Monday, May 9, 2011

AAP Issues Guidelines on Chaperone Use During Pediatric Exam

From Medscape Education Clinical Briefs
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

Pediatrics. Published online April 25, 2011

The purpose and extent of the physical examination in a pediatric patient should be communicated clearly from the physician to the patient and parents. In infants, toddlers, or children, the examination should be performed with a parent or guardian present or, in certain cases, with a chaperone present.

This policy statement from the AAP Committee on Practice and Ambulatory Medicine addresses the use of chaperones during the physician examination of the pediatric patient.

Study Highlights

The physician should clearly communicate the extent of the physical examination to the patient and parents to prevent misunderstanding about the purpose and conduct of the examination.
In case of possible physical or psychological discomfort during the examination, measures to preserve privacy should be used for patient and parent support.
Some state medical boards have regulations regarding chaperone use.
A chaperone is recommended for adolescents or young adults who require inspection or palpation of the anorectal or genital areas or of the female breast.
The chaperone serves to reinforce the professional nature and content of the examination and as a witness in case of any misunderstandings.
The decision to use a chaperone should be shared between the patient and the physician.
The patient's preference should have highest priority.
It is advisable that male clinicians have a chaperone for the female anorectal, genital, or breast examination.
Chaperones can be indicated for same-sex examinations.
The patient's wishes and comfort should determine the sex of the chaperone.
The chaperone should be a nurse or medical assistant.
Family members or friends should not be chaperones unless requested by the patient and, if possible, in the presence of another chaperone.
Reasons that patients might not want a chaperone present include belief that privacy and confidentiality are compromised and embarrassment and vulnerability.
Reasons that pediatricians might find use of a chaperone problematic include the need for additional staff or inability to provide either a male or a female chaperone.
Reasons for a physician to request a chaperone include patient or parent with mental health issues, developmental issues, and anxiety, tension, or reluctance about the examination.
Physicians should explain to the patient and parent why a chaperone is required in these circumstances.
If the patient refuses a chaperone and the physician is concerned about possible false allegations or medicolegal risk, then the physician is not obligated to provide further medical care.
If the patient requests a chaperone, but a chaperone is not available, then the patient can refuse further treatment, and the physician should discuss risks of not receiving care and offer alternatives to care.
Pediatricians should develop a policy about chaperone use for the office or clinic setting. The chaperone's respect for privacy and confidentiality should be included in this policy.
Medical record documentation should reveal that the scope and findings of the examination were reviewed with the patient and parents, the name of the chaperone, whether the patient declines a chaperone, if the patient's request for a chaperone cannot be accommodated and alternatives offered, and if the office policy or state medical board regulations on chaperones cannot be followed.

Clinical Implications

A chaperone for an adolescent or young adult in the medical office is recommended when the physical examination requires inspection or palpation of anorectal or genital areas or of the female breast.
The decision to use a chaperone for the physical examination of an adolescent or young adult in the medical office setting should be shared between the patient and the physician. The chaperone should be a nurse or medical assistant, and the sex of the chaperone should be determined according to the patient's wishes and comfort level.


Anonymous said...

when i was 12 i was in a group home and was told i needed a physical.there was a young lady who was a staff member and she said that she would be taking me to my appointment.i was being chaperoned by an unfamiliar female and i was a male.we talked and listened and to the radio on the way there.i thought she was just going to take me to the appointment and wait outside. we filled out some questions and both went into the exam room.i thought she would leave when the doctor came in. the doctor arrived for my exam and she was a woman. she came in and the two of them talked then she said to me take off my clothes. here i was in front of two woman i had never met before and removing my clothes. i was almost 13 and just started getting pubes.when she said that i must have looked scared and she said to leave my underwear on. so it wasnt that bad. there were two chairs i was sitting on one the lady on the other.i had put my clothes on the chair next to her.then i got up on the exam table. i was sitting on the table and my legs were facing the lady in the chair. the doctor was doing her normal things. then she said lay down. the two women were talking and she started pressing on my stomach and in one quick yank my underwear were around my ankles. i was in shock. she was standing at my chest talking to this lady who could see everything in full view. she now took my underwear off completely and put them on the chair with my other clothes. there i was completely naked in front of two women i didnt even know.and they were both getting a great show of me. it seemed to last a long time but i was probably over in a minute or two. then she said ok and i leaped up to get to my underwear jumped off the table and almost fell. the lady sitting in the chair caught me. yes i was still completely naked. she actually helped me put my underwear back on and my stuff was just inches from her face. on the ride home it was very quiet and we didnt talk about what happened.

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