Support People, Chaperones, and Observers

Policy

At times, another person or people (in addition to the clinician and patient) may be present (physically or virtually) during a consultation or examination. This includes:

• support person requested by the patient

  Under Right 8 of the Code of Health and Disability Services, patients can have one or more support persons present at their consultation.

  Common reasons for this include:

  • Patient feels more comfortable with a support person present.
  • First consultation with a new clinician.
  • Cultural expectations include the presence of another person.
  • Age (either young or old).
  • Assistance understanding what is happening in the consultation.
  • Some degree of mental or physical disability.
• compulsory observer or support person for minors or patients with reduced capacity
• interpreter or translator
• observer for the clinician (required for intimate examinations or Continuing Professional Development)

  An intimate examination is any examination that may intrude on the patient's personal boundaries, and can be embarassing or distressing for the patient. It is likely to include examinations of breasts, genitalia, or rectum, but could include any examination where it is necessary to touch or even be close to the patient. Be sensitive to what the patient may consider intimate.

  Having another person present for physical or intimate examination may be requested by any patient, regardless of gender.

  Best practice is to offer a chaperone for all intimate examinations to protect the doctor and ensure patient comfort.

• student or trainee clinician
• clinician's chaperone, if required.

  Some clinicians have conditions on their registration or practising certificate requiring them to have a chaperone present during consultations. This may be as a result of disciplinary action and is intended as protection for the clinician and the patient.

  In this situation:

  • notices must be put up in the waiting room and in examination areas
  • clinician must disclose the reason behind this requirement if asked.

  The presence of a chaperone is not optional and any patient who is not comfortable with this will need to see another clinician. The only exception is in a medical emergency – the clinician may attend, even if a chaperone isn't available.

We display information in the reception area about the patient's right to have another person present during a consultation.

Patients with reduced capacity must have an observer or support person (over 18 years of age). Patients under 16 years of age should be offered the same.

Choosing a suitable person

Depending on the situation, a suitable person may be a member of the practice staff, or a relative or friend of the patient. Ideally, the person will be:

• sensitive and respectful of the patient's dignity and privacy
• prepared to reassure the patient if they show signs of distress or discomfort
• familiar with the procedures involved in a routine intimate examination (if medically trained)
• prepared to raise concerns about a clinician.

During the consultation

1. Where possible, discuss having another person present with the patient in private and ahead of time.
2. Record this discussion in the patient record. The patient should not have to make this decision in front of the proposed person.
3. Before the consultation, agree the level of involvement of the observer or support person, and where that person will stand during an examination.
4. Once the person's involvement is agreed:
   • Record their name, role/relationship to the patient and the purpose of their attendance
   • Record the patient's agreement to their attendance
   • Ensure they are aware of the importance of respecting the patient's privacy (personal information and physical privacy) and the practice's expectations around the use of mobile devices and social media.
   • Introduce them to the patient if not already known (name and role/position).
   • Excuse the person when agreed with the patient (they may not need to be present for discussions that follow the examination).

Ensure the consultation stays on topic and that other information is not discussed. Be prepared to stop the consultation at any stage if the patient requests, or if the observer/support person behaves inappropriately. Record any issues or concerns in the PMS immediately following the consultation.

Declines and disputes

We respect a patient's right to decline having another person present at their consultation. If the patient does not want an observer present, record that the offer was made and declined.

• If either clinician or patient doesn't want to proceed without a chaperone present, delay the consultation until a suitable person is available.
• If either clinician or patient is uncomfortable with the choice of person, delay the consultation until a person is available that both agree on.

It may be necessary to suggest the patient sees another clinician. In this case, reassure the patient that their care will not be affected.

Resources

• Code of Health and Disability Services Consumers' Rights 1996
• MCNZ: When another person is available during a consultation
• RNZCGP: Chaperone poster (English) and (Te Reo)