Although the use of chaperones is widely recommended for intimate examinations, there is wide variation in practice, and little is known about patient attitudes and beliefs regarding chaperones. In particular, the attitudes of male patients have not been studied. As the number of female physicians increases, this issue may become increasingly important. Whitford and colleagues used focus groups and surveys to assess patient perspectives on use of chaperones in primary care.

The authors worked with 18 women and 13 men in four focus groups to identify the principal issues concerning use of chaperones in British general practice. A questionnaire based on these issues was mailed to more than 800 adult patients of three research practices in England. Responses were received from 451 patients. Women were significantly more likely to reply than men (64.4 compared with 47.5 percent).

The researchers were surprised to discover that the percentage of patients who resented having a chaperone (15 percent) was the same as patients who always wanted one present. The former patients believed that the presence of a chaperone had a negative effect on the consultation. An additional 59 percent of patients replied that they would feel uncomfortable if a chaperone were present when one had not been requested. Almost 90 percent of women and 78 percent of men reported that they wished to be asked if a chaperone should be present for an intimate examination. The attitude and the previous relationship of the physician with the patient appeared to be the most important factors influencing a patient's preference for a chaperone. With the patient's usual physician of the same gender, 3 percent of men and 11 percent of women preferred a chaperone for intimate examinations. When the patient's usual physician was of the opposite gender, these preferences increased to 11 and 51 percent, respectively. For an unfamiliar physician, the numbers increased to 13 percent in men and 55 percent in women. Nurses were preferred as chaperones by 90 percent of women and 39 percent of men. None of the patients preferred office staff as chaperones, and 74 percent reported that this option would be unacceptable.

The authors conclude that patients vary widely in attitudes and beliefs about using chaperones during examinations. Overwhelmingly, patients stressed the importance of being asked about and involved in decisions to use a chaperone. Shared decision-making within a consultation should be more important than a rigid approach toward use of chaperones.