Andrew Burd: Chaperones, sex, and lies

Andrew BurdI suspect that like many others of my generation the concept of a chaperone was introduced through school era reading of the classic works of Jane Austin. The necessity to protect the virtue of the young unmarried lady (of any significant social standing) required the presence of an older companion if any social intercourse with the opposite sex were to be encountered.

In medicine the need for, and understanding of, the concept of a chaperone has changed. In my early days of training the focus was on protecting female patients from male doctors. This then evolved to a polar opposite; to protect the professional integrity of the male doctor from the false accusations of unreliable, unstable, and untrustworthy female patients.  The games we play in medicine, particularly that classic game deceivingly described as “professional ethics” has continually changed rules and certainly my advice to students and junior staff nowadays, is that when a doctor of either sex performs any procedure on a patient of either sex ensure that there is a third party present who is preferably a member of the healthcare community. In Hong Kong, and I suspect in many other parts of the world, it remains a tradition for the chaperone to be female, irrespective of the sex of the patient or the doctor. Even if a procedure is not being performed and the doctor-patient interaction is taking place across a desk in an office I would still recommend keeping the door open.

This does sound rather tragic in terms of trust and respect, and of course such advice or recommendations are not inviolable.  Such caution is reinforced, however, when you consider human interaction in the non-medical context and this has come to the fore when considering sexual harassment in a tertiary teaching institution.  Last week I attended an open forum where a report of a special committee appointed to review policies and procedures regarding sexual harassment was shared publicly. The stimulus for this review came from a recommendation made by a coroner at the inquest of a senior administrator who had committed suicide and had, in life, claimed that she was a victim of sexual harassment by a senior university official.

One concern expressed at the open forum is what to do about false allegations of sexual harassment? False allegations are very difficult to deal with and certainly few publicly accountable institutions such as universities or hospitals have the expertise or training to establish the truth when there are no witnesses. It should be noted that this is very much in the domain of the police who have specialist training in interview (and interrogation) techniques.  One of the best insights into these techniques unfolds in a fictional novel, The Headhunters, by Jo Nesbo. Perhaps training in the nine step Reid technique should be a compulsory requirement for those working in the higher levels of any institution’s human resources team.

But back at the coal face we have to actively consider prevention, and this underlines the need, not only in medicine and teaching, but in the workplace generally, to maintain constant vigilance. It calls for a reinterpretation of the enlightened “open door” policy of the good manager.  So if I catch a subordinate or student behaving in an inappropriate way it is no longer a case of “my office, now” Keep it personal, keep it private, but keep any interaction in open view, from now on it is, “Canteen, now” or if someone walks into your office, don’t ask them to close the door.

Andrew Burd is professor of plastic, reconstructive, and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.