Chaperone: For or Against Doctors

599 On June 26th 2007 and October 16th 2008, Korean newspapers reported two separate incidents in which two women alleged that their male doctors sexually assaulted them during a gastroscopy and a gynaecological examination, respectively. As a consequence, an internist was convicted with sexually assaulting more than 3 of his female patients under sedation in a 2 month period, while a gynaecologist was charged with alleged sexual misconduct. Although both instances arose from different circumstances, both occurred when the patients were alone with the doctors, without supervision or assistance of any other medical staff. For example, a nurse who would effectively act as a chaperone. Chaperones have conventionally been used during intimate examinations: this refers to any examination involving the genital, groin, or anal region in any patient, including breasts in female patients, as well as other situations that may cause embarrassment or stress to patients. For example, when a patient needs to undress for a skin check. Unfortunately, it is a reality that there have always been healthcare professionals who abuse their positions of trust. Similarly, there have also been instances when patients falsely accused their doctors of sexual abuse, including rape. When accusations arise, there is potentially no way of discerning who is telling the truth without a witness in the room. It is also possible that patients may perceive an examination as abusive, because of a lack of understanding of the procedure, inadequate communication, or mental health issues. In today’s medical environment, and both doctors and nurses routinely consult patients alone, particularly in emergency situations especially in Korea. Most local clinics allow male doctors to examine female patients without the presence or offer of a chaperone and vice versa. Such practice is surely beyond justification. Chaperoning can be considered as a risk management strategy when performing intimate examinations. The use of a chaperone may protect the doctor from allegations of inappropriate behaviour and misconduct, or from misconduct by the patient. The UK General Medical Council (GMC) states that the function of a chaperone is primarily to protect the patient, but the protection of doctors is surely also of benefit. The consequences of a false accusation, if no chaperone is present, can destroy a doctor’s reputation and lead to suspension and removal from the specialist register, with loss of livelihood, and also possible criminal proceedings. A recent consultation in the UK advocated that the burden of proof for professional misconduct enquiries should be changed from the criminal to the civil, making conviction against a doctor more likely. For all these reasons, therefore, the role of a chaperone should be not only for the protection of the patient but also for the protection of both doctors and nurses. The American Medical Association (AMA) recommends that an authorised Letter to the Editor DOI 10.3349/ymj.2009.50.4.599 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(4): 599-600, 2009