Nina Stüven

Chaperones in general practice – philosophical, theoretical and empirical consideration of third parties in intimate examinations in general practice in Germany

Although most examinations of the genital area of patients in Germany are carried out by specialists for urology or gynaecology, there is a significant number of examinations that general practitioners also carry out in rgeard to their patients. These include digital rectal examinations for prostate cancer screening, examinations for unexplained vaginal bleeding, haemorrhoids and breast examinations for a range of issues. General practitioners regularly come into contact with their patients' intimate areas. There are no clear guidelines on how to deal with patient privacy in such situations.

In English-speaking countries, particularly in the UK, it is widely recommended that a so-called "chaperone" is offered. A chaperone is a third person who is present during the consultation and observes the procedure. On the one hand, the chaperone should ensure for the patient that no inappropriate actions are taken by the practitioner or inappropriate statements are made. They can support patients emotionally during painful or embarrassing examinations or answer questions. On the other hand, the role of a chaperone in the sense of a witness also offers the practitioner an opportunity to provide retrospective clarification of their perception of the situation in case of doubt. Especially in the case of accusations by the patient against the practitioner, a chaperone can have a supportive effect.

In Germany, there is no clear recommendation in general medical guidelines as to whether and when third parties should be used, although a similar number of examinations are carried out on patients of all genders in Germany that affect their privacy. At the same time, it is unclear whether there is even a need for patients in Germany to be offered the regular presence of an accompanying person or witness before such examinations. There is also a lack of insight into whether and to what extent such services are already offered by general practitioners. An attempt will be made to close these gaps with the planned dissertation. In addition, this philosophical, theoretical and empirical work will examine the concepts of intimacy, shame and protection underlying an intimate examination, as well as the situation of the intimate examination as such in its cultural context, with a particular focus on the third-person perspective. The role of the chaperone and the sometimes contradictory demands placed on them will also be analysed. Finally, the results of the philosophical-theoretical investigations and the qualitative-empirical focus groups will be summarised in order to illuminate the concept of chaperones in general practice from as many perspectives as possible.

First supervisor: Prof. Dr. Christina Schües
Co-supervisor: Prof. Dr. Annika Waldmann, Institut für Sozialmedizin und Epidemiologie