offered for intimate examinations and the name of the chaperone should be documented. Record keeping is often found to be suboptimal in litigation. Our proformas have prompts for both offer and name of chaperone. <h3>Aim/objectives</h3> To audit our documentation of chaperone offer (including name) for intimate examinations. <h3>Methods</h3> 20% case notes for new episodes seen by doctors May–July 2014 were randomly selected and reviewed. Gender of doctor and patient were recorded. <h3>Results</h3> 208 case notes were examined. 114 patients were examined (61 not examined; 33 inadequate documentation). 96/114 (84.2%) had the offer of a chaperone documented; 18 (15.8%) did not. Of the 96 where the chaperone was documented as offered, 89 (93%) had the chaperone’s name documented; 7 (7%) did not. In 64 cases, doctor and patient were the same gender, and in 50 cases they were opposite gender – chaperone offer was documented in 87.5% and 80% respectively (p = 0.278, student’s 2 tailed t-test). <h3>Discussion</h3> Chaperones for intimate examinations reassure and protect both doctors and patients. With the GMC dealing with just under 30 allegations in 2014 recording of this is potentially pivotal. Despite prompts, only 78% had both offer and name documented. It was concerning that in 33 cases it was not clear as to whether or not an examination had occurred. The results ran counter to expectations with offer of a chaperone higher when patient and doctor were the same gender although this was non-significant.

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

My personal diagnostic delay: 'Physician, prevent thyself'.

As an epidemiologist, I knew that I had none of the main risk factors for colorectal carcinoma.1 As a GP, I always had an irrational horror of per rectum investigation, colonoscopy being the one I prayed I would never need. Therefore, when my only symptom was intermittent, painless rectal bleeding, I made the standard response of a clinical academic meeting a concept outwith his or her paradigm. I ignored it. Well, it was probably just haemorrhoids, or something; I was otherwise fit and healthy, and I was far too busy and important to spend all that time attending clinics and being investigated. I was probably also reluctant to expose myself to the indignity and vulnerability of intimate examination by my professional colleagues. It was only after several months (or probably more) that I had an actual conversation with myself, in which part of me was a layman seeking informal advice from my medical self. Not until I heard my response — ‘For goodness’ sake, go and see your GP immediately! …

Intimate examinations and treatments.

Intimate examinations, particularly of the genitals and rectum, are often a source of considerable distress and embarrassment to patients ( Coldicott et al, 2003 ). Treatments that involve touching intimate areas may also be a source of unease for nurses. This article will consider the legal and professional obligations on nurses in relation to intimate examinations and treatment.

Medical Students in Breast Clinics—How Welcome Are They and How Can We Improve Their Learning Opportunities?

Clinical examination skills are an essential component of medical education, with students having the opportunity to practice important skills to facilitate their learning. The opportunities to practice intimate examinations, however, can be varied, with a number of patients declining to give consent, limiting the learning opportunities in clinic. This study aimed to identify whether patient demographics correlated with varying degrees of consent toward student participation. A questionnaire was distributed to patients attending a surgical preassessment clinic with confirmed breast pathology regarding their attitudes toward different roles they were happy for students to have in their treatment journey. These results were analyzed using SPSS 20. Overall, 111 patients responded, aged between 17 and 86 years; 42 (38%) were under the care of a male surgeon. Patients under the care of a female surgeon were less likely to agree to students being in clinic (p = 0.009), take a history (p = 0.012), or examine them (p = 0.019). Increasing age was associated with increased agreement to being examined (p = 0.028), but there was no correlation between clinic attendance frequency and acceptance of students. Our findings suggest patients under the care of a male surgeon were more likely to consent to history taking and examination by students, though this may be owing to patient selection bias. Older patients were more likely to consent to being examined, though previous clinic attendance did not improve consent to medical students.

Compliance with GMC guidelines for chaperone use in intimate examinations and the influence of junior doctor education on practice

Compliance with GMC guidelines for chaperone use in intimate examinations and the influence of junior doctor education on practice

Attitudes of UK doctors to intimate examinations

Medical culture has portrayed intimate examinations as important in maintaining the sexual and reproductive health of patients. Intimate examinations have also been at the centre of high-profile scandals. Existing literature suggests there is considerable heterogeneity in the use of intimate examinations, as influenced by underlying attitudes. This study sought to ask how doctors make decisions to perform intimate examinations and negotiate the emotional aspects. In-depth interviews were conducted with 38 doctors of different grades and from different areas of clinical practice in the South East of England. Data were analysed thematically using NVivo 9, adopting a constructivist approach. Findings indicate that doctors' emotional constructions of intimate examinations coalesce around feelings of embarrassment, fear and anxiety, and vulnerability. Understandings of gender, sex and power also influence emotional constructions. Doctors utilise varying methods to negotiate emotions, some of which may be detrimental to patient care. These emotional constructions lead doctors to attribute values to intimate examinations and to chaperones that extend beyond responding to indications or following guidelines for examination. Doctors who resolve their own feelings of embarrassment, anxiety and vulnerability may be more likely to perform intimate examinations when indicated, to use chaperones appropriately and to offer the best standards of patient care.