GMC: Intimate Examinations and Chaperones: Summary

SJT Textbook: Intimate Examinations & Chaperones

Intimate examinations & chaperones GMC guidance requires doctors to explain, obtain consent, offer a trained chaperone, protect dignity, and document every step.

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🎯 THE CORE PRINCIPLE

Intimate examinations are intrusive and potentially distressing. GMC guidance requires doctors to conduct them only when clinically justified, with careful communication, explicit consent, appropriate chaperones, privacy, professionalism, and meticulous documentation. The goal is to protect patient dignity, maintain trust, and safeguard both patient and doctor.

In the MSRA SJT, intimate examination questions often involve missed steps (e.g., no chaperone offered), poor communication, inadequate privacy, inappropriate behaviour, or issues involving children, vulnerable patients, or unconscious patients. High-scoring actions demonstrate transparency, safety, and sensitivity.

🧩 9 KEY PRINCIPLES (MSRA SJT Interpretation)

1. Clear explanation before the examination

Core idea: Patients need to understand *why*, *what*, and *how* before consenting.
Include:

* Purpose of examination
* What it will involve
* Potential discomfort
* Opportunity to ask questions

2. Obtain explicit consent

Consent must be:

* Informed
* Voluntary
* Confirmed before proceeding
* Reconfirmable throughout (“Is it okay if I continue?”)

Patients may refuse or ask to stop at any time.

3. Offer a chaperone

This is mandatory practice for all intimate examinations, regardless of gender.
Chaperone must be:

* A trained health professional
* Independent and impartial
* Sensitive and respectful

If a patient declines a chaperone and safety allows, delay or rearrange the exam.

4. Relatives are not appropriate chaperones

Family/friends may be present, but they are *not* suitable impartial chaperones.
A proper chaperone should still be offered.

5. Protect privacy and dignity

High-yield actions:

* Provide space to undress
* Use curtains, gowns, drapes
* Only expose necessary areas
* Avoid unnecessary conversation

6. Maintain professionalism at all times

Avoid:

* Personal comments
* Jokes
* Unnecessary touch
* Improper behaviour

Stop immediately if the patient becomes distressed or requests it.

7. Children and vulnerable patients

For children:

* Assess competence (Gillick)
* Involve parents if appropriate
* Always act in the child’s best interests
* Chaperone is essential

For vulnerable adults:

* Offer chaperones proactively
* Safeguarding concerns → escalate

8. Anaesthetised patients require prior written consent

Intimate examinations under anaesthesia (e.g., pelvic exam) require:

* Prior explicit consent
* Documentation
* Only for legitimate clinical/teaching reasons
Never assume implied consent.

9. Documentation is essential

Record:

* Explanation given
* Consent obtained
* Chaperone offered
* Chaperone’s name and role
* Any issues or refusal
* Patient’s response

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Explain the procedure, purpose, and risks in plain language.
2. Obtain informed consent and check understanding.
3. Offer and document a trained chaperone.
4. Provide privacy for undressing and redressing.
5. Maintain dignity using drapes/gowns.
6. Stop immediately if the patient requests.
7. Safeguard children and vulnerable adults.
8. Obtain written consent for examinations under anaesthesia.
9. Document everything accurately.
10. Seek senior advice when consent or safeguarding is unclear.

These traps often involve missing one essential step of consent–chaperone–privacy.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Would you like a trained chaperone present?”
* “Please let me know at any point if you want me to stop.”
* “I’ll give you privacy now to get ready.”
* “I must arrange a chaperone before proceeding.”
* “For examinations under anaesthesia, we will need your written consent.”

C – Consent explained clearly
H – Health professional chaperone offered
A – Anaesthesia requires written consent
P – Privacy for undressing
E – Expose only necessary areas
R – Respect and reassurance throughout
O – Observe boundaries
N – Note everything in documentation
E – Escalate safeguarding concerns

📋 QUICK FAQ

Do I need to offer a chaperone even if I am the same gender as the patient?
Yes — always offer. Can a relative be the chaperone?
No — they can be present but are not a formal chaperone. What if the patient refuses a chaperone?
Proceed only if safe; otherwise delay or arrange another clinician. Do I need written consent for intimate exams under anaesthesia?
Yes — essential. What if the patient becomes distressed during the exam?
Stop immediately.

📚 GMC ANCHOR POINTS

* Consent
* Maintaining trust
* Professional boundaries
* Safeguarding
* Protecting dignity and privacy
* Documentation standards
* Good Medical Practice

💡 MINI PRACTICE SCENARIO

A patient presents for a breast exam. You explain the procedure and offer a chaperone, but they refuse and want to proceed immediately. Best action: Ensure the refusal is informed, document it, assess whether it is safe to continue, and proceed only if you feel comfortable; otherwise arrange another clinician. Why: The patient’s autonomy matters, but you must ensure safety and comply with GMC standards.

🎯 KEY TAKEAWAYS

✓ Always explain and obtain explicit consent
✓ Always offer a trained chaperone
✓ Protect dignity, privacy, and safety
✓ Maintain professionalism at all times
✓ Written consent required when anaesthetised
✓ Safeguard children and vulnerable adults
✓ Document discussions, consent, and chaperone details

Failure to follow intimate examinations & chaperones GMC guidance places both patient safety and professional registration at risk.

🔗 RELATED TOPICS

* → Consent
* → Safeguarding
* → Professional boundaries
* → Communication skills
* → Children & young people guidance

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You need to perform a pelvic examination on a patient.

Options:
A. Offer a trained chaperone
B. Proceed immediately without explanation
C. Explain the procedure in detail
D. Allow the patient to undress behind a curtain
E. Decline their request for a friend to be present
F. Document discussion and chaperone
G. Make reassuring personal comments
H. Proceed even if patient expresses uncertainty

Example SJT — Rank 5 (best → worst)

A 14-year-old needs a genital examination. They are anxious and ask for their mother to be present but refuse a chaperone.

Options:
A. Explain the role of a chaperone and why one is required
B. Perform the exam without a chaperone to respect autonomy
C. Seek senior advice due to safeguarding concerns
D. Delay the exam if clinically safe and revisit consent
E. Proceed with mother present and document it carefully