Mandated Use of Chaperones in Intimate Medical Exams: Protecting the Patient or the Hospital?

Mandating chaperones in intimate medical exams has become an increasingly frequent hospital practice to increase patient safety and minimize clinician misconduct. Formal recommendations and legal precedent illustrate a tension between patient values and hospitals’ interest in minimizing liability. Having examined policies of institutions and associations, it is clear they do not represent patient preferences or values. The American College of Obstetricians and Gynecologists recommends chaperoning everything from breast to rectal exams, noting that if the patient refuses, the clinician should delay the exam or suggest they seek care elsewhere, putting the patient in a corner. Since this 2007 recommendation, institutions have become more unyielding, shifting from opt-in protocols to mandated chaperone use despite studies of patient preferences illustrating patterns of women not preferring a chaperone, and preferences varying based on the gender of the practitioner, medical history of the patient, and whether the patient already has a trusted relationship with their practitioner, for patients of all genders. In the pediatric context, studies show 99% of patients prefer not to have a non-parent chaperone present. Presently, there is no uniform set of preferences warranting the regular or mandated use of chaperones. In this talk, I will discuss tensions in both pediatric and adult contexts and present practical recommendations centered on patient values.

Lori Bruce – Yale Interdisciplinary Center for Bioethics – Yale University