title: Chaperone use during intimate examinations in primary care: postal survey of family physicians.
abstract: BACKGROUND
  Physicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use.
  
  
  METHODS
  Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams.
  
  
  RESULTS
  276 of 500 were returned (56%), of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p < 0.001), with the female pelvic exam being the most likely of the five exams to be attended by a chaperone (53%). As well, male physicians were more likely to use chaperones for examination of female patients than were female physicians for the examination of male patients. Logistic regression analyses identified two independent factors--sex of physician and availability of a nurse--that were significantly associated with chaperone use. For female pelvic exam, male physicians were significantly more likely to report using a chaperone (adjusted Odds Ratio [OR] 40.62, 95% confidence interval [CI] 16.91-97.52). Likewise, having a nurse available also significantly increased the likelihood of a chaperone being used (adjusted OR 6.92, 95% CI 2.74-17.46). This pattern of results was consistent across the other four exams. Approximately two-thirds of respondents reported using nurses as chaperones, 15% cited the use of other office staff, and 10% relied on the presence of a family member.
  
  
  CONCLUSIONS
  Clinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.
authors.affiliation: Department of Family and Community Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON M4N 3M5, Canada. davidhprice@gmail.com
authors.forename: David H
authors.initials: DH
authors.lastname: Price
authors.forename: C Shawn
authors.initials: CS
authors.lastname: Tracy
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D000328:Adult; D001941:Breast Diseases / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000379:methods*; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis; D005832:Genital Diseases, Male / Q000175:diagnosis; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data*; D009819:Office Visits; D009864:Ontario; D010808:Physical Examination / Q000379:methods* / Q000592:standards; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012002:Rectal Diseases / Q000175:diagnosis; D012737:Sex Factors; D011795:Surveys and Questionnaires