Service standards for sexual health.

Madam We fail to understand why Dr Stephen Searle1 feels that implementing the Faculty’s Service Standards2 should detract from our level of client care. If a service has a clear chaperone policy or protocol then the amount of actual documentation required is minimal. An entry in the case notes ‘chaperone declined’ or ‘chaperone: Nurse Smith’ should suffice to indicate adherence with the policy. In Abacus Clinics in Liverpool we established a chaperone policy in 2001 in response to guidance from the General Medical Council3 and the Royal College of Obstetricians and Gynaecologists.4 This followed a lengthy in-house discussion and required a significant ‘culture change’ for a predominantly female staff who previously viewed the offer of a chaperone as a purely gender issue with medico-legal implications. Some felt that the offer of a chaperone would alarm clients and make them suspicious of the clinician. There were concerns about the chaos that would ensue in busy clinics if all clients wanted a chaperone. In the event, these fears were unfounded. A review of staff perspectives on the policy a year after its introduction showed that the majority of staff felt that less than 5% of clients accepted a chaperone when offered. It was felt that the reason for requesting a chaperone had more to do with relieving the client’s anxiety about the examination rather than concerns about unprofessional behaviour by the clinician. Whilst only 18% of staff members stated that they always offered a chaperone, up to 80% usually or sometimes did so. The main reason given for not offering a chaperone was that they simply forgot to do so because it was a change to their previous routine practice. Those who did offer documented the offer on most occasions. There was no evidence to suggest that implementing the policy had a significant detrimental effect on clinic times or workload. Documentation relating to practical procedures, e.g. fitting an intrauterine device (IUD), may be more time consuming but it is important, not just for medico-legal reasons, but for ensuring continuity of good clinical care and risk management. Perhaps the devil is in the detail. It is up to us as clinicians to decide what is and what is not essential documentation. Following an audit5 of relevant case notes within our service, carried out in 2000, we established a minimum standard6 for documentation relating to IUD insertion acceptable to all our clinicians. In our experience staff have been happy to implement these standards, accepting them as a useful aid to maintaining good clinical care. Standards achieved by consensus should serve to protect both client and clinician.