(156) IMPACT AND PROVIDER SENTIMENT TOWARDS MANDATORY CHAPERONE POLICY DURING GENITOURINARY EXAMS: SURVEY OF A LARGE ACADEMIC UROLOGY PRACTICE
Authors: Reddy S , Cahill E , Heckscher D , Rotker K , Honig S 
Published: December 2024

Abstract

Introduction
Increased adoption of medical chaperones has been reported nationwide. Specialties performing sensitive examinations, such as sexual medicine and reproductive urology, are particularly affected by such policies, given the regular utilization of genitourinary exam for clinical decision making. These policies were put in place both to improve patient comfort and as a medicolegal safeguard. Our academic institution implemented a mandatory chaperone policy for all sensitive examinations last year, now with widespread utilization across all providers.

Objective
The purpose of this study was to assess our department’s initial experience with the mandated usage of medical chaperones during all genitourinary examinations.

Methods
An anonymous, web-based survey was developed and distributed to faculty at our academic urology practice, including physicians and advanced practice providers. Baseline clinician characteristics were collected. The survey included questions regarding clinical impact of the chaperone policy on workflow, patient perception, and provider sentiment towards regular chaperone use during exams. Data was collected and analyzed using descriptive statistics.

Results
There were 28 respondents to the survey, the majority of which were male (n = 20, 71%) (Table 1). Respondents represented a variety of urologic sub-specialties, with 3 sexual medicine specialists participating (11%). There was a variety of responses on how many patients required a chaperone, although all sexual medicine specialists reported &gt;50% of their patients requiring a chaperone (Table 2). The most common eligible chaperones included nurses, medical assistants, and other physicians. Providers perceived most patients (67%) to be either understanding or neutral towards chaperones, including sexual medicine specialists; however, 25% felt patients to be upset and embarrassed due to their presence. Most providers (61%) documented the use of a chaperone in the clinic note. All sexual medicine specialists felt it was easy to find a chaperone, similar to most of the survey group; however, 29% of respondents expressed difficulty. Like most clinicians, the incorporation of a mandatory chaperone added &lt;2 minutes to each patient visit (60%) for the sexual medicine specialists. All respondents believed it added &lt;5 minutes. Although the addition of a chaperone appears to be relatively low impact on clinician workflow, only 50% of providers felt the chaperone policy to have a positive impact on the practice. Additionally, only 21% of providers felt patients liked the policy, with 43% feeling that it slowed down their workflow. Although the chaperone policy is meant to serve as a medicolegal safeguard, nearly 1/3 of respondents felt it did not protect them from patient sexual harassment concerns. All sexual medicine specialists agreed that a chaperone protected them from a medicolegal perspective.

Conclusions
Despite widespread acceptance of medical chaperones in our large academic urology practice, clinician perspectives greatly varied on their impact on patient comfort, clinic efficiency, and medicolegal risk. Amongst sexual medicine specialists, there was an overall positive experience with chaperones, with minimal impact on clinic workflow and perceived benefits from a medicolegal perspective. Assessment of patient perspectives on the presence of a chaperone during sensitive genitourinary examination may help determine their future role in a sexual medicine and reproductive urology practice.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo, Fellow, Hims, Posterity Health, Winfertility.