Medical chaperoning at a tertiary care hospital in Saudi Arabia: prevalence and patient preference.

To the Editor: The prevalence of medical chaperoning and the related patient preference in Saudi Arabia (or other Islamic/Arab countries) have not been well documented. We examined these issues in the out-patient clinics of a tertiary care hospital in Riyadh, Saudi Arabia, using a questionnaire that was completed during a personal interview. The study protocol, including verbal consent, was approved by the Research Ethics Committee of the institution. Two hundred thirty-nine patients were approached and 224 (94%) agreed to participate (15 declined for undeclared reasons).

Two hundred and five participants (2 males and 203 females, 92%) were seen by a physician of the opposite gender; 78 (38%) and 53 (26%) of which did not have a chaperone during the current medical interview and exam, respectively. When not present, a chaperone was rarely offered by medical staff (2%) and never requested by the patient. Of the 224 participants, 72 (32%) and 48 (21%) recalled that a chaperone was absent during previous medical interviews and exams, respectively. Table 1 shows chaperoning according to types of clinic and medical encounter. A significant association was found between the presence of a chaperone and clinic types for both interview and exam. There was also a significant association between the presence of a chaperone and types of medical encounter for all clinics (P<0.0001) and in the case of Family Medicine and Polyclinics (P<0.0001). Of the 78 participants interviewed by a physician of the opposite gender in the absence of a chaperone, 77 (99%) were not offered a chaperone by the hospital staff and none requested one. Similarly, of the 53 participants examined by a physician of the opposite gender in the absence of a chaperone, 52 (98%) were not offered a chaperone and none requested one.

Table 1

Chaperoning according to types of clinic and medical encounter.

Clinic	Interview Number (%)		Exam Number (%)
	Yes	No	Yes	No
Cardiovascular	20 (61)	13 (39)*	26 (79)	7 (21)*
Family Medicine & Polyclinics	10 (24)	32 (76)*	11 (26)	31 (74)*
Medicine	32 (78)	9 (22)*	29 (71)	12 (29)*
Neurosciences	19 (79)	5 (21)*	24 (100)	0 (0)*
Obstetrics & Gynecology	8 (47)	9 (53)*	16 (94)	1 (5.9)*
Surgery	14 (64)	8 (36)*	21 (96)	1 (4.5)*
Oncology	17 (90)	2 (11)	18 (95)	1 (5.3)*
Orthopedic Surgery	5 (100)	0 (0)	5 (100)	0 (0)
Kidney Transplant	2 (100)	0 (0)	2 (100)	0 (0)

The P value of Fisher’s exact test for the association of chaperone presence and types of clinic is P< 0.0001 for both interview and exam.

Ninety-one percent of chaperones during an interview were patient relatives. Relatives and staff nurses contributed equally during an exam (38% and 39%, respectively). Fifty-six percent and 21% of chaperones during an interview or exam, respectively, were males.

Figure 1 depicts the preference of the 224 participants regarding chaperoning. Fifty-one percent and 85%, respectively, of the participants who did not have a chaperone viewed the presence of a chaperone as commendable/preferred during interview and exam. The reasons most commonly cited for preferring a chaperone during an interview/exam were religious (53%/63%), psychological (50%/49%), and social (22%/25% ) and for preferring not to have one were psychological (58%/38%) and privacy and confidentiality (52%/63%). The prevalence of chaperoning in our study (62% during an interview and 74% during an exam) is consistent with the results of previously reported studies in other parts of the world, which were mostly physician-based rather than patient-based.1–3

Figure 1

Patient’s view of chaperoning during medical encounter.

In contrast to previous reports,1–3 we found that family members comprised the majority of chaperones. This could be due to inadequate nursing staff or to the social norm that most female patients are usually accompanied by family members. Compared to previous reports,4–6 our study showed a higher rate of patient preference for chaperoning, which is likely related to different social norms and religious values. Given this degree of preference, our observation that the patients who had a medical encounter without a chaperone were rarely offered a chaperone and never asked for one raises concerns about the training of hospital staff and the knowledge of patients about their rights. The results of the study may not be generalizable to all patients in Saudi Arabia. We studied only outpatient clinics in one hospital. Further, although we aimed to study both male and female patients, our participants were 97% females.

Several bodies have developed guidelines and policies for chaperoning. 7–9 The standards of practice regarding chaperoning at KFSH&RC are not clearly stated. Since there is a strong patient preference to have a chaperone during medical encounters, clear policies and guidelines should be developed and more resources should be allocated to educate both patients and hospital staff on patient rights. Further studies in other hospitals in Saudi Arabia will assist in determining the over all degree of deficiency in chaperoning as well as the preferences of patients and may help set national guidelines.