The key principles of communication and record keeping will ensure that the healthcare professional and patient relationship is maintained and act as a safeguard against formal complaints, or in extreme cases, legal action.The most common cause of patient complaints is the failure in communication between both parties, either in the practitioner’s explanation or the patients understanding in the process of examination or treatment. It is essential that the healthcare professional explains the nature of the examination and offers them a choice whether to continue. This should also be recorded in the patient’s notes. It is acceptable for a healthcare professional to perform an intimate examination without a chaperone if the situation is life threatening or speed is essential in the care or treatment of the patient. The decision and rationale should be documented in the patient’s notes. In cases where the patient is not competent to make an informed decision then the healthcare professional must use their own clinical judgement and be able to justify this course of action. A decision to continue or otherwise must be jointly reached. If the seriousness of the condition would dictate that a delay is inappropriate then this should be explained to the patient and recorded in their notes. If the patient has requested a chaperone and none are available at that time the patient must be given the opportunity to reschedule their appointment within a reasonable timeframe (this may include simple waiting in the practice until a member of staff is available). Where a chaperone is needed but not available In this case, the practitioner must make his/her own decision and carefully document this with the details of any procedure undertaken. However, there may be cases where the practitioner may feel unhappy to proceed, for example where there is a significant risk of the patient displaying unpredictable behaviour, or making false accusations. If a chaperone is refused, a healthcare professional cannot usually insist that one is present. Staff should be aware that intimate examinations might cause anxiety for both male and female patients whether or not the examiner is of the same gender. If the patient is offered and does not want a chaperone it is important to record that the offer was made and declined. It is good practice to offer all patients a chaperone of the same sex for any examination or procedure. However this should not detract from the fact that any patient is entitled to a chaperone if they feel one is required. A practitioner may have no doubts about a patient they have known for a long time and feel it is not necessary to offer a formal chaperone. The relationship between a patient and healthcare professionals is based on trust. The patient should always have the opportunity to decline a particular person as a chaperone if that person is not acceptable to them for any justifiable reason. If the patient is requesting a male chaperone then a male GP can be called upon to act as the chaperone or the patient can be offered to rebook their appointment with a male GP. There will be occasions when this is difficult to achieve. Protecting the patient from vulnerability and embarrassment means that the chaperone would usually be of the same sex as the patient. It is important that chaperones have had sufficient training to understand the role expected of them and that they are not expected to undertake a role for which they have not been trained for. This individual will have a specific role to play in terms of the consultation and this role should be made clear to both the patient and the chaperone. A ‘formal’ chaperone implies a clinical health care professional, such as a nurse or a healthcare assistant.
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