Chaperones for Medical Examinations of Older Children and Adolescents: Who, when and for what?

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Background: A medical chaperone is a person who serves as a witness for a patient and healthcare practitioner during a medical examination. The presence of a chaperone may help to emphasize the professional nature of the interaction, the content of the examination, and to have a witness of the interaction in case there is misunderstanding. Pediatric literature regarding medical chaperone use and preference is extremely limited.

Objective: The purpose of our investigation is to better understand attitudes and beliefs of parents and children towards the use of chaperones during physical exams of pediatric patients.

Design/Methods: This is a cross-sectional study of children aged 8-18 years and their parents, who presented a children's hospital to receive care. Eligible patients and their parents were approached in the emergency department, ambulatory clinic, and inpatient unit. Those who consented to participate received separate, anonymous, surveys. The survey collected demographic data and asked which individuals should be present in the room for different aspects of the child's physical examination. Data were collected with electronic tablets (iPads) using Qualtrics XM online survey platform.

Results: The survey was completed by 86 patients and 71 parents. Mean age for patients was 14 years and 59% were female. Mean age for parents was 42 years and 85% were female. Of patients, 78% responded that they were heterosexual. Patient preference for examination presence is shown in Figure 1. When being examined by a provider of the opposite sex as compared to a same sex provider, there were significant differences in preferences among female patients for exam of the breasts, genitalia, and rectum, but not the throat, heart/lungs, or abdomen. Male patients did not have any significant preference for any aspects of the exam by provider type. Parents preferences are shown in Table 1. There was no difference in parent preferences when their child was being examined by a provider of the same vs. opposite sex as their child.

Conclusion(s): This study indicates that adolescent females, but not males, have significant differences for who they prefer to be in the room for certain aspects of the physical exam. A minority of patients and parents preferred a chaperone to be present, whereas the majority preferred a parent to be in the room. Patient and parent considerations should be taken into account when creating policies for the use of medical chaperones.

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Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine
University of Connecticut
Yale University School of Medicine

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